Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.322
Filtrar
1.
Mymensingh Med J ; 30(2): 262-266, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33830101

RESUMO

Low back pain (LBP) is a common problem and is an important public health issue. A major proportion of LBP is concomitant with prolong and repetitive awkward postures, related with occupation like miners, health workers and professional drivers. Physicians are exposed to a wide range of occupational risk factors which results in LBP. A variety of occupational and personal factors are responsible for increased risk of low back pain among physicians. This cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018, to estimate the proportion of LBP among physicians. Data were collected from purposively selected 102 physicians of different levels by face to face interview using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 20.0. The study results revealed that majority (60.8%) of the physicians were in the age group of 31-50 years. Mean age of the physicians was 49.9 years with a standard deviation (SD) of 3.61 years. More than three fourth (79, 77.5%) of the physicians were male and 23(22.5%) were female. Out of 102 physicians more than two third (70, 68.6%) had LBP while 32(31.4%) did not have any LBP. Proportion of low back pain among physician was 68.6%. Low back pain was found in all age group. Among the physicians having low back pain, 55(78.6%) were male and 15(21.4%) were female. Among 102 physicians, 45(44.1%) had different types of comorbidities while 57(55.9%) did not have any comorbidities. Among the co-morbidities HTN, DM, Dyslipidemia, CHD and asthma were common. Results of the study concluded that 68.6% physicians had low back pain. Physicians of age group 31-60 years (88.5%) and male (78.6%) experienced LBP more. Further multi-centric large scale case control study is recommended to determine the risk factors of LBP among physicians of Bangladesh.


Assuntos
Dor Lombar , Doenças Profissionais , Médicos , Adulto , Bangladesh/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 100(12): e25187, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761700

RESUMO

INTRODUCTION: Duplicate kidneys are the most common congenital abnormality of the urinary system. The location of duplicate kidneys varies. We report a case of an adolescent with upper and lower kidneys that are arranged vertically and approximately T-shaped. PATIENT CONCERNS: A 16-year-old male teenager was examined for pain in the left side of the waist. The Computed Tomography scan revealed that the left kidney was incompletely duplicated and fused; the left upper urinary tract was incompletely obstructed. DIAGNOSIS: The abdominal tomography confirmed the diagnosis of incomplete duplicate kidney. INTERVENTIONS: The patient underwent laparoscopic surgery. The failure to ligate the renal pedicle resulted in increased bleeding during the operation and an open ureteral stump. OUTCOMES: No urine leakage occurred after the operation. Doppler ultrasound of the urinary system showed no hydronephrosis, and the patient was asymptomatic. CONCLUSION: Through this case report, we found that the duplicate kidneys could be arranged in a T-shape under laparoscopy. Although only the supply of the duplicate renal arteries can be ligated during surgical resection, the renal pedicle must also be ligated during the operation if there is a lot of bleeding.


Assuntos
Rim/anormalidades , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Laparoscopia/efeitos adversos , Dor Lombar/etiologia , Masculino , Nefrectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Ureter/anormalidades , Ureter/cirurgia
3.
Medicine (Baltimore) ; 100(9): e24830, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655945

RESUMO

ABSTRACT: Low back pain (LBP) is one of the most common symptoms of work-related musculoskeletal disorders in pharmacists. This can impede the physical functions of the body and lead to incapacitation, resulting in significant social and economic burden. This study aimed to investigate the incidence and risk factors that correlate with LBP in Taiwanese pharmacists.A retrospective cohort study was conducted among all registered pharmacists aged 20 to 40 years using the National Health Insurance Research Database (2000-2013) in Taiwan. The LBP diagnosis was confirmed with one episode of hospitalization or at least three claimed outpatient visits for LBP. Data on workplace characteristics as well as comorbidities were also collected for the analyses. A Cox proportional hazard regression was used to estimate the risk factors for LBP.The incidence rate of LBP among pharmacists was 16.60% in this study. Older pharmacists (28.49%; P < .01) and those who worked at district hospitals (23.51%; P < .01) showed a higher proportion of LBP. Furthermore, after adjustment for selected potential confounding factors, female pharmacists [adjusted hazard ratio (aHR): 1.12, 95% confidence interval (95% CI): 1.01-1.24, P = .0354] and pharmacists with diabetes (aHR: 1.55; 95% CI: 1.20-2.01; P = .0008) and gout (aHR: 1.70; 95% CI: 1.37-2.09; P < .0001) had significantly higher risks of LBP.In conclusion, age was positively correlated with LBP, and the workplace was an important factor in the development of LBP in pharmacists. We suggest that pharmacists who work in district hospitals should pay more attention to the development of LBP.


