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1.
Am J Case Rep ; 20: 1299-1304, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31474745

RESUMO

BACKGROUND For the past 20 years, numerous of clinical trials focusing on the use of mesenchymal stem cells (MSC) in spinal cord injury (SCI) treatment has been conducted. However, controversies over whether stem cells are the main factor in a patient's recovery still persisted in sub-acute SCI. This study aimed to evaluate the motoric recovery in a chronic SCI patient treated with bone marrow derived MSC (BM-MSC) transplantation. CASE REPORT We present a case report of patient with a 12-year-long-chronic SCI that was treated by BM-MSC) transplantation using a serial administration protocol. The protocol consisted of direct parenchymal injection to the affected lesion and multiple (5 times) intravenous stem cell injection as the adjuncts. There was no complication or serious adverse effects encountered during the procedure and follow up. At the final follow up of 5 years, the patient neurological status improved from American Spinal Injury Association (ASIA) A status to ASIA C status, which signifies improvement in his ambulatory status. Magnetic resonance imaging and electrophysiology examination also showed changes that indicated recovery of the neurologic function. CONCLUSIONS Based on the limited adverse reaction and outcome, our case report may serve as an additional alternative protocol in stem cell administration to improve the outcome of chronic spinal cord injury patients.


Assuntos
Transplante de Células-Tronco Mesenquimais , Paraplegia/terapia , Traumatismos da Medula Espinal/complicações , Adulto , Músculos do Dorso/inervação , Eletromiografia , Humanos , Imagem por Ressonância Magnética , Masculino , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/terapia , Exame Neurológico , Paraplegia/etiologia
2.
IEEE Int Conf Rehabil Robot ; 2019: 1159-1166, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374786

RESUMO

Over the last decade, the use of wearable exoskeletons for human locomotion assistance has become more feasible. The VariLeg powered lower limb robotic exoskeleton is an example of such systems, potentially enabling paraplegic users to perform upright activities of daily living. The acceptance of this type of robotic assistive technologies is often still affected by limited usability, in particular regarding the physical interface between the exoskeleton and the user (here referred to as pilot). In this study, we proposed and evaluated a novel pilot attachment system (PAS), which was designed based on user-centered design with experienced paraplegic exoskeleton users. Subjective assessments to compare usability aspects of the initial and the redesigned physical interfaces were conducted with two paraplegic and five healthy pilots. The redesigned PAS showed a 45% increase in the system usability scale (SUS), normalized to the PAS of a commercial exoskeleton assessed in the same manner. Pain rating scales assessed with healthy pilots indicated an increased comfort using the redesigned PAS while performing several activities of daily living. Overall, an improvement in usability relative to the initial PAS was achieved through intensified user evaluation and individual needs assessments. Hence, a user-centered design of physical body-machine interfaces has the potential to positively influence the usability and acceptance of lower limb exoskeletons for paraplegic users.


Assuntos
Exoesqueleto Energizado , Paraplegia/terapia , Atividades Cotidianas , Humanos , Extremidade Inferior/fisiologia , Dor/fisiopatologia , Paraplegia/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia
3.
J Therm Biol ; 83: 1-7, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31331507

RESUMO

Spinal cord ischemia can result from cardiac arrest. It is an important cause of severe spinal cord injury that can lead to serious spinal cord disorders such as paraplegia. Hypothermia is widely acknowledged as an effective neuroprotective intervention following cardiac arrest injury. However, studies on effects of hypothermia on spinal cord injury following asphyxial cardiac arrest and cardiopulmonary resuscitation (CA/CPR) are insufficient. The objective of this study was to examine effects of hypothermia on motor deficit of hind limbs of rats and vulnerability of their spinal cords following asphyxial CA/CPR. Experimental groups included a sham group, a group subjected to CA/CPR, and a therapeutic hypothermia group. Severe motor deficit of hind limbs was observed in the control group at 1 day after asphyxial CA/CPR. In the hypothermia group, motor deficit of hind limbs was significantly attenuated compared to that in the control group. Damage/death of motor neurons in the lumbar spinal cord was detected in the ventral horn at 1 day after asphyxial CA/CPR. Neuronal damage was significantly attenuated in the hypothermia group compared to that in the control group. These results indicated that therapeutic hypothermia after asphyxial CA/CPR significantly reduced hind limb motor dysfunction and motoneuronal damage/death in the ventral horn of the lumbar spinal cord following asphyxial CA/CPR. Thus, hypothermia might be a therapeutic strategy to decrease motor dysfunction by attenuating damage/death of spinal motor neurons following asphyxial CA/CPR.


