Effects of tacrolimus and erythropoietin in experimental spinal cord lesion in rats: functional and histological evaluation.

STUDY DESIGN: Experimental study with rats. OBJECTIVE: To evaluate functional and histological effects of tacrolimus (FK 506) and erythropoietin (EPO) after experimental spinal cord contusion injury (SCI). SETTING: Brazil. METHODS: Wistar rats (n=60) were submitted to SCI with the NYU Impactor system. The control group received saline; the EPO group received EPO; the group EPO+FK 506 received EPO associated with tacrolimus and the group FK 506 received tacrolimus only. The Sham group underwent SCI, but did not receive any drug. Locomotor function was evaluated after SCI by BBB (Basso, Beattie and Bresnahan) weekly and by the motor-evoked potential test in 42 days. The spinal cord was histologically evaluated. RESULTS: There was a significant difference between treated and the control groups from the seventh day on for BBB scores, with no difference between the groups EPO and EPO+FK 506 by the end of the study. There were significant differences between groups for necrosis and bleeding, but not for hiperemia, degeneration and cellular infiltrate. Axon neuron count was different between all groups (P=0.001), between EPO+FK 506 and FK 506 (P=0.011) and between EPO+FK 506 and Sham (P=0.002). Amplitude was significantly different between all groups except between control and sham. For latency, there was no difference. CONCLUSIONS: This study did not reveal significant differences in the recovery of locomotor function, or in the histological and electrophysiological analysis in animals treated with EPO and tacrolimus after thoracic SCI.

Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury: a prospective study.

BACKGROUND: Spinal cord injuries has increased together with urban violence and show a high rates of incidence. Besides the onus to patient and society, it can also cause other serious complications to victims. Acute pancreatitis has an important impact on this disease and has been underdiagnosed in several patients. OBJECTIVES: The aim of this study was investigate the association of acute pancreatitis in acute spinal cord injuries. The secondary aim was to propose an investigation protocol to early diagnose and prevent it. METHODS: A prospective observational study was conducted in 78 patients who presented acute spinal cord injury (SCI) at our emergency department, confirmed by clinical and imaging examination, in according to the American Spinal Injury Association (ASIA) Classification. Exclusion criteria were chronic or associate diseases in spinal cord, pancreatic direct trauma, alcoholism and chronic pancreatic disease. RESULTS: The association of acute pancreatitis in patients with SCI was 11.53%. The occurrence of pancreatitis or high levels of serum pancreatic enzymes in patients with ASIA A was 41.7% and only 4.17% in patients with ASIA E. In all, 55.2% of patients who presented pancreatitis or high levels of serum pancreatic enzymes had cervical level of SCI and 34.5% had thoracic level. Adynamic ileus was observed in 68.96% of this group. CONCLUSION: We concluded that, in acute spinal cord injuries, the occurrence of acute pancreatitis or high serum levels of pancreatic enzymes are more frequent in patients with ASIA A Classification, cervical/thoracic level of spinal injury and adynamic ileus.

Gunshot injuries in the spine.

STUDY DESIGN: Review article. OBJECTIVES: To review the literature regarding treatment approaches in cases of gunshot wounds (GSWs) affecting the spine. SETTING: Brazil. METHODS: Narrative review of medical literature. RESULTS: GSWs are an increasing cause of morbidity and mortality. Most patients with spinal GSW have complete neurological deficit. The injury is more common in young men and is frequently immobilizing. The initial approach should follow advanced trauma life support, and broad-spectrum antibiotic therapy should be initiated immediately, especially in patients with perforation of the gastrointestinal tract. The indications for surgery in spinal GSW are deterioration of the neurologic condition in a patient with incomplete neurological deficit, the presence of liquor fistula, spinal instability, intoxication by the metal from the bullet or risk of bullet migration. CONCLUSION: Surgical treatment is associated with a higher complication rate than conservative treatment. Therefore, the surgeon must know the treatment limitations and recognize patients who would truly benefit from surgery.

