Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 3.621
Filter
1.
Medicina UPB ; 41(1): 38-50, mar. 2022. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1362691

ABSTRACT

Las urgencias oncológicas son complicaciones comunes de la evolución natural del tumor o de su manejo. Algunas pueden presentarse de manera sutil y ser pasadas por alto, lo que aumenta la morbimortalidad. El objetivo de esta revisión narrativa es recopilar información actualizada de las principales complicaciones oncológicas, para ello se realizó una revisión de artículos originales, revisiones sistemáticas y narrativas en bases de datos como Scopus, SciELO, PubMed, ScienceDirect y en el buscador Google Scholar. Se seleccionaron 63 referencias que mostraran información relevante acerca de las urgencias oncológicas planteadas para el desarrollo del artículo. En la revisión se discute que las complicaciones pueden clasificarse de acuerdo con su origen en infecciosas (neutropenia febril), metabólicas (síndrome de lisis tumoral e hipercalcemia maligna) y obstructivas (síndrome de vena cava superior, obstrucción intestinal, compresión medular y taponamiento cardiaco). El diagnóstico requiere un alto índice de sospecha, el médico debe tener la capacidad resolutiva y el conocimiento necesarios para el manejo y hacer uso racional de los recursos diagnósticos. Es necesario adoptar medidas terapéuticas que impacten positivamente en el pronóstico y que reduzcan la morbimortalidad.


Oncological emergencies are common complications resulting from the natural evolution of the tumor or its management; however, some of them may be subtle or even overlooked, which contributes to greater morbidity and mortality. Our aim was to gather updated information on the main oncological complications. A narrative literatura review was performed by searching for original articles, systematic reviews and narratives, in databases such as Scopus, SciELO, PubMed, ScienceDirect and in the Google Scholar search engine. 63 references were selected that addressed relevant information about the oncological emergencies raised for the development of the article. According to their origin, complications can be classified into infectious (febrile neutropenia), metabolic (tumor lysis syndrome and malignant hypercalcemia) and obstructive (superior vena cava syndrome, intestinal obstruction, spinal cord compression and cardiac tamponade). Facing these complications requires a high level of suspicion; the physician must be able to resolve each complication and have the necessary knowledge to approach each case, with a rational use of diagnostic resources. It is also necessary to adopt therapeutic measures that positively impact patients. patient prognosis, decreasing morbidity and death.


As urgências oncológicas são complicações comuns da evolução natural do tumor ou do seu manejo. Algumas podem apresentar-se de maneira sutil e ser passadaspor encima, o que aumenta a morbimortalidade. O objetivo desta revisão narrativa é recopilar informação atualizada das principais complicações oncológicas, para isso se realizou uma revisão de artigos originais, revisões sistemáticas e narrativas em bases de dados como Scopus, SciELO, PubMed, ScienceDirect e no buscador Google Scholar. Se selecionaram 63 referências que mostraram informação relevante sobre às urgências oncológicas apresentadas para o desenvolvimento do artigo. Na revisão se discuteque as complicações podem classificar-se de acordo com a sua origem em infecciosas (neutropenia febril), metabólicas (síndrome de lise tumoral e hipercalcemia maligna) e obstrutivas (síndrome de veia cava superior, obstrução intestinal, compressão medular e entupimento cardíaco). O diagnóstico requere um alto índice de suspeita, o médico deve ter a capacidade resolutiva e o conhecimento necessário para o manejo e fazer uso racional dos recursos diagnósticos. É necessário adotar medidas terapêuticas que impactem positivamente no prognóstico e que reduzam a morbimortalidade.


Subject(s)
Humans , Neoplasms , Spinal Cord Compression , Superior Vena Cava Syndrome , Cardiac Tamponade , Tumor Lysis Syndrome , Emergencies , Febrile Neutropenia , Hypercalcemia
2.
Coluna/Columna ; 20(4): 291-294, Oct.-Dec. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1356184

ABSTRACT

ABSTRACT Objectives: To evaluate the epidemiological profile of patients with spinal fractures over a two-year period (2017 and 2018) in a quaternary hospital in the city of São Paulo. Methods: A cross-sectional study was carried out through the analysis of the electronic medical records of patients treated by the Spine group of the Department of Orthopedics and Traumatology at the Orthopedics and Traumatology Emergency Room of Hospital das Clínicas de São Paulo in the years 2017 and 2018. Results: A total of 185 patients were evaluated over two years. Males were the gender most frequently evaluated (69.19%), and the mean patient age was 43.95 years. The most common trauma mechanisms were falls from a height (45.95%) and traffic accidents (29.73%). The cervical spine, affected in 28.65%, was the most affected region, followed by the thoracolumbar region (26.56%). Most patients did not present deficits at the initial moment (71.89%) and 54.05% of patients underwent surgery for treatment. Conclusion: Most traumas involving the spine affect adults of working age (from 20 to 60 years old), with a predominance of males. Most injuries occurred in the cervical region, which is the region most commonly associated with severe trauma and neurological injuries. This study can help in planning prevention and precaution strategies for spinal trauma. Level of evidence III; Cross-sectional study.


RESUMO Objetivos: Avaliar o perfil epidemiológico dos pacientes com fraturas da coluna vertebral no período de dois anos (2017 e 2018) em hospital quaternário da cidade de São Paulo. Métodos: Foi realizado um estudo transversal mediante análise dos prontuários eletrônicos de pacientes atendidos pelo grupo de Coluna do Departamento de Ortopedia e Traumatologia no Pronto Socorro de Ortopedia e Traumatologia do Hospital das Clínicas de São Paulo nos anos de 2017 e 2018. Resultados: Um total de 185 pacientes foram avaliados ao longo de dois anos. O sexo masculino foi predominante na avaliação (69,19%), e a média de idade dos pacientes de foi de 43,95 anos. Os mecanismos de trauma mais comuns foram queda de altura (45,95%) e acidentes de trânsito (29,73%). A coluna cervical, acometida em 28,65%, foi a mais afetada, seguida pela região toracolombar (26,56%). A maioria dos pacientes não apresentava déficits no momento inicial (71,89%) e 54,05% dos pacientes foram submetidos a cirurgia para o tratamento. Conclusão: A maioria dos traumas envolvendo a coluna vertebral acometem a população economicamente ativa (dos 20 aos 60 anos), com predomínio no sexo masculino. A maioria das lesões ocorreram na região cervical, que é a região mais comumente associada a traumas graves e lesões neurológicas. Este estudo pode ajudar a planejar estratégias de prevenção e precaução dos traumas da coluna vertebral. Nível de evidência III; Estudo transversal.


