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While the message emanating from physiological and psychological research has extolled the general advantages of exercise in physical and cognitive health, the social distancing and the impossibility of group exercises have revealed more complex conditions. Therefore, we performed an experimental study comparing the effect of individual and group cognitive-motor training on reconstructing subjective well-being (SWB) and quality of life (QOL) in older males who recovered from COVID-19. The study's design is a single-blind, randomized controlled trial (RCT). The participants, 36 older men (65-80 yrs.) recovering from COVID-19, were randomly divided into (1) Group A (cognitive-motor training, G-CMT); (2) Group B (individual cognitive-motor training, I-CMT); and (3) Group C (control). Both training interventions involved performing a training protocol (cognitive-motor training) twice a week for four weeks. The outcomes included an assessment of the SWB and QOL of participants by SWB scale and world health organization QOL scale at baseline and two weeks after interventions. Except for the effect of age and number of children variables on QOL, other demographic variables had no significant effect on the results of SWB or WHOQOL of participants (P > 0.05). The SWB results in G-CMT were better than I-CMT and control groups in emotional and social well-being domains. Also, WHOQOL test results in G-CMT were better than control groups in domains of psychological and social relationships, whereas I-CMT performed better than G-CMT and control groups in domains of cognitive well-being, physical health, and environment. The results revealed that the mean test scores of SWB and WHOQOL in G-CMT and I-CMT were better than the control group (P ≤ 0.001). The positive effects of cognitive-motor training on reconstructing SWB and QOL are associated with the synchronicity of cognitive and motor components in these exercises. We suggest that the emotional, social, and psychological benefits of cognitive-motor training override cognitive, physical, and environmental changes. The future line of the present study will include pathophysiology and further clinical aspect of recovering from COVID-19.
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COVID-19 , Masculino , Criança , Humanos , Idoso , Qualidade de Vida , Terapia por Exercício/métodos , Exercício Físico , Cognição/fisiologiaRESUMO
OBJECTIVE: The incidence of COVID-19 disease in the elderly can accelerate normal degenerative process of cognitive functions. Interactive cognitive-motor training (CMT) is an intervention that integrates cognitive and motor tasks to promote individuals' physical and psychological health. The present study aimed to examine the effect of CMT on reconstructing cognitive health components in older men, who have recently recovered from COVID-19. MATERIALS AND METHODS: This study is a quasi-experimental repeated measure (without control group). Participants were 42 elderly men (65-80 years) who recovered from the COVID-19 disease that individually participated in a 4-week CMT program twice a week. The cognitive health components of the participants were assessed by the General Health Questionnaire (GHQ-2) and the Mini-Mental State Examination (MMSE) at 3 stages before the beginning of the intervention (baseline assessment); 2 weeks after the intervention (short-term follow-up); and 3 months after the intervention (long-term follow-up). RESULTS: The results showed that the scores of depression, anxiety, physical symptoms, and social performance components and the overall GHQ score improved significantly in short-term follow-up (P < 0.05) and also in long-term follow-up compared to baseline assessment (P < 0.05). It was also found that attention and calculation, recall, lingual skill, and action performance components and the overall score of MMSE were also improved at three stages of assessments. Other components did not differ among stages. CONCLUSIONS: This study adds to the research on the effectiveness of using CMT for reconstructing cognitive health components in older adults, recovered from the COVID-19, and supports CMT as a viable intervention practice.
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COVID-19 , Idoso , Atenção , Cognição , Humanos , Masculino , Testes de Estado Mental e Demência , SARS-CoV-2RESUMO
With the advancement of miniaturization in electronics and the ubiquity of micro-electro-mechanical systems (MEMS) in different applications including computing, sensing and medical apparatus, the importance of increasing production yields and ensuring the quality standard of products has become an important focus in manufacturing. Hence, the need for high-accuracy and automatic defect detection in the early phases of MEMS production has been recognized. This not only eliminates human interaction in the defect detection process, but also saves raw material and labor required. This research developed an automated defects recognition (ADR) system using a unique plenoptic camera capable of detecting surface defects of MEMS wafers using a machine-learning approach. The developed algorithm could be applied at any stage of the production process detecting defects at both entire MEMS wafer and single component scale. The developed system showed an F1 score of 0.81 U on average for true positive defect detection, with a processing time of 18 s for each image based on 6 validation sample images including 371 labels.
