Estudo sobre a associação de cerâmica a plasma rico em plaquetas na coluna vertebral de ratos / Study about fusion using ceramic with platelet-rich plasma in the spine of rats

OBJETIVO: Analisar o efeito osteoindutor dos fatores de crescimento contidos no plasma rico em plaquetas (PRP) quando associados a cerâmicas no processo de fusão na coluna vertebral de ratos. MATERIAL E MÉTODO: Laminectomia lombar foi realizada em 16 ratos Lewis isogênicos para implantar cerâmica. O PRP foi preparado no ato operatório a partir do sangue de outras duas cobaias.os grupos estudo e controle foram estabelecidos por randomização, recebendo o grupo estudo cerâmica associada a PRP e o controle apenas cerâmica. Os animais foram sacrificados após 10 semanas e as colunas enviadas para análise histopatológica. RESULTADOS: Intensa atividade osteoblástica e osteoclástica e completa reabsorção da cerâmica foram achados no grupo estudo. No grupo controle havia ilhotas de osso em meio a tecido fibroso e cerâmica não reabsorvida. Discussão: Os fatores de crescimento liberados pelas plaquetas agem ligando-se à superfície de osteoblastos e fibroblastos, estimulando a síntese de colágeno para formação de matriz óssea. macrófagos ativados continuam secretando os fatores de crescimento e estimulando a osteogênese. CONCLUSÃO: O uso de PRP associado a cerâmica mostrou maior atividade osteoblástica e osteoclástica e completa reabsorção da cerâmica em relação à enxertia da mesma isoladamente na coluna vertebral de ratos.

OBJECTIVE: To assess the osteoinductive action of platelet-rich plasma when associated to ceramics in the spine of rats. MATERIAL AND METHOD: Laminectomy was performed in 16 isogenic Lewis rats for posterior ceramic grafting. PRP was prepared intraoperatively using blood collected from two other rats. Study and control groups were set by randomization, with the study group receiving ceramics associated to PRP, and the control group receiving only ceramics. The animals were sacrificed for histopathological analysis after 10 weeks. RESULTS: Strong osteoblastic and osteoclastic activity and full re-absorption of ceramics were found on study group. In control group, small bone islands across fibrous tissue and non-reabsorbed were seen. Discussion: growth factors released by platelets bind to osteoblasts and fibroblasts surfaces, stimulating collagen synthesis to form bone matrix. Activated macrophages keep releasing growth factors and stimulating osteogenesis. CONCLUSION: The use of PRP associated to ceramics showed stronger osteoblastic and osteoclastic activity and full ceramics re-absorption compared to standalone grafting on the spine of rats.

[Septic spondylodiscitis: diagnosis and treatment]. / Espondilodiscites sépticas: diagnóstico e tratamento.

We studied retrospectively 24 patients with septic discitis of different etiologies (hematogenic, primary and infantile) and the different aspects involved in its diagnosis and treatment. Erythrocyte sedimentation rate proved to be a valuable parameter and should always be interpreted carefully along with the clinical and neuroimaging findings. Biopsies should be reserved for doubtful cases with atypical course. Clinical treatment should be initiated after the following situations have been ruled out: sepsis, neurological deficit, severe deformity, epidural abscess and foreign body (primary disease). The surgical approach may be chosen based on the stage of disease, being preferably posterior in suppurative forms and anterior in the non-suppurative stage. Based on our experience and on information gathered by literature review, we propose an algorithm to guide diagnosis and treatment in patients with septic discitis.

Espondilodiscites sépticas: diagnóstico e tratamento / Septic spondylodiscitis: diagnosis and treatment

Estudamos retrospectivamente 24 pacientes com espondilodiscite séptica de diferentes etiologias (hematogênica, primária e infantil) e os diferentes aspectos envolvidos em seu diagnóstico e tratamento. Constatamos que a velocidade de hemossedimentaçäo é um bom parâmetro laboratorial para acompanhar a evoluçäo da doença, mas deve ser sempre interpretada conjuntamente com o quadro clínico e os achados de neuroimagem. Biópsias devem ser reservadas para os casos de diagnóstico duvidoso e o tratamento clínico realizado sempre que afastadas as seguintes condiçöes: sepse, déficit neurológico, deformidade severa, abscesso epidural e corpo estranho (discite primária). A abordagem cirúrgica deve ser planejada levando em conta o estágio da doença, sendo preferencialmente por via posterior nas fases supurativas e anterior nas demais. Baseados em nossa experiência e em revisäo da literatura, propomos um algoritmo para orientar o diagnóstico e o tratamento das espondilodiscites sépticas

Chordoid meningioma: report of two cases.

