RESUMO
Low back pain is a common symptom that can lead to disability and major socio-professional repercussions. Despite advances in imaging, the etiology of the pain often remains unknown. Morphological changes related to normal ageing of the disc appear on MR imaging without any symptoms. The potential impact of changes seen on imaging, especially MRI, also warrants discussion. The purpose of this work is to review the state-of-the-art of this subject, underlining relevant key features for routine radiological practice. We will first discuss anterior and posterior segments of the spine with a focus on anatomical, physiopathological and semiological findings. Secondly we will discuss the diagnostic value of each sign.
Assuntos
Dor Lombar/diagnóstico , Imageamento por Ressonância Magnética , Humanos , Vértebras Lombares/patologiaRESUMO
Therapy with anti-TNFalpha in rheumatoid arthritis may induce autoimmune disorders. Induction of autoantibodies is frequently observed, but lupus-like syndrome is rare and few cases only have been reported. We report a 41-year-old female, treated with etanercept for a rheumatoid arthritis, who developed a cutaneous lupus induced without any other organ involvement, associated with high ANA and DNA antibody titres. The skin biopsy and the histological analysis with immunofluorescence confirmed the diagnosis. The anti-TNFalpha treatment was stopped. Corticosteroids were increased and hydroxychloroquine administered because skin lesions persist after three months.
Assuntos
Antirreumáticos/efeitos adversos , Toxidermias/etiologia , Imunoglobulina G/efeitos adversos , Lúpus Eritematoso Cutâneo/induzido quimicamente , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Etanercepte , Feminino , Humanos , Receptores do Fator de Necrose TumoralRESUMO
Herpes zoster is a disease which occurs secondary to the reactivation of varicella-zoster virus. Motor involvement in acute herpes zoster is rare. We report a case of sciatica L5 due to herpes zoster infection with motor loss. Typical skin lesions occurred one week before the sciatica. Radiological finding did not explain the paresis. The diagnosis of zoster sciatica with motor involvement was suspected. Serological tests and cerebrospinal fluid examination established the diagnosis. The antiviral and physical treatment was conducted in order to improve functional outcome.
Assuntos
Antivirais/uso terapêutico , Ataxia/tratamento farmacológico , Herpes Zoster/complicações , Neuroborreliose de Lyme/diagnóstico , Neuroborreliose de Lyme/tratamento farmacológico , Meningomielocele/virologia , Ciática/etiologia , Idoso , Eletromiografia , Feminino , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Humanos , Neuroborreliose de Lyme/patologia , Imageamento por Ressonância Magnética , Meningomielocele/diagnóstico , Meningomielocele/tratamento farmacológico , Reação em Cadeia da Polimerase , Ciática/virologia , Dermatopatias/etiologia , Dermatopatias/virologia , Medula Espinal/patologiaRESUMO
In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance. Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff, with calcification measuring 10 mm or more in maximum dimension. The primary outcome measure was the change in the Constant and Murley Score. A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean of 110 (41 to 255) days after treatment when the increase in Constant and Murley score was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the low-energy group. The improvement from the baseline level was significant in the high-energy group, with a mean gain of 12.5 (-20.7 to 47.5) points (p < 0.0001). The improvement was not significant in the low-energy group. Total or subtotal resorption of the calcification occurred in six patients (15%) in the high-energy group and in two patients (5%) in the low-energy group. High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up, but the calcific deposit remains unchanged in size in the majority of patients.
Assuntos
Calcinose/terapia , Ondas de Choque de Alta Energia/uso terapêutico , Manguito Rotador , Tendinopatia/terapia , Adulto , Calcinose/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Satisfação do Paciente , Estudos Prospectivos , Radiografia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Dor de Ombro/fisiopatologia , Tendinopatia/fisiopatologia , Resultado do TratamentoRESUMO
UNLABELLED: The purpose of the study is to evaluate the efficacy of C1-C2 block from a posterior parasagittal approach to treat Arnold neuralgia. MATERIALS AND METHODS: 24 patients have been interviewed after 33 blocks were performed. The mean delay was 22 months. The posterior approach had always been performed using fluoroscopy. 27 blocks were performed with Hydrocortancyl((R)), 6 with Altim((R)). RESULTS: 71% of patients were symptomatically improved after one month, 62% after 3 months and more than 50% after one year. Using a visual analogue scale, pain was reduced of 5.8, i.e. 70% of patients were improved. An important reduction of pain killer requirements was noted for improved patients, patients with pain recurrence asked for a new infiltration. No significant side effect was noted. CONCLUSION: Our method seems to be an efficient alternative to blocks performed on the origin of the nerve and to surgical treatment.