RESUMEN Objetivos: Evaluar el perfil epidemiológico de pacientes con fracturas de columna vertebral en un período de dos años (2017 y 2018) en un hospital cuaternario de la ciudad de São Paulo. Métodos: Se realizó un estudio transversal mediante el análisis de historias clínicas electrónicas de pacientes atendidos por el grupo de Columna Vertebral del Departamento de Ortopedia y Traumatología de la Sala de Emergencias de Ortopedia y Traumatología del Hospital de Clínicas de São Paulo en 2017 y 2018. Resultados: Se evaluó a un total de 185 pacientes durante dos años. En la evaluación predominó el sexo masculino (69,19%), siendo la edad promedio de los pacientes de 43,95 años. Los mecanismos traumatológicos más frecuentes fueron las caídas de altura (45,95%), seguidos de los accidentes de tráfico (29,73%). La columna cervical, afectada en un 28,65%, fue la más afectada, seguida de la región toracolumbar (26,56%). La mayoría de los pacientes no tenían déficits al inicio del estudio (71,89%) y el 54,05% de ellos fueron sometidos a cirugía para su tratamiento. Conclusión: La mayoría de los traumatismos que involucran la columna afectan a la población económicamente activa (20 a 60 años), con predominio del sexo masculino. La mayoría de las lesiones se produjeron en la región cervical, que es la región más comúnmente asociada a los traumatismos graves ya las lesiones neurológicas. Este estudio puede ayudar a planificar estrategias de prevención y precaución de los traumatismos de la columna vertebral. Nivel de evidencia III; Estudio transversal.

3.
Rev. bras. ciênc. vet ; 28(4): 190-197, out./dez. 2021. il.
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1363199

ABSTRACT

As lesões decorrentes de atropelamento são as principais causas de fraturas e luxações vertebrais, ocasionando graus variáveis de injúrias vertebrais e medulares. O presente trabalho tem como objetivo relatar a ocorrência de lesão traumática em coluna vertebral de cão sem raça definida, com quatro anos de idade, resultando em luxação T11-12, com exposição de T11 e secção medular, estando o paciente paraplégico, com sinais de lesão em neurônio motor superior e ausência de nocicepção profunda em membros pélvicos. O tratamento de escolha foi a vertebrectomia de T11, associada ao alinhamento de T10-12 com introdução de pinos e fixação com polimetilmetacrilato (PMMA) associado à ceftriaxona. Em decorrência de lesão na pleura parietal no trans-cirúrgico, optou-se pela toracostomia para introdução de tubo torácico, o qual permaneceu no paciente por quatro dias. No pós-operatório, o paciente apresentou recuperação satisfatória, sendo recomendado aos tutores a confecção de cadeira de rodas a fim de facilitar sua locomoção. A técnica mostrou-se satisfatória para minimizar as infecções passíveis de ocorrência em fraturas expostas, bem como melhorar a qualidade de vida do paciente, evitando-se dores crônicas.


Injuries resulting from being run over are the leading causes of vertebral fractures and dislocations, causing varying vertebral and spinal injuries. The present study aims to report the occurrence of traumatic injury to the spine of a mixed breed dog, aged four years, resulting in a T11-12 dislocation, with T11 exposure and spinal section, with the patient showing paraplegia, signs of an upper motor neuron lesion and absence of deep nociception in pelvic limbs. The treatment of choice was T11 vertebrectomy, associated with the alignment of T10-12 with the introduction of pins and fixation with polymethylmethacrylate (PMMA) associated with ceftriaxone. Due to a lesion in the parietal pleura during the surgery, thoracostomy was chosen to introduce a chest tube, which remained in the patient for four days. In the postoperative period, the patient presented a satisfactory recovery, and it was recommended that tutors make a wheelchair to facilitate their mobility. The technique proved to be satisfactory for minimizing infections that could occur in open fractures and improving the patient's quality of life, avoiding chronic pain.


Subject(s)
Animals , Spinal Cord Injuries/veterinary , Surgery, Veterinary , Spinal Fractures/veterinary , Paraplegia/veterinary , Thoracostomy/veterinary , Fracture Dislocation/veterinary
4.
Arq. bras. neurocir ; 40(3): 229-237, 15/09/2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1362115

ABSTRACT

Introduction Dorsal root entry zone (DREZ) leasioning (DREZ-otomy) is considered an effective treatment for chronic pain due to spinal cord injuries, brachial and lumbosacral plexus injuries, postherpetic neuralgia, spasticity, and other conditions. The objective of the technique is to cause a selective destruction of the afferent pain fibers located in the dorsal region of the spinal cord. Objective To identify and review the effectiveness and the main aspects related to DREZ-otomy, as well as the etiologies that can be treated with it. Methods The PubMed, MEDLINE and LILACS databases were used as bases for this systematic review, having the impact factor as the selection criteria. The 23 selected publications, totalizing 1,099 patients, were organized in a table for systematic analysis. Results Satisfactory pain control was observed in 70.1% of the cases, with the best results being found in patients with brachial/lumbosacral plexus injury (70.8%) and the worst, in patients with trigeminal pain (40% to 67%). Discussion Most of the published articles observed excellent results in the control of chronic pain, especially in cases of plexus injuries. Complications are rare, and can be minimized with the use of new technologies for intraoperative monitoring and imaging. Conclusion DREZ-otomy can be considered a great alternative for the treatment of chronic pain, especially in patients who do not tolerate the side effects of the medications used in the clinical management or have refractory pain.

5.
Coluna/Columna ; 20(3): 224-228, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339750

ABSTRACT

ABSTRACT Objective The aim of this paper is to analyze the epidemiological profile of a large series of spine trauma victims in the Southernmost state of Brazil. Methods A retrospective study including spine trauma patients was performed at a tertiary hospital from January 1st, 2013 to December 31st, 2018. The variables analyzed include demographic data, information related to the trauma (etiology, trauma mechanism, type of spine injury, number of vertebrae involved, vertebral segment involved), neurological status at hospital admission (Frankel scale), treatment performed and the outcome (number of days in hospital, neurological outcome, and mortality). Results A total of 808 patients were included. The mean age was 47.9 (±19.0), and the majority were male and Caucasian. The most frequent etiology was falls from height (N=508; 62.9%) followed by traffic accidents (N=185; 22.9%). The thoracolumbar segment was the spinal segment most frequently affected, occurring in 401 (52.1%) patients, followed by the cervical, thoracic and lumbar segments. The incidence of SCI was 16.7%. Non-operative treatment was indicated in 510 (63.1%) patients. Conclusion The authors presented the largest epidemiological profile regarding spine trauma in Latin America, analyzing a total of 808 patients, which represents an incidence of 134.6 cases/year. This paper fills a gap in the medical literature regarding the epidemiological profile of this disease in Latin America. Level of evidence II; Prognostic study.