Potentializing the effects of GM1 by hyperbaric oxygen therapy in acute experimental spinal cord lesion in rats.

STUDY DESIGN: Experimental, controlled, animal study. OBJECTIVES: To evaluate the effect of GM1 ganglioside, hyperbaric oxygen and both in combination, in the treatment of experimental spinal cord lesions in rats. SETTING: Brazil. METHODS: Thirty-two Wistar rats with spinal cord lesions were divided into four groups: one group received GM1 ganglioside, one was submitted to hyperbaric oxygen therapy (HBOT), the third received both treatments and the fourth received no treatment (control). RESULTS: There were no significant differences between the groups in the histological analysis, for any of the variables (necrosis, hemorrhage, hyperemia, cystic degeneration, P>0.06). Neither were there any significant differences in the comparison of left and right sides in the functional tests (P>0.06 for all). No significant differences were found in the locomotor ratings, in the comparison of groups at 2, 7, 21 and 28 days after the surgical procedure. However, in the evaluation on day 14, group 3, which received the combined therapy, showed a significantly higher Basso Beattie and Bresnahan score than the other groups (P=0.015). CONCLUSION: The therapeutic effect of GM1 in locomotor evaluation of rats submitted to spinal cord lesion is anticipated by HBOT.

WITHDRAWN: Association between polymorphisms in genes of inflammatory response and axonal repair with spinal cord injury.

Ahead of Print article withdrawn by publisher. Please see re-submitted article 'DNA polymorphisms as tools for spinal cord injury research' Spinal Cord advance online publication, 20 May 2008; doi:10.1038/sc.2008.67.

[Retrospective study of traffic accident victims: incidence after the new National Traffic Code implantation]. / Estudo retrospectivo dos pacientes vítimas de acidente de trânsito: incidência após a introdução do novo código nacional de trânsito.

The authors present a study about the frequency of the injuries caused by traffic accidents on the orthopedic patients admitted to the emergency of Institute of Orthopedics and Traumatology at the Hospital das Clínicas of the School of Medicine São Paulo University, before and after the new National Traffic Code. They found a decreased number of polytraumatized patients and severe injuries after the beginning of this new legislation.

[Spinal cord injuries in children]. / Traumatismo raquimedular em crianças.

Spinal cord injuries are rare in children, in face of their higher mobility comparing to adults. The high cervical and the thoracic segments of the spine are more frequently affected. In the last 10 years we had 90 cases of spinal injuries in our service being 12 with neurologic deficient (8 male and 4 female) and four of them without radiographic abnormality, even in the dynamics studies. The authors emphasise the possibility of occurrence of neurologic deficit in children after trauma, even without any radiographic abnormality.

[Traumatic spondylolysis]. / Espondilolise traumática.

The authors present the results of treatment of seven cases of spondylolysis with a two years follow up. Six patients were treated with the thoracolumbosacral orthosis and one with L5-S1 fusion. At the end of the follow up all patients were pain free.

Immunofluorescence on skeletal muscle and skin biopsy specimens in muscle diseases.

A series of 110 muscle and 40 skin biopsy specimens were examined using direct immunofluorescence aiming to identify features that may differentiate the myopathy of connective tissue disease from other muscle diseases. The skeletal muscle fluorescence was positive in 75% of the patients with muscle diseases. The sarcolemmal staining was higher in mitochondrial encephalomyopathy. Fiber and vascular staining occurred in all muscle diseases, except in cases of myasthenia. Our results showed that 42% of patients with polymyositis and 43% of patients with peripheral motor neuron diseases have vascular deposits of immune complexes suggesting that these two diseases could result from an immune-complex-induced vasculopathy. The IF test in skin specimens was positive in 60% of the patients with muscular diseases. The absence of immunoglobulin deposit at the dermoepidermal junction and at epidermal nuclei in cases of peripheral motor neuron disease suggest that this skin test may be useful in the differentiation of muscle diseases.

Evaluation of the physical fitness by the Bruno Balke protocol in sedentary and wheelchair trained paraplegic patients.

