Hip-spine syndrome, radiographic evaluation of the sagittal balance / Síndrome quadril-coluna, avaliação radiográfica no balanço sagital / Síndrome de columna-cadera, evaluación radiográfica en el balance sagital

ABSTRACT Objectives The hip-spine syndrome (HSS) is defined as the simultaneous degeneration of the hip and lumbar spine. The objective of this study is to quantify the sagittal balance values in the population with HSS and to compare them with the normal sagittal balance parameters. Methods A retrospective study was conducted in which 30 patients with HSS who were waiting for total hip arthroplasty (THA) were evaluated. The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and spinopelvic harmony (SH) angles and the BMI of these patients were measured. Results Seventeen women and 13 men participated in the study, with a mean LL of 39.55°, a mean SS of 36.92°, a mean PT of 25.77°, a mean PI of 62.72°, a mean SH of 23.17° and a mean BMI of 25.55. Only the SS did not present a changed value when compared to the normal values of the population. Conclusions HSS is increasingly present in our environment due to the aging population. Sagittal balance is gaining more and more attention in studies related to spinal pathologies. All the parameters measured in this study, except for SS, presented altered values when compared to the populational means. Evidence Level II. Observational and retrospective study.

RESUMO Objetivos A síndrome quadril-coluna (SQC) é definida como a degeneração simultânea do quadril e da coluna lombar. O objetivo do presente estudo consiste em quantificar os valores do equilíbrio sagital na população com SQC e compará-los com os parâmetros normais do equilíbrio sagital. Métodos Foi realizado um estudo retrospectivo em que foram avaliados 30 pacientes com SQC aguardando cirurgia de artroplastia total de quadril (ATQ). Foram aferidos os ângulos de lordose lombar (LL), declive sacral (DS), versão pélvica (VP), incidência pélvica (IP), harmonia espinopélvica (HP) e o IMC dos pacientes no estudo. Resultados Participaram do estudo 17 mulheres e 13 homens, sendo que a LL média foi de 39,55°, DS 36,92°, VP 25,77°, IP 62,72°, HP 23,17° e IMC 25,55. Apenas o DS não apresentou valor alterado quando comparado aos valores normais da população. Conclusão A SQC está cada vez mais presente em nosso meio devido ao envelhecimento populacional. O equilíbrio sagital ganha cada vez mais espaço nos estudos relacionados às patologias da coluna vertebral. Com exceção do DS, os demais parâmetros medidos nesse estudo apresentaram valores alterados quando comparados à média populacional. Nível de Evidência II. Estudo observacional e retrospectivo.

RESUMEN Objetivos El Síndrome de Columna-Cadera (SCC) se define como la degeneración simultánea de la columna lumbar y la cadera. El objetivo del presente estudio consiste en cuantificar los valores del equilibrio sagital en la población con SCC y compararlos con los parámetros normales del equilibrio sagital. Métodos Se realizó un estudio retrospectivo en el que se evaluaron 30 pacientes con SCC que esperaban cirugía para artroplastia total de cadera (ATC). Fueron medidos los ángulos de lordosis lumbar (LL), pendiente sacra (PS), versión pélvica (VP), incidencia pélvica (IP), armonía espinopélvica (AP) y el IMC de los pacientes en el estudio. Resultados Participaron en el estudio 17 mujeres y 13 hombres, siendo que la LL promedio fue de 39,55 °, PS 36,92°, VP 25,77°, IP 62,72°, AP 23,17° e IMC 25,55. Sólo la PS no presentó un valor alterado, cuando comparado a los valores normales de la población. Conclusión El SCC está cada vez más presente en nuestro medio debido al envejecimiento poblacional. El equilibrio sagital está ganando cada vez más espacio en los estudios relacionados a las patologías de la columna vertebral. Con excepción de la PS, los demás parámetros medidos en este estudio presentaron valores alterados cuando comparados al promedio poblacional. Nivel de Evidencia II. Estudio observacional y retrospectivo.

Avaliação técnica do dispositivo de fechamento vascular Exoseal-Cordis / Technical evaluation of Exoseal-Cordis vascular closure device

Contexto: Os dispositivos de oclusão vascular (DOV) permitem rápida remoção da bainha introdutora de um acesso arterial, reduzindo o tempo de hemostasia, a restrição do paciente ao leito e as complicações no sítio de punção. Objetivos: Avaliar a eficácia e possíveis complicações do uso de dispositivo de oclusão arterial comparado com a compressão manual. Métodos: Estudo longitudinal prospectivo randomizado com 20 pacientes no período de dezembro de 2014 a julho de 2015 em Maringá (PR). Foram divididos em dois grupos: aqueles que utilizaram DOV (grupo DOV) e aqueles submetido apenas a compressão manual (grupo CM). Realizaram-se exames de ultrassom Doppler para avaliar a espessura pele-artéria pré e pós-procedimento e verificou-se o tempo de compressão e de deambulação. Os dados foram analisados pelo Programa Statistical Analysis Software. Resultados: Um total de 60% dos pacientes eram do sexo masculino e a média de idade de ambos os grupos foi de aproximadamente 60 anos. Não houve diferença na espessura pele-artéria entre os grupos. O tempo de compressão no grupo DOV foi de 2 minutos e no grupo CM foi de 21±2,11 minutos (p = 0,0005), e o tempo para retorno de movimentos no membro inferior puncionado foi de 2,35±0,75 horas no grupo DOV e de 6 horas no grupo CM (p = 0,0005). Não houve complicações. Conclusões: Neste estudo a hemostasia por compressão manual foi tão efetiva quanto o uso de DOV, embora o tempo de compressão e o tempo para retorno às atividades sejam menores nos pacientes submetidos ao uso do dispositivo