RESUMO Objetivos O objetivo deste artigo é analisar o perfil epidemiológico, com base em uma grande série de pacientes acometidos por trauma raquimedular no extremo sul do Brasil. Métodos Estudo retrospectivo que incluiu pacientes com trauma raquimedular realizado em um hospital terciário entre 1o de janeiro de 2013 e 31 de dezembro de 2018. As variáveis analisadas incluem dados demográficos, informações referentes ao trauma (etiologia, mecanismo, tipo de lesão, número de vértebras envolvidas e segmento vertebral afetado), estado neurológico à internação (escala de Frankel), tratamento realizado e desfecho (dias de internação, resultado neurológico e mortalidade). Resultados Um total de 808 pacientes foram incluídos. A média de idade do grupo foi de 47,9 (± 19,0), sendo a maioria do sexo masculino e caucasiana. A etiologia mais frequente foi queda de altura (N = 508; 62,9%) seguida de acidentes de trânsito (N = 185; 22,9%). O segmento toracolombar foi o mais acometido, ocorrendo em 401 (52,1%) pacientes, seguido pelo cervical, torácico e lombar. A incidência de lesão raquimedular foi de 16,7%. O tratamento não cirúrgico foi indicado para 510 (63,1%) pacientes. Conclusão Os autores apresentam o maior perfil epidemiológico de trauma de coluna da América Latina, analisando um total de 808 pacientes, o que representa uma incidência de 134,6 casos / ano. Este artigo preenche uma lacuna da literatura médica no que diz respeito ao perfil epidemiológico desta doença na América Latina. Nível de evidência II; Estudo Prognóstico.


RESUMEN Objetivos El objetivo de este artículo es analizar el perfil epidemiológico, con base en una gran serie de pacientes acometidos por trauma raquimedular en el extremo sur de Brasil. Métodos Estudio retrospectivo que incluyó a pacientes con trauma raquimedular realizado en un hospital terciario entre el 1 de enero de 2013 y el 31 de diciembre de 2018. Las variables analizadas incluyen datos demográficos, informaciones referentes al trauma (etiología, mecanismo, tipo de lesión, número de vértebras involucradas y segmento vertebral afectado), estado neurológico para el internamiento (escala de Frankel), tratamiento realizado y resultados (días de internamiento, resultado neurológico y mortalidad). Resultados Fue incluido un total de 808 pacientes. El promedio de edad del grupo fue de 47,9 (± 19,0), siendo la mayoría del sexo masculino y caucásico. La etiología más frecuente fue caída de altura (N = 508; 62,9%) seguida de accidentes de tránsito (N = 185; 22,9%). El segmento toracolumbar fue el más acometido, ocurriendo en 401 (52,1%) pacientes, seguido por el cervical, torácico y lumbar. La incidencia de lesión raquimedular fue de 16,7%. El tratamiento no quirúrgico fue indicado para 510 (63,1%) pacientes. Conclusión Los autores presentan el mayor perfil epidemiológico de trauma de columna de América Latina, analizando un total de 808 pacientes, lo que representa una incidencia de 134,6 casos/año. Este artículo llena un vacío de la literatura médica en lo que se refiere al perfil epidemiológico de esta enfermedad en América Latina. Nivel de evidencia II; Estudio Pronóstico.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Spinal Cord Injuries/epidemiology , Brazil/epidemiology , Retrospective Studies , Spinal Fractures , Fractures, Bone
6.
Rev. Assoc. Med. Bras. (1992) ; 67(9): 1342-1348, Sept. 2021. graf
Article in English | LILACS | ID: biblio-1351459

ABSTRACT

SUMMARY OBJECTIVE: This study aimed to assess the effect of the collagen/silk fibroin scaffolds seeded with human umbilical cord-mesenchymal stem cells on functional recovery after acute complete spinal cord injury. METHODS: The fibroin and collagen were mixed (mass ratio, 3:7), and the composite scaffolds were produced. Forty rats were randomly divided into the Sham group (without spinal cord injury), spinal cord injury group (spinal cord transection without any implantation), collagen/silk fibroin scaffolds group (spinal cord transection with implantation of the collagen/silk fibroin scaffolds), and collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group (spinal cord transection with the implantation of the collagen/silk fibroin scaffolds co-cultured with human umbilical cord-mesenchymal stem cells). Motor evoked potential, Basso-Beattie-Bresnahan scale, modified Bielschowsky's silver staining, and immunofluorescence staining were performed. RESULTS: The BBB scores in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group were significantly higher than those in the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.05 or p<0.01). The amplitude and latency were markedly improved in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group compared with the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.05 or p<0.01). Meanwhile, compared to the spinal cord injury and collagen/silk fibroin scaffolds groups, more neurofilament positive nerve fiber ensheathed by myelin basic protein positive structure at the injury site were observed in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group (p<0.01, p<0.05). The results of Bielschowsky's silver staining indicated more nerve fibers was observed at the lesion site in the collagen/silk fibroin scaffolds + human umbilical cord-mesenchymal stem cells group compared with the spinal cord injury and collagen/silk fibroin scaffolds groups (p<0.01, p< 0.05). CONCLUSION: The results demonstrated that the transplantation of human umbilical cord-mesenchymal stem cells on a collagen/silk fibroin scaffolds could promote nerve regeneration, and recovery of neurological function after acute spinal cord injury.


