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The COVID 19 pandemic has triggered concerns and assumptions globally about transmission of the SARS-CoV-2 virus via cash transactions. This paper assesses the risk of contracting COVID-19 through exposure to SARS-CoV-2 via cash acting as a fomite in payment transactions. A quantitative microbial risk assessment was conducted for a scenario assuming an infectious person at the onset of symptoms, when virion concentrations in coughed droplets are at their highest. This person then contaminates a banknote by coughing on it and immediately hands it over to another person, who might then be infected by transferring the virions with a finger from the contaminated banknote to a facial mucous membrane. The scenario considered transfer efficiency of virions on the banknote to fingertips when droplets were still wet and after having dried up and subsequently being touched by finger printing or rubbing the object. Accounting for the likelihood of the scenario to occur by considering (1) a local prevalence of 100 COVID-19 cases/100,000 persons, (2) a maximum of about one-fifth of infected persons transmit high virus loads, and (3) the numbers of cash transactions/person/day, the risk of contracting COVID-19 via person-to-person cash transactions was estimated to be much lower than once per 39,000 days (107 years) for a single person. In the general populace, there will be a maximum of 2.6 expected cases/100,000 persons/day. The risk for a cashier at an average point of sale was estimated to be much less than once per 430 working days (21 months). The depicted scenario is a rare event, therefore, for a single person, the risk of contracting COVID-19 via person-to-person cash transactions is very low. At a point of sale, the risk to the cashier proportionally increases but it is still low.
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COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , Fômites , Medição de RiscoRESUMO
PURPOSE: Magnetic-controlled growing rods (MCGRs) are now routinely used in many centres to treat early-onset scoliosis (EOS). MCGR lengthening is done non-invasively by the external remote controller (ERC). Our experience suggests that there may be a discrepancy between the reported rod lengthening on the ERC and the actual rod lengthening. The aim of this study was to investigate this discrepancy. METHODS: This was a prospective series. Eleven patients who were already undergoing treatment for EOS using MCGRs were included in this study. RESULTS: One hundred and ninety-two sets of ultrasound readings were obtained (96 episodes of rod lengthening on dual-rod constructs) and compared to their ERC readings. Only 15/192 (7.8%) readings were accurate; 27 readings (14.9%) were false positive; and 8 readings (4.2%) were an underestimation while 142 readings (74.0%) were an overestimation by the ERC. Average over-reporting by the ERC was 5.31 times of the actual/ultrasound reading. When comparing interval radiographs with lengthening obtained on ultrasound, there was a discrepancy with an average overestimation of 1.35 times with ultrasound in our series. There was a significant difference between ERC and USS (p = 0.01) and ERC and XR (p = 0.001). However, there was no significant difference between USS and XR (p > 0.99). CONCLUSION: The reading on the ERC does not equate to the actual rod lengthening. The authors would recommend that clinicians using the MCGR for the treatment of early-onset scoliosis include pre- and post-extension imaging (radiographs or ultrasound) to confirm extension lengths at each outpatient extension. In centres with ultrasound facilities, we would suggest that patients should have ultrasound to monitor each lengthening after distraction but also 6-month radiographs. These slides can be retrieved under Electronic Supplementary Material.
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Escoliose , Criança , Pré-Escolar , Feminino , Humanos , Fenômenos Magnéticos , Masculino , Estudos Prospectivos , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , UltrassonografiaRESUMO
BACKGROUND: Back pain is a common problem and has been shown to affect approximately 85% of the adult population at any one time. The source of this pain can be difficult to identify and the sacroiliac joint (SIJ) has been proposed as a possible pain source. Its percentage contribution to lower back pain is controversial. Clinical provocative tests for SIJ pathology have been developed but these have high intra and inter-observer variability and the significant of positive findings is unclear. This study proposes that the SIJ should not be imaged as part of a routine MRI lumbar spine series. METHODS: We retrospectively reviewed the images of 353 patients who had MRI lumbar spine scans. 130 had the SIJ imaged. We recorded the clinical findings and diagnosis at referral. We reviewed the images and documented the radiological findings. RESULTS: SI joint pathology was most frequently identified when clinical suspected. Overall SIJ pathology found on MRI in only 0.02% of patients. CONCLUSIONS: We conclude that routinely imaging the SIJ in MRI lumbar spine series is not cost-effective or a useful use of resources. The SIJ should be imaged only if significant clinical findings are demonstrated.
