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Introducción: La Discectomía Endoscópica Lumbar Percutánea (DELP) es una técnica mínimamente invasiva que se usa en distintos países desde finales de los ochenta para el tratamiento de las Hernias Discales. Objetivo: El propósito del presente artículo es presentar los resultados de la evolución clínica de 110 pacientes operados de distintas hernias discales lumbares por técnica endoscópica percutánea, con seis meses de seguimiento. Asimismo, describir la técnica realizada y los aspectos más relevantes del planning preoperatorio, entre ellos el punto de ingreso percutáneo. Materiales y Métodos: En un grupo de 110 pacientes y 141 discos operados entre abril de 2016 y octubre de 2019, se recogieron datos como la edad, el sexo, la clínica, las imágenes de RMN y el planning del ingreso (Skin Entry Point) con target en el fragmento discal herniado. Se realizó en todos los casos una fragmentectomía dirigida, y luego se complementó con técnica In-Out. Se registró, como dato principal, la diferencia en los puntajes de Oswestry (ODI) pre y postquirúrgico a los 6 meses del procedimiento. También se constató la duración de la operación, el tiempo de hospitalización, y la necesidad de reintervención. Todos los pacientes se operaron despiertos, recibiendo anestesia peridural y sedación. Resultados: Se operaron 110 pacientes y 141 hernias discales. El promedio de reducción en ODI a los 6 meses fue 47,5 puntos (SD=5,7), representando un porcentaje medio de reducción de 85% (SD=9,5). Desde el punto de vista técnico se logró promediar la distancia de línea media al ingreso o Skin Entry Point, según el nivel operado y el abordaje elegido. Conclusión: a la luz de los resultados en nuestra serie de 110 pacientes con hernias discales lumbares, operados despiertos por endoscopía percutánea, se obtuvieron mejorías en el dolor promedio del 85% a seis meses. La técnica endoscópica puede ser considerada como un procedimiento efectivo para pacientes con hernias foraminales, extraforaminales y centrales en los niveles L3L4, L4L5 y L5S1.
Introduction: Introduction: PELD is a minimally invasive technique that has been used in different countries since the late 1980s for the treatment of Herniated Discs. Objective: to describe the surgical method from the Approach point of view and PELD results in a series of 110 patients. Materials and Methods: In a group of 110 patients who together had 141 discs operated on between April 2016 and October 2019, data were collected on patients age and gender, clinical presentation, MRI abnormalities and Skin Entry Point (SEP) with target in the herniated disc fragment. A focused fragmentectomy was performed in all cases, and then it was complemented with an In-Out technique. The main result was the difference in the pre and postoperative Oswestry Disability Index (ODI) scores 6 months after the procedure. The operation duration, the lenght of hospitalization, and the need for reoperation were also recorded. All patients underwent surgery awake, receiving epidural anesthesia and sedation. Results: Respecting the SEP of the endoscope according to the MRI planning focused in the herniated fragment, the evolution of the patients was very favorable. The average reduction in ODI at 6 months was 47.5 points (SD = 5.7), representing an average percentage reduction of 85% (SD = 9.5). The average surgery time was 58 minutes, and the hospitalization time 8.5 hours. Conclusions: In our series of surgical patients with lumbar disc herniations, PELD with focused fragmentectomy in awake patients proved to be a technique with very good results, especially with prior planning of the SEP to achieve effective root decompression
Subject(s)
Humans , Diskectomy , General Surgery , Endoscopy , Hernia , Intervertebral Disc DisplacementABSTRACT
Introducción: La DELP es una técnica mínimamente invasiva que se usa en distintos países desde finales de los años ochenta para el tratamiento de las hernias discales. Nuestro objetivo es describir los resultados de las DELP en una serie de pacientes despiertos, con anestesia peridural y sedación. Materiales y Métodos: En un grupo de 60 pacientes y 77 hernias de discos operados entre abril de 2016 y marzo de 2018, se recogieron datos como la edad, el sexo, la imagen clínica y las anomalías de imágenes mediante MRI. El resultado principal fue la diferencia en los puntajes de Oswestry (ODI) pre y postquirúrgico a las 8 semanas del procedimiento. También se evaluaron los criterios de Macnab, la duración de la operación, el tiempo de hospitalización, las complicaciones quirúrgicas y la necesidad de reintervención. Los pacientes recibieron anestesia peridural y sedación. Resultados: Se operaron 60 pacientes y 77 hernias discales. El promedio de reducción en ODI a las 8 semanas fue 48 puntos (SD=5), representando un porcentaje medio de reducción de 85%(SD=8). Según los criterios de Macnab, tuvieron excelente o buena evolución el 85% de los pacientes, regular 10% y mala evolución 5%. El tiempo de cirugía promedio fue de 50 minutos y el de hospitalización 8,6 horas. Conclusiones: En nuestra serie de pacientes quirúrgicos con hernias discales lumbares la DELP resultó ser una técnica con muy buenos resultados en la reducción del dolor, de corta duración quirúrgica, sin complicaciones y breve estadía hospitalaria. La opción del paciente despierto y la modalidad ambulatoria fueron muy aceptadas por los pacientes y resultaron de factible ejecución.