Background: Vascular closure devices (VCD) make it possible to rapidly remove the introducer sheath from an arterial access, thereby reducing the length of time in hemostasis, the time patients are restricted to their beds, and the number of puncture site complications. Objectives: To evaluate the efficacy and possible complications associated with use of an arterial occlusion device compared with manual compression. Methods: This was a prospective, randomized, longitudinal study of 20 patients conducted from December 2014 to July 2015 in Maringá, PR, Brazil. They were divided into two groups: those who were treated using a VCD (VCD group) and those for whom only manual compression was used (MC group). Doppler ultrasound examination was used to determine skin-artery depth before and after the procedure and the length of time compression was maintained and the delay before mobilization were also recorded. Data were analyzed using the program Statistical Analysis Software. Results: A total of 60% of the patients were male and the mean age of both groups was approximately 60 years. There was no difference in skin-artery depth between the groups. The duration of compression in the VCD group was 2 minutes and in the MC group it was 21±2.11 minutes (p = 0.0005), while the delay before return to mobility of the lower limb that had been punctured was 2.35±0.75 hours in the VCD group and 6 hours in the MC group (p = 0.0005). There were no complications. Conclusions: In this study, hemostasis by manual compression exhibited equal efficacy to use of a VCD, but the duration of compression and delay before resumption of activity were shorter in the patients for whom the device was employed

Glutathione and related enzymes in Egyptian bladder cancer patients

Enzymes metabolizing foreign compounds may modify the risk of chemically induced bladder cancer. The aim of the present work was to determine the level of detoxifying macromolecules and activities of detoxifying enzymes, namely; glutathione [GSH], glutathione S-transferase pie [pi-GST], glutathione peroxidase [GPx], and glutathione reductase [GR] in blood of bladder cancer patients; as well as; groups at high risk for this type of cancer who are subjected to environmental chemical pollution such as smoking and biological pollution such as schistosomiasis. The ultimate goal of the study is to search among these parameters for a marker that could be of value in detection of bladder cancer or at least might have a role in selecting individuals that are at high risk for bladder cancer. A total of eighty individuals were included in the present study. They were divided into 4 groups: Healthy normal subjects as control group, Smoking group, Schistosomal patients group, and Bladder cancer patients group. All the parameters were determined either by spectrophotometric or ELISA technique. Glutathione level, Pi-GST and GR activities were slightly elevated among smokers and schistosomal patients. Nevertheless, their levels were highly significantly elevated in sera of bladder cancer patients as compared with their corresponding levels among the other groups [p<0.001]. Beside, pi-GST was elevated in cases with squamous cell carcinoma [SCC] more than those with transitional cell carcinoma [TCC]. However, GPx showed no significant changes among all investigated groups [p=0.122]. We suggest that the values of GSH, pi-GST and GR activities could be added to tumor markers for bladder cancer detection, or at least for indicating groups who are at high risk to put them under medical surveillance

Influence of tumor grade and CD95 expression on progression-free survival following surgery and irradiation for localized intracranial ependymoma

This study was conducted to evaluate the impact of extent of tumor resection, histological grade and CD95 expression on the progression-free survival [PFS] after surgical excision and irradiation [RT] for patients with localized intracranial ependymomas. This study includes thirty four patients with localized intracranial ependymomas with median age of 23.5 [range 2-65] at the time of surgical excision. All patients underwent microsurgical resection followed by RT with or without chemotherapy during the period between January 2000 and June 2003. Ten patients were histologically identified as anaplastic ependymoma [AEP]. Immunohistochemical staining for CD95 was applied as a marker for apoptosis for all specimens of the studied group. The extent of surgical resection was estimated as gross total resection in 21 patients [61.8%], near total resection in 4 patients [11.8%] and subtotal resection in 9 patients [26.5%]. The median dose of RT to the primary site was 55Gy. Only 8 patients received pre RT chemotherapy [CTh]. At a median follow up period of 24.5 months [range 6-51 months], 25 patients were alive, while, at a median follow up of 22 months [range 8-49 months], progression occurred in 15 patients [12 local and 3 local and distant], with a median time to failure after RT of 18 months [range 5-37 months]. There was a significant influence of gross total resection [p=0.003] and tumor grade [p=0.009] on the PFS after RT. The two years PFS rate was 26% +/- 13% for patients with AEP compared with 82% +/- 7% for patients with EP. When correlating these findings with the extent of surgical resection, age less than 4 years, pre-RT CTh and CD95 expression, they remained significant. AEP was more frequent in the supratentorial ependymomas. Five of 9 patients with supratentorial tumors developed recurrence and all were anaplastic type [AEP] and CD95-stained tumors. Progression-free survival was found to be significantly influenced by the extent of surgical resection. Tumor grade and apoptosis have an impact upon the outcome of patients with ependymoma treated with surgery and RT. CTh before RT had a worse effect on the PFS and overall survival.