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Dor Lombar/diagnóstico , Vértebras Lombares/patologia , Articulação Sacroilíaca/patologia , Espondilite Anquilosante/diagnóstico , Adulto , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Dor Lombar/etiologia , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilite Anquilosante/complicaçõesRESUMO
Transmission via fomites poses a major dissemination route for many human pathogens, particularly because of transfer via fingertips. Here, we present a protocol to investigate direct transfer of infectious agents from fomites to humans via naked fingertips. The protocol is suitable for pathogens requiring highest biosafety levels (e.g., SARS-CoV-2). We used an artificial skin to touch a defined volume of virus suspension and subsequent quantification of infectious entities allows quantitative measurement of transfer efficiency and risk assessment. For complete information on the generation and use of this manuscript, please refer to Todt et al. (2021).
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COVID-19 , Vírus , Fômites , Humanos , SARS-CoV-2 , TatoRESUMO
The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created a significant threat to global health. While respiratory aerosols or droplets are considered as the main route of human-to-human transmission, secretions expelled by infected individuals can also contaminate surfaces and objects, potentially creating the risk of fomite-based transmission. Consequently, frequently touched objects such as paper currency and coins have been suspected as potential transmission vehicle. To assess the risk of SARS-CoV-2 transmission by banknotes and coins, we examined the stability of SARS-CoV-2 and bovine coronavirus, as surrogate with lower biosafety restrictions, on these different means of payment and developed a touch transfer method to examine transfer efficiency from contaminated surfaces to fingertips. Although we observed prolonged virus stability, our results indicate that transmission of SARS-CoV-2 via contaminated coins and banknotes is unlikely and requires high viral loads and a timely order of specific events.
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Circumferential (360°) fusion yields better long-term outcome in patients with high-grade spondylolisthesis. This result may be achieved by combined anterior and posterior techniques or by an all-posterior approach. As the anterior approach is fraught with numerous complications, many surgeons prefer the all-posterior approach to achieve circumferential fusion. We have described in this chapter the technique of using HMA screws to achieve posterior interbody fusion in situ, to be combined with posterolateral fusion and pedicle screw instrumentation to provide the 360° fusion in high-grade spondylolisthesis. This technique not only provides an increased chance of interbody fusion because of cancellous bone but also avoids the donor site morbidity associated with cortical fibular strut graft.
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Parafusos Ósseos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Análise de Falha de Equipamento , Humanos , Desenho de Prótese , Radiografia , Espondilolistese/diagnóstico por imagem , Resultado do TratamentoRESUMO
PURPOSE: Surgical approaches to the upper thoracic spine are fraught with many problems as they involve thoracotomy or sternotomy. We analyzed 102 midsagittal MRI scans to evaluate the level of the sternal notch in relation to the upper thoracic spine, so that if the tangential line through the upper part of the sternal notch passed below the level of the involved vertebra, we could surgically access the involved vertebra by the low anterior cervical approach, which is familiar to most spinal surgeons. MATERIALS AND METHODS: Between January and June 2002, 102 consecutive mid-sagittal T2 weighted MRI scans were evaluated. The line as described above was then drawn on each MRI to assess the level of the involved vertebra. RESULTS: In 68.7% of the cases, the level of the sternal notch corresponded to T2 and T3. This method of assessing accessibility was used in a patient with a fractured T3 that yielded excellent surgical exposure. It was found that routine use of saturation bands is not needed in upper thoracic spine pathology as it obscured the visualization of the sternal notch in 20% of the cases. CONCLUSION: In patients with high thoracic fractures who require surgical decompression and stabilization, pre-operative MR scan and assessing the level of the vertebra in relation to the sternal notch can allow a low anterior cervical approach to be used thus decreasing the patient morbidity related to the surgical approach.