Assuntos
Bloqueio Nervoso Autônomo/métodos , Doenças dos Nervos Cranianos/terapia , Neuralgia/terapia , Nervo Vago , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
UNLABELLED: The role of epidural fibrosis in postoperative sciatica is unclear. Few therapeutic trials have been published. We evaluated the mechanical effects of forceful saline injections through the sacrococcygeal hiatus comparatively with glucocorticoid injections. PATIENTS AND METHODS: Forty-seven patients with postdiscectomy sciatica but no evidence of compression by computed tomography or magnetic resonance imaging were included in a multicenter, randomized, controlled, parallel-group study comparing forceful injections of saline (20 ml) with or without prednisolone acetate (125 mg) to epidural prednisolone acetate (125 mg) alone. Each of the three treatments was given once a month for three consecutive months. Outcome measures were pain severity on a visual analog scale (VAS) and the scores on the Dallas algofunctional self-questionnaire on day 0, day 60, and day 120. Analysis of variance for repeated measures and Student's t test for paired series were used to evaluate the data. RESULTS: Forty-seven patients were evaluated. The VAS score improved significantly between day 0 and day 30 in the glucocorticoid group as compared to the forceful injection group (P = 0.01). No other significant differences were found across the groups. The VAS score improved steadily in the forceful injection group, producing a nearly significant difference on day 120 as compared to baseline (P = 0.08). CONCLUSION: Forceful epidural injections produced a non-significant improvement in postdiscectomy sciatica four months after surgery. Epidural glucocorticoids used alone induced short-lived pain relief.
Assuntos
Discotomia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Prednisolona/uso terapêutico , Região Sacrococcígea , Ciática/tratamento farmacológico , Cloreto de Sódio/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Método Duplo-Cego , Espaço Epidural/patologia , Feminino , Fibrose/etiologia , Fibrose/patologia , Humanos , Injeções Epidurais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prednisolona/administração & dosagem , Ciática/etiologia , Cloreto de Sódio/administração & dosagem , Estresse Mecânico , Resultado do TratamentoRESUMO
OBJECTIVES: Although the cause of Sjögren's syndrome remains unknown, many arguments suggest a role for both environmental and genetic factors. An association with HLA molecules has been established. Other genes on the short arm of chromosome 6 may be involved, most notably the TNF gene, which may be pivotal in the development of the epithelial lesions. METHODS: We investigated TNFalpha microsatellites in 35 patients with primary Sjogren's syndrome and in 146 healthy controls. RESULTS: The frequency of the TNFalpha10 allele showed a non-significant increase in the Sjögren's disease group (28.6% vs 15.8%; P = NS). We found significant increases when we considered only those Sjögren's disease patients with joint manifestations (N = 24; 37.5% vs 15.7%; P < 0.05) or only those with anti-Ro(SSA) antibodies (N = 10; 50% vs 15.7%; P < 0.05). CONCLUSION: Our data support a role for the TNFalpha10 allele in primary Sjögren's syndrome, particularly those forms with joint symptoms and anti-Ro(SS-A) antibodies.
