Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life

Abstract Background: The aim of this study was to evaluate the QoL of patients undergoing heart valve replacement using the SF-36 questionnaire, compare it between patients with mechanical prosthesis and patients with bioprosthesis, and correlate the results with sociodemographic variables. Objective: To assess the QoL of patients undergoing heart valve replacement and compare it between patients with bioprosthetic valves and patients with mechanical prosthetic valves. Methods: We included 36 consecutive patients (16 men) with a mean age of 51 years and six months, who underwent mitral or aortic valve replacement from September 2007 to December 2011. The study was conducted between March and May 2012 and involved the application of the SF-36 survey and a sociodemographic questionnaire. Statistical tests were performed, and data are expressed as absolute frequency and percentile, and median and interquartile range (P25 and P75) (Mann-Whitney test), considering a significance of 95%. Results: The average time of surgery was 32.5 months (8-61 months). Participants were asked about the practice of physical activity, and 41.7% were physically active. For the SF-36 domains, the highest scores were observed for the social domain whereas the lowest scores were found for mental health, with a mean of 89.25 and 54.44, respectively. In the statistical analysis, we found statistically higher values in emotional functional for patients with mechanical valve prosthesis (p = 0.0084). Conclusion: The QoL of the patients undergoing heart valve replacement improves considerably after the surgery, except for the mental health domain, probably due to the low practice of physical activity. The type of prosthesis seems not to influence the QoL or the patients in the late postoperative period.

Discal Cyst: a Rare Cause of Neurologic Compression in the Young Adult

INTRODUCTION: discal cysts are rare pathology. Its clinical presentation can be mistaken for disc herniation, with back pain, radiculopathy and neurological deficit. It is more common in male patients in their fourth life decade. Because they are rare, there is no consensus about the treatment. A great variety of procedures, from medication for the pain to endoscopic or microdiscectomy excision, have been described. OBJETIVE: Describe a case of discal cyst on the l4-l5 level with compression of l5 right nerve root treated successfully with a minimal invasive procedure. : Case report. METHODS: Review medical records, pertinent images, interview with the patient and surgical team, intraoperative and histopathological findings. The surgical technique used was minimally invasive. RESULTS: Magnetic resonance imaging (MRI) demonstrated a cystic lesion imaging at the level of the L4-L5 disc. The cystic mass displaced the thecal sac dorsally compressed the L5 transversing root. The patient was submitted to a minimally invasive microendoscopic technique using a tubular retractor. He recovered completely after the procedure, presenting absence of leg pain and went back to his regular activities 3 weeks after the surgery. Histopathological examination of the cyst revealed thick fibrous connective tissue interspersed with areas of chronic inflammation. CONCLUSION: Discal cysts are rare intraspinal lesions. They can trigger severe neurological symptoms, and should be differentiated from other forms of epidural cysts and tumors. There are many treatment options that can be chosen from but no consensus. We used a treatment that was less invasive than the ones described in the literature.

INTRODUÇÃO: cistos discais são patologia rara. Sua apresentação clínica pode ser confundida com hérnia de disco, com dor nas costas, radiculopatia e déficit neurológico. É mais comum em pacientes do sexo masculino em sua quarta década de vida. Porque eles são raros, não há consenso sobre o tratamento. Uma grande variedade de procedimentos, de medicação para a dor para a endoscopia ou excisão microdiscectomy, têm sido descritas. OBJETIVO: descrever um caso de cisto discal no nível L4-L5 com compressão da raiz nervosa L5 di-reita tratada com sucesso com um procedimento minimamente invasivo. Desenho do estudo: Relato de caso. MÉTODO: revisão de registros médicos, imagens pertinentes, entrevista com o paciente e equipe cirúrgica, intra e histopatológicos. A técnica cirúrgica utilizada foi minimamente invasiva. : A ressonância magnética (MRI) demonstrou uma imagiologia lesão cística ao nível do disco L4-L5. A massa cística deslocou o saco tecal dorsal comprimido a transversing raiz L5. O paciente foi submetido a uma técnica microendoscópica minimamente invasiva utilizando um afastador tubular. Ele se recuperou completamente após o procedimento, apresentando ausência de dor nas pernas e voltou às suas atividades regulares 3 semanas após a cirurgia. O exame histopatológico do cisto revela tecido conjuntivo fibroso de espessura intercaladas com áreas de inflamação crónica. CONCLUSÃO: cistos discais são lesões intra-espinhais raras. Eles podem desencadear os sintomas neurológicos graves, e deve ser diferenciada de outras formas de cistos epidurais e tumores. Há muitas opções de tratamento que podem ser escolhidos a partir de, mas não há consenso. Utilizou-se um tratamento que era menos invasiva do que os descritos na literatura.