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Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Técnicas de Apoio para a Decisão , Humanos , Imageamento por Ressonância Magnética , Prontuários Médicos , Cuidados Pré-Operatórios , Estudos Retrospectivos , Doenças da Coluna Vertebral/patologia , Esterno/patologia , Esterno/cirurgia , Vértebras Torácicas/patologiaRESUMO
BACKGROUND: Posterior epidural migration is an interesting but rare path taken by a prolapsed intervertebral disc fragment. There are only seven cases reported of a similar migration of the disc fragment in the lumbar spine. PURPOSE: To diagnose the unusual presentation and interpretation of the sequestrated disc in the posterior epidural space. STUDY DESIGN: Case report. METHODS: Two cases of migration of the sequestrated disc into the posterior epidural space are presented. In one patient there was weakness of the ankle dorsiflexors, foot invertors, and toe extensors of the left foot, with sensory loss over the back of the calf and over the lateral three toes. The left ankle jerk was also absent. However, in the other case, there was no objective evidence of neurological deficit distally. RESULTS: Gadolinium magnetic resonance imaging scans showed ring enhancement preoperatively. Biopsy of the specimen taken from surgery confirmed it to be sequestrated disc fragment. CONCLUSION: Diagnosis of posterior epidural migration of the sequestrated discs may be difficult. It may present with subtle clinical features even though the disc transgresses through numerous anatomic restraints including the nerve roots in such cases.
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Migração de Corpo Estranho , Deslocamento do Disco Intervertebral/patologia , Disco Intervertebral/patologia , Vértebras Lombares/patologia , Síndromes de Compressão Nervosa/patologia , Polirradiculopatia/patologia , Adulto , Espaço Epidural , Feminino , Gadolínio , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Polirradiculopatia/etiologia , Polirradiculopatia/cirurgiaRESUMO
This study investigated the effects of noribogaine, the principal metabolite of the drug ibogaine, on substance-related disorders. In the first experiment, mice chronically treated with morphine were subjected to naloxone-precipitated withdrawal two hours after oral administration of noribogaine. Oral noribogaine dose dependently decreased the global opiate withdrawal score by up to 88% of vehicle control with an ED50 of 13 mg/kg. In the second experiment, blood and brain levels of noribogaine showed a high brain penetration and a brain/blood ratio of 7±1 across all doses tested. In a third experiment, rats given oral noribogaine up to 100 mg/kg were tested for abuse liability using a standard biased conditioned place paradigm. Noribogaine-treated rats did not display place preference, suggesting that noribogaine is not perceived as a hedonic stimulus in rodents. Retrospective review of published studies assessing the efficacy of ibogaine on morphine withdrawal shows that the most likely cause of the discrepancies in the literature is the different routes of administration and time of testing following ibogaine administration. These results suggest that the metabolite noribogaine rather than the parent compound mediates the effects of ibogaine on blocking naloxone-precipitated withdrawal. Noribogaine may hold promise as a non-addicting alternative to standard opiate replacement therapies to transition patients to opiate abstinence.
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Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Ibogaína/análogos & derivados , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Administração Oral , Animais , Relação Dose-Resposta a Droga , Ibogaína/farmacologia , Masculino , Camundongos , Morfina/farmacologia , Naloxona/farmacologia , Ratos , Ratos Sprague-Dawley , Estudos Retrospectivos , Roedores/metabolismo , Síndrome de Abstinência a Substâncias/metabolismoRESUMO
The aim of this study was to switch patients established on methadone opioid substitution therapy (OST) to morphine over 1 week. Subjects established on daily methadone OST (mean dose 60 mg/day) were switched to morphine slow-release capsules, dosed at 4× the previous total daily methadone dose, for 6 days, then given morphine syrup dosed q3h. All 27 subjects enrolled in this study completed the switch from methadone to morphine. Opioid withdrawal symptoms (OWS) peaked within 12-24 hours of starting morphine, and 24/27 subjects required higher daily morphine doses (mean 5.2× multiple). Pharmacokinetic evaluation showed that 91% of methadone was cleared during this time, with a mean elimination half-life of 59 hours. The most frequent treatment-emergent non-OWS adverse events were headache, nausea, constipation, and neck pain. The method described here appears to be a safe and acceptable approach to switch subjects from methadone to morphine.