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Sistemas Microeletromecânicos , Algoritmos , Humanos , Inteligência , Aprendizado de MáquinaRESUMO
Cargo handling is an operation, which requires a high level of performance from the officer of the watch (OOW). This study aimed to investigate the effect of different shift schedules on sleep quality, cognitive performance, and sleepiness of 139 OOWs on oil tankers with 4on-8off shifts, during the first shift of cargo handling. Sleep quality (Pittsburgh Sleep Quality Index (PSQI)), level of sleepiness (the Karolinska Sleepiness Scale (KSS)), Psychomotor Vigilance Task (PVT), and Arrow Flanker task performance were examined. The results showed that OOWs with (00:00-04:00, 12:00-16:00) and (04:00-08:00, 16:00-20:00) shifts had impaired cognitive performance and higher sleepiness during the cargo handling operation, and they also experienced impaired sleep quality. The results demonstrated that the circadian rhythm and homeostatic sleep drive have a greater impact on cognitive performance and sleepiness than time on shifts. These results suggest that allocating rest hours immediately before the cargo handling operation may reduce the risk of fatigue. Practitioner Summary: To the best of our knowledge, this maritime field study shows for the first time the prevalence of seafarers' sleepiness and cognitive performance while on duty during cargo handling, using a pre-post shift comparison between three different shifts. The results show the negative effects of keeping watch at night on sleep quality, sleepiness, and the impaired cognitive performance both in the day and the night shifts.
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Sonolência , Tolerância ao Trabalho Programado , Fadiga , Humanos , Sono , VigíliaRESUMO
Chronic non-bacterial prostatitis (CNP) is the most common type of prostatitis and oxidative stress (OS) was shown to be highly elevated in prostatitis patients. This study aimed to investigate the protective effect of pentoxifylline (PTX) on CNP induced by carrageenan in rats. Male adult Wistar rats (n = 30) were divided into control, CNP and three treatment groups (n = 6) including CNP + cernilton and CNP + PTX groups. CNP was induced by single intraprostatic injection of 1% carrageenan (100 µl). Rats in treatment groups received orally cernilton 100 mg/kg and PTX at 50 and 100 mg/kg 1 week after CNP induction for 21 days. Prostatic index (PI), prostatic specific antigen (PSA), tumor-necrosis factor alpha (TNF-α), serum lipid peroxidation (MDA), blood urea nitrogen, creatinine and histopathological changes were compared between groups. There were significant increase of PI, serum levels of PSA, TNF-α and MDA in CNP group at 29 day. In treatment groups, significant reduction in PI, serum levels of PSA, TNF-α, MDA and creatinine was observed especially in rats treated with dose of 50 mg/kg of PTX. In CNP group, histopathological changes of the prostate such as leucocyte infiltration, large involutions and projection into the lumen and reducing the volume of the lumen were observed as well. Whereas PTX, especially at dose of 50 mg/kg, could improve the above-mentioned changes remarkably in CNP treated rats. For the first time, our findings indicated that PTX improved CNP induced by carrageenan in rats.