Subject(s)
Humans , Animals , Rats , Spinal Cord Injuries , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells , Fibroins , Spinal Cord , Umbilical Cord , Collagen , Recovery of Function , Tissue Scaffolds
7.
J. Hum. Growth Dev. (Impr.) ; 31(2): 318-335, May-Aug. 2021.
Article in English | LILACS, INDEXPSI | ID: biblio-1340091

ABSTRACT

INTRODUCTION: The spine is the most frequent area of bone metastasis in patients with systemic neoplastic disease. The goal of its treatment is immediate decompression, in order to prevent deterioration or reverse the deficit in neurological functionOBJECTIVE: To analyze the characteristics of the scientific literature on the effectiveness of surgery associated with radiotherapy to improve the neurological deficit caused by metastatic spinal cord compressionMETHODS: Descriptive study based on bibliometric and scientometric methods. Using both, it is possible to qualify, verify and give meaning to the data and have, as a result, a broad study about the productions of the theme in question. Articles published in the National Library of Medicine (Pubmed), Web of Science and Virtual Health Library (VHL) were used, searched using keywords obtained from the Descriptors in Health Sciences (DeCS), of the VHLRESULTS: The searches resulted in 131 articles. After filtering by reading titles, 100 articles were selected for reading the abstract. At the end of the collection, 15 articles were selected. Of these, the year of publication was distributed every two years for analysis, with a significant growth in 2015 and 2016. As for the origin of the studies, 60% (n = 9) had data collection developed in China, Japan or the United States of America. Regarding the gender of the sample, 57.14% of them contained the predominantly or totally male sample and 42.85% female. Regarding the histological type of tumor, there was a wide variation between studies. In some of them, the sample contained different groups of tumor diagnosisCONCLUSION: The combination of surgery with postoperative radiotherapy proved to be effective and more efficient than these alone for the treatment of patients affected by metastatic neurological compression


INTRODUÇÃO: A coluna vertebral é a área mais frequente de metástase óssea em pacientes com doença neoplásica sistêmica. O objetivo do seu tratamento a descompressão imediata, a fim de evitar deterioração ou reverter o déficit da função neurológicaOBJETIVO: Analisar as características da literatura científica sobre a eficácia da cirurgia associada a radioterapia para melhora do déficit neurológico causado por compressão medular metastáticaMÉTODO: Estudo descritivo, a partir dos métodos da bibliometria e cientometria. Utilizando ambos, pode-se qualificar, constatar e atribuir sentido aos dados e ter, como resultado, um estudo amplo acerca das produções do tema em questão. Foram utilizados artigos publicados no National Library of Medicine (Pubmed), Web of Science e Biblioteca Virtual em Saúde (BVS), pesquisados através de palavras-chave obtidas no Descritores em Ciências da Saúde (DeCS), da BVSRESULTADOS: As buscas resultaram em 131 artigos. Após a filtragem por leitura de títulos, selecionou-se 100 artigos para leitura do resumo. Ao final da coleta foram selecionados 15 artigos. Destes, o ano de publicação foi distribuído bienalmente para análise, com um crescimento significativo no ano de 2015 e 2016. Quanto à procedência dos estudos, 60% (n = 9) tiveram a coleta dados desenvolvida na China, Japão ou Estados Unidos da América. Em relação ao sexo da amostra, 57,14% deles continham a amostra predominante ou totalmente masculina e 42,85% feminina. Em relação ao tipo histológico do tumor, houve uma grande variação entre os estudos. Em alguns deles, a amostra continha grupos diferentes de diagnostico tumoralCONCLUSÃO: A combinação de cirurgia com radioterapia pós-operatória se mostrou eficaz e mais eficiente do que estas isoladas para o tratamento de pacientes acometidos por compressão neurológica metastática


Subject(s)
Humans , Male , Female , Radiotherapy , Spinal Cord Compression , Therapeutics , Neoplasms, Unknown Primary , Neoplasm Metastasis
8.
Rev. colomb. anestesiol ; 49(2): e501, Apr.-June 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1251503

ABSTRACT

Abstract Introduction Neuropathic pain is present in up to 40 % of all cancer patients. A considerable number of patients fail to achieve enough pain relief with conventional treatment, which is why therapeutic alternatives such as spinal cord stimulation should be considered. Case description and results This is the case of a female patient with chronic neuropathic pain secondary to a partial femoral nerve injury sustained during resection and lymph node dissection surgery with curative intent for a large stage II cell squamous cell carcinoma T2N0M0, localized in the right popliteal fossa. The patient presented with difficult to manage chronic neuropathic pain, despite receiving multiple oral analgesics and nerve blocks. A medullary neurostimulator was implanted that relieved the patient's pain intensity in up to 80%, in addition to improved function and quality of life. Conclusions Spinal cord stimulation is considered an effective neuromodulatory intervention which has shown satisfactory results in the treatment of various types of refractory chronic pain in cancer patients, including neuropathic pain.


Resumen Introducción El dolor neuropático está presente hasta en el 40 % de los pacientes con cáncer. Un número considerable de pacientes no logran un alivio suficiente del dolor con el tratamiento convencional, por lo cual deben considerarse alternativas terapéuticas como la estimulación de la médula espinal. Descripción del caso y resultados Caso de una paciente con dolor neuropático crónico secundario a lesión parcial de nervio femoral durante cirugía de resección y vaciamiento ganglionar con objetivos curativos de carcinoma escamocelular de célula grande T2N0M0 estadio II, localizado en la fosa poplítea derecha, quien cursó con dolor neuropático crónico de difícil manejo a pesar de recibir múltiples analgésicos orales y bloqueos nerviosos. Se implantó un neuroestimulador medular con lo cual se logró un alivio hasta del 80 % en intensidad de dolor de la paciente, además de una mejoría de su funcionalidad y calidad de vida. Conclusiones La estimulación de la médula espinal se considera una intervención neuromoduladora eficaz, que ha demostrado resultados satisfactorios para tratar diversas formas de dolor crónico refractario en los pacientes con cáncer, incluido el dolor neuropático.


