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1.
Zhonghua Wai Ke Za Zhi ; 58(3): 161-164, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187918

RESUMO

Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.


Assuntos
Fraturas por Compressão/cirurgia , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Biópsia , Fraturas por Compressão/etiologia , Humanos , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral/patologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(2): e18756, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914098

RESUMO

RATIONALE: Liver transplantation (LT) is the preferred surgical option for the treatment of early hepatocellular carcinoma (HCC). In contrast, surgical treatment of progressive HCC metastasized to the spine following LT constitutes a considerable challenge. Here, we report the first case of progressive HCC metastasized to the T12 vertebra after local radiotherapy, treated successfully with en bloc lumpectomy following LT for HCC. PATIENT CONCERNS: A 40-year-old man who had undergone LT for the treatment of HCC 2 months prior presented to our clinic with symptoms of progressive back pain. Magnetic resonance imagining (MRI) and positron emission tomography (PET) examinations showed a solitary metastasis at T12 without recurrence in the liver or metastasis to other organs. DIAGNOSES: The patient was diagnosed with HCC metastasized to the T12 vertebra after liver transplantation. INTERVENTIONS: Local radiation therapy of the T12 vertebra was performed; however, the lesion continued to grow one month after irradiation. Accordingly, the patient was treated with en bloc lumpectomy of the T12 vertebra. After surgery, the patient reported significant pain relief. At 11 months post-surgery, a C4 metastasis with spinal cord compression was revealed by MRI. Multiple grafted liver metastases were also detected by ultrasound along with several lung metastases, which were discovered by X-ray. The patient was treated with a pedicle screw system and a mesh cage filled with frozen autografts for C4 metastasis. OUTCOMES: The patient died 15 months after liver transplantation due to recurrence in the liver and metastasis to the lung. LESSONS: En bloc lumpectomy may be a viable therapeutic option for patients with progressive solitary spinal metastases after LT refractory to radiotherapy. Use of immunosuppressive therapy after LT may significantly inhibit immune function, making patients more susceptible to HCC recurrence and bone metastasis.


Assuntos
Neoplasias Ósseas/secundário , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Adulto , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Masculino , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia
3.
Eur J Endocrinol ; 182(3): 303-311, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31940278

RESUMO

Objective: Roux-en-Y-gastric bypass (RYGB) surgery is an effective treatment for morbid obesity. A possible overlooked side effect is negative bone metabolic consequences. Design: A seven-year prospective study following ten women and seven men after RYGB (baseline mean age 43 ± 8 years, BMI 42 ± 6 kg/m2). Methods: Lumbar spine and total hip bone mineral density (BMD) using dual energy x-ray absorptiometry, distal radius and tibia bone geometry, volumetric BMD, microarchitecture and finite element estimated bone strength using high-resolution peripheral quantitative CT and biochemical markers of bone remodelling were assessed at baseline, 2 and 7 years. Results: Compared to baseline, body weight was 24 ± 10% lower after 2 years and 21 ± 11% after 7 years. During the 7 years of follow-up, radius and tibia vBMD had declined 13 ± 8% and 8 ± 7% from baseline to 2 years and further 10 ± 7% and 7 ± 8% from 2 to 7 years (all P < 0.001). At both radius and tibia, cortical thickness declined and cortical porosity increased. From baseline to 7 years, there were clear indications of deteriorations of the trabecular network with fewer, more widely spaced and more in-homogeneously distributed trabeculae in both radius and tibia. Overall, declines in estimated bone strength of 16 ± 9% in radius and 16 ± 7% in tibia were observed (both P < 0.001). Conclusion: Seven years after RYGB, evidence of continuous declines in BMD and ongoing deterioration of bone microarchitecture and reduced estimated bone strength compared to baseline and 2 years post-surgery results were found. These findings emphasize the need for regular assessment of bone health in patients with prior RYGB.