Assuntos
Dor Lombar/epidemiologia , Doenças Profissionais/epidemiologia , Saúde do Trabalhador , Farmacêuticos/estatística & dados numéricos , Vigilância da População/métodos , Local de Trabalho/normas , Adulto , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Medição da Dor , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Taiwan/epidemiologia , Adulto Jovem
4.
Praxis (Bern 1994) ; 110(4): 221-224, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33726519

RESUMO

Lumbar Back Pain and Impaired Vision - an Alarming Differential Diagnosis Abstract. Aortic dissection is much less common than other causes of back pain, yet associated with a high mortality. Despite major advances in noninvasive imaging, the correct diagnosis is made in less than half of the cases. End-organ malperfusion can lead to a broad spectrum of symptoms making diagnosis difficult. This clinical case illustrates the importance of a careful history and thorough clinical examination, as well as noninvasive imaging without delay in order to improve the prognosis and chances of survival.


Assuntos
Aneurisma Dissecante , Dor Lombar , Aneurisma Dissecante/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Dor Lombar/etiologia , Prognóstico
5.
Medicine (Baltimore) ; 100(5): e23851, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592841

RESUMO

BACKGROUND: Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA. METHODS: This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12). DISCUSSION: This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.


Assuntos
Acidentes de Trânsito , Terapia por Acupuntura/métodos , Dor Aguda/terapia , Dor Lombar/terapia , Dor Aguda/etiologia , Adulto , Idoso , Feminino , Humanos , Pacientes Internados , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 100(4): e23285, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530156

RESUMO

BACKGROUND: Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability. METHODS: This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m2) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface. RESULT: Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate. CONCLUSION: Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.


Assuntos
Terapia por Exercício/métodos , Instabilidade Articular/terapia , Dor Lombar/terapia , Obesidade/complicações , Doenças da Coluna Vertebral/terapia , Músculos Abdominais/fisiopatologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Instabilidade Articular/etiologia , Dor Lombar/etiologia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Contração Muscular , Obesidade/fisiopatologia , Medição da Dor , Equilíbrio Postural , Doenças da Coluna Vertebral/etiologia , Resultado do Tratamento
9.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472804

RESUMO

Six days after a normal delivery, a 24-year-old woman with atraumatic lumbosacral pain radiating to the left groin was referred to the orthopaedic surgeon due to worsening pain and impossible load bearing on the left lower limb. Standard pelvic radiographs revealed an unstable displaced left neck of femur (NOF) fracture. A CT scanner and MRI showed diffuse osteopaenia of the left proximal femur and the corresponding acetabulum. A diagnosis of transient osteoporosis of the hip (TOH) complicated by a pathological displaced subcapital NOF fracture was established. The patient underwent total hip arthroplasty without complication and recovered excellent function after rehabilitation. Awareness of the differential diagnosis of TOH in pregnancy, a high index of suspicion and early MRI to make an early diagnosis and to prevent devastating fracture complications are mandatory.


Assuntos
Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Dor Lombar/diagnóstico , Osteoporose/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Artroplastia de Quadril , Feminino , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/cirurgia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Osteoporose/complicações , Gravidez , Terceiro Trimestre da Gravidez , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Medicine (Baltimore) ; 100(2): e24042, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466154

RESUMO

RATIONALE: The prevalence of ectopic thyroid is extremely low, with the condition observed in approximately 1 in 100,000 to 300,000 people. Thyroid gland ectopia develops as a result of the presence of developmental abnormalities during the migration of the thyroid anlage from the floor of the primitive foregut to its final position in the neck. Ectopic thyroid tissue is commonly observed in the lingual region, but can also present in other head and neck regions, as well as regions located at a large distance from the neck. PATIENT CONCERNS: A 67-year-old woman who had experienced left lumbago and leg pain was transferred to our hospital following the worsening of her lumbago-related symptoms in the 2 months preceding her presentation. Seven years ago, the patient had recurrent lumbago and leg pain without obvious inducement, and visited a local clinic for treatment. The severity of her symptoms fluctuated; their intensity increased after participation in activities and decreased after rest. DIAGNOSES: The patient was diagnosed as having an ectopic thyroid gland that was located on the L4 vertebral body. INTERVENTIONS: The patient chose to undergo surgery, with supportive care, following tumor discovery. OUTCOMES: After surgical treatment, the degree of lumbar spinal stenosis improved, and the patient's clinical symptoms were alleviated. LESSONS: Clinically, ectopic goiter is diagnosed through radionuclide thyroid imaging, ultrasound examination, computed tomography, magnetic resonance imaging, and biopsy pathology. However, the imaging manifestations in this case were atypical, leading to greater diagnostic difficulties. A conclusion was finally reached based on pathology.