Subject(s)
Humans , Female , Middle Aged , Carcinoma, Squamous Cell , Chronic Pain , Pain Management , Spinal Cord Stimulation , Lymph Node Excision , Neoplasms , Quality of Life , Therapeutics , Cells , Femoral Nerve , Analgesics , Nerve Block , Neuralgia
9.
Coluna/Columna ; 20(2): 78-83, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1249663

ABSTRACT

ABSTRACT Objective: Cervical spondylotic myelopathy (CSM) is the main cause of spinal dysfunction in adults. The type of surgical approach to treatment is not well defined in the literature. The objective is to report the results obtained through isolated posterior decompression in patients with a previous indication of the combined approach for the treatment of cervical spondylotic myelopathy. Methods: This is a therapeutic study with level of evidence II, according to the Oxford classification table. Ten patients who underwent isolated posterior approach surgery for the treatment of cervical spondylotic myelopathy were evaluated through imaging and questionnaires (visual analog scale, mJOA-Br scale - Brazilian Portuguese version of the Modified Japanese Orthopedic Association Scale, and Neck Disability Index (NDI)), comparing pre- and postoperative results. Results: Late evaluation of the 10 patients was performed in the period ranging from 24 to 36 months (mean of 30.3 months ± 7.25) following surgery. The comparison of the clinical and radiological parameters in all patients showed a statistical difference in relation to the preoperative scales applied and to the degree of cervical lordosis (p <0.05), evidencing improvement after decompression and posterior fixation of the cervical spine. Conclusions: The isolated posterior approach (decompression, fixation and arthrodesis) allowed the clinical and radiological improvement of patients with cervical spondylotic myelopathy and who had an indication of the complementary anterior approach. Level of evidence II; Retrospective study.


RESUMO Objetivo: A mielopatia cervical espondilótica (MCE) é a principal causa de disfunção medular nos adultos. O tipo de abordagem cirúrgica para o tratamento não é bem definido na literatura. O objetivo é relatar os resultados obtidos por meio da descompressão posterior isolada nos pacientes com indicação prévia da abordagem combinada para o tratamento da mielopatia cervical espondilótica. Métodos: Trata-se de um estudo terapêutico com nível de evidência II, conforme a tabela de classificação Oxford. Dez pacientes submetidos apenas à abordagem cirúrgica posterior para tratamento de mielopatia cervical espondilótica foram avaliados por meio de exames de imagem e de questionários (escala visual analógica, escala mJOA-Br - Versão em Português da Escala Modificada da Sociedade Japonesa de Ortopedia e escala de incapacidade cervical - Neck Disability Index - NDI), comparando os resultados pré e pós-operatórios. Resultados: A avaliação tardia dos 10 pacientes foi realizada no período que variou de 24 a 36 meses (média de 30,3 meses ± 7,25) de pós-operatório. A comparação dos parâmetros clínicos e radiológicos em todos os pacientes mostrou diferença estatística com relação ao pré-operatório para as escalas aplicadas e para o grau de lordose cervical (p < 0,05), evidenciando a melhora depois da descompressão e da fixação posterior da coluna cervical. Conclusões: A abordagem posterior isolada (descompressão, fixação e artrodese) permitiu a melhora clínica e radiológica de pacientes com mielopatia cervical espondilótica e que tinham indicação da abordagem anterior complementar. Nível de evidência II; Estudo retrospectivo.


RESUMEN Objetivo: La mielopatía cervical espondilótica (MCE) es la principal causa de disfunción medular en los adultos. El tipo de abordaje quirúrgico para el tratamiento no está bien definido en la literatura. El objetivo es relatar los resultados obtenidos por medio de la descompresión posterior aislada en los pacientes con indicación previa del abordaje combinado para el tratamiento de la mielopatía cervical espondilótica. Métodos: Se trata de un estudio terapéutico con nivel de evidencia II, conforme a la tabla de clasificación Oxford. Diez pacientes sometidos únicamente al abordaje quirúrgico posterior para el tratamiento de la mielopatía cervical espondilótica fueron evaluados mediante exámenes de imagen y cuestionarios (escala analógica visual, escala mJOA-Br - versión en portugués de la escala modificada de la Sociedad Japonesa de Ortopedia y escala de incapacidad cervical - Neck Disability Index - NDI), comparando los resultados pre y postoperatorios. Resultados: La evaluación tardía de los 10 pacientes fue realizada en el período que varió de 24 a 36 meses (promedio de 30,3 meses ± 7,25) de postoperatorio. La comparación de los parámetros clínicos y radiológicos en todos los pacientes mostró diferencia estadística con relación al preoperatorio para las escalas aplicadas y para el grado de lordosis cervical (p <0,05), evidenciando la mejora después de la descompresión y de la fijación posterior de la columna cervical. Conclusiones: El abordaje posterior aislado (descompresión, fijación y artrodesis) permitió la mejora clínica y radiológica de pacientes con mielopatía cervical espondilótica y que tenían indicación del abordaje anterior complementario. Nivel de evidencia II; Estudio retrospectivo.


Subject(s)
Humans , Spinal Osteophytosis , Spinal Cord Diseases , Cervical Vertebrae
10.
Coluna/Columna ; 20(2): 123-126, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1249660

ABSTRACT

ABSTRACT Objective: To outline the clinical-epidemiological profile of patients who were victims of SCT, to identify the main trauma mechanisms for this injury and its outcome. Methods: Retrospective cross-sectional study, in which the epidemiological data, computed tomography reports and medical records of patients with fractures identified in their examinations at trauma reference hospitals in Curitiba-PR, in 2018, were analyzed. Results: 705 patients were studied. There was a male prevalence (64%), the most affected age group was 21 to 30 years old (18%), the mean age was 48.23 years, the mean female age being approximately 10 years higher. The main mechanisms were traffic accidents (34%), falls from a higher level (29%) and falls from the same level (25%). The most affected segment was the lumbar with 46% of cases. The incidence of surgical treatment was 15%, of spinal cord injury was 5%, and death was the outcome in less than 3% of cases. Conclusions: The profile of the patient victim of SCT in 2018 in Curitiba-PR was that of a young man, victim of a traffic accident with thoracolumbar involvement without spinal cord injury, under conservative treatment.Level of evidence II; Retrospective Study.


RESUMO Objetivo: Traçar o perfil clínico-epidemiológico dos pacientes vítimas de TRM, identificar os principais mecanismos de trauma para esta lesão e seu desfecho. Métodos: Estudo transversal retrospectivo, em que foram analisados dados epidemiológicos, laudos de tomografia computadorizada e prontuários dos pacientes que apresentaram fratura em seus exames, nos hospitais-referência de trauma em Curitiba-PR, no ano de 2018. Resultados: Dos 705 pacientes estudados, houve prevalência masculina (64%); a faixa-etária mais acometida foi de 21 a 30 anos (18%); a idade média geral foi de 48,23 anos, sendo a média feminina aproximadamente 10 anos mais alta. Os principais mecanismos foram acidente de trânsito (34%), queda de nível (29%) e queda de mesmo nível (25%). O segmento mais acometido foi lombar com 46% dos casos; tratamento cirúrgico teve incidência de 15%, lesão medular de 5% e óbito foi desfecho em menos de 3% dos casos. Conclusões: O perfil do paciente vítima de TRM no ano de 2018 em Curitiba-PR foi de um homem jovem, vítima de acidente de trânsito com acometimento toracolombar sem lesão medular, sob tratamento conservador. Nível de evidência II; Estudo Retrospectivo.