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Carragenina/farmacologia , Pentoxifilina/farmacologia , Prostatite/induzido quimicamente , Prostatite/tratamento farmacológico , Substâncias Protetoras/farmacologia , Animais , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/farmacologia , Prostatite/metabolismo , Ratos , Ratos Wistar , Secale , Fator de Necrose Tumoral alfa/metabolismoRESUMO
PURPOSE: Weight regain after metabolic bariatric surgery is a common problem. Food addiction is an eating disorder that can be one of the reasons for weight regain in these patients. This study aimed to evaluate the effects of probiotic supplementation with a weight loss program and cognitive behavioral therapy (CBT) on anthropometric measures, eating behavior, food addiction, and related hormone levels, in patients with food addiction and weight regain after metabolic bariatric surgery. MATERIALS AND METHODS: This randomized, triple-blind, placebo-controlled clinical trial was conducted on patients with food addiction and weight regain after metabolic bariatric surgery. Participants (n = 50) received a weight loss program and CBT plus probiotic, or placebo for 12 weeks. Then, anthropometric measurements, biochemical markers, eating behavior, and food addiction were assessed. RESULTS: Weight and body mass index (BMI) decreased significantly in the probiotic group compared to placebo (p = 0.008, p = 0.001, respectively). Fat mass was significantly decreased in the probiotic group (p < 0.001). Moreover, a significant improvement was observed in the probiotic group's eating behavior and food addiction compared to the placebo group (p < 0.001). Serum levels of leptin decreased significantly (p = 0.02), and oxytocin serum levels increased significantly (p = 0.008) in the probiotic group compared to the placebo group. CONCLUSION: Adding probiotic supplements to the weight loss program and CBT is superior to the weight loss program and CBT alone in improving weight loss, eating behavior, and food addiction in patients with food addiction and weight regain after metabolic bariatric surgery.
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OBJECTIVES: Sedentary life style separated during COVID-19 pandemic. Patients with cardiovascular diseases (CVD) are vulnerable with sedentary life style. Therefore, the aim of this study was to investigate the effect of 8 weeks of combined and high intensity interval training (HIIT) on C Reactive protein, galectin-3, leptin, fibrinogen and insulin resistance index in coronary heart disease after COVID-19. METHODS: Thirty-six cardiovascular patients (55.14 ± 1.4 years, 78.6 ± 5.1 kg) were divided into three groups of combined exercise (n=13), HIIT (n=12) and control group (n=11). Combined exercise consisted of aerobic (4 weeks) and aerobic + HIIT exercise (4 weeks), three sessions per weeks. The protocol of the HIIT group included performing high intensity interval training, three sessions per weeks for 8 weeks. Blood samples were taken 24 h before the first training session and 48 h after the last training. C Reactive protein (CRP), galectin-3, leptin, fibrinogen measured with ELISA kit. RESULTS: CRP, galectin-3 and fibrinogen decreased significantly after 8 weeks of combined training and HIIT (compare to pre-test). Also, insulin resistance index after 8 weeks of combined exercise showed a significant decrease compare to pre-test (p<0.05). After 8 weeks, CRP, galectin-3 and insulin resistance significantly decreased compare to control group (p<0.05). CONCLUSIONS: In the patient with CVD, combined exercise training may be more effective than HIIT in reducing metabolic and heart risk factors after an epidemic such as COVID-19. However, change of leptin need to more studies.