Assuntos
Anastomose em-Y de Roux/efeitos adversos , Densidade Óssea , Osso e Ossos/patologia , Complicações Pós-Operatórias/patologia , Absorciometria de Fóton , Adulto , Remodelação Óssea , Osso e Ossos/ultraestrutura , Estudos de Coortes , Feminino , Seguimentos , Quadril/patologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Coluna Vertebral/patologia
4.
World Neurosurg ; 133: e156-e164, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476474

RESUMO

OBJECTIVE: To elucidate the correlation between changes in spinal/pelvic sagittal parameters and clinical treatment outcomes after oblique lumbar interbody fusion (OLIF). METHODS: Eighty-two patients with lumbar degenerative disease (LDD) treated by OLIF were retrospectively analyzed. The visual analog scale (VAS) score and Oswestry Disability Index (ODI) score were compared before and after surgery. Disk height (DH) and various spinal/pelvic sagittal parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA), were measured preoperatively and at the last postoperative follow-up. The correlation between the changes in sagittal parameters before and after surgery and the clinical treatment outcomes were observed. RESULTS: ODI score, VAS score, and DH were significantly better at the last follow-up compared with before surgery. The change in PI was not statistically significant before and after surgery. PT significantly decreased and SS and LL significantly increased after surgery. Significant linear relationships were found for several independent variables (difference in DH before and after surgery, postoperative LL, difference in LL before and after surgery, PI-LL match status, and SVA status) and the dependent variable ODI. The difference in DH before and after surgery showed the strongest correlation. The percentages of PI-LL match were 37% before surgery and 66% after surgery. The percentage of the normal SVA was 9% before surgery and 62% after surgery. CONCLUSIONS: OLIF for treatment of LDD had significant clinical outcomes, effectively restored the spinal/pelvic sagittal balance, and helped to improve the patients' clinical conditions.


Assuntos
Vértebras Lombares/cirurgia , Ossos Pélvicos/diagnóstico por imagem , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/patologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Resultado do Tratamento
5.
Maturitas ; 131: 40-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31787146

RESUMO

OBJECTIVES: To investigate whether low bone mineral density (BMD) and history of fracture at baseline are associated with the development of echogenic carotid plaques over a 10-year follow-up period. STUDY DESIGN: A prospective cohort study. MAIN OUTCOME MEASURES: Development of echogenic plaques identified by ultrasonography of the carotid arteries. METHODS: Among 1048 women aged 40 or more who completed the baseline survey of the Japanese Population-based Osteoporosis (JPOS) cohort study, 500 women who completed the first decade of follow-up and 267 women who completed the second decade of follow-up were included. We identified history and incidence of clinical osteoporotic fracture during the follow-up through medical interviews, and determined vertebral fractures by morphometry of absorptiometric images. RESULTS: We identified 67 (13.4%) and 31 (11.6%) women with echogenic plaques at the end of first and second decade of follow-up, respectively. Participants with echogenic plaques were significantly older, exhibited lower spine BMD, and had a higher prevalence of osteoporotic fracture, diabetes, and hypertension. A generalized estimating equation analysis was used to combine the participants from the two follow-up periods into a single cohort, and showed that osteoporotic BMD and osteoporotic fractures were significantly associated with the development of echogenic plaques, after adjusting for atherosclerosis risk factors (odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.04, 4.44; OR: 1.84, 95% CI: 1.03, 3.28, respectively). CONCLUSION: Osteoporotic BMD and osteoporotic fracture history were significantly, and independently, associated with an increased occurrence of echogenic plaques. Ultrasonographic screening of the carotid artery may benefit patients with osteoporosis.


Assuntos
Densidade Óssea , Doenças Cardiovasculares/complicações , Artérias Carótidas/diagnóstico por imagem , Osteoporose/complicações , Fraturas por Osteoporose/complicações , Placa Aterosclerótica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Artérias Carótidas/patologia , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Incidência , Japão/epidemiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Estudos Prospectivos , Fatores de Risco , Coluna Vertebral/patologia
6.
Nat Commun ; 10(1): 5643, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31822662