The Bruno Balke test is one of the methods available to measure the oxygen intake in wheelchair users. The equation of the test is:intake O2 = 33+ (speed average-133) x 0.17 ml/kg x min. (-1). The average speed represents the acceleration and may be used to measure the level of physical fitness. In order to verify the efficiency of this kind of evaluation, we selected ten male, sedentary paraplegic patients, level D5-D12 in an ordinary rehabilitation program and ten paraplegic athletes. All of them were submitted to the Bruno Balke test. The results demonstrated that the average speed, the covered distance and the oxygen intake were significantly greater in athletes than in sedentary individuals.

[Effect of electromagnetic fields on osteogenesis: an experimental study on rats]. / Efeito do campo magnético na osteogênese: estudo experimental em ratos.

The authors studied experimentally the electromagnetic pulsing field effects in an experimental model in rats, for evaluation of the velocity of consolidation of tibial and fibular fractures. The animals were followed for a period of three weeks under continuous stimulation and there were done radiological evaluation weekly and histological study at the end of the study. There were no histological, clinical or radiological differences between the group of rats submitted to electromagnetic pulsing fields and the control group.

Herniation of the lumbar disk in adolescents.

The authors review eight cases of lumbar intervertebral disk herniation in adolescents aged less than 16 years, with a minimum follow-up treatment of 2 years during an 18-year period. All patients presented lower back and sciatic pain, antalgic scoliosis, and a positive Lasègue sign. Nerve compression signs were present in 25+ of the cases. Seventy-five percent of the cases underwent myelography and 25% underwent computerized axial tomography. Results were good in all cases.

Study of fracture healing in protein malnutrition.

The present study was designed to assess the effects of nutrition on fracture healing in a controlled animal model. Tibial fractures were studied in 115 Wistar rats divided into four groups: group 1,50 control animals kept on a normal diet; groups 2 and 3, 45 protein-deprived animals, and group 4, 20 animals submitted to protein malnutrition before the fracture and then placed on a normal laboratory diet. The parameters evaluated during the study were: variation in animal weight during the experiment (confirmation of protein malnutrition), fracture healing as determined by bone callus radiology, macroscopic evaluation of bone callus mechanical resistance, and histological fracture examination by common light microscopy after staining with hematoxylin-eosin. The results showed the beneficial effects of protein nutrition support on the healing of lone bone fractures. Callus formation was significantly improved in groups 1 and 4 compared to groups 2 and 3. In groups 1 and 4, callus development was normal, with regular bone tissue formation, whereas in groups 2 and 3 there was a large amount of fibrous-connective tissue with scarce formation of osseous tissue.

Atlanto-axial dislocation in children.

The authors present 14 cases of C1 C2 dislocations in children (8 boys and 6 girls; mean age, 6.9 years) seen at the Orthopedics and Traumatology Institute of the University Hospital, Faculty of Medicine, University of São Paulo from 1978 to 1990. In view of the disappointing results obtained by conservative treatment in 6 of the 14 patients, the authors recommend early atlanto-axial arthrodesis in cases of C1 C2 dislocation in children.

[Surgical treatment of idiopathic scoliosis in adolescents by the Harrington method]. / Tratamento cirúrgico das escolioses idiopáticas no adolescente pelo método de Harrington.

Forty six patients with idiopathic scoliosis were treated according the Harrington method. The surgical treatment was done with the Harrington distraction rod, and vertebral arthrodesis with autogenous iliac bone graft. The patients wore a Risser-Cotrel body-cast for nine months but started walking two days after casting. Good clinical results were obtained in all the patients. Final curve correction was 40%. In this series of patients no pseudoarthrosis occurred.

[Complications of herniated disk surgery]. / Complicações da cirurgia de hérnia discal.

The author studies the complications that can occur in the lumbar spine operations particularly in the disc protrusion surgeries. The pre, intra and post-operative complications as well as the early and late complications were analysed. The factors that may lead to bad surgical results are discussed.