RESUMEN Objetivo: Trazar el perfil clínico-epidemiológico de los pacientes víctimas de TRM, identificar los principales mecanismos de trauma para esta lesión y su resultado. Métodos: Estudio transversal retrospectivo, en el que fueron analizados datos epidemiológicos, laudos de tomografía computarizada e historiales médicos de los pacientes que presentaron fractura en sus exámenes, en los hospitales referencia de trauma, en Curitiba-PR, en el año 2018. Resultados: De los 705 pacientes estudiados, hubo prevalencia masculina (64%); el grupo de edad más acometido fue de 21 a 30 años (18%); la edad promedio general fue de 48,23 años, siendo el promedio femenino aproximadamente 10 años más alto. Los principales mecanismos fueron accidente de tránsito (34%), caída de nivel (29%) y caída del mismo nivel (25%). El segmento más acometido fue el lumbar con 46% de los casos; el tratamiento quirúrgico tuvo incidencia del 15%, la lesión medular de 5% y la muerte fue resultado en menos del 3% de los casos. Conclusiones: El perfil del paciente víctima de TRM en 2018 en Curitiba-PR fue de un hombre joven, víctima de accidente de tránsito con acometimiento toracolumbar sin lesión medular, bajo tratamiento conservador.Nivel de evidencia II; Estudio retrospectivo.


Subject(s)
Humans , Spinal Injuries , Spinal Cord Injuries , Spine , Epidemiology , Spinal Fractures
11.
Arq. bras. neurocir ; 40(2): 125-129, 15/06/2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1362195

ABSTRACT

Objective To analyze the epidemiological profile of patients with spinal cord injury treated at POLEM ­ Associação de Apoio às Pessoas comLesão Medular (Association for Supporting People with Spinal Cord Injury). Method The population studied comprised 113 patients with spinal cord injury, of traumatic or nontraumatic etiology, and the data obtained were compared with those of other institutions. Results Of the 113 patients, 70.8% were male and 29.2% female. Traumatic lesions were responsible for 54% of the patients, and nontraumatic for 46%. Of the patients with traumatic injury, 90.2% were male, the main cause being traffic accidents. In nontraumatic lesions, women were the most affected, 51.9%; and dysraphism and myelitis were the main causes (31% and 21%, respectively). Conclusion The results showed an important incidence of spinal cord injury due to trauma,mainly affecting young individuals of productive age and low educational level, representing high economic and social costs. The data found in the present study are similar to those of other studies performed in our country.

12.
Barbarói ; (58): 141-153, jan.-jun. 2021. ilus
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1150774

ABSTRACT

O objetivo desse estudo é analisar e investigar a qualidade de vida em pessoas com lesão medular, através de uma revisão sistemática. Buscaram-se os principais trabalhos publicados no período de 2006 a 2019, nas bases de dados CAPES e Scielo. Todos os estudos utilizaram medidores quantitativos sobre qualidade de vida, os quais são: o WHOQOL-Bref e o SF-36. Os resultados de forma geral mostraram que o sujeito com lesão medular avalia sua qualidade de vida como boa e sua saúde de forma geral satisfatória. O domínio físico e do meio ambiente foram os domínios mais citados nas pesquisas como um fator negativo, sendo ele relacionado com a questão da acessibilidade. Verificou-se que estudos futuros são de extrema importância, para compreender a qualidade de vida desses indivíduos, assim como para a melhoria de políticas públicas para questão de acessibilidade e autonomia desses sujeitos.(AU)


The aim of this study is to analyze and investigate the quality of life in people with spinal cord injury, through a systematic review. The main studies published in the period 2006 to 2019 were searched in the CAPES, Scielo. All the studies used quantitative measure about quality of life, which were the WHOQOL-Bref and the SF-36. The results generally showed that the subject with spinal cord injury evaluates their quality of life as good and their health in a general satisfactory manner. The physical and environmental domains were the most cited domains in the researches as a negative factor, being related to the issue of accessibility. It was found that future studies are extremely important to understand the quality of life of these individuals, as well as for the improvement of public policies for the question of accessibility and autonomy of these subjects.(AU)


Subject(s)
Humans , Quality of Life , Spinal Cord Injuries , Disabled Persons , Public Policy , Personal Autonomy
13.
Rev. argent. radiol ; 85(3): 57-61, abr. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1356971

ABSTRACT

Resumen Introducción: Las secuencias ponderaras en T2 con tiempo de eco largo son tradicionalmente usadas para la evaluación de las lesiones de la médula espinal en esclerosis múltiple (EM). Existen otras secuencias, como la densidad de protones (primer eco T2), que pueden ser útiles en el plano axial pero que no se han estudiado lo suficiente. Objetivos Establecer la concordancia entre la densidad de protones (DP) y las secuencias axiales ponderadas en T2 en las lesiones de la médula espinal cervical en pacientes con EM. Métodos: Se trata de un estudio de concordancia entre secuencias DP y T2 axiales en magneto de 1,5 Tesla en sujetos colombianos. Las imágenes fueron revisadas por dos radiólogos, que determinaron el número de lesiones, así como la intensidad de señal - mediante la relación contraste- ruido (RCR). La comparación se realizó con el coeficiente de correlación y concordancia de Lin. Resultados: Se evaluaron 56 pacientes, 30,36% hombres y 69,64% mujeres. Se encontraron diferentes números de lesiones entre las secuencias axiales DP vs T2 (210 vs 144), coeficiente de concordancia entre el número de lesiones 0,72 (IC95%: 0,6-0,82, error estándar 0,05, desviación estándar 1,37) y en la conspicuidad -RCR- 0,62 (IC95%: 0,48-0,75, SE 0,05, DE 12,25). Conclusión: No encontramos concordancia en la evaluación del número o intensidad de la señal entre secuencias axiales DP y T2. Aunque las secuencias ponderadas en T2 son las más utilizadas, investigaciones recientes han demostrado falta de concordancia e incluso superioridad de las secuencias DP en otros planos, lo que sugiere que es necesario realizar estudios para evaluar la efectividad de las secuencias DP en el plano axial.