RESUMO

Spinal pain is a major clinical problem, however, its origins and underlying mechanisms remain unclear. Here we report that in mice, osteoclasts induce sensory innervation in the porous endplates which contributes to spinal hypersensitivity in mice. Sensory innervation of the porous areas of sclerotic endplates in mice was confirmed. Lumbar spine instability (LSI), or aging, induces spinal hypersensitivity in mice. In these conditions, we show that there are elevated levels of PGE2 which activate sensory nerves, leading to sodium influx through Nav 1.8 channels. We show that knockout of PGE2 receptor 4 in sensory nerves significantly reduces spinal hypersensitivity. Inhibition of osteoclast formation by knockout Rankl in the osteocytes significantly inhibits LSI-induced porosity of endplates, sensory innervation, and spinal hypersensitivity. Knockout of Netrin-1 in osteoclasts abrogates sensory innervation into porous endplates and spinal hypersensitivity. These findings suggest that osteoclast-initiated porosity of endplates and sensory innervation are potential therapeutic targets for spinal pain.


Assuntos
Hipersensibilidade/patologia , Placa Motora/patologia , Netrina-1/metabolismo , Osteoclastos/metabolismo , Células Receptoras Sensoriais/metabolismo , Coluna Vertebral/patologia , Envelhecimento/patologia , Animais , Comportamento Animal , Dinoprostona , Modelos Animais de Doenças , Humanos , Hiperalgesia/patologia , Vértebras Lombares/patologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Netrina-1/deficiência , Dor/patologia , Porosidade , Transdução de Sinais
7.
Acta Cir Bras ; 34(11): e201901105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859818

RESUMO

PURPOSE: To evaluate the effects of Dexmedetomidine (Dex) on spinal pathology and inflammatory factor in a rat model of Diabetic neuropathic pain (DNP). METHODS: The rats were divided into 3 groups (eight in each group): normal group (N group), diabetic neuropathic pain model group (DNP group), and DNP model with dexmedetomidine (Dex group). The rat model of diabetes was established with intraperitoneal streptozotocin (STZ) injections. Nerve cell ultrastructure was evaluated with transmission electron microscopy (TEM). The mechanical withdrawal threshold (MWT) and motor nerve conduction velocity (MNCV) tests documented that DNP rat model was characterized by a decreased pain threshold and nerve conduction velocity. RESULTS: Dex restored the phenotype of neurocytes, reduced the extent of demyelination and improved MWT and MNCV of DNP-treated rats (P=0.01, P=0.038, respectively). The expression of three pain-and inflammation-associated factors (P2X4, NLRP3, and IL-IP) was significantly upregulated at the protein level in DNP rats, and this change was reversed by Dex administration (P=0.0022, P=0.0092, P=0.0028, respectively). CONCLUSION: The P2X4/NLRP3 signaling pathway is implicated in the development and presence of DNP in vivo, and Dex protects from this disorder.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Dexmedetomidina/farmacologia , Neuropatias Diabéticas/tratamento farmacológico , Proteína 3 que Contém Domínio de Pirina da Família NLR/análise , Receptores Purinérgicos P2X4/análise , Coluna Vertebral/efeitos dos fármacos , Animais , Western Blotting , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/patologia , Neuropatias Diabéticas/patologia , Modelos Animais de Doenças , Interleucina-1beta/análise , Interleucina-1beta/efeitos dos fármacos , Masculino , Microscopia Eletrônica de Transmissão , Proteína 3 que Contém Domínio de Pirina da Família NLR/efeitos dos fármacos , Condução Nervosa/efeitos dos fármacos , Limiar da Dor , Distribuição Aleatória , Ratos Sprague-Dawley , Receptores Purinérgicos P2X4/efeitos dos fármacos , Reprodutibilidade dos Testes , Transdução de Sinais/efeitos dos fármacos , Coluna Vertebral/patologia , Estreptozocina , Nervo Sural/efeitos dos fármacos , Nervo Sural/patologia , Fatores de Tempo
8.
Rinsho Shinkeigaku ; 59(11): 723-729, 2019 Nov 08.
Artigo em Japonês | MEDLINE | ID: mdl-31656267

RESUMO

In order to clarify the changes in the medical management of patients with Duchenne muscular dystrophy after publication of a practical guideline, questionnaire surveys targeting Japanese certified neurologists and child neurologists before and four years after publication of the guideline were conducted. The practical guideline was evaluated by the majority of specialists as their preferred information source. After the guideline, a more aggressive trend was seen in steroid treatment, rehabilitation, regular assessment of spinal deformity, etc., and significant differences were observed in respiratory care and nutritional management. Although there were concerns that it would be hard to produce useful guidelines due to the lack of high-level evidence for a rare disease, guidelines including expert recommendations have proved to be an important tool for disseminating best practicable care. We are planning to revise the guideline based on the results of the analysis.