We present CT scan, MRI and histopathologic findings of two patients harboring a rare type of meningioma. In the first case, a 52 year-old male patient, a large parasellar mass invading the cavernous sinus, infiltrating the infratemporal fossa and extending as low as C2 was founded. The tumor was isointense on T1, enhanced strongly with gadolinium injection, and was hyperintense on T2. In the second case, a 19-year-old male patient, a large high density temporal right mass was disclosed by CT scan. Both patients were taken to surgery. In the first case, only a partial removal was possible to be accomplished due to a severe intra operative bleeding. In the second case, the tumor was totally removed. Both showed characteristic pathologic findings of a meningioma resembling a chordoma. Meningioma is a relatively common intracranial tumor, occurring most frequently in adults, showing a wide variety of growth patterns. We described a pattern that had a peculiar chordoma-like appearance. The pathological findings and the differential diagnosis from chordoma are discussed.

Chordoid meningioma. Report of two cases

We present CT scan, MRI and histopathologic findings of two patients harboring a rare type of meningioma. In the first case, a 52 year-old male patient, a large parasellar mass invading the cavernous sinus, infiltrating the infratemporal fossa and extending as low as C2 was founded. The tumor was isointense on T1, enhanced strongly with gadolinium injection, and was hyperintense on T2. In the second case, a 19-year-old male patient, a large high density temporal right mass was disclosed by CT scan. Both patients were taken to surgery. In the first case, only a partial removal was possible to be accomplished due to a severe intra operative bleeding. In the second case, the tumor was totally removed. Both showed characteristic pathologic findings of a meningioma resembling a chordoma. Meningioma is a relatively common intracranial tumor, occurring most frequently in adults, showing a wide variety of growth patterns. We described a pattern that had a peculiar chordoma-like appearance. The pathological findings and the differential diagnosis from chordoma are discussed

Adenomas hipofisários. Artigo de revisão / Pituitary adenomas. Case report

Os autores fazem revisão dos adenomas hipofisários: classificação anatomopatológica, métodos de diagnóstico - com especial atenção para a escala de Hardy-Vezina & Wilson, história e evolução da técnica cirúrgica, bem como estudo do índice proliferativo celular. A casuística dos autores, constituída de 126 casos coletados no período de dez anos, é comparada às principais séries da literatura em relação à incidência dos diversos tipos de adenoma.

Anaplastic meningioma: case report

Intracranial meningiomas continue to challenge our best clinical efforts to eliminate them once discovered and deemed appropriate for treatment. Malignant meningiomas constitute 10 percent to 15 percent of all meningiomas and limited information exists regarding adjuvant treatment. The external whole brain irradiation is recommended. Traditional chemotherapy has proven ineffective; thus, new chemotherapeutic agents and new methods of delivery should be developed. Immunotherapy may be considered for patients with malignant meningiomas when all others previous treatment have failed. We report a case of anaplastic papillary meningioma. A 67-year-old man presented with partial complex seizures, headache and aggressiveness. A computerized tomography and magnetic resonance image demonstrated a large left temporo-occipital mass with difuse contrast enhancement and extensive surrounding edema. A left temporo-occipital flap was performed. The tumor and the infiltrated dura were radically removed. Postoperatively, the patient remained neurologically intact. The treatment was complemented by external whole brain radiation

Tratamento cirúrgico das lesoes traumáticas do segmento médio-inferior da coluna cervical / Surgical treatment of the traumatic lesions of medium--inferior segment of cervical column

O nível C2 é o mais frequente em lesoes traumáticas da coluna cervical, sendo seguido por C5 e C6. Elas ocorrem, mais habitualmente, na terceira década de vida, com incidência decrescente na idade avançada. Como parte destas lesoes está localizada nos elementos da coluna anterior, segundo a conceituaçao de Denis e, levado-se em consideraçao os estudos biomecânicos do segmento médio--inferior da coluna cervical, bem como os mecanismos que causam estas lesoes, elaboramos este estudo, com o intuito de apresentar as técnicas de fusao cervical anterior, com enxerto ósseo e placas de Caspar, Morscher (CSLP) e ORION™. Mostramos e discutimos as vantagens e desvantagens de cada tipo de fixaçao anterior, com base nos dados de literatura, evidenciando a melhoria no material de implante e das técnicas de fixaçao