Assuntos
Parada Cardíaca/complicações , Hipotermia Induzida/métodos , Isquemia/terapia , Neurônios Motores/fisiologia , Paraplegia/terapia , Animais , Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/terapia , Isquemia/etiologia , Região Lombossacral/irrigação sanguínea , Região Lombossacral/fisiopatologia , Masculino , Paraplegia/etiologia , Ratos , Ratos Sprague-Dawley
4.
Curr Neurol Neurosci Rep ; 19(4): 18, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30820684

RESUMO

PURPOSE OF REVIEW: Hereditary spastic paraplegias are a genetically heterogeneous group of neurological disorders. Patients present lower limb weakness and spasticity, complicated in complex forms by additional neurological signs. We review here the major steps toward understanding the molecular basis of these diseases made over the last 10 years. RECENT FINDINGS: Our perception of the intricate connections between clinical, genetic, and molecular aspects of neurodegenerative disorders has radically changed in recent years, thanks to improvements in genetic approaches. This is particularly true for hereditary spastic paraplegias, for which > 60 genes have been identified, highlighting (i) the considerable genetic heterogeneity of this group of clinically diverse disorders, (ii) the fuzzy border between recessive and dominant inheritance for several mutations, and (iii) the overlap of these mutations with other neurological conditions in terms of their clinical effects. Several hypotheses have been put forward concerning the pathophysiological mechanisms involved, based on the genes implicated and their known function and based on studies on patient samples and animal models. These mechanisms include mainly abnormal intracellular trafficking, changes to endoplasmic reticulum shaping and defects affecting lipid metabolism, lysosome physiology, autophagy, myelination, and development. Several causative genes affect multiple of these functions, which are, most of the time, interconnected. Recent major advances in our understanding of these diseases have revealed unifying pathogenic models that could be targeted in the much-needed development of new treatments.


Assuntos
Paraplegia/genética , Paraplegia Espástica Hereditária/genética , Animais , Heterogeneidade Genética , Humanos , Mutação , Paraplegia/fisiopatologia , Paraplegia/terapia , Paraplegia Espástica Hereditária/fisiopatologia , Paraplegia Espástica Hereditária/terapia
5.
Ann Vasc Surg ; 59: 306.e1-306.e5, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30684624

RESUMO

PURPOSE: Spinal cord ischemia (SCI) is a rare complication of endovascular repair of abdominal aortic aneurysm that is attributed to the variable anatomy of the artery of Adamkiewicz, embolization of the collateral circulation, or hypoperfusion of cord structures secondary to hypotension. CASE REPORT: A hypertensive 83-year-old male with chronic obstructive pulmonary disease presented with a 2.3-cm right iliac artery dissecting aneurysm. Paraplegia occurred on the first day after endovascular repair of iliac artery aneurysm. Postoperative magnetic resonance imaging showed multiple foci of spinal cord ischemia involvement from T10 to L1. Neither arterial pressure augmentation nor steroid therapy was effective. We hypothesized that the compromised blood flow from the artery of Adamkiewicz, combined with the transient hypotension and embolism, resulted in spinal cord infarction. The patient was eventually transferred to a nursing facility, with no improvement in his neurological status. CONCLUSIONS: SCI after endovascular aortic repair is an extremely rare and unpredictable complication. Physicians should pay more attention to the patients with comorbidities of atherosclerosis, chronic obstructive pulmonary disease, or peripheral artery occlusive disease.


Assuntos
Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Aneurisma Ilíaco/cirurgia , Isquemia do Cordão Espinal/etiologia , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/terapia , Fatores de Risco , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/terapia , Resultado do Tratamento
6.
Crit Care Med ; 46(9): e955-e958, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29985213

