RESUMEN
Until very recently, intervertebral disc innervation was a subject of considerable debate. Nowadays, the introduction of inmunohistochemical techniques associated to specific antibodies and studies with retrograde tracers in nerves have allowed greater understanding of disc innervation in physiological and pathological conditions and also endings characteristics and their patterns of distribution in both situations. The existing controversies regarding structural basis of discogenic pain, have raised the interest of knowing the influence of innervation in back pain from discal origin and its characteristics. Today, we know that pathologic neoinnervation accompanying radial fissures is an important factor in the genesis of discogenic pain; within a complex mechanism in which other neurobiomechemical, inflammatory and biomechanical factors are involved.
Asunto(s)
Dolor de Espalda/etiología , Disco Intervertebral/inervación , Fibras Adrenérgicas/fisiología , Dolor de Espalda/fisiopatología , Humanos , Inmunohistoquímica , Inflamación , Mediadores de Inflamación/fisiología , Desplazamiento del Disco Intervertebral/embriología , Desplazamiento del Disco Intervertebral/etiología , Desplazamiento del Disco Intervertebral/fisiopatología , Mecanorreceptores/fisiología , Factores de Crecimiento Nervioso/fisiología , Nociceptores/fisiología , Células Receptoras Sensoriales/fisiologíaRESUMEN
PURPOSE: Nonlinear dynamics has enhanced the diagnostic abilities of some physiological signals. Recent studies have shown that the complexity of the intracranial pressure waveform decreases during periods of intracranial hypertension in paediatric patients with acute brain injury. We wanted to assess changes in the complexity of the cerebrospinal fluid (CSF) pressure signal over the large range covered during the study of CSF circulation with infusion studies. METHODS: We performed 37 infusion studies in patients with hydrocephalus of various types and origin (median age 71 years; interquartile range 60-77 years). After 5 min of baseline measurement, infusion was started at a rate of 1.5 ml/min until a plateau was reached. Once the infusion finished, CSF pressure was recorded until it returned to baseline. We analysed CSF pressure signals using the Lempel-Ziv (LZ) complexity measure. To characterise more accurately the behaviour of LZ complexity, the study was segmented into four periods: basal, early infusion, plateau and recovery. RESULTS: The LZ complexity of the CSF pressure decreased in the plateau of the infusion study compared to the basal complexity (p=0.0018). This indicates loss of complexity of the CSF pulse waveform with intracranial hypertension. We also noted that the level of complexity begins to increase when the infusion is interrupted and CSF pressure drops towards the initial values. CONCLUSIONS: The LZ complexity decreases when CSF pressure reaches the range of intracranial hypertension during infusion studies. This finding provides further evidence of a phenomenon of decomplexification in the pulsatile component of the pressure signal during intracranial hypertension.
Asunto(s)
Presión del Líquido Cefalorraquídeo/fisiología , Presión Intracraneal/fisiología , Dinámicas no Lineales , Anciano , Humanos , Hidrocefalia/líquido cefalorraquídeo , Persona de Mediana EdadRESUMEN
Ischemic complications after resection of high-grade glioma are frequent and may constitute potential cause of false-positive results in postsurgical evaluation using F-fluorocholine PET/CT. On the other hand, hypoxia caused by ischemia promotes invasive glioma growth. We present 3 cases of patients with different grades of ischemic injury after resection of high-grade glioma. The combined interpretation of diffusion-weighted imaging and apparent diffusion coefficient map on MRI, in this clinical setting, is mandatory to avoid PET/CT misinterpretations.
Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Colina/análogos & derivados , Glioma/patología , Glioma/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Isquemia Encefálica/complicaciones , Neoplasias Encefálicas/complicaciones , Diagnóstico Diferencial , Femenino , Glioma/complicaciones , Humanos , Masculino , Clasificación del Tumor , Neoplasia ResidualRESUMEN
BACKGROUND: Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections. METHODS: We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery. RESULTS: The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization. CONCLUSION: We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.
Asunto(s)
Tornillos Óseos , Vértebras Cervicales/cirugía , Fístula/cirugía , Faringe/lesiones , Complicaciones Posoperatorias/cirugía , Fusión Vertebral/efectos adversos , Anciano , Endoscopía , Fístula/etiología , Humanos , Masculino , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/cirugía , Faringe/cirugíaRESUMEN
Hasta hace poco la inervación del disco intervertebral fue objeto de debate. La introducción de técnicas de inmunohistoquímica asociadas a anticuerpos específicos y los estudios con trazadores nerviosos retrógrados han permitido conocer mejor la inervación del disco en condiciones normales y patológicas así como las características de las terminaciones y sus patrones de distribución en ambas situaciones. Las controversias que existen acerca de las bases estructurales del dolor discogénico han despertado el interés por conocer la influencia de la inervación en el dolor lumbar de origen discal y sus características. Actualmente sabemos que la neoinervación patológica de las fisuras radiales es un factor importante en la génesis del dolor discogénico dentro de un complejo mecanismo en que están implicados factores neurobioquímicos, inflamatorios y biomecánicos (AU)
Until very recently, intervertebral disc innervation was a subject of considerable debate. Nowadays, the introduction of inmunohistochemical techniques associated to specific antibodies and studies with retrograde tracers in nerves have allowed greater understanding of disc innervation in physiological and pathological conditions and also endings characteristics and their patterns of distribution in both situations. The existing controversies regarding structural basis of discogenic pain, have raised the interest of knowing the influence of innervation in back pain from discal origin and its characteristics. Today, we know that pathologic neoinnervation accompanying radial fissures is an important factor in the genesis of discogenic pain; within a complex mechanism in which other neurobiomechemical, inflammatory and biomechanical factors are involved