Assuntos
Distrofia Muscular de Duchenne/reabilitação , Distrofia Muscular de Duchenne/terapia , Guias de Prática Clínica como Assunto , Prova Pericial , Feminino , Glucocorticoides/administração & dosagem , Humanos , Japão , Masculino , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/patologia , Neurologistas , Apoio Nutricional , Assistência ao Paciente , Respiração Artificial , Coluna Vertebral/patologia , Inquéritos e Questionários
9.
J Clin Neurosci ; 70: 257-259, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31629609

RESUMO

Calcifying pseudoneoplasms of the neuroaxis (CAPNON) are rare, slow-growing, fibro-osseous lesions that can occur throughout the entire neuroaxis with few reported cases. We describe a case of craniocervical CAPNON that was treated by our unit and review the available literature. CAPNON are rare benign lesions occurring throughout the neuroaxis. Although rare, these lesions should be considered in cases of histopathological and radiology features of calcified lesions in both brain and spine. Despite a paucity of reports complete safe surgical resection should remain the goal to obtain the best clinical outcomes.


Assuntos
Articulação Atlantoccipital/patologia , Calcinose/patologia , Idoso , Encéfalo/patologia , Humanos , Masculino , Coluna Vertebral/patologia
10.
Ideggyogy Sz ; 72(9-10): 357-360, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31625703

RESUMO

Neurofibromatosis type 1 (NF-1; also known as Von Recklinghausen's disease) is a common autosomal dominant disease that occurs in the general population at the rate of 1 in 3000. Many NF-1 patients present with spinal malformations. A 54-year-old female patient was admitted to the Outpatient Clinic of Dermatology with gradually increasing swelling and spots on the body that had been present for a long period of time. Cervical vertebral scalloping, pedicle deficiencies and dural ectasia (DE) were also detected. She was diagnosed with NF-1. NF-1 is routinely seen in dermatology practice. Coexistence of NF-1 with vertebral scalloping, pedicle deficiencies and DE rarely occurs. Our case is the second reported instance in the literature of NF-1 with a spinal anomaly in the cervical region, and the first reported instance of the coexistence of NF-1 with cervical vertebral scalloping, pedicle deficiencies and DE.


Assuntos
Neurofibromatose 1/diagnóstico , Curvaturas da Coluna Vertebral/diagnóstico , Coluna Vertebral/patologia , Vértebras Cervicais , Dilatação Patológica/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Coluna Vertebral/anormalidades
11.
Int J Mol Sci ; 20(18)2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31505901

RESUMO

Upon peripheral nerve injury, vesicular ATP is released from damaged primary afferent neurons. This extracellular ATP subsequently activates purinergic receptors of the spinal cord, which play a critical role in neuropathic pain. As an inhibitor of the vesicular nucleotide transporter (VNUT), Evans blue (EB) inhibits the vesicular storage and release of ATP in neurons. Thus, we tested whether EB could attenuate neuropathic pain behavior induced by spinal nerve ligation (SNL) in rats by targeting VNUT. An intrathecal injection of EB efficiently attenuated mechanical allodynia for five days in a dose-dependent manner and enhanced locomotive activity in an SNL rat model. Immunohistochemical analysis showed that EB was found in VNUT immunoreactivity on neurons in the dorsal root ganglion and the spinal dorsal horn. The level of ATP in cerebrospinal fluid in rats with SNL-induced neuropathic pain decreased upon administration of EB. Interestingly, EB blocked ATP release from neurons, but not glial cells in vitro. Eventually, the loss of ATP decreased microglial activity in the ipsilateral dorsal horn of the spinal cord, followed by a reduction in reactive oxygen species and proinflammatory mediators, such as interleukin (IL)-1ß and IL-6. Finally, a similar analgesic effect of EB was demonstrated in rats with monoiodoacetate-induced osteoarthritis (OA) pain. Taken together, these data demonstrate that EB prevents ATP release in the spinal dorsal horn and reduces the ATP/purinergic receptor-induced activation of spinal microglia followed by a decline in algogenic substances, thereby relieving neuropathic pain in rats with SNL.