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COVID-19 , Doenças Cardiovasculares , Doença das Coronárias , Resistência à Insulina , Humanos , Leptina , Proteína C-Reativa , Galectina 3 , Pandemias , Exercício Físico , Inflamação , Insulina , Fatores de Risco , FibrinogênioRESUMO
OBJECT: The X-Stop interspinous device is designed for the treatment of patients with neurogenic intermittent claudication due to lumbar spinal stenosis. It distracts the posterior elements of adjacent vertebral bodies, unloading the intervertebral disc, limiting spinal extension, and improving central canal and neuroforaminal stenosis. In this paper, the authors reviewed the complications and failure/reoperation rates in a small series of patients and compared their results with other reported complication and failure/reoperation rates. METHODS: The medical records of all patients who underwent placement of the X-Stop device for the treatment of NIC at the authors' institution were retrospectively evaluated, and demographic information, diagnosis, and preoperative pain levels were recorded. Postoperatively, patients subjectively graded the percentage (0-100%) of improvement in pain as well as the amount of residual pain and underwent imaging at 1-, 3-, and 6-month intervals. Approximately 4 years after X-Stop placement, information on long-term outcomes was obtained from patient medical records or additional follow-up. RESULTS: Thirteen patients (8 men and 5 women) underwent placement of the X-Stop device. Central canal stenosis with bilateral foraminal stenosis was diagnosed in all patients: 9 (69%) of 13 had severe stenosis and 4 (31%) of 13 had moderate stenosis. Five patients (38%) also had associated Grade I spondylolisthesis. Nine patients underwent placement of the X-Stop device at the L4-5 interspinous space and 4 at both the L3-4 and L4-5 levels. The average duration of follow-up was 42.9 months (range 3-48 months). Initially, pain improved an average of 72% (range 50-100%) in these patients; however, preoperative pain returned in 77% of the patients (10 of 13). The overall complication rate was 38%, including 3 spinous process fractures (23%) and 2 instances of new-onset radiculopathy (15%). The ultimate failure rate requiring additional spinal surgery was 85% (11 of 13 patients). These complication and failure rates are much higher than those previously reported. CONCLUSIONS: Overdistraction, poor bone density, poor patient selection, and preexistent adjacent foraminal stenosis may all be factors in the development of the aforementioned complications. Thus, careful attention should be paid preoperatively to adjacent-level disease, bone density, appropriate implant size, and optimal patient selection.
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Claudicação Intermitente/cirurgia , Fixadores Internos/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Claudicação Intermitente/fisiopatologia , Fixadores Internos/normas , Dor Lombar/fisiopatologia , Dor Lombar/cirurgia , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Implantação de Prótese/métodos , Recidiva , Reoperação , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/fisiopatologia , Estenose Espinal/fisiopatologia , Espondilose/fisiopatologia , Espondilose/cirurgiaRESUMO
METHODS: This study is semiexperimental with an intragroup design. A number of 10 military marksmen (30-42 years old) with at least 10 years of experience in shooting performed under four attentional focus strategies in a counterbalanced design. In each strategy, two blocks (each consisting of 20 trials) were conducted. Shooters' performance was recorded using SCATT device and analyzed using the factorial variance analysis with repeated measure. RESULTS: Results showed that the interactional effects of internal-external/relevant-irrelevant focuses of attention were significant on shooting record, shooting accumulation, and stability on the target center. Results suggest that the external-relevant attentional focus strategies were more effective than other focus strategies. CONCLUSION: The results of the study support the hypothesis that external-relevant attentional focus produced better scores, better accumulation, more stability at the target center, and less average fluctuation. Therefore, this attentional focus strategy improves performance precision of military elite shooters.
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Armas de Fogo , Militares , Esportes , Adulto , Análise de Variância , Atenção , HumanosRESUMO
BACKGROUND: The high number of marine incidents in port and coastal areas due to the tired deck officers' erroneous actions are one of the major challenges of marine transportation. Approaching, berthing, and cargo handling (ABC) are the most stressful and exhausting operations of the ship in these areas, which are carried out consecutively and uninterruptedly. MATERIALS AND METHODS: This study examined Psychomotor Vigilance Task (PVT) performance, Arrow Flanker Task performance and the Pittsburgh Sleep Quality Index (PSQI) of 70 deck officers of ocean-going oil tankers with 4on-8off shifts at the end of the first shift of cargo-handling operations. In this case, they had worked more than 14 hours continuously. Also, their level of sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) at the beginning, middle, and end of their first shift of handling operation. RESULTS: The results were analysed according to the duration at sea and deck officers rank. PSQI, KSS, PVT mean reaction times and lapses, and also Flanker's variables were higher among the chief and second officers who were present on board between 0-30 days. The state of officers who were present on board between 31 to 60 days was better than the officers with 0-30 and 61-90 days' duration at sea. In addition, the results show that sleep quality during tour of duty affects cognitive performance and sleepiness of officers during cargo handling operations. CONCLUSIONS: The paper concludes by discussing possible solutions for reducing fatigue and human error among seafarers.