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Analgésicos Opioides/administração & dosagem , Substituição de Medicamentos/métodos , Metadona/administração & dosagem , Morfina/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/sangue , Método Duplo-Cego , Feminino , Cefaleia/induzido quimicamente , Humanos , Ibogaína/administração & dosagem , Ibogaína/efeitos adversos , Ibogaína/análogos & derivados , Ibogaína/sangue , Masculino , Metadona/efeitos adversos , Metadona/sangue , Morfina/efeitos adversos , Morfina/sangue , Náusea/induzido quimicamente , Tratamento de Substituição de Opiáceos/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/sangue , Resultado do TratamentoRESUMO
BACKGROUND CONTEXT: There have been no studies with medium-term follow-up of magnetic controlled growing rods (MCGRs). PURPOSE: This study aimed to report our single center experience of a magnetic growing rod system with an average of 4 years' follow-up. STUDY DESIGN/SETTING: A retrospective case series was carried out. PATIENT SAMPLE: The sample comprised patients with early-onset scoliosis treated with magnetic controlled growth rods who were operated in 2011. OUTCOME MEASURES: Cobb angle, spinal growth rate, complications, and revision were the outcome measures. METHODS: Clinical case notes and radiographs were reviewed. RESULTS: There were 8 patients (5 dual-rod construct, 3 single-rod construct) who had a minimum of 44 months' follow-up and average of 48 months (44-55 months). Mean age at surgery was 8.2 years (range 3-10). Mean preoperative Cobb angle was 60° (34-94), whereas mean postoperative Cobb angle was 42° (32-63). The average number of extensions was 13.8 (range: 12-20). There were 6 patients (75%) who required 8 revision surgeries: rod problems (N=4), proximal screw pull-out (N=3), and development of proximal junction kyphosis (N=1). All three patients who had single-rod construct underwent revision procedure. Currently, four patients (50%) still have the magnetic rods in situ. The mean duration of MCGR in the patient in the removed group was 39 months (range: 34-46). CONCLUSIONS: Medium-term results of MCGR are not as promising as previously reported early results. Hence, MCGRs should be used with caution. Single-rod constructs should definitely be avoided. The role of MCGRs in revision cases still remains unknown.
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Fixadores Internos , Imãs , Procedimentos Ortopédicos/instrumentação , Escoliose/cirurgia , Parafusos Ósseos , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Cifose/etiologia , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Escoliose/fisiopatologiaRESUMO
BACKGROUND CONTEXT: The main advantage cited for the use of the magnetic controlled growing rod (MCGR) system over the conventional growing rod (CGR) in early-onset scoliosis is avoiding repeated invasive surgical procedures for lengthening, thus reducing, complications. PURPOSE: The study aimed to evaluate the complications of the MCGR system against the CGR system in our center. STUDY DESIGN/SETTING: This is a retrospective case control series. PATIENT SAMPLE: The sample includes patients with early-onset scoliosis treated with MCGR or CGR. OUTCOME MEASURES: Complications and unplanned return to theater were the outcome measures. RESULTS: Of the 37 patients (MCGR, N=10; CGR, N=27) in our cohort, 28 patients (76%) had at least one complication. Taking into account the follow-up period, MCGR had a higher complication rate than CGR group (0.32 complication per patient per year vs. 0.15 complication per patient per year). The use of MCGR was associated with a lower risk of deep infection (odds ratio [OR]: 0.22; p=.22) and superficial infection (OR: 0.07, p=.017) but increased risk of metalwork problems (OR: 4.67; p=.045) and unplanned return to theater (OR: 2.92; p=.05) compared with CGR. CONCLUSIONS: Although MCGR has a lower rate of both deep and superficial infections when compared with CGR, it does not completely avoid repeated invasive surgical procedures as previously suggested. It does have a significant increased risk of metalwork problems and unplanned return to theater.