RESUMO

OBJECTIVE: To assess the long-term outcomes of patients hospitalized with severe West Nile neuroinvasive disease. DESIGN: Retrospective cohort. SETTING: Patients admitted to a referral center (Saint Mary's Hospital, Mayo Clinic). PARTICIPANTS: Twenty-six patients with West Nile neuroinvasive disease were identified by retrospective search of electronic database of Saint Mary's Hospital from January 1999 to November 2016. INTERVENTIONS: Retrospective electronic medical records review and prospective telephone follow-up. MEASUREMENTS AND MAIN RESULTS: Functional disability and cognitive outcomes were evaluated with the modified Rankin Scale and the Telephone Interview for Cognitive Status scores. Data on the time that the patient returned home after the hospitalization for West Nile neuroinvasive disease and the time of return to work were also collected. We identified 26 patients (81% males), 59 ± 17 years old. After a median hospital stay of 14.5 days (3-126), four patients died and 90% of survivors had a modified Rankin Scale of 3-5. Two additional patients died, and 80% of survivors had a modified Rankin Scale of 0-2 after a median follow-up of 73 months (1-144). Seven patients had cognitive impairment, which was severe in two of them. The combination of encephalitis and acute flaccid paralysis at presentation was associated with lower likelihood of returning home within 1 month after discharge (p < 0.01). Patients who required mechanical ventilation were more likely to have a modified Rankin Scale of 3-5 at last follow-up (p = 0.03), less likely to return home within 1 month of discharge (p < 0.01), less likely to return to their jobs (p < 0.01), and showed a trend toward having cognitive impairment (p = 0.05). CONCLUSIONS: Despite having poor outcomes at discharge, most West Nile neuroinvasive disease survivors with severe early disability can recover functional independence in the long term, justifying aggressive support during the acute phase and extensive rehabilitation efforts.


Assuntos
Meningite/terapia , Meningite/virologia , Paralisia/terapia , Paralisia/virologia , Paraplegia/terapia , Paraplegia/virologia , Febre do Nilo Ocidental/complicações , Febre do Nilo Ocidental/terapia , Doença Aguda , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
7.
BMJ Open ; 8(6): e021936, 2018 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29934392

RESUMO

INTRODUCTION: Sedentary behaviour is a distinct risk factor for cardiovascular disease (CVD) and could partly explain the increased prevalence of CVD in people with spinal cord injury (SCI). Interrupting prolonged sitting periods with regular short bouts of walking acutely suppresses postprandial glucose and lipids in able-bodied individuals. However, the acute CVD risk marker response to breaking up prolonged sedentary time in people with SCI has not been investigated. METHODS AND ANALYSIS: A randomised two-condition laboratory crossover trial will compare: (1) breaking up prolonged sedentary time with 2 min moderate-intensity arm-crank activity every 20 min, with (2) uninterrupted prolonged sedentary time (control) in people with SCI. Outcomes will include acute effects on postprandial glucose, insulin, lipids and blood pressure. Blood samples will be collected and blood pressure measured at regular intervals during each 5½-hour condition. ETHICS AND DISSEMINATION: This study was approved by the Cambridge South National Health Service Research Ethics Committee. This research will help determine if breaking up prolonged sedentary time could be effective in lowering CVD risk in people with SCI. The findings of the research will be published in a peer-reviewed journal and disseminated to relevant user groups. TRIAL REGISTRATION NUMBER: ISRCTN51868437; Pre-results.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Paraplegia/terapia , Comportamento Sedentário , Traumatismos da Medula Espinal/terapia , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Doenças Cardiovasculares/complicações , Estudos Cross-Over , Humanos , Insulina/sangue , Modelos Lineares , Lipídeos/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Traumatismos da Medula Espinal/complicações , Fatores de Tempo
8.
Cytotherapy ; 20(6): 796-805, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29784434