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Fadiga , Navios , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Tolerância ao Trabalho Programado , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Naval , Testes Neuropsicológicos , Fatores de RiscoRESUMO
Delayed traumatic intracranial aneurysms of the posterior circulation caused by nonpenetrating head injury are rare, especially in pediatric patients. The true incidence and natural history of these aneurysms are poorly understood. We report a case of a 15-year-old boy who initially presented with subarachnoid hemorrhage of the posterior fossa without any evidence of associated aneurysm. On a routine computed tomography of the head, however, he was found to have a saccular aneurysm of the proximal posterior inferior cerebellar artery. The patient was treated successfully by microsurgical clipping and PICA/PICA bypass.
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Traumatismos Cranianos Fechados/complicações , Aneurisma Intracraniano/patologia , Dissecação da Artéria Vertebral/patologia , Artéria Vertebral/patologia , Adolescente , Angiografia Cerebral , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Fossa Craniana Posterior/cirurgia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/cirurgiaRESUMO
Different auditory and visual cues have been proven to be very effective in improving the mobility of people with Parkinson's (PwP). Nonetheless, many of the available methods require user intervention and so on to activate the cues. Moreover, once activated, these systems would provide cues continuously regardless of the patient's needs. This research proposes a new indoor method for casting dynamic/automatic visual cues for PwP based on their head direction and location in a room. The proposed system controls the behavior of a set of pan/tilt servo motors and laser pointers, based on the real-time skeletal information acquired from a Kinect v2 sensor. This produces an automatically adjusting set of laser lines that can always be in front of the patient as a guideline for where the next footstep would be placed. A user interface was also created that enables users to control and adjust the settings based on the preferences. The aim of this research was to provide PwP with an unobtrusive/automatic indoor system for improving their mobility during a Freezing of gait (FOG) incident. The results showed the possibility of employing such system, which does not rely on the subject's input nor does it introduce any additional complexities to operate.
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Transtornos Neurológicos da Marcha/reabilitação , Doença de Parkinson/reabilitação , Telerreabilitação/instrumentação , Telerreabilitação/métodos , Adulto , Sinais (Psicologia) , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Lasers , Masculino , Doença de Parkinson/complicações , Adulto JovemRESUMO
The Kinect sensor has been widely used in different applications such as rehabilitation and gait analysis. Whilst Kinect v2 was released with several improvements over its predecessor, it still incorporates depth-map intrinsic inaccuracies. This results in inconsistencies in skeletal-data acquisition, especially in joint localisation and distance-to-ground tracking with respect to the Kinect's 3-D Cartesian coordinate reference point. This research proposes a correction technique based on the two-point linear equation derived from the information gathered from different subjects' skeletal data and data regression analysis to compensate the inaccuracies in joint-to-ground data collection. The research also proposes a new footsteps detection method based on skeletal data and plane detection techniques that calculates a footstep by using the ankle's Euclidean distance from the floor, regardless of the subject's distance from the camera. The results show that after the correction technique was applied, data acquisition proved to be consistent and more accurate within a distance range of 1.6-2.9 m from the Kinect camera, regardless of the subject's location to the camera's reference point. Moreover, the inconsistency of joint data read by the Kinect was reduced from 25.69% to 5.25% and the footsteps detection accuracy increased from 42.85% to 79.76% on average for both legs.