Assuntos
Repetições de Microssatélites , Síndrome de Sjogren/genética , Fator de Necrose Tumoral alfa/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Anticorpos Antinucleares/sangue , Anticorpos Antinucleares/genética , Artralgia/complicações , Artralgia/genética , Artralgia/patologia , Artrite/complicações , Artrite/genética , Artrite/patologia , Feminino , Frequência do Gene , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Síndrome de Sjogren/complicações , Síndrome de Sjogren/imunologia , Síndrome de Sjogren/patologiaRESUMO
OBJECTIVE: To determine whether spinal magnetic resonance imaging performed one month into anti-microbial therapy for pyogenic discitis demonstrated changes of value for predicting outcomes and making therapeutic decisions. METHODS: Prospective study of 16 patients with discitis. A physical evaluation, laboratory tests for inflammation, plain radiographs centered on the affected vertebral level, and magnetic resonance imaging with gadolinium injection were performed at baseline and on day 30. All 16 patients were reevaluated after three months and 15 after six months. RESULTS: The 12 men and four women had a mean age of 59 years. Fourteen patients had a paravertebral abscess (n=12) and/or an epidural abscess (n=6). On day 30, 14 of the 16 patients were clinically improved and ten were radiologically improved. The C-reactive protein level was still elevated in five cases. All reevaluated patients were improved after three months (16/16) and six months (15/15). Only two magnetic resonance imaging features improved during the first month: the size of paravertebral abscesses decreased in 11 of 12 patients, and the size of epidural abscesses decreased in four of six patients. CONCLUSION: Paravertebral and epidural abscesses improve promptly under antimicrobial therapy. However, the presence of these lesions have no prognostic significance. Magnetic resonance imaging does not add significantly to the follow-up of patients who respond clinically to antimicrobial therapy. However, in patients with an unsatisfactory clinical response, follow-up magnetic resonance imaging can provide useful therapeutic orientation by showing whether the paravertebral and/or epidural abscesses have decreased in size.
Assuntos
Discite/tratamento farmacológico , Discite/patologia , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Discite/microbiologia , Progressão da Doença , Abscesso Epidural/microbiologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To determine whether the osteoarticular changes associated with genetic hemochromatosis could be explained by metabolic parathyroid hormone (PTH) disorders. METHODS: The study involved 210 patients with liver iron overload syndromes. Osteoarticular changes were numerically scored as the number of damaged joints. PTH 1-84 and 44-68 were assayed. RESULTS: An increase in serum PTH 44-68 levels was found in one-third of untreated patients who had no calcium or PTH 1-84 abnormalities. Serum PTH 44-68 levels correlated positively with serum ferritin levels. In multivariate analyses, the number of affected joints correlated positively with age, serum PTH 44-68 levels, and serum ferritin levels. CONCLUSION: Liver iron overload syndromes, especially genetic hemochromatosis, are associated with elevated circulating levels of PTH fragments containing the 44-68 region, which appears to play a role in osteoarticular changes. This increase seems to be a consequence of iron overload.
Assuntos
Condrocalcinose/metabolismo , Hemocromatose/metabolismo , Hormônio Paratireóideo/sangue , Fragmentos de Peptídeos/sangue , Adolescente , Adulto , Idoso , Condrocalcinose/complicações , Condrocalcinose/patologia , Feminino , Ferritinas/sangue , Hemocromatose/complicações , Hemocromatose/genética , Humanos , Ferro/metabolismo , Articulações/metabolismo , Articulações/patologia , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Transferrina/metabolismoRESUMO
Epidural injections of corticosteroids in the cervical spine can provide effective treatment of cervicobrachial neuralgia. This technique is mainly described by anesthesiologists who perform injections without imaging control. We demonstrate that this infiltration can be easily performed under CT-guidance by radiologists.
Assuntos
Anti-Inflamatórios/uso terapêutico , Neurite do Plexo Braquial/tratamento farmacológico , Glucocorticoides/uso terapêutico , Prednisolona/uso terapêutico , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Anti-Inflamatórios/administração & dosagem , Vértebras Cervicais/diagnóstico por imagem , Meios de Contraste , Glucocorticoides/administração & dosagem , Humanos , Injeções Epidurais/instrumentação , Injeções Epidurais/métodos , Iopamidol , Ligamento Amarelo/diagnóstico por imagem , Agulhas , Prednisolona/administração & dosagem , SegurançaRESUMO
We studied 20 normal subjects and 20 suffering from sacro-iliitis. The performance of the two techniques were compared in studying reports ROC curve from several readers. We assessed the performance of each technique and each sign: CT scan appears as a better technique than plain films. Some signs present a poor interest: osteophytes seen on CT or plain films, subchondral cysts seen on CT. In other respects, articular cartilage erosions, subchondral sclerosis are main signs as much on CT as on plain films. In conclusion, CT scan allowed an accurate analysis of sacro-iliitis. It has a better diagnostic value than plain films and, in case of doubt, should be performed to increase diagnosis sensibility and specificity.
Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulação Sacroilíaca , Tomografia Computadorizada por Raios X , Adulto , Artrite Reumatoide/diagnóstico , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROCRESUMO
What is the role of physical training in the prevention of osteoporosis? The authors tried to answer the question, comparing the positive and negative effects of exercise on women bone mass before and after the menopause and proposed a way of management of bone loss in amenorrheic women athletes.
Assuntos
Densidade Óssea , Exercício Físico , Osteoporose/prevenção & controle , Esportes , Amenorreia/etiologia , Feminino , Humanos , Menopausa/fisiologia , Osteoporose/fisiopatologia , Esforço Físico , Fatores de RiscoRESUMO
HLA-DP polymorphism was examined in 71 rheumatoid arthritis patients and 148 controls, using dot-blot analysis with 14 synthetic oligonucleotide probes specific for the variable region of the DPB1 second exon. The DPB1 0401 allele was found to be significantly more frequent in RA patients than in controls (77.46% vs 55.40%, p less than 0.002, pc less than 0.03, relative risk value: 2.74). An association between DPB1 0401 and seropositivity for rhumatoid factors was also observed: 44 of the 55 seropositive RA patients were DPB1 0401 (p less than 0.001). Analyzing the HLA DPB1 alleles frequencies in 57 HLA-DR-typed RA patients did not show any linkage between the DPB1 0401 and the DR4 specificities. Furthermore, the DPB1 0401 homozygous frequency was increased in DR4-negative RA patients. Our findings suggest an independent role of the DPB1 0401 allele in the genetic susceptibility to RA.
Assuntos
Artrite Reumatoide/genética , Genes MHC da Classe II , Antígenos HLA-DP/genética , Polimorfismo Genético/genética , Adulto , Idoso , Sondas de DNA de HLA/genética , Feminino , Frequência do Gene , Cadeias beta de HLA-DP , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Risco , População Branca/genéticaAssuntos
Artrite Reumatoide/genética , Antígenos HLA-DQ/genética , Antígeno HLA-DR4/genética , Haplótipos/genética , Polimorfismo de Fragmento de Restrição , Artrite Reumatoide/imunologia , Marcadores Genéticos , Antígenos HLA-DQ/imunologia , Antígeno HLA-DR4/imunologia , Haplótipos/imunologia , HumanosRESUMO
The authors describe a new canal syndrome, which they call the "superficial sural aponeurosis canal syndrome" or "sural nerve tunnel syndrome". Mostly seen in sportsmen, it was observed in this case in the context of a myositis ossificans circumscripta of the tendo-muscular junction of the heel. The clinical signs are caused by compression of the sural nerve where it passes through a nonextensible tunnel formed by the fold of the posterior sural aponeurosis. This is distinguished from a loge syndrome; the most typical clinical sign is increased pain in the territory of the sural nerve during plantar flexion of the ankle; in this position reduced sensory conduction velocity is measured. The treatment consists in a section of the fibro-aponeurotic arch.
Assuntos
Síndromes de Compressão Nervosa/diagnóstico , Nervos Espinhais , Nervo Sural , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Nervos Espinhais/cirurgia , Nervo Sural/cirurgiaRESUMO
In order to reduce refractory chronic pain of the musculoskeletal system, the orthopedic surgeon can stimulate electrically the peripheral nerves or the posterior funiculi of the spinal cord (epidural neurostimulation). The authors specify their current indications for epidural stimulation in the treatment of such painful diseases: radicular pain caused by arachnoepidurites, sequelae of trauma inflicted to the spine and medulla; postoperative lomboradicular pain of mixed source, and distal lesions of the plexus brachialis. The indication for an implant stems from a rigorous strategy which requires more particularly that pain regress by more than 50% under transcutaneous neurostimulation applied for a period of least one month and that the psychological and spinal-cerebral integrity be verified. The surgical procedure comprises two stages: first, positioning of an epidural electrode and, then, insertion of a totally implantable multiprogrammable radiostimulator. Judging from a prospective assessment of 20 cases of postoperative lumbar arachnoepiduritis treated in this way, the results are considered quite encouraging.