RESUMO

BACKGROUND AIMS: Recently, clinical studies show that cell therapy with mesenchymal stromal cells (MSCs) improves the sequelae chronically established in paraplegic patients, being necessary to know which of them can obtain better benefit. METHODS: We present here a phase 2 clinical trial that includes six paraplegic patients with post-traumatic syringomyelia who received 300 million MSCs inside the syrinx and who were followed up for 6 months. Clinical scales, urodynamic, neurophysiological, magnetic resonance (MR) and studies of ano-rectal manometry were performed to assess possible improvements. RESULTS: In all the cases, MR at the end of the study showed a clear reduction of the syrinx, and, at this time, signs of improvement in the urodynamic studies were found. Moreover, four patients improved in ano-rectal manometry. Four patients improved in neurophysiological studies, with signs of improvement in evoked potentials in three patients. In the American Spinal Injury Association (ASIA) assessment, only two patients improved in sensitivity, but clinical improvement in neurogenic bowel dysfunction was observed in four patients and three patients described improvement in bladder dysfunction. Spasms reduced in two of the five patients who had them previous to cell therapy, and spasticity was improved in the other two patients. Three patients had neuropathic pain before treatment, and it was reduced or disappeared completely during the study. Only two adverse events ocurred, without relation to the cell therapy. CONCLUSIONS: Cell therapy can be considered as a new alternative to the treatment of post-traumatic syringomyelia, achieving reduction of syrinx and clinical improvements in individual patients.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Traumatismos da Medula Espinal/terapia , Siringomielia/terapia , Adulto , Terapia Baseada em Transplante de Células e Tecidos/efeitos adversos , Humanos , Imagem por Ressonância Magnética , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/fisiologia , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/terapia , Paraplegia/diagnóstico , Paraplegia/etiologia , Paraplegia/terapia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Siringomielia/diagnóstico , Siringomielia/etiologia , Resultado do Tratamento
9.
Spinal Cord ; 56(10): 940-948, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29686256

RESUMO

STUDY DESIGN: Repeated measures. OBJECTIVES: Reports suggest passive limb movement (PLM) could be used as a therapy to increase blood flow and tissue perfusion in the paralyzed lower limbs of those with spinal cord injuries. However, the hyperemic response to PLM appears to be transient, lasting only 30-45 s despite continued limb movement. The purpose of this investigation was to determine whether the hyperemic response is repeatable across multiple short bouts of passive limb movement. SETTING: Cleveland Veterans Affairs Medical Center. METHODS: Nine individuals with paraplegia 46 ± 6 years of age, 17 ± 12 years post injury (range: 3-33 years) with complete T3-T11 injuries were subject to 5 × 1 min bouts of passive knee extension/flexion at 1 Hz with a 1 min recovery period between each bout. Heart rate (HR), mean arterial pressure (MAP), femoral artery blood flow (FABF), skin blood flow (SBF), and tissue perfusion in the lower limb were recorded during baseline and throughout each bout of PLM. RESULTS: Despite no increase in HR (p ≥ 0.8) or MAP (p ≥ 0.40) across all four bouts of PLM, the average increase in FABF during each bout ranged from 71 ± 87% to 88 ± 93% greater than baseline (p ≤ 0.043). SBF also increased between 465 ± 302% and 582 ± 309% across the five bouts of PLM (p ≤ 0.005). CONCLUSIONS: Repeated bouts of PLM in those with SCI while in an upright position resulted in a robust and steady increase in FABF and SBF which could have implications for improving vascular health and tissue perfusion in the lower limbs of those with paraplegia.


Assuntos
Terapia por Exercício/métodos , Extremidade Inferior , Paraplegia/terapia , Fluxo Sanguíneo Regional , Traumatismos da Medula Espinal/terapia , Adulto , Pressão Arterial , Feminino , Artéria Femoral/fisiopatologia , Frequência Cardíaca , Hemoglobinas/metabolismo , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Postura , Pele/irrigação sanguínea , Traumatismos da Medula Espinal/fisiopatologia , Vértebras Torácicas , Fatores de Tempo , Resultado do Tratamento
11.
Spinal Cord ; 56(6): 575-581, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29453362

RESUMO

STUDY DESIGN: Prospective observational. AIM: The aim of this study was to analyse changes in bladder and bowel management methods in persons with long-standing spinal cord injury (SCI). SETTING: Two spinal centres in UK. METHOD: Data were collected through interviews and examinations between 1990 and 2010 in a sample of persons injured more than 20 years prior to 1990. RESULTS: For the 85 participants who completed the 2010 follow-up, the mean age was 67.7 years and the mean duration of injury was 46.3 years, 80% were male, 37.7% had tetraplegia AIS grade A, B, or C, 44.7% paraplegia AIS A, B, or C, and 17.6% an AIS D grade regardless of level. In all, 50.6% reported having changed their bladder method, 63.1% their bowel method, and 40.5% both methods since they enroled in the study. The reasons for change were a combination of medical and practical. In men, condom drainage remained the most frequent bladder method, and in women, suprapubic catheter replaced straining/expressing as the most frequent method. The use of condom drainage and straining/expressing bladder methods decreased, whereas the use of suprapubic and intermittent catheters increased. Manual evacuation remained the most frequent bowel management method. The percentage of participants on spontaneous/voluntary bowel emptying, straining and medications alone decreased, whereas the use of colostomy and transanal irrigation increased over time. CONCLUSIONS: More than half the sample, all living with SCI for more than 40 years, required change in their bladder and bowel management methods, for either medical or practical reasons. Regular follow-ups ensure adequate change of method if/when needed.


