Epidemiology of spinal trauma surgically treated at the unicamp hospital das clínicas / Epidemiologia do traumatismo raquimedular tratado cirurgicamente no hospital das clínicas da unicamp / Epidemiología del traumatismo raquimedular tratado quirúrgicamente en el hospital das clínicas de unicamp

ABSTRACT Objective: To report the epidemiological profile of patients operated for treatment of spinal trauma in the UNICAMP Hospital das Clínicas. Methods: Patients older than 14 years with spinal trauma operated in the service from 2012 to 2017 with complete radiological and clinical data were evaluated. Results: A total of 143 patients were included, 120 men and 23 women, with a mean age of 37.8 years. Falls from height (32%), motorcycle (26%) and car accidents (24%) were the most common trauma mechanisms. The most affected vertebral level was C6 (11%) and most patients (55%) had some neurological deficits. The overall postoperative complication rate was 23%. Conclusions: Spinal trauma has a high socioeconomic impact due to its high morbidity and mortality, and it is necessary to study its epidemiology for the development of public policies for prevention and treatment financing. Level of Evidence: III. Type of study: Retrospective study.

RESUMO Objetivo: Reportar o perfil epidemiológico dos pacientes operados para tratamento do TRM no Hospital das Clínicas da UNICAMP. Métodos: Pacientes maiores de 14 anos, com TRM operados no serviço no período de 2012 a 2017, com dados radiológicos e clínicos completos foram avaliados. Resultados: 143 pacientes foram incluídos, sendo 120 homens e 23 mulheres, com idade média de 37,8 anos. Quedas (32%), acidentes de motocicletas (26%) e de automóveis (24%) foram os mecanismos de trauma mais comuns. O nível vertebral mais acometido foi o de C6 (11%) e a maioria dos pacientes tinha algum déficit neurológico (55%). A taxa geral de complicação pós-operatória foi de 23%. Conclusões: O Traumatismo Raquimedular (TRM) tem alto impacto sócio-econômico devido sua alta morbi-mortalidade, sendo que é necessário estudar sua epidemiologia para o desenvolvimento de políticas públicas de prevenção e financiamento do tratamento do mesmo. Nível de evidência III. Tipo de estudo: Estudo Retrospectivo.

RESUMEN Objetivo: Describir el perfil epidemiológico de los pacientes operados para tratamiento quirúrgico debido a TRM en el Hospital das Clínicas de UNICAMP. Métodos: Se evaluaron pacientes mayores de 14 años con TRM operados en el servicio de 2012 a 2017, con datos radiológicos y clínicos completos. Resultados: Fueron incluidos 143 pacientes, siendo 120 hombres y 23 mujeres, con una edad promedio de 37,8 años. Caídas de altura (32%), accidentes de motocicleta (26%) y accidentes de autos (24%) fueron los mecanismos de trauma más comunes. El nivel vertebral más afectado fue C6 (11%) y la mayoría de los pacientes tenía algún déficit neurológico (55%). La tasa global de complicaciones postoperatorias fue del 23%. Conclusiones: El TRM tiene un alto impacto socioeconómico debido a su alta morbilidad y mortalidad; por lo tanto es necesario estudiar su epidemiología para el desarrollo de políticas públicas de prevención y financiamiento del tratamiento. Nivel de evidencia: III. Tipo de Estudio: Estudio retrospectivo.

Cervicomedullary Junction Ependymoma Associated with Neurofibromatosis Type II: Case Report and Literature Review

Neurofibromatosis type II (NF2) is a rare autosomal dominant inherited disease caused by a mutation in chromosome 22q12 and associated with multiple central nervous system tumors. In this paper, we describe a rare case of cervicomedullary junction ependymoma associated with NF2 in a 25-year-old man who underwent surgical treatment with total resection and had a good clinical outcome. We discussed the nuances of the surgical resection and the literature concerning this rare form of presentation of NF2.

Neurofibromatose tipo II (NF2) é uma doença autossômica dominante provocada por uma mutação no cromossomo 22q12, e que está relacionada ao surgimento de múltiplos tumores do sistema nervoso central. Neste artigo, é descrito um caso raro de um paciente com 25 anos de idade submetido ao tratamento cirúrgico de um ependimoma da junção cervicobulbar, com ressecção total "en bloc" e bom resultado clínico. Discutimos as nuances da ressecção cirúrgica, bem como a literatura sobre o tratamento destas lesões raras.

Reliability and safety of a new upper cervical spine injury treatment algorithm.