Assuntos
Trifosfato de Adenosina/líquido cefalorraquidiano , Azul Evans/farmacologia , Neuralgia , Coluna Vertebral , Animais , Modelos Animais de Doenças , Gânglios Espinais/metabolismo , Gânglios Espinais/patologia , Gânglios Espinais/fisiopatologia , Interleucina-1beta/líquido cefalorraquidiano , Interleucina-6/líquido cefalorraquidiano , Masculino , Neuralgia/líquido cefalorraquidiano , Neuralgia/tratamento farmacológico , Neuralgia/patologia , Neuralgia/fisiopatologia , Neurônios/metabolismo , Neurônios/patologia , Ratos , Ratos Sprague-Dawley , Coluna Vertebral/metabolismo , Coluna Vertebral/patologia , Coluna Vertebral/fisiopatologia
12.
World Neurosurg ; 132: 118-128, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476476

RESUMO

Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Humanos , Pelve/patologia , Pelve/cirurgia , Neoplasias da Coluna Vertebral/secundário
13.
Surg Technol Int ; 35: 325-335, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476792

RESUMO

Aneurysmal bone cyst is a rare lesion that is most often found in young adults and children. It can have an unpredictable behavior, with a high recurrence rate after treatment. Treatment is based on personal and institutional experience and preferences. Standard treatment consists of curettage (manual + motorized high-speed burr) plus local adjuvants and bone grafting to fill the void. In anatomical locations that are difficult to reach surgically, percutaneous procedures (injection of sclerosant agents, radiofrequency thermal ablation (RFTA)) or selective arterial embolization (SAE) are used. Medical management with bisphosphonates (BPs) or denosumab has also been advocated. Minimally invasive surgical procedures such as "curopsy" and percutaneous demineralized bone matrix (DBM) and/or autologous bone marrow concentrate (BMC) grafting have also been proposed. SAE is used as a pre-operative procedure to reduce intra-operative bleeding in the case of large lesions and as primary treatment for spinal lesions. The purpose of this review is to present currently available options for the management of aneurysmal bone cyst.


Assuntos
Cistos Ósseos Aneurismáticos , Ablação por Cateter , Embolização Terapêutica , Cistos Ósseos Aneurismáticos/terapia , Transplante Ósseo , Criança , Curetagem , Humanos , Coluna Vertebral/patologia , Resultado do Tratamento , Adulto Jovem
14.
Isr Med Assoc J ; 21(8): 532-537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474015

RESUMO

BACKGROUND: Implant-related spinal infections are a surgical complication associated with high morbidity. Due to infection, hardware removal may be necessary, which could lead to pseudarthrosis and the loss of stability and alignment. OBJECTIVES: To evaluate the accuracy and diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the workup of patients with suspected implant-related infections of the spine and to assess the clinical impact of PET/CT results on the management of these infections. METHODS: The study included nine consecutive patients with a history of spinal surgery who underwent PET/CT for evaluation of suspected spinal implant related infection. All imaging studies were performed between January 2011 and December 2013. All 18F-FDG PET/CT scans were performed on an 8 slice PET/CT following an 18F-FDG injection. Images were scored both visually and semi-quantitatively by a radiology expert. Results were compared to additional imaging studies when available, which were correlated to clinical and bacteriological findings allowing calculation of sensitivity, specificity and accuracy. RESULTS: Among the patients, five experienced hardware-related spinal infection. 18F-FDG PET/CT sensitivity was 80%, specificity 100%, and accuracy 88.9%. One scan produced a false negative; however, a second PET/CT scan revealed an infection. CONCLUSIONS: PET/CT was found to be valuable for the diagnosis of postoperative hardware-related spinal infection, especially when other imaging modalities were uninformative or inconclusive. As such, PET/CT could be useful for management of infection treatment.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Infecções Relacionadas à Prótese/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Coluna Vertebral/patologia
15.
Med. clín (Ed. impr.) ; 153(6): 250-255, sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-184032