Assuntos
Dor Lombar/etiologia , Vértebras Lombares/patologia , Disgenesia da Tireoide/complicações , Idoso , Feminino , Humanos , Vértebras Lombares/cirurgia , Disgenesia da Tireoide/cirurgia
12.
Am J Case Rep ; 22: e928014, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33479190

RESUMO

BACKGROUND Lumbar discitis caused by Clostridium perfringens is extremely rare. There have only been 7 published cases of confirmed discitis caused by Clostridium perfringens. We write this report to underscore this unusual relationship by discussing an additional case and providing a review of the previously published cases so clinicians can adequately evaluate and treat patients presenting with discitis. CASE REPORT A 64-year-old morbidly obese man presented with an acute onset of worsening back pain and generalized weakness after incurring physical trauma related to falling. Additionally, he also developed fever and chills before the presentation. Based on the clinical presentation and elevated serum levels of inflammatory markers, magnetic resonance imaging was ordered, which showed L5-S1 discitis with extension of infection into the epidural space. Fluoroscopy-guided aspiration of the L5-S1 epidural space facilitated the detection of Clostridium perfringens as the involved pathogen. Based on the antibiotic susceptibility report, the patient was treated with intravenous ampicillin for 8 weeks, after which his symptoms resolved. CONCLUSIONS Diagnosis of discitis can be very challenging due to its ambiguous clinical presentation, especially in the elderly population due to the presence of underlying degenerative changes. Even though Clostridium perfringens remains a rare cause of lumbar discitis, it should be considered as a pathogen capable of causing infection of the vertebrae and intervertebral discs, thus allowing clinicians to make necessary diagnostic evaluations to provide appropriate targeted treatment to patients presenting with discitis.


Assuntos
Infecções por Clostridium/complicações , Clostridium perfringens/isolamento & purificação , Discite/complicações , Dor Lombar/etiologia , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Discite/diagnóstico , Discite/microbiologia , Humanos , Dor Lombar/diagnóstico , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
13.
BMC Surg ; 21(1): 39, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461536

RESUMO

BACKGROUND: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. METHODS: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD. RESULTS: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825-(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12-64.78 in the early group versus mean 45.34 min; 95% CI, 42.45-48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups. CONCLUSION: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.


Assuntos
Descompressão Cirúrgica/métodos , Espaço Epidural/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Lasers , Curva de Aprendizado , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Internist (Berl) ; 62(1): 34-46, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33355682

RESUMO

Back pain is a common reason for consulting a general practitioner. For 80% of patients, the back pain is nonspecific. Specific back pain has a determinable cause that needs to be rapidly identified. The diagnostic work-up to clarify spinal pain involves a detailed patient history taking into account the "red flags", a clinical examination and further stepwise diagnostics. In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis, as well as extravertebral causes. The diagnosis, treatment and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists.


Assuntos
Dor nas Costas/etiologia , Exame Físico , Atenção Primária à Saúde/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico por Imagem/métodos , Humanos , Dor Lombar/etiologia , Anamnese , Fatores de Risco , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Avaliação de Sintomas/métodos
15.
Bone Joint J ; 103-B(1): 131-140, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380193

RESUMO

AIMS: To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. METHODS: This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. RESULTS: Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. CONCLUSION: This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131-140.


Assuntos
Dor Lombar/etiologia , Vértebras Lombares , Radiculopatia/etiologia , Estenose Espinal/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Avaliação da Deficiência , Feminino , Hong Kong , Humanos , Perna (Membro) , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Inquéritos e Questionários
16.
Med Clin North Am ; 105(1): 1-17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246512

RESUMO

A review of the literature, including recent guidelines and original studies, has informed this detailed description of best clinic practices used to evaluate, diagnose, treat, and manage adult patients who present to the outpatient clinic with complaints of low back pain. A case-based format helps guide the reader through clinical decision making and the key learning objectives.


Assuntos
Dor Lombar/diagnóstico , Dor Lombar/terapia , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Dor Aguda/terapia , Algoritmos , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/terapia , Diagnóstico Diferencial , Feminino , Humanos , Dor Lombar/etiologia , Anamnese , Pessoa de Meia-Idade , Exame Físico , Prognóstico
17.
Medicine (Baltimore) ; 99(50): e23499, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327288