METHODS: Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index. RESULTS: The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons' personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. CONCLUSION: The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

Reliability and safety of a new upper cervical spine injury treatment algorithm / Avaliação de reprodutibilidade e segurança de um novo algoritmo de tratamento das lesões cervicais altas

ABSTRACT In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index. Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

RESUMO Avaliamos a reprodutibilidade e segurança do algoritmo Upper Cervical Spine Injuries Treatment Algorithm (UCITA) recém proposto para a escolha do tratamento das lesões traumáticas da junção crânio-cervical. Métodos Trinta casos previamente tratados de acordo com o algoritmo foram apresentados a quatro cirurgiões de coluna, sendo questionada a conduta pessoal dos mesmos e a conduta segundo a aplicação do algoritmo. Após 4 semanas, foram refeitas as mesmas perguntas para avaliar a reprodutibilidade (intra e interobservador) do algoritmo, através do índice estatístico “Kappa”. Resultados A reprodutibilidade da conduta com o uso do algoritmo foi superior a reprodutibilidade da conduta pessoal dos cirurgiões. Com o uso do UCITA, a concordância do tratamento realmente efetivado foi encontrada em mais de 89% dos casos. Conclusão O uso do UCITA foi seguro e reprodutível, podendo ser usado como ferramenta auxiliar na tomada de decisão entre tratamento cirúrgico versus conservador dos traumatismos da junção crâniocervical.

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7).

OBJECTIVE The authors evaluated a new classification for subaxial cervical spine trauma (SCST) recently proposed by the AOSpine group based on morphological criteria obtained using CT imaging. METHODS Patients with SCST treated at the authors' institution according to the Subaxial Cervical Spine Injury Classification system were included. Five different blinded researchers classified patients' injuries according to the new AOSpine system using CT imaging at 2 different times (4-week interval between each assessment). Reliability was assessed using the kappa index (κ), while validity was inferred by comparing the classification obtained with the treatment performed. RESULTS Fifty-one patients were included: 31 underwent surgical treatment, and 20 were managed nonsurgically. Intraobserver agreement for subgroups ranged from 0.61 to 0.93, and interobserver agreement was 0.51 (first assessment) and 0.6 (second assessment). Intraobserver agreement for groups ranged from 0.66 to 0.95, and interobserver agreement was 0.52 (first assessment) and 0.63 (second assessment). The kappa index in all evaluations was 0.67 for Type A, 0.08 for Type B, and 0.68 for Type C injuries, and for the facet modifier it was 0.33 (F1), 0.4 (F2), 0.56 (F3), and 0.75 (F4). Complete agreement for all components was attained in 25 cases (49%) (19 Type A and 6 Type C), and for subgroups it was attained in 22 cases (43.1%) (16 Type A0 and 6 Type C). Type A0 injuries were treated conservatively or surgically according to their neurological status and ligamentous status. Type C injuries were treated surgically in almost all cases, except one. CONCLUSIONS While the general reliability of the newer AOSpine system for SCST was acceptable for group classification, significant limitations were identified for subgroups. Type B injuries were rarely diagnosed, and only mild (Type A0) and extreme severe (Type C) injuries had a high rate of interobserver agreement. Facet modifiers and intermediate injury patterns require better descriptions to improve their low agreement in cases of SCST.

Incidence of Trypanosoma cruzi transmission through breastfeeding during acute experimental Chagas disease.

OBJECTIVE: To verify the incidence of T. cruzi transmission through breastfeeding during acute experimental Chagas' disease. METHODS: Fifteen female Swiss mice were mated and, after pregnancy confirmation, placed in individual cages. A few hours after birth, the females were inoculated with 0.1 mL of blood containing approximately 3 x 10(5) trypomastigote forms of Y strain of T. cruzi and continued breastfeeding for 25 days. RESULTS: In 142 offspring examined no infection through breast-feeding was observed. CONCLUSIONS: The low number of trypomastigote forms ingested by the newborn mice combined with biological and biochemical characteristics of blood trypomastigotes may explain the lack of transmission in this experiment.

Incidence of Trypanosoma cruzi transmission through breastfeeding during acute experimental Chagas disease

OBJECTIVE: To verify the incidence of T. cruzi transmission through breastfeeding during acute experimental Chagas' disease. METHODS: Fifteen female Swiss mice were mated and, after pregnancy confirmation, placed in individual cages. A few hours after birth, the females were inoculated with 0.1 mL of blood containing approximately 3 x 10(5) trypomastigote forms of Y strain of T. cruzi and continued breastfeeding for 25 days. RESULTS: In 142 offspring examined no infection through breast-feeding was observed. CONCLUSIONS: The low number of trypomastigote forms ingested by the newborn mice combined with biological and biochemical characteristics of blood trypomastigotes may explain the lack of transmission in this experiment.