Abstract Introduction: Traditionally, T2 long echo time sequences are used for the evaluation of spinal cord lesions in multiple sclerosis. There are other sequences, like proton density (first echo of T2) that may be useful in the axial plane but have not been sufficiently studied. Objectives: To establish the agreement between axial PD and T2 sequences in cervical spinal cord lesions in patients with multiple sclerosis. Methods: This is a concordance study between axial PD and T2 sequences in a 1.5 Tesla magnet. The images were reviewed by two radiologists, who determined the number of lesions and signal intensity with the Contrast to Noise Ratio. The comparison was made with the Lin's concordance correlation coefficient. Results: 56 patients were evaluated, 30.36% men and 69.64% women; there were 210 lesions with PD vs 144 with T2, LCC for the number of lesions was 0.72 (95% CI: 0.6-0.82, SE 0.05) and for conspicuity was 0.62 (95% CI: 0.48-0.75, SE 0.05). Conclusion: This study did not find a satisfactory agreement in the evaluation of the number or signal intensity between PD and T2. Recent research has shown superiority of PD over T2 in other planes, suggesting that further studies are needed to evaluate the effectiveness of PD in the axial plane.

14.
Prensa méd. argent ; 107(2): 112-117, 20210000. fig, tab
Article in English | LILACS, BINACIS | ID: biblio-1361445

ABSTRACT

Las metástasis óseas se desarrollan en aproximadamente 30 a 70% de todos los pacientes con cáncer. El dolor es una experiencia de la condición humana universal, y es común que las personas busquen atención médica a raíz de ello. El presente estudio tuvo como objetivo describir la eficacia y el papel de diferentes estrategias en el control del dolor óseo en pacientes cancerosos metastásicos. Se trata de un estudio observacional realizado entre el 1 de diciembre de 2018 y el 30 de diciembre de 2019. Se inscribieron exactamente 100 pacientes cancerosos. Los pacientes fueron evaluados antes de recibir las modalidades de control del dolor, al principio y al final del tratamiento. La puntuación del dolor óseo se utilizó de 0 (sin dolor) a 10 (el peor dolor). Nuestros hallazgos con respecto al sexo, hubo 51 (51%) hombres y 49 (49%) mujeres. La edad media fue de 57,3 ± 11,2 años y el grupo de edad más frecuente fue de 41-50 años, 37 (37%). Entre los tipos de cáncer, el cáncer de mama ocupa el primer lugar entre los casos estudiados en nuestra investigación 37 (37%), seguido del cáncer de próstata 24 (24%). Las vértebras de la columna fueron el sitio más representado en un 52%, seguido de los huesos pélvicos en un 36%. La mayoría de los pacientes no requirieron cirugía. Mientras que el 15% de los pacientes se sometieron a descompresión del cordón, el 13% requirió fijación interna y solo cuatro pa- LA PRENSA MÉDICA ARGENTINA Bony pain management in cancerous patients 117 V.107/Nº 2 cientes se sometieron a vertebroplastia. El dolor agudo se describió comúnmente en un 40%, seguido de naturaleza punzante en un 15%. El dolor frecuente fue más prevalente en el 60% de los pacientes, mientras que el dolor constante se presentó en el 40%. La noche fue el momento más común de sentir dolor en el 55%. Después de recibir el tratamiento, varias modalidades provocan un desplazamiento de la puntuación del dolor hacia abajo. Combinación de más de estrategias más eficientes que utilizar una opción para el manejo del dolor óseo con un mejor resultado y pronóstico.


Bone metastases develop in approximately 30­70% of all cancer patients. Pain is a universal human experience condition, and it is a common question for people to seek health care. The study aimed to describe the efficacy and roles of different strategies in the control of bony pain in metastatic cancerous patients. This is an observational study carried out, from the 1st of December 2018 to the 30th of December 2019. Exactly 100 cancerous patients were enrolled. Patients were assessed before received of pain control modalities, in the beginning, and at the end of treatment. Bone pain scoring was used from 0 (no pain) to 10 (the worst pain). Our findings regarding sex, there were 51(51%) male and 49(49%) female. The mean age was 57.3±11.2 years, and the most frequent age group was 41-50 years as 37(37%). Among cancer types, breast cancer comes in 1st rank cases studied in our research 37(37%), followed by prostate cancer 24(24%). Spine vertebrae were the most site figured 52%, followed by pelvic bones in 36%. Most patients did not require surgery. Whereas 15% of patients underwent cord decompression, 13% required internal fixation and only four patients performed for vertebroplasty. The sharp pain was commonly described by 40%, followed by stabbing nature in 15%. Frequent pain was more prevalent in 60% of patients, whereas constant pain presented in 40%. The night was the commonest timing of feeling pain in 55%. After receiving treatment, several modalities cause shifting of the pain scoring downward. Combination of more than strategies more efficient than of use one option for manage of bone pain with a better outcome, and prognosis.


Subject(s)
Humans , Adult , Middle Aged , Aged , Pain/prevention & control , Bone Neoplasms/therapy , Cancer Pain/therapy , Neoplasm Metastasis/therapy
15.
Acta fisiátrica ; 28(1): 54-65, mar. 2021.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1342375

ABSTRACT

Objetivo: Avaliar os efeitos das medidas não farmacológicas na prevenção de perda ou no aumento da densidade mineral óssea de pacientes com lesão medular. Método: Revisão sistemática usando as bases de dados Medline, Embase, Cochrane Library e Lilacs com pesquisa entre 2009 e junho de 2019. Resultados: Foram encontrados 801 artigos dos quais foram selecionados, de acordo com os critérios de inclusão e exclusão, 15 artigos: 8 Estudos Clínicos Randomizados (ECR), 5 Estudos de Intervenção e 2 Revisões Sistemáticas. Conclusão: As evidências do uso de terapias não farmacológicas para prevenção e tratamento da osteoporose em LM são fracas e seus estudos contêm inúmeros vieses impossibilitando conclusões definitivas. O FES é a modalidade mais estudada e seu uso pode ser benéfico tanto para prevenção como para o tratamento da perda de massa óssea. Os resultados são observados com um uso frequente (5 sessões semanais) e associado a atividades físicas em especial as que promovam maior resistência muscular. Destacamos também que o retardo na perda de massa óssea está circunscrito ao período de aplicação, cessando após o término do mesmo. A associação de eletroestimulação e exercícios parece potencializar a ação medicamentosa, mas mais estudos são necessários para ratificar esta impressão. Intervenções não farmacológicas como o ortostatismo, atividades físicas, treino de marcha e a eletroestimulação são estratégias de baixo custo, baixo risco, poucos efeitos colaterais e com inúmeros outros benefícios na reabilitação de lesados medulares. Por isso, ainda que não tenhamos evidências consistentes de ação na massa óssea, estão fortemente recomendados.