RESUMO

RATIONALE: Synovial sarcoma (SS) is a soft tissue neoplasm that rarely occurs in the vertebral body and should be considered in the differential diagnosis in patients with SS and vertebral lesions. SS often presents as a painless mass in the spine, which may undergo slow enlargement, resulting in sustained symptoms of neurologic deficit and pain. Due to the difficulty in differentiating between SS from other soft tissue tumors and metastatic tumors, careful histological confirmation is required for definite diagnosis. Furthermore, due to its malignancy, the appropriate treatment procedure for SS should be carefully considered. PATIENT CONCERNS: A 56-year-old female patient had low back pain. Radiological examination revealed bony erosion of the L-2 vertebral body, and no soft tissue mass around the lumbar spine. DIAGNOSIS: Histopathological and immunohistochemical examination revealed SS. INTERVENTIONS: The initial treatment of posterior laminectomy decompression and percutaneous vertebro plasty (PVP) was performed, however, this initial treatment course was inappropriate, but she eventually underwent L-2 complete resection and internal fixation. After the second surgery, she was treated by external beam radiation therapy. OUTCOMES: operation radiotherapy was finally performed. No local recurrence in L-2 vertebral body or distant metastasis was found at 1-year follow up postoperation; the neurologic symptom gradually relieved, and no other symptom was noted. And no local recurrence in L-2 vertebral body and distant metastasis was found in 1 year follow up postoperation. LESSONS: Solitary spinal SS is extremely rare. Early surgery for total resection and adjuvant radiotherapy/chemotherapy should be emphasized.


Assuntos
Vértebras Lombares , Sarcoma Sinovial/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Laminectomia , Dor Lombar/etiologia , Pessoa de Meia-Idade , Sarcoma Sinovial/complicações , Sarcoma Sinovial/diagnóstico por imagem , Sarcoma Sinovial/terapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia
18.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334744

RESUMO

Myxopapillary ependymoma (MPE) is a rare glial tumour mainly located in the areas of the conus medullaris, cauda equina and filum terminale of the spinal cord. Ectopic MPE tends to behave more aggressively and distant metastases are often seen. Unfortunately, no standard treatment options are established as only small series of treated patients and a few reported cases are available in the literature. We report the case of a 25-year-old woman who was initially diagnosed with a metastatic MPE, with multiple bilateral lung metastases. She was treated with an investigational monoclonal antibody antiprogrammed cell death protein 1, called tislelizumab (BGB-A317), following surgical resection of the perisacral primary mass. The response was long-lasting and side effects nil. Immunotherapy is a treatment modality to be considered in patients with rare tumours.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Drogas em Investigação/uso terapêutico , Ependimoma/terapia , Neoplasias Pulmonares/terapia , Neoplasias da Medula Espinal/terapia , Biópsia com Agulha de Grande Calibre , Quimioterapia Adjuvante/métodos , Ependimoma/complicações , Ependimoma/diagnóstico , Ependimoma/secundário , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Invasividade Neoplásica , Sacro/diagnóstico por imagem , Sacro/patologia , Sacro/cirurgia , Medula Espinal/patologia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
19.
Medicine (Baltimore) ; 99(50): e23587, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327321

RESUMO

RATIONALE: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. PATIENT CONCERNS: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. DIAGNOSES: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. INTERVENTIONS: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. OUTCOMES: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. CONCLUSION: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.


Assuntos
Fraturas Espontâneas/diagnóstico , Hemangiossarcoma/diagnóstico , Vértebras Lombares , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Parafusos Pediculares , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia
20.
Medicine (Baltimore) ; 99(51): e23812, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371159

RESUMO

ABSTRACT: Ninety percent of elderly patients with lumbar disc herniation (LDH) have problems with the mechanics of the spine and muscle tissue. Shi-style spine balance manipulation combined with guidance (Daoyin) of muscle and bone as an alternative therapy for LDH can tone the muscle groups around the spine and maintain optimal mechanical and static sagittal balance of the spine. This study will be performed to investigate the effect of a combination of Shi-style spine balance manipulation and Daoyin therapy on LDH in middle-aged and elderly patients. In this non-blinded, randomized controlled trial, 72 eligible patients will be randomly divided into a treatment group (Shi-style spine balance manipulation combined with Daoyin therapy) and a control group (lumbar mechanical traction). Before and after the intervention, lumbar X-ray and magnetic resonance imaging examinations will be performed to observe the sagittal balance parameters of the spine and pelvis and the lumbar muscle strength. The visual analog scale score, Oswestry disability index score, and pressure pain threshold will be evaluated at baseline and at 2, 4, 12, and 24 weeks. During the treatment period, any signs of acute adverse events, such as paralysis of the lower extremities or cauda equina syndrome, will be recorded at each visit. Although Shi-style spine manipulation combined with Daoyin therapy has been used in the treatment of LDH in middle-aged and elderly people in China for many years, there is no consensus on its effectiveness. This experiment will provide convincing evidence of the efficacy of Shi-style spine manipulation combined with Daoyin therapy in the treatment of LDH in middle-aged and elderly people.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Manipulação da Coluna/normas , Adulto , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Manipulação da Coluna/métodos , Manipulação da Coluna/estatística & dados numéricos , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Medição da Dor/métodos , Resultado do Tratamento , Ultrassonografia/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...