Identification of the Artery of Adamkiewicz Using Multidetector Computed Tomography Angiography (MCTA).

Objective The aim of the present study is to evaluate the artery of Adamkiewicz by multidetector computed tomography angiography (MCTA) in a Brazilian population. Methods Two independent observers evaluated 86 coronary MCTA examinations. The variables studied included the identification of the artery of Adamkiewicz at its origin level, and its entry side in the spine. Results The artery of Adamkiewicz was detected in 71 (82.5%) examinations. The origin level was identified between the 9th and 11th thoracic vertebrae (T9 and T11) in 56 (79.2%) patients. In 65 (91.5%) patients, the artery was on the left side. The identification of the artery of Adamkiewicz using MCTA showed high reproducibility. Conclusions Our results were consistent with the literature regarding the identification of the artery of Adamkiewicz using MCTA, suggesting that this technique should be considered as an option to recognize this structure. In addition, we found that the distribution of the artery of Adamkiewicz in the Brazilian population is similar to that of other populations, that is, its most common origin is at the left side, between the 8th and 12th thoracic vertebrae (T8-T12).

Identification of the Artery of Adamkiewicz Using Multidetector Computed Tomography Angiography (MCTA) / Identificação da artéria de Adamkiewicz usando angiotomografia computadorizada por multidetectores (ATCM)

Abstract Objective The aim of the present study is to evaluate the artery of Adamkiewicz by multidetector computed tomography angiography (MCTA) in a Brazilian population. Methods Two independent observers evaluated 86 coronary MCTA examinations. The variables studied included the identification of the artery of Adamkiewicz at its origin level, and its entry side in the spine. Results The artery of Adamkiewicz was detected in 71 (82.5%) examinations. The origin level was identified between the 9th and 11th thoracic vertebrae (T9 and T11) in 56 (79.2%) patients. In 65 (91.5%) patients, the artery was on the left side. The identification of the artery of Adamkiewicz using MCTA showed high reproducibility. Conclusions Our results were consistent with the literature regarding the identification of the artery of Adamkiewicz using MCTA, suggesting that this technique should be considered as an option to recognize this structure. In addition, we found that the distribution of the artery of Adamkiewicz in the Brazilian population is similar to that of other populations, that is, its most common origin is at the left side, between the 8th and 12th thoracic vertebrae (T8-T12).

Resumo Objetivo Avaliar a artéria de Adamkiewicz por angiotomografia computadorizada por multidetectores (ATCM) em uma população brasileira. Métodos Dois observadores independentes avaliaram 86 exames de ACTM. As variáveis estudadas incluíram a identificação da artéria de Adamkiewicz no nível de origem e o lado de entrada da artéria na coluna vertebral. Resultados A artéria de Adamkiewicz foi identificada em 71 (82,5%) exames. O nível de origem foi identificado entre a 9a e a 11a vértebras torácicas (T9 e T11) em 56 (79,2%) pacientes. Em 65 (91,5%) pacientes, a artéria foi identificada no lado esquerdo. A identificação da artéria de Adamkiewicz usando ACTM mostrou elevada reprodutibilidade. Conclusões Obtivemos resultados consistentes com os da literatura prévia quanto à identificação da artéria de Adamkiewicz utilizando angiotomografia computadorizada por multidetectores. Nossos resultados sugerem que a ATCM pode ser considerada como uma opção para identificar a artéria de Adamkiewicz. Além disso, encontramos uma distribuição da artéria de Adamkiewicz na população brasileira semelhante à de outras populações, com a artéria de Adamkiewicz originando-se mais comumente no lado esquerdo, entre a 8a e a 12a vértebras torácicas (T8-T12).

Standing frame and electrical stimulation therapies partially preserve bone strength in a rodent model of acute spinal cord injury.

OBJECTIVE: The aim of this study was to compare the effect of standing frame and electrical stimulation on bone quality in a rodent transection model of spinal cord injury (SCI). DESIGN: Seven-week-old male Wistar rats were divided into four groups: sham, n = 10; SCI, n = 7; SCI + standing frame, n = 7; and SCI + electrical stimulation, n = 7. Complete SCI was generated by surgical transection of the cord at the T10 level. Therapies were initiated 3 days after the surgery, 3 days/wk, 20 mins/day, for 30 days. Animals were killed on day 33 postinjury. RESULTS: No treatment preserved bone mineral density at any skeletal site tested (P = 0.08-0.99). Standing frame therapy preserved maximal load at the lumbar vertebral body (14% vs. 37% reduction, P = 0.01) and prevented SCI-induced loss of stiffness at both the femur (8% vs. 37% reduction, P = 0.03) and the tibia (35% vs. 56% reduction, P < 0.0001). Electrical stimulation therapy reduced SCI-induced loss of stiffness at the tibia only (40% vs. 56% reduction, P = 0.003). CONCLUSIONS: Standing frame and electrical stimulation may have potential as future therapeutic modalities to treat or prevent bone loss after SCI.

Ultrasonographic evaluation of Achilles tendon repair after percutaneous sectioning for the correction of congenital clubfoot residual equinus.

BACKGROUND: Most cases of congenital clubfoot treated with the Ponseti technique require percutaneous Achilles tenotomy to correct the residual equinus. Clinical evidence suggests that complete healing occurs between the cut tendon stumps, but there have not yet been any detailed studies investigating this reparative process. This study was performed to assess Achilles tendon repair after percutaneous section to correct the residual equinus of clubfoot treated with the Ponseti method. METHOD: A prospective study analyzed 37 tenotomies in 26 patients with congenital clubfoot treated with the Ponseti technique, with a minimum follow-up of 1 year after the section. The tenotomy was performed percutaneously with a large-bore needle bevel with patient sedation and local anesthesia. Ultrasonographic scanning was performed after section to ascertain that the tenotomy had been completed and to measure the stump separation. In the follow-up period, the reparative process was followed ultrasonographically and assessed at 3 weeks, 6 months, and 1 year posttenotomy. RESULTS: The ultrasonography performed immediately after the procedure showed that in some cases, residual strands between the tendon ends persisted, and these were completely sectioned under ultrasound control. A mean retraction of 5.65 mm+/-2.26 mm (range, 2.3 to 11.0 mm) between tendon stumps after section was observed. Unusual bleeding occurred in one case and was controlled by digital pressure, with no interference with the final treatment. After 3 weeks, ultrasonography showed tendon repair with the tendon gap filled with irregular hypoechoic tissue, and also with transmission of muscle motion to the heel. Six months after tenotomy, there was structural filling with a fibrillar aspect, mild or moderate hypoechogenicity, and tendon scar thickening when compared with a normal tendon. One year after tenotomy, ultrasound showed a fibrillar structure and echogenicity at the repair site that was similar to a normal tendon, but with persistent tendon scarring thickness. CONCLUSIONS: There is a fast reparative process after Achilles tendon percutaneous section that reestablishes continuity between stumps. The reparative tissue evolved to tendon tissue with a normal ultrasonographic appearance except for mild thickening, suggesting a predominantly intrinsic repair mechanism.