RESUMO
Introdução: O osteossarcoma é o tumor maligno primário dos ossos mais frequente. Esta patologia é classicamente descrita como neoplasia de alto grau de células malignas que produzem osteoides. Objetivo: Abordar sobre sinais e sintomas associados ao osteossarcoma, bem como, diagnóstico e manejo. Método: Estudo realizado através de artigos, literatura e relatos de caso sobre osteossarcoma. Resultados: O diagnóstico precoce é decisivo quando discutimos sobre prognóstico, tratamento cirúrgico e quimioterápico para ressecção do tumor, na tentativa de evitar amputação de membros. Conclusão: Uma boa anamnese, reconhecendo desde os primeiros sinais e sintomas, até a chegada em um serviço de saúde terciário é de extrema importância. Além disso, devemos identificar as características clínicas e epidemiológicas desta doença, com auxílio de equipes multidisciplinares desde o diagnóstico até o tratamento destes pacientes.
Introduction: Osteosarcoma is the most frequently primary malignant bone tumor. Classically, this disease is described as high-grade neoplasm of malignant cells that produce osteoids. Objective: Approach to signs and symptoms related to osteosarcoma, as well as diagnosis and management. Method: Study performed through articles, literature and case reports osteosarcoma. Results: Early diagnosis is decisive when discussing prognosis, surgical and chemotherapy treatment for tumor resection in attempt to avoid limb amputations. Conclusion: A good medical history, recognizing from the first signs and symptoms until arrival in a tertiary health service, is extremely important. Furthermore, we should identify clinical and epidemiological characteristics of this disease with help of multidisciplinary teams, from diagnosis to treatment of these patients.
Assuntos
Neoplasias Ósseas , Osteossarcoma/diagnósticoRESUMO
BACKGROUND: An imbalance in the excitatory/inhibitory systems in the pain networks may explain the persistent chronic pain after hallux valgus surgery. Thus, to contra-regulate this dysfunction, the use of transcranial direct current stimulation (tDCS) becomes attractive. OBJECTIVE: We tested the hypothesis that two preoperative active(a)-tDCS sessions compared with sham(s)-tDCS could improve the postoperative pain [as indexed by Visual Analogue Scale (VAS) at rest and during walking (primary outcomes)]. To assess their effect on the change in the Numerical Pain Scale (NPS0-10) during Conditioned Pain Modulation (CPM-task), disability related to pain (DRP) and analgesic consumption (secondary outcomes). Also, we assessed if the brain derived neurotrophic factor (BDNF) in the cerebral spinal fluid (CSF) after tDCS could predict the intervention's effect on the DRP. METHODS: It is a prospective, double blind, sham-controlled, randomized single center, 40 women (18-70 years-old) who had undergone hallux valgus surgery were randomized to receive two sessions (20 minutes each) of anodal a-tDCS or s-tDCS on the primary motor cortex at night and in the morning before the surgery. To assess the DRP was used the Brazilian Profile of Chronic Pain: Screen (B-PCP:S). RESULTS: A-tDCS group showed lower scores on VAS at rest and during walking (P<0.001). At rest, the difference between groups was 2.13cm (95%CI = 1.59 to 2.68) while during walking was 1.67cm (95%CI = 1.05 to 2.28). A-tDCS, when compared to s-tDCS reduced analgesic doses in 73.25% (P<0.001), produced a greater reduction in B-PCP:S (mean difference of 9.41 points, 95%CI = 0.63 to 18.21) and higher function of descending pain modulatory system (DPMS) during CPM-task. CONCLUSION: A-tDCS improves postoperative pain, the DRP and the function of DPMS. Also, the CSF BDNF after a-tDCS predicted the improvement in the DRP. In overall, these findings suggest that a-tDCS effects may be mediated by top-down regulatory mechanisms associated with the inhibitory cortical control. TRIAL REGISTRATION: ClinicalTrials.gov NCT02360462.