RESUMO

Las enfermedades reumáticas de afectación axial que cursan con dolor cervical y lumbar son muy prevalentes y conllevan un importante consumo de recursos sanitarios. La acupuntura es un procedimiento médico avalado por la Organización Mundial de la Salud con un amplio abanico de indicaciones. Nuestro objetivo fue revisar la evidencia sobre la eficacia de la acupuntura en estas enfermedades. Se realizó búsqueda sistemática: MEDLINE, CENTRAL y EMBASE (mayo de 2017): 535 citas, incluimos 4 revisiones globales (45 revisiones sistemáticas) y 3 revisiones sistemáticas (70 ensayos clínicos).La acupuntura mejora el dolor cervical y la funcionalidad de forma inmediata y a corto plazo. También es eficaz en lumbalgia aguda y crónica como primera línea terapéutica, comparada con placebo, y como coadyuvante de otros tratamientos convencionales. Es una intervención segura. Los resultados no son concluyentes en radiculopatías (cervicales y lumbares), estenosis canal lumbar y espondilitis anquilosante. Faltan estudios bien diseñados con evaluación a medio y largo plazo


Rheumatic diseases involving the spine, mainly cervical and lumbar spine, are highly prevalent, and consume considerable health resources. Acupuncture is a medical procedure endorsed by the WHO, with a wide spectrum of medical applications. The aim of this study was to review the evidence on acupuncture efficacy in these diseases. A literature search was performed in MEDLINE, CENTRAL and EMBASE (May 2017): 535 citations. We included four global reviews(45 systematic reviews) and three Systematic Reviews(70 clinical trials). Acupuncture improved cervical pain and functionality both immediately and in the short term. It also proved effective in the treatment of acute and chronic low back pain as the first therapeutic line, compared with placebo, and as an adjunct to other conventional treatments. Acupuncture is a safe intervention. However, acupuncture efficacy in radiculopathies (cervical, lumbar), lumbar spinal stenosis and ankylosing spondylitis is still inconclusive. Well-designed studies with medium and long-term evaluation are required


Assuntos
Humanos , Terapia por Acupuntura/tendências , Acupuntura/instrumentação , Doenças Reumáticas/terapia , Doenças da Coluna Vertebral/terapia , Coluna Vertebral/patologia , Dor Lombar/etiologia , Dor Lombar/terapia , Qualidade de Vida
16.
PLoS One ; 14(8): e0219662, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390345

RESUMO

Bone remodeling is an essential physiological process in growth and healing. In modern systems deviations from normal bone physiology in the form of pathologies aid in the understanding of normal bone metabolism. Here we use external morphology and X-ray microtomography to diagnose and describe a metabolic bone disease in an amniote from the early Permian. The specimen consists of two fused tail vertebrae of a small varanopid from early Permian (289 million years old) cave deposits near Richards Spur, Oklahoma, USA. Inspection of the outer morphology reveals that the fusion encompasses the vertebral centra, zygopophyses and haemal arches, with the fusion zones distinctly swollen on the left side of the specimen. With visualization of its internal structure by microCT, this specimen is diagnosed as a complex metabolic bone disease. The radiological imaging suggests a pathologically high bone turnover rate, as shown by abnormal bone formation in some areas and increased bone resorption in others. This supports that the varanopid suffered from a metabolic bone disease similar to Paget's disease of bone as seen in humans today, which is linked to both genetic and viral factors. This finding extends the occurrence of Paget-like disease to the early Permian, and-provided a viral component was present-would also be by far the oldest evidence of viral infection in the fossil record.