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Pé/fisiologia , Análise da Marcha/métodos , Articulações/fisiologia , Adulto , Algoritmos , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Caminhada/fisiologia , Adulto JovemRESUMO
Parkinson's is a neurodegenerative condition associated with several motor symptoms including tremors and slowness of movement. Freezing of gait (FOG); the sensation of one's feet being "glued" to the floor, is one of the most debilitating symptoms associated with advanced Parkinson's. FOG not only contributes to falls and related injuries, but also compromises quality of life as people often avoid engaging in functional daily activities both inside and outside the home. In the current study, we describe a novel system designed to detect FOG and falling in people with Parkinson's (PwP) as well as monitoring and improving their mobility using laser-based visual cues cast by an automated laser system. The system utilizes a RGB-D sensor based on Microsoft Kinect v2 and a laser casting system consisting of two servo motors and an Arduino microcontroller. This system was evaluated by 15 PwP with FOG. Here, we present details of the system along with a summary of feedback provided by PwP. Despite limitations regarding its outdoor use, feedback was very positive in terms of domestic usability and convenience, where 12/15 PwP showed interest in installing and using the system at their homes. Implications for Rehabilitation Providing an automatic and remotely manageable monitoring system for PwP gait analysis and fall detection. Providing an automatic, unobtrusive and dynamic visual cue system for PwP based on laser line projection. Gathering feedback from PwP about the practical usage of the implemented system through focus group events.
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Acidentes por Quedas/prevenção & controle , Transtornos Neurológicos da Marcha/reabilitação , Monitorização Ambulatorial/instrumentação , Doença de Parkinson/reabilitação , Tecnologia Assistiva , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Qualidade de VidaRESUMO
Uveitis is a major cause of vision loss. Methotrexate (MTX) has been widely used in uveitis due to its relatively safe profile. The purpose of this study was to evaluate the effects of two different dosages of MTX via intra-vitreal administration for treatment of endotoxin induced uveitis (EIU) in an experimental model. Thirty-five healthy rabbits were randomly divided into four groups and all animals were tolerated intra-vitreal injections. The first group received normal saline (NS), the second group received normal saline plus Salmonella typhimurium lipopolysaccharide endotoxin (LPS), (NS+LPS), the third group received 400 µg MTX plus LPS (LPS+MTX 400) and the fourth group received 800 µg MTX plus LPS (LPS+MTX 800). Intra-ocular inflammation was evaluated by clinical examination scoring during 7 post-injection days and histopathological examination at the end of study. Kruskal-Wallis and Mann-Whitney U tests were used to compare the histopathological and clinical scores. According to the clinical examinations, all groups demonstrated higher uveitis score than group 1 on first post-injection day. Also, groups 2 and 3 showed greater uveitis score than group 4. On the third, fifth and seventh post-injection days, clinical uveitis score in groups 2, 3 and 4 was significantly higher than group 1. The mean histopathological inflammation intensity scores in groups 2, 3 and 4 were significantly higher than group 1. Single intra-vitreal injection of 400 µg and 800 µg of MTX did not show significant anti-inflammatory effects on EIU in rabbits.
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The objective of the present study was to investigate the clinical and histopathological effects of intravitreal injection of pentoxifylline (PTX) the management of an experimental model of uveitis. Fifty-two rabbits were divided randomly into six intravitreal treated groups as below: 1) Balanced salt solution (BSS), 2) Salmonella typhimurium lipopolysaccharide endotoxin (LPS) + BSS, 3) LPS + PTX 100 µg, 4) LPS + PTX 500 µg, 5) BSS + PTX 100 µg and 6) BSS + PTX 500 µg. Inflammation was evaluated by clinical examinations using slit lamp on days 1, 3, 5 and 7 post injections and histopathological examinations were also performed at the end of the study. Clinical examinations demonstrated a statistically significant difference between group 1 and group 2 on day 5 and day 7. Moreover, the comparison of clinical severity scores of group 1 with groups 3, 4, 5 and 6, on third, fifth and seventh post-injection days showed statistically significant differences. The mean histopathological inflammation intensity score in groups 5 and 6 was significantly higher than group 1. The mean histopathological inflammation intensity score in groups 3, 4, 5 and 6 was significantly higher than group 2. Intravitreal injection of PTX in an experimental model of uveitis in rabbits not only does not reduce inflammation but also leads to inflammation when used alone or in combination with LPS.