Assuntos
Gerenciamento Clínico , Doenças Retais/terapia , Traumatismos da Medula Espinal/terapia , Transtornos Urinários/terapia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Defecação , Progressão da Doença , Feminino , Seguimentos , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/terapia , Estudos Prospectivos , Quadriplegia/etiologia , Quadriplegia/fisiopatologia , Quadriplegia/terapia , Doenças Retais/etiologia , Doenças Retais/fisiopatologia , Fatores Sexuais , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Micção , Transtornos Urinários/etiologia , Transtornos Urinários/fisiopatologia
12.
R I Med J (2013) ; 101(1): 10-11, 2018 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-29393302
13.
Am J Med ; 131(5): 574.e1-574.e11, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29274759

RESUMO

BACKGROUND: Cardiovascular disease has become a leading cause of death for patients with paraplegia. Acute myocardial infarction in patients with paraplegia has not been described in the literature. This study investigates clinical features, management strategies, and outcomes of these patients. METHODS: Acute myocardial infarction in patients with or without paraplegia was identified in the New York State Inpatient Database between 2007 and 2013. Clinical comorbidities, management strategies and their associated outcomes were compared using propensity score-matching analysis. RESULTS: Among 402,569 patients with acute myocardial infarction, 1400 had a concomitant diagnosis of paraplegia. Compared with those without, patients with paraplegia were younger, more likely to be black, and had a higher prevalence of hypertension, anemia, congestive heart failure, coagulopathy, and depression, but a lower prevalence of diabetes, hyperlipidemia, obesity, chronic lung disease, and renal failure. Patients with paraplegia were more likely to receive medical therapy without a diagnostic cardiac catheterization than those without (83.7% vs 64.5%, P < .001). Nine percent of patients with paraplegia received revascularization, which was significantly lower than that without paraplegia. In terms of the clinical outcome, patients with paraplegia had higher in-hospital mortality than those without (22.4% vs 16.8%, P < .001). Among the patients with paraplegia, the subcohort that received revascularization had lower in-hospital mortality (9.5% vs 22.0%, P < .01), had shorter length of stay (13.0 vs 16.9 days, P =.08), and higher hospital charges ($130,079 vs $92,125, P < .001) than those without revascularization. Furthermore, the paraplegic subcohort underwent coronary artery bypass grafting that was associated with higher in-hospital mortality (21.7% vs 1.7%, P < .001), longer length of stay (24.8 vs 14.2 days, P < .001), and higher hospital charges ($231,323 vs $144,449, P < .01) than subcohort that received percutaneous coronary intervention. CONCLUSIONS: Acute myocardial infarction patients with concomitant paraplegia had distinct clinical characteristics and comorbidity profiles; were less likely to receive revascularization therapy; and had higher in-hospital mortality. Acute myocardial infarction patient with paraplegia who underwent revascularization were associated with better clinical outcomes, in particular, those who were treated with percutaneous coronary intervention had significantly lower in-hospital mortality than those treated with coronary artery bypass grafting.


Assuntos
Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Paraplegia/epidemiologia , Idoso , Anemia/epidemiologia , Estudos de Casos e Controles , Depressão/epidemiologia , Coagulação Intravascular Disseminada/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Preços Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Revascularização Miocárdica/estatística & dados numéricos , New York/epidemiologia , Paraplegia/terapia , Estudos Retrospectivos
14.
Ann Vasc Surg ; 47: 281.e5-281.e10, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28893706