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Fixadores Internos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Escoliose/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Imãs , Masculino , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Ibogaine is a psychoactive substance that may reduce opioid withdrawal symptoms. This was the first clinical trial of noribogaine, ibogaine's active metabolite, in patients established on methadone opioid substitution therapy (OST). In this randomized, double-blind, placebo-controlled single ascending-dose study, we evaluated the safety, tolerability, and pharmacokinetics of noribogaine in 27 patients seeking to discontinue methadone OST who had been switched to morphine during the previous week. Noribogaine doses were 60, 120, or 180 mg (n = 6/dose level) or matching placebo (n = 3/dose level). Noribogaine was well tolerated. The most frequent treatment-emergent adverse events were noneuphoric changes in light perception â¼1 hour postdose, headache, and nausea. Noribogaine had dose-linear increases for AUC and Cmax and was slowly eliminated (mean t1/2 range, 24-30 hours). There was a concentration-dependent increase in QTcI (0.17 ms/ng/mL), with the largest observed mean effect of â¼16, 28, and 42 milliseconds in the 60-, 120-, and 180-mg groups, respectively. Noribogaine showed a nonstatistically significant trend toward decreased total score in opioid withdrawal ratings, most notably at the 120-mg dose; however, the study design may have confounded evaluations of time to resumption of OST. Future exposure-controlled multiple-dose noribogaine studies are planned that will address these safety and design issues.
Assuntos
Ibogaína/análogos & derivados , Adulto , Área Sob a Curva , Relação Dose-Resposta a Droga , Método Duplo-Cego , Eletrocardiografia/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Ibogaína/administração & dosagem , Ibogaína/efeitos adversos , Ibogaína/farmacocinética , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/fisiopatologia , Masculino , Metadona , Entorpecentes , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Síndrome de Abstinência a Substâncias/tratamento farmacológicoRESUMO
BACKGROUND CONTEXT: Symptomatic high-grade spondylolisthesis (Meyerding III-V) is usually treated by surgery. Recent literature shows that in situ fusion is better than reduction of the slip and fusion in high-grade spondylolisthesis. Furthermore, the outcome is improved if circumferential fusion is performed in severe spondylolisthesis. We have performed a new technique of circumferential fusion in high-grade spondylolisthesis using two transsacral hollow modular anchorage (HMA) screws supplemented with pedicle screw fixation and posterolateral fusion. PURPOSE: The aim of the study is to analyze the results of circumferential fusion using transsacral HMA screws supplemented with posterolateral fusion and pedicle screw fixation. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Twelve patients with high-grade spondylolisthesis were reviewed. OUTCOME MEASURES: Outcome was measured using short form 36 (SF-36) and the ability to return to work at the most recent follow-up. METHODS: All patients had interbody fusion using transsacral HMA screws filled with cancellous bone graft and supplemented with pedicle screw instrumentation and posterolateral fusion. RESULTS: The male to female ratio was 2:1 with a mean age of 31 years (range 13-54 years). Eleven of 12 patients had disappearance of leg pain. There were no neurological complications in any of them. Circumferential fusion was achieved in all of them at a mean follow-up of 21 months. The average physical function score improved from 22.50+/-10.34 to 57.50+/-17.39 (p=.001, 95% confidence interval [CI] -44.48 to -25.52), whereas the average pain score improved from 22.22+/-13.40 to 61.11+/-15.35 (p=.001, 95% CI -51.12 to -26.66). CONCLUSIONS: HMA screws avoid the complications associated with autologous cortical fibular strut graft and also are useful to promote interbody fusion, as the hollowness in the screw can be filled with cancellous bone graft that helps in better fusion. Supplementary pedicle screw fixation is necessary to protect the HMA screws, and they together give a stable construct that can achieve a circumferential fusion in high-grade spondylolisthesis.