Introduction: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally-invasive technique that has been used in different countries since the late eighties for the treatment of herniated discs. Objective: To describe the results of PELD in a series of awake patients, treated with epidural anesthesia and mild sedation. Methods and Materials: In a group of 60 patients, who together had 77 discs operated upon between April 2016 and March 2018, data were collected on patient age and gender, clinical presentation, and MRI abnormalities. The main outcome of interest was the difference between preoperative and postoperative Oswestry (ODI) scores eight weeks after the procedure. Macnab criteria, operation duration, length of hospitalization, surgical complications, and the need for reoperation were other outcomes evaluated. All patients received epidural anesthesia and mild sedation. Results: The average reduction in ODI at 8 weeks was 48 points (SD = 5), representing an average percentage reduction of 85% (SD = 8). By Macnab's criteria, 85% of patients experienced either an excellent or good result, while 10% and 5% had a fair and poor result, respectively. Average surgery time was 50 minutes and in-hospitalization stay 8.6 hours. Conclusions: In our series of surgical patients with lumbar disc herniations, PELD yielded very good results, manifest as significantly reduced pain, brief procedural durations, no complications, and short hospital stays. Patients accepted the option of being awake and immediately ambulatory, and the approach proved highly feasible to execute.
Subject(s)
Humans , Hernia , General Surgery , Therapeutics , Diskectomy, Percutaneous , DiskectomyABSTRACT
Abstract: Undoubtedly, the publication of floristic lists and phytosociological studies are important tools for metadata generation, quantification and characterization of the megadiversity of Brazilian forests. In this sense, this work had the objective of describing the composition and the structure of the tree community of one hectare of Dense Atlantic Rainforest, at an altitude of 800 m. All individuals, including trees, palm trees, arborescent ferns and dead and standing stems, with a diameter at breast height (DBH) of ≥ 4.8 cm were sampled. After the identification of the botanical material, we proceeded to calculate the usual phytosociological parameters, besides the Shannon diversity index (H') and Pielou equability index (J). A total of 1.791 individuals were sampled, of which 1.729 were alive, belonging to 185 species, 100 genera and 46 families. The results obtained showed a strong similarity of structure and floristic composition with plots of both Montana and Sub Montana Ombrophilous Dense Forest studied in the same region. This reinforces the hypothesis that the transition between the phytophysiognomies of the Atlantic Ombrophylous Dense Forest is gradual, and that the boundaries between them cannot be clearly established.
Resumo: Indiscutivelmente a publicação de listas florísticas e estudos fitossociológicos são importantes ferramentas para a geração de metadados, quantificação e caracterização da megadiversidade das florestas brasileiras. Neste sentido, o presente trabalho teve por objetivo descrever a composição e a estrutura da comunidade arbórea de um hectare de Floresta Ombrófila Densa Atlântica, na cota dos 800 m de altitude. Para tanto foram estabelecidas 100 subparcelas de 10 x 10 m, distribuídas em quatro blocos amostrais de 0,25 ha, onde foram amostrados todos os indivíduos arbóreos, incluindo palmeiras, fetos arborescentes e indivíduos mortos e em pé, com DAP (diâmetro à altura do peito) ≥ 4,8 cm. Após a identificação do material botânico e do cálculo dos parâmetros fitossociológicos usuais, foram calculados os índices de diversidade de Shannon (H') e de eqüabilidade de Pielou (J). Foram amostrados 1.791 indivíduos arbóreos, sendo 1.729 vivos pertencentes a 185 espécies, 100 gêneros e 46 famílias. Os resultados obtidos mostram forte similaridade de estrutura e composição florística com parcelas tanto de Floresta Ombrófila Densa Montana como Floresta Ombrófila Densa Submontana estudadas na mesma região, reforçando a hipótese que a transição entre as fitofisionomias da Floresta Ombrófila Densa Atlântica é gradual e que os limites entre elas não podem ser claramente estabelecidos.