RESUMO

Thoracic endovascular aortic repair (TEVAR) is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year-old male was admitted to the emergency department following a high-impact road traffic collision. Whole-body computed tomography (CT) scan documented multiple injuries, including rupture of descending thoracic aorta just below the isthmus. There was no evidence of paraplegia or stroke. We decided to treat him in an endovascular fashion with a Zenith Cook (Cook Incorporated, Bloomington, IN) endograft. Final angiography confirmed the proper positioning of the device, no infoldings, and the optimal filling of the thoracic aorta downstream of the endoprosthesis. In the postoperative period, the patient showed high blood pressure which was treated with 4 different antihypertensive drugs. He was discharged on cardioaspirine. CT scan control was scheduled after 30 days and 6 months, but he referred to our emergency department after less than 6 months with paraplegia, abdominal pain, and acute renal failure. He had independently discontinued antiplatelet therapy 3 months before. Emergency CT control documented the presence of intimal flap and thrombus at the distal edge of the device. The magnetic resonance imaging revealed ischemic damage of the spinal cord. We decided to reline the endograft using another Zenith Cook device with very good results. Renal failure and bowel pain gradually improved, but paraplegia is still present. TEVAR is the most suitable treatment for blunt thoracic aortic injury in the modern era. Concerns arise from what can happen to a young aorta receiving a stiff endovascular graft that should be carried all lifelong. These devices have been associated with acute hypertension and cardiac remodeling. Less stiffer stent grafts should be studied for young patients. High attention must be posed in the follow-up for the immediate resolution of eventual problems.


Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular , Prótese Vascular , Procedimentos Endovasculares , Hipertensão/etiologia , Paraplegia/etiologia , Stents , Trombose/etiologia , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Anti-Hipertensivos/uso terapêutico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Paraplegia/diagnóstico por imagem , Paraplegia/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Desenho de Prótese , Trombose/diagnóstico por imagem , Trombose/terapia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia , Adulto Jovem
15.
J Med Case Rep ; 11(1): 334, 2017 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-29187247

RESUMO

BACKGROUND: Chronic renal failure is an important clinical problem with significant socioeconomic impact worldwide. Thoracic spinal cord entrapment induced by a metabolic yield deposit in patients with renal failure results in intrusion of nervous tissue and consequently loss of motor and sensory function. Human umbilical cord mesenchymal stem cells are immune naïve and they are able to differentiate into other phenotypes, including the neural lineage. Over the past decade, advances in the field of regenerative medicine allowed development of cell therapies suitable for kidney repair. Mesenchymal stem cell studies in animal models of chronic renal failure have uncovered a unique potential of these cells for improving function and regenerating the damaged kidney. CASE PRESENTATION: We report a case of a 62-year-old ethnic Indonesian woman previously diagnosed as having thoracic spinal cord entrapment with paraplegic condition and chronic renal failure on hemodialysis. She had diabetes mellitus that affected her kidneys and had chronic renal failure for 2 years, with creatinine level of 11 mg/dl, and no urinating since then. She was treated with human umbilical cord mesenchymal stem cell implantation protocol. This protocol consists of implantation of 16 million human umbilical cord mesenchymal stem cells intrathecally and 16 million human umbilical cord mesenchymal stem cells intravenously. Three weeks after first intrathecal and intravenous implantation she could move her toes and her kidney improved. Her creatinine level decreased to 9 mg/dl. Now after 8 months she can raise her legs and her creatinine level is 2 mg/dl with normal urinating. CONCLUSIONS: Human umbilical cord mesenchymal stem cell implantations led to significant improvement for spinal cord entrapment and kidney failure. The major histocompatibility in allogeneic implantation is an important issue to be addressed in the future.


Assuntos
Falência Renal Crônica/terapia , Rim/fisiologia , Transplante de Células-Tronco Mesenquimais , Síndromes de Compressão Nervosa/terapia , Regeneração Nervosa/fisiologia , Paraplegia/terapia , Terapia Baseada em Transplante de Células e Tecidos , Creatinina/metabolismo , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/fisiopatologia , Testes de Função Renal , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/fisiopatologia , Paraplegia/fisiopatologia , Resultado do Tratamento
17.
Sci Rep ; 7(1): 13476, 2017 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-29074997

RESUMO

The prognosis for recovery of motor function in motor complete spinal cord injured (SCI) individuals is poor. Our research team has demonstrated that lumbosacral spinal cord epidural stimulation (scES) and activity-based training can progressively promote the recovery of volitional leg movements and standing in individuals with chronic clinically complete SCI. However, scES was required to perform these motor tasks. Herein, we show the progressive recovery of voluntary leg movement and standing without scES in an individual with chronic, motor complete SCI throughout 3.7 years of activity-based interventions utilizing scES configurations customized for the different motor tasks that were specifically trained (standing, stepping, volitional leg movement). In particular, this report details the ongoing neural adaptations that allowed a functional progression from no volitional muscle activation to a refined, task-specific activation pattern and movement generation during volitional attempts without scES. Similarly, we observed the re-emergence of muscle activation patterns sufficient for standing with independent knee and hip extension. These findings highlight the recovery potential of the human nervous system after chronic clinically motor complete SCI.