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The thoracic duct along with the cisterna chyli is a major lymphatic pathway near the anterior thoracolumbar spine. Despite the fragile nature of the lymphatic system and its proximity to the spinal column, chylorrhea is rarely encountered by spine surgeons. The authors present a unique case of chylorrhea associated with a left thoracoscopic, transdiaphragmatic discectomy and fusion for a T12-L1 herniated disc. The anomalous location of the thoracic duct at the left lateral vertebral column contributes to this unusual complication.
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Quilotórax/etiologia , Discotomia/efeitos adversos , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Vértebras Torácicas/cirurgia , Toracoscopia/efeitos adversos , Tubos Torácicos , Quilotórax/diagnóstico por imagem , Quilotórax/terapia , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Nutrição Parenteral Total , Radiografia TorácicaRESUMO
The role of surgical debridement and internal fixation in treatment of vertebral osteomyelitis has been evolving. The standard surgical approach to thoracolumbar vertebral osteomyelitis requiring extensive thoracotomy or retroperitoneal exposure carries significant associated morbidity and postoperative pain. Minimally invasive thoracoscopic spine surgery is designed to improve postoperative morbidity associated with the traditional open surgery. We report a case of a 70-year-old man who developed T11-T12 pyogenic vertebral osteomyelitis 3 months after undergoing posterior laminectomy and microsurgical excision of a herniated thoracic disc. The patient underwent minimally invasive thoracoscopic radical debridement and anterior spinal reconstruction and fusion. Patients with vertebral osteomyelitis may benefit from the decreased postoperative morbidity that is associated with minimally invasive thoracoscopic spinal surgery.
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Desbridamento/métodos , Discite/cirurgia , Osteomielite/cirurgia , Doenças da Coluna Vertebral/cirurgia , Toracoscopia , Idoso , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Próteses e Implantes , Doenças da Coluna Vertebral/microbiologia , Fusão VertebralRESUMO
Photophobia is a common neurological and ophthalmological symptom that has been associated with a growing number of neurosurgical conditions, especially compressive lesions. The exact signaling pathways and neurophysiological features of the disorder are not well understood; however, data from multiple studies have shown the significance of the trigeminal system and the pretectal nuclei in its pathophysiology. The authors report on a rare case of a blind patient who presented with photophobia without evidence of light perception. They also review the literature and early experimental data in an effort to understand the possible neuronal pathways and structures involved in photophobia.
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Adenoma/complicações , Cegueira/complicações , Fotofobia/etiologia , Neoplasias Hipofisárias/complicações , Adenoma/radioterapia , Adenoma/cirurgia , Idoso , Feminino , Humanos , Neoplasias Hipofisárias/radioterapia , Neoplasias Hipofisárias/cirurgia , Vias Visuais/fisiopatologiaRESUMO
Endoscopic third ventriculostomy (ETV) has gained popularity and has become the treatment of choice for certain pediatric and adult hydrocephalic conditions. The authors report their experience with 36 adult patients and evaluate the long-term outcome and safety of ETV. They discuss several improvements to the surgical techniques that they have developed based on their experience, including the use of intraoperative Doppler imaging before fenestration to trace the location of vessels underlying the floor of the third ventricle. They also report the use of a Rickham reservoir and endoventricular stent in selected cases and discuss the indications for their use. In cases of obstructive hydrocephalus due to congenital or acquired aqueductal stenosis in adults, the success rate of ETV in avoidance of shunt placement is 72%. Twenty-two percent of the patients in this series in whom ETV was initially successful later experienced closure of the fenestration and recurrent symptoms at a mean interval of 3.75 years. Thus, in patients who undergo this treatment, long-term periodic follow-up review should be performed.