Assuntos
Osteíte Deformante/diagnóstico por imagem , Osteíte Deformante/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Microtomografia por Raio-X , Animais , Fósseis
18.
Anticancer Res ; 39(8): 4463-4465, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366545

RESUMO

This case report describes a patient with a rare occurrence of primary spinal intramedullary Ewing's sarcoma (ES) in the cervical and thoracic spine. The older age of disease occurrence, uncommon location in the cervical and thoracic spine, and EWSR1 gene fusion as the basis of diagnosis are unique features of this case. There is no clear protocol for treatment of primary extraskeletal ES of the spine, with controversy between evidence for pursuing surgery versus a combination of radiation and chemotherapy. Our patient was treated with temozolomide chemotherapy for recurrent metastatic disease of primary ES of the spine.


Assuntos
Tumores Neuroectodérmicos Primitivos/tratamento farmacológico , Proteína EWS de Ligação a RNA/genética , Sarcoma de Ewing/tratamento farmacológico , Temozolomida/administração & dosagem , Adulto , Idoso , Humanos , Masculino , Pescoço/patologia , Tumores Neuroectodérmicos Primitivos/genética , Tumores Neuroectodérmicos Primitivos/patologia , Sarcoma de Ewing/genética , Sarcoma de Ewing/patologia , Coluna Vertebral/efeitos dos fármacos , Coluna Vertebral/patologia , Parede Torácica/efeitos dos fármacos , Parede Torácica/patologia
19.
Presse Med ; 48(7-8 Pt 2): e251-e256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447338

RESUMO

Cancer patients quite commonly will report different types of pain associated with the disease substrate. Systemic analgesia and radiotherapy provide only partial pain relief in the majority of these patients. Interventional Oncology techniques for pain management and mobility improvement in cancer patients include percutaneous techniques such as neurolysis, ablation and augmentation (both in the spine and peripheral skeleton) as well as trans-arterial embolization. Percutaneous neurolysis acts indirectly providing regional anesthesia whilst the rest of the aforementioned techniques act directly upon the tumor either by inhibiting local growth or by providing stability and skeletal augmentation. Whenever possible, techniques such as ablation and trans-arterial embolization apart from pure palliation may add to the principle of local tumor control. The aim of this review is to provide details concerning the Interventional Oncology techniques used for cancer pain management and to address the necessity for a tailored-based approach applying different techniques or combinations of them in different cases and locations.


Assuntos
Dor do Câncer/terapia , Oncologia/métodos , Neoplasias/terapia , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Anestesia por Condução , Osso e Ossos/cirurgia , Ablação por Cateter/métodos , Embolização Terapêutica/métodos , Humanos , Oncologia/tendências , Neoplasias/complicações , Bloqueio Nervoso/métodos , Cuidados Paliativos/tendências , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos
20.
Cytogenet Genome Res ; 158(3): 121-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31315107

RESUMO

VACTERL association is defined by the occurrence of congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with esophageal atresia, radial and renal dysplasia, and limb defects. No genetic alterations have been discovered except for some sporadic chromosomal rearrangements and gene mutations. We report a boy with VACTERL association and shawl scrotum with bifid scrotum who presented with a de novo Yq11.223q11.23 microdeletion identified by array CGH. The deletion spans 3.1 Mb and encompasses several genes in the AZFc region, frequently deleted in infertile men with severe oligozoospermia or azoospermia. Herein, we discuss the possible explanation for this unusual genotype-phenotype correlation. We suggest that the deletion of the BPY2 (previously VCY2) gene, located in the AZFc region and involved in spermatogenesis, contributed to the genesis of the phenotype. In fact, BPY2 interacts with a ubiquitin-protein ligase, involved in the SHH pathway which is known to be implicated in the genesis of VACTERL association.


Assuntos
Canal Anal/anormalidades , Deleção Cromossômica , Cromossomos Humanos Y/genética , Esôfago/anormalidades , Cardiopatias Congênitas/genética , Cardiopatias Congênitas/patologia , Rim/anormalidades , Deformidades Congênitas dos Membros/genética , Deformidades Congênitas dos Membros/patologia , Proteínas/genética , Escroto/patologia , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Canal Anal/patologia , Hibridização Genômica Comparativa , Esôfago/patologia , Estudos de Associação Genética , Humanos , Lactente , Rim/patologia , Masculino , Coluna Vertebral/patologia , Traqueia/patologia , Ubiquitina-Proteína Ligases/metabolismo , Incerteza
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