Assuntos
Movimento , Reabilitação Neurológica/métodos , Paraplegia/terapia , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/métodos , Adulto , Eletrodos Implantados , Espaço Epidural/cirurgia , Humanos , Perna (Membro)/fisiopatologia , Masculino , Contração Muscular , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Reabilitação Neurológica/instrumentação , Paraplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal/instrumentação
18.
Schmerz ; 31(5): 527-545, 2017 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-28940094

RESUMO

Chronic pain is one of the most reported health problems in patients suffering from spinal cord injuries and is described by the patients as one of the most burdensome sequelae of paraplegia. Various types of pain, such as nociceptive, neuropathic and other types of pain can occur. In addition, multiple pathophysiological mechanisms based on the biopsychosocial pain model play a role in the origins of the pain. These aspects necessitate a multimodal pain management approach in this patient group. This article presents an overview of the occurrence, importance and pathophysiology of chronic pain following spinal cord injury as well as diagnostic and therapeutic approaches.


Assuntos
Dor Crônica/diagnóstico , Medição da Dor , Paraplegia/diagnóstico , Encéfalo/fisiopatologia , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Terapia Combinada , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Neuralgia/diagnóstico , Neuralgia/fisiopatologia , Neuralgia/terapia , Nociceptores/fisiologia , Paraplegia/fisiopatologia , Paraplegia/terapia , Nervos Periféricos/fisiopatologia , Psicologia , Fatores de Risco , Medula Espinal/fisiopatologia , Raízes Nervosas Espinhais/fisiopatologia
19.
Vasc Endovascular Surg ; 51(7): 517-520, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28820047

RESUMO

BACKGROUND: Neurological adverse events with spinal cord ischemia (SCI) remain one of the most feared complications in patients undergoing thoracic endovascular aortic repair (TEVAR). These patients can develop irreversible paraplegia with lifelong consequences with physical and psychological agony. CASE PRESENTATION: We herein present a patient who developed SCI with bilateral lower leg paraplegia on the third postoperative day following TEVAR. Spinal catheter was inserted for spinal fluid drainage. A hyperbaric oxygen therapy was initiated for 90 minutes for 2 days, which was followed by therapeutic hypothermia for 24 hours with a target temperature of 33°C. The patient exhibited significant neurological recovery following these treatments, and he ultimately regained full neurological function without spinal deficit. DISCUSSION: This represents the first reported case of full neurological recovery of a patient who developed complete SCI following TEVAR procedure. The neurological recovery was due in part to immediate therapeutic hypothermia and hyperbaric oxygen therapy which reversed the spinal ischemia.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Oxigenação Hiperbárica , Hipotermia Induzida , Isquemia do Cordão Espinal/terapia , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Terapia Combinada , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/terapia , Recuperação de Função Fisiológica , Fluxo Sanguíneo Regional , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia , Resultado do Tratamento
20.
J Pediatr Hematol Oncol ; 39(8): e479-e482, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28582275

RESUMO

Ewing sarcoma (ES) infrequently affects the spine. Diagnosis is usually made several weeks following growing symptoms. In this report, we present the case of a child with ES localized at the upper thoracic level. ES was revealed by isolated acute complete paraplegia mimicking medullary stroke. The girl was operated for decompressive laminectomy and tumor removal. Afterwards, she received adjuvant therapy. Subsequently, the child showed a slow improvement of her leg sensitivity associated with a partial motor recovery. ES can affect the mobile spine. Acute symptomatology due to intratumoral hemorrhage and sudden spinal cord compression may suggest the diagnosis. Neurological outcomes following ES are generally poor.


Assuntos
Neoplasias Ósseas/complicações , Paraplegia/diagnóstico , Paraplegia/etiologia , Sarcoma de Ewing/complicações , Vértebras Torácicas/patologia , Biópsia , Neoplasias Ósseas/diagnóstico , Criança , Terapia Combinada , Descompressão Cirúrgica , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Paraplegia/terapia , Sarcoma de Ewing/diagnóstico , Esteroides/uso terapêutico , Vértebras Torácicas/diagnóstico por imagem
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