Percutaneous Pedicle Screws Positioning by means of the "Scotty Dog" Imaging Monitoring Technique in Spine Surgery: A Case Series / Posicionamento de parafuso pedicular percutâneo por meio do método Scotty Dog de monitoramento de imagem em cirurgia de coluna: uma série de casos

Objectives Vertebrae, when looked at in x-rays with oblique incidence (45°), seem similar in shape to a Scottish Terrier dog. The "Scotty Dog" incidence is commonly used in spinal pain treatments such as radiofrequency and transforaminal blockages for correct insertion of the needle, because it allows complete visualization of the pedicle. The objective is to describe a series of cases of spinal surgery using the "Scotty Dog" monitoring technique and to evaluate safety. Methods In this study, we describe all consecutive patients operated by the same surgeon from August 2011 to August 2012 using the "Scotty Dog" technique of fluoroscopic monitoring. Patients were operated for spondylolisthesis, lumbar canal stenosis, spinal disc herniations, and fractures. All patients underwent computed tomography (CT) after surgery to confirm the correct positioning of screws. Results During the study period, 42 patients with a mean age of 64.5 years underwent operation, most of them for spinal disc herniation correction. In all cases, visualization of the pedicle was possible in all its length and no case of foramen invasion was registered. Surgical time was 98 minutes on average, with no need for transfusion or complications requiring admission to the ICU. There was one case of infection. Conclusions The Scotty Dog technique for imaging monitoring of the spine provides easy visualization of the whole pedicle, allowing a safe screw insertion. In this case series, there was no case of foramen invasion.

Objetivos As vértebras, visualizadas pela incidência oblíqua (45°) nos raios-X, têm o formato de um cão da raça Scottish Terrier. A incidência Scotty Dog é usada em tratamentos de dor na coluna, como radiofrequência e bloqueios transforaminais, para correta inserção da agulha, porque permite completa visualização do pedículo. O objetivo deste trabalho é descrever uma série de casos de cirurgia de coluna usando a técnica de monitoramento Scotty Dog e avaliar segurança. Métodos Todos os pacientes consecutivos operados pelo mesmo cirurgião de agosto de 2011 a agosto de 2012 usando a técnica Scotty Dog de monitoramento fluoroscópico foram descritos. Pacientes foram operados devido a espondilolistese, estenose do canal vertebral, hérnias e fraturas. Todos os pacientes foram submetidos a tomografia computadorizada após a cirurgia para confirmação do correto posicionamento dos parafusos. Resultados No período do estudo, 42 pacientes foramoperados, commédia de idade de 64,5 anos, a maioria para correção de hérnia de disco. Em todos os casos, a visualização do pedículo foi possível emtoda a sua extensão e não foi registrado caso de invasão do forame. O tempo de cirurgia foi de 98 minutos em média, sem necessidade de transfusões ou complicações exigindo internação em unidade de terapia intensiva. Houve um caso de infecção. Conclusões A técnica Scotty Dog de monitoramento por imagem da coluna permite fácil visualização de todo o pedículo e inserção do parafuso com segurança, com nenhum caso de invasão foraminal nesta série de casos.

Transitional cell carcinoma of the ureter and struvite calculi

Context: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. Case Report: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years andhad received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Metrotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.

Penis wound by scorpion sting

The majority of scorpion stings are oligosymptomatic, occurring mainly on the hands and feet Fatality is rare. Case report: A 33-year old man suffered a severe sting on his penis from a scorpion of the species Tytius trivittatus. Alcohol and salt were used without success in an effort to relieve pain. Medical assistance was sought 4 hours after the event, at which time diffuse erythema, edema and punctiform injury on the glans penis were observed, with no systemic manifestation. Intravenous meperidine was administered with immediate relief of the pain. The local signs disappeared within 48 hours, with the patient remaining asymptomatic.