Objective: To evaluate the effects of non-pharmacological measures (exercise, orthostatism, electrical stimulation, gait training, vibrating platform and physical activity) in preventing loss or increasing bone mineral density in patients with spinal cord injury. Method: Systematic review using the Medline, Embase, Cochrane Library and Lilacs databases with research between 2009 and June 2019. Results: 801 articles were found from which 15 articles were selected, according to the inclusion and exclusion criteria: 8 Randomized Clinical Studies (RCT), 5 Intervention Studies and 2 Systematic Reviews. Conclusions: Evidence of the use of non-pharmacological therapies for the prevention and treatment of osteoporosis in SCI is weak and its studies contain numerous biases making definitive conclusions impossible. FES is the most studied modality. Its use can be beneficial for both prevention and treatment of bone loss. The results are observed with frequent use (5 weekly sessions) and associated with physical activities, especially those that promote greater muscular resistance. The delay in the loss of bone mass is limited to the application period, stopping after the end of the application. The association of electrostimulation and exercise seems to enhance the medication action, but more studies are needed to confirm this impression. Non-pharmacological interventions such as orthostatism, physical activities, gait training and electrostimulation are low-cost, low-risk , have few side effects and a numerous other benefits in the rehabilitation of SCI. Therefore, although we do not have consistent evidence of action on bone mass, they are strongly recommended.

16.
Rev. bras. ortop ; 56(1): 114-117, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1288651

ABSTRACT

Abstract Arachnoid cysts are rare; they can occur at all levels of the dural sac, and can have a congenital, traumatic, iatrogenic or inflammatory origin. In the present article, we report a patient presenting a compressive thoracic myelopathy due to an unusual intradural arachnoid cyst with posttraumatic manifestation and its resolution, in addition to a literature review on the subject. These cysts mainly occur at the thoracic spine, followed by the lumbar, lumbosacral and thoracolumbar spines. Traumatic cysts are caused by an injury to the inner dural layer. These lesions produce neurological deficits through a mass effect on the spinal cord. Concomitant compressive myelopathy is even rarer. In case of myelopathy, cyst resection or drainage is the treatment of choice, and it must be performed immediately. Although rare, arachnoid cysts can be a complication of spine fractures; as such, orthopedists and neurosurgeons, who commonly see these injuries, must be prepared for this unusual situation.


Resumo Cistos aracnóides são raros, podem ocorrer em todos os níveis do saco dural, e sua origem pode ser congênita, traumática, iatrogênica ou inflamatória. Neste artigo, relatamos o caso de uma paciente com mielopatia torácica compressiva decorrente de um cisto aracnóide intradural incomum, de manifestação pós-traumática, assim como sua resolução, além de realizar revisão da literatura sobre o tema. A principal localização é na coluna torácica, seguida das colunas lombar, lombossacra e toracolombar. O cisto com origem traumática é causado por lesão da camada interna da dura-máter. Essas lesões produzem déficit neurológico por meio de efeito de massa sobre a medula espinhal. A existência de mielopatia compressiva associada é mais rara ainda. A ressecção ou drenagem dos cistos na vigência de mielopatia deve ser imediata, sendo o tratamento de escolha. Apesar de raros, podem ser uma complicação de fraturas da coluna vertebral que são muito comuns na prática de ortopedistas e neurocirurgiões, que devem estar preparados para essa situação incomum.


Subject(s)
Humans , Female , Middle Aged , Spinal Cord Compression , Spinal Cord Injuries , Arachnoid Cysts
17.
BrJP ; 4(1): 2-8, Jan.-Mar. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1249136

ABSTRACT

ABSTRACT BACKGROUND AND OBJECTIVES: To pursue safer and more effective treatments for rheumatoid arthritis, the effect of dexamethasone treatment (DEX, 0.25mg/kg) combined with transcranial direct current stimulation (tDCS) in the behavior and neurochemical parameters of arthritic rats was evaluated. METHODS: Thirty-six Wistar rats were divided into four groups: control+DEX (CTRL+DEX), arthritis+DEX (RA+DEX), arthritis+DEX+sham-tDCS (RA+DEX+sham-tDCS) and arthritis+DEX+tDCS (RA+DEX+tDCS). The arthritic model (RA) was induced by complete Freund's adjuvant (CFA) paw administration. Paw edema and mechanical allodynia were assessed by plethysmometer and von Frey apparatus, respectively. Fourteen days after the CFA injection, rats received the treatment for eight days (DEX and/or tDCS). Behavioral parameters were measured with the Open-Field test. ELISA was used to evaluate hippocampal and spinal cord tumor necrosis factor (TNF-α) levels, cerebral cortex and brainstem BDNF levels. RESULTS: In pre-treatment measurements, arthritic rats presented an increase in joint swelling and mechanical allodynia when compared to the control group, confirming chronic pain establishment. A slight antinociceptive effect of dexamethasone combined with tDCS in the pain model was observed. The pain model significantly induced an increase in the grooming behavior and a reduction in the spinal cord and hippocampal TNF-α levels; these effects were reverted in the sham- and active-tDCS-treated rats. However, no effects of DEX or tDCS were observed in the BDNF levels in the cerebral cortex and brainstem. CONCLUSION: Despite the small effect observed, tDCS treatment cannot be discarded as a non-pharmacological adjuvant technique for inflammatory chronic pain treatment.


RESUMO JUSTIFICATIVA E OBJETIVOS: Para investigar métodos mais seguros e eficazes para o manejo da artrite reumatoide, avaliou-se o efeito do tratamento com dexametasona (DEX, 0,25mg/kg) combinado com estimulação transcraniana por corrente contínua (ETCC) sobre parâmetros comportamentais e bioquímicos de ratos submetidos a um modelo de artrite reumatoide. MÉTODOS: Trinta e seis