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Parafusos Ósseos , Sacro/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Adolescente , Adulto , Transplante Ósseo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Espondilolistese/reabilitação , Resultado do Tratamento , Adulto JovemRESUMO
In this retrospective study, we used anteroposterior plain radiographs of the neck to analyze sternal notch level in relation to the upper thoracic spine and to assess the usefulness of this relation in deciding how to approach the upper thoracic spine. We reviewed 53 patients' anteroposterior plain radiographs of the cervicothoracic spine and thoracic magnetic resonance imaging (MRI) scans. On the plain radiographs, we drew a horizontal line joining the lower-fifth edge of the medial end of the 2 clavicles; on the midsagittal thoracic MRI scans, we drew a tangential line to the sternal notch. Then we noted the vertebral level of the 2 lines. In all cases, the horizontal line on the plain radiographs and the tangential line on the MRI scans corresponded to each other without discrepancy. We evaluated this method in a patient with a fractured T3 vertebral body, in whom a satisfactory procedure was performed using low anterior cervical spine approach. As the level of sternal notch is found to be present below the level of T2 and T3 radiologically in most cases, a low cervical approach can be contemplated in most patients with upper thoracic spine pathology depending on their sternal level as determined by preoperative radiographs. MRI scans are not needed to decide the approach, as it can be assessed with plain radiographs alone, as shown in this study.
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Vértebras Cervicais/cirurgia , Pescoço/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Esterno/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Esterno/diagnóstico por imagem , Esterno/patologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Adulto JovemRESUMO
A syndrome now known as Ehlers-Danlos, comprising laxity and fragility of the skin associated with hypermobility of the large joints, was published in 1892 by Tschernogobow. Ehlers-Danlos type VIIA is an extremely rare form of the syndrome. While the UK-based Ehlers-Danlos Support Group recommends that the surgical management of patients with Ehlers-Danlos VIIA should be carried out in conjunction with a plastic surgeon, there is nothing in the plastic surgery literature regarding this syndrome. The management of patients suffering from Ehlers-Danlos VIIA is highly complex, as a result of the breadth of genetic and phenotypic presentations, and resulting complications. We present a review of the literature regarding this syndrome and, in particular, the surgical problems that may be encountered. A case report outlining our experience of successfully managing this condition is also presented.
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Síndrome de Ehlers-Danlos/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Pré-Escolar , Cicatriz/patologia , Procedimentos Cirúrgicos Dermatológicos , Síndrome de Ehlers-Danlos/genética , Síndrome de Ehlers-Danlos/patologia , Humanos , Masculino , Escoliose/cirurgia , Pele/patologia , CicatrizaçãoRESUMO
BACKGROUND CONTEXT: Treatment of unstable burst fractures in the dorsolumbar spine still remains controversial. Surgical stabilization has been aimed to prevent long-term back pain and progression of deformity. PURPOSE: This study was aimed to analyze the degree of loss of correction of the angle of kyphosis with pedicle screw instrumentation in place and the components responsible for the recurrence of kyphosis after surgical stabilization of dorsolumbar A3 fractures and to assess the return of functional capacity in these patients. STUDY DESIGN: Retrospective study. PATIENT SAMPLE: This study involves 26 patients who had dorsolumbar unstable burst fractures (Arbeitsgemeinschaft für Osteosynthesefragen type A3). OUTCOME MEASURES: Radiological assessment at injury, immediate postoperative period, and most recent follow-up along with functional assessment using short form 36 (SF-36) and return to work. METHODS: All the patients had posterior pedicle screw instrumentation without fusion for unstable dorsolumbar burst compression (A3) fractures. The mean follow-up period was 25.5 months. All of them had their fractures stabilized with Universal Spinal System (Synthes, Welwyn Garden City, UK) Fracture System. Serial standing lateral radiographs were taken from the immediate postoperative period to the most recent follow-up. The angle of kyphosis; the heights of the discs above and below the fractured vertebra; and the heights of the vertebral bodies above, at, and below the fractured level were measured. The height at each level was measured in three segments (anterior, middle, and posterior). The values were normalized to avoid discrepancies while comparing radiographs. The difference in the height of each segment measured between the immediate postoperative period and the most recent follow-up was computed. RESULTS: The mean angle of kyphosis was 6.3+/-8.9 in the immediate postoperative period and 15.7+/-6.7 at the most recent follow-up (p<.001). The mean patient function score from SF-36 was 52.3%, and the mean pain score was 44.9%. There was no relationship to the loss of correction angle of kyphosis to the patient function score (r=0.06, p=.76) and the pain score (r=0.11, p=.58). The correlation between the corresponding difference in the height of each segment and the degree of loss of correction of the angle of kyphosis showed positive correlation to the decrease in the anterior and middle segment heights at the fractured vertebral level. CONCLUSION: There is a progressive loss of correction of the angle of kyphosis after posterior stabilization with instrumentation even without implant removal that mainly corresponds to the decrease in the anterior segment height of the fractured vertebral body.