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Objectives:To compare the early curative effect of visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis.Methods:49 patients with single segmental lumbar spinal stenosis combined with lumbar disc herniation(LDH) were treated in our hospital from March 2016 to March 2017.Among them,21 cases accepted VPTED,and 28 cases underwent MED.The length of incision,amount of bleeding during operation,operation time,length of hospital stay and the cost of hospitalization were recorded in the both groups.Visual analogue scale(VAS) was used to evaluate the effect of surgery,Oswestry disability index(ODI) was used to evaluate the clinical efficacy.The modified MacNab criteria were used to evaluate the efficacy of the patients at final follow-up.Results:There were no statistical differences among the age,the ratio of male to female,follow-up time,low back pain,weakness,sensory disturbance,general reflexes and prominent segments(P＞0.05).There were statistically significant differences between the two groups in preoperative and postoperative VAS and ODI scores(P＜0.05).There was no significant difference in VAS or ODI score between groups at the same time (P＞0.05).The length of incision(0.78±0.06cm vs 1.95±0.12cm),the amount of intraoperative perspective(15.86± 2.66 vs 2.18±0.38) and the operation time(87.51±30.46min vs 47.53±13.61min) had significant difference between VPTED and MED group(P＜0.05).There was no significant difference in hospitalization time or hospitalization expenses between the two groups(P＞0.05).At final follow-up,based on the MacNab standard,it was excellent in 17 cases,good in 3 cases,fair in 1 case in VPTED group;it was excellent in 22 cases,good in 4 cases,fair in 2 cases in MED group.Excellent rate of the VPTED group was 95.24％,and that was 92.86％ in the MED group,there was no significant difference between the two groups(P＞0.05).Conclusions:Visualization of percutaneous transforaminal endoscopic discectomy (VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis have good short-term curative effect,it iproves that VPTED is a safe and effective minimally invasive surgery.
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<p><b>OBJECTIVE</b>To analyze the complications of lumbar intervertebral disc herniation treated with percutaneous endoscopic lumbar discectomy(PELD), and discuss how to avoid these complications.</p><p><b>METHODS</b>The data of 132 patients with lumbar intervertebral disc herniation underwent PELD from October 2013 and June 2015 were retrospectively analyzed, including 85 males and 47 females with an average age of 42.9 years old. There were 6 cases of L₃,₄, 68 of L₄,₅ and 58 of L₅S₁. The incidences of intraoperative and postoperative complications were analyzed.</p><p><b>RESULTS</b>There was spinal dura mater injury in 1 patient, but no cerebrospinal fluid leakage and nerve function deficit was found, the muscle strength did not decrease postoperatively and the incision healed well. Two patients converted to open surgery ultimately because of stenosis of the intervertebral foramen and adhesion between nucleus pulposus and spinal dura mater; two patients complicated with early recurrence(in 3 months);nucleus pulposus residue developed in 3 patients; all of them were treated by open surgery and got satisfactory results. One patient with heart disease history complicated with supraventricular tachycardia after surgery and 2 patients with the increased cerebrospinal fluid pressure during surgery.</p><p><b>CONCLUSIONS</b>PELD have a steep learning curve, and the technology is a safe and effective method in treating lumbar disc herniation, but the beginners must have enough open surgery experience, and to grasp indications strictly.</p>
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Based on biological and meteorological long-term database (1979-1983 and 1996-2000), we analyzed the variation in the juvenile recruitment and artisanal fishery landings of the mullet (Mugil platanus) in the Patos Lagoon estuary and its relationships with the regional rainfall and estuarine salinity anomalies during two strong El Niño events (1982-83 and 1997-98). Juvenile and adult mullets declined in abundance under the high rainfall and near-zero salinity that prevailed in the estuary during both El Niño events. We proposed two different hypotheses to explain the El Niño-induced effects on the juvenile and adult stages of the mullet in the estuary. First, high freshwater outflow during a very strong El Niño might render ineffective the mechanism of passive immigration of juvenile mullets into the estuary, which can lead to their decline in the estuary during El Niño events. Second, near-zero salinity at the estuarine area along several months during strong El Niño events could lead to higher spatial dispersion of the maturing mullet during their migration to the ocean , resulting in smaller shoals of individuals and, consequently, lower catches by artisanal fishermen.
Episódios El Niño ocorrem na região tropical do Oceano Pacífico e estão associados com o aumento da descarga continental de água na Lagoa dos Patos (10.360 km²) e sua região estuarina (971 km²). A partir de um banco de dados meteorológicos e biológicos de longo prazo (1979-1983 e 1996-2000), este trabalho investiga as variações no recrutamento de juvenis e no desembarque da pesca artesanal da tainha (Mugil platanus) no estuário da Lagoa dos Patos e suas relações com anomalias regionais de chuva e anomalias locais de salinidade durante dois fortes episódios El Niño (1982-1983 e 1997-1998). Tanto os juvenis quanto a captura dos adultos na pesca artesanal diminuíram em abundância durante as chuvas excessivas e salinidades próximas a zero que prevaleceram no estuário durante ambos eventos climáticos. Duas hipóteses são sugeridas para explicar os efeitos ocasionados pelo El Niño sobre as fases juvenis e adultas da tainha no estuário da Lagoa dos Patos. Primeiro, a elevada descarga continental durante forte eventos El Niño poderia afetar negativamente o transporte passivo de juvenis de tainha para o interior do estuário, o que levaria ao declínio de juvenis na região nesse período. Segundo, as salinidades próximas a zero durante vários meses no estuário durante forte eventos El Niño poderia acarretar maior dispersão dos cardumes de tainhas adultas durante a sua migração reprodutiva para o mar, resultando em menores capturas pelos pescadores artesanais da região.