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Fraturas por Compressão/cirurgia , Cifose/etiologia , Vértebras Lombares/lesões , Complicações Pós-Operatórias , Fraturas da Coluna Vertebral/cirurgia , Adulto , Idoso , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Humanos , Cifose/diagnóstico por imagem , Cifose/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Radiografia , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Adulto JovemRESUMO
Talampanel is a novel anticonvulsant that acts as an allosteric inhibitor of the AMPA receptor. Talampanel has a broad spectrum of action in animal models of epilepsy and neuroprotection. Clinical experience to date has been able to show effectiveness in reduction of seizures in patients with refractory partial seizures.
Assuntos
Antineoplásicos , Benzodiazepinas , Epilepsia/tratamento farmacológico , Animais , Encéfalo/efeitos dos fármacos , Ensaios Clínicos como Assunto , HumanosRESUMO
Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one particular joint may affect the biomechanics of loading of the upper cervical spine. We aimed to analyse the relationship of odontoid fractures to the pattern of upper cervical spine osteoarthritis in the elderly. We studied the CT-scan images of the cervical spine in 23 patients who were over the age of 70 years and had odontoid fractures. In each patient, the type of odontoid fracture and the characteristics of the degenerative changes in each joint were analysed. Twenty-one of 23 patients had Type-II odontoid fractures. The incidence of significant atlanto-odontoid degeneration in these individuals was very high (90.48%), with relative sparing of the lateral atlantoaxial joints. Osteoporosis was found in 13 of 23 patients at the dens-body junction and in seven of 23 patients at the odontoid process and body of the axis. With ageing, progressively more severe degenerative changes develop in the atlanto-odontoid joint. These eventually obliterate the joint space and fix the odontoid to the anterior arch of the atlas. In contrast, the lateral atlantoaxial joints are hardly affected by osteoarthritis. Thus, ultimately, atlantoaxial movements including atlantoaxial rotation are markedly limited by osteoarthritis of the atlanto-odontoid joint. However, there is still potential for movement in the lateral atlantoaxial joints, as they remain relatively free of degenerative change. The vulnerability of the atlantoaxial segment is further increased by markedly limited rotation below the axis vertebra due to severe facet-joint degeneration. As a consequence, a relatively low-energy trauma to the lateral part of the face, for instance by a fall, will induce forced atlantoaxial rotation. This, with the marked limitation of movement at the atlanto-odontoid joint, will produce a torque force at the base of the odontoid process leading to a Type II fracture.
Assuntos
Artrite/complicações , Vértebras Cervicais/patologia , Processo Odontoide/lesões , Processo Odontoide/patologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/patologia , Idoso , Envelhecimento/patologia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Processo Odontoide/diagnóstico por imagem , Fraturas da Coluna Vertebral/classificação , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/patologia , Articulação Zigapofisária/fisiopatologiaRESUMO
STUDY DESIGN: A case of L4 spinous process avulsion following a hyperflexion injury treated with surgical excision. OBJECTIVE: To show that single photon emission computerized tomography is essential for the diagnosis and that excision can provide a successful outcome. SUMMARY OF BACKGROUND DATA: The avulsion resulted from a forced hyperflexion injury at the L4/5 area, where the interspinous ligament provides a high resistance to flexion. METHODS: A 29-year-old international rugby football player injured his low back during a match. Plain radiography and magnetic resonance imaging did not reveal the injury. Single photon emission computerized tomography and computerized tomography showed the lesion. RESULTS: Initial conservative therapy failed to control the symptoms, and, therefore, late excision was performed with pain-free return to contact sports at 3 months. CONCLUSIONS: Few cases of interspinous process avulsions have been described, and, to our knowledge, this is the first reported case of rugby football player who had a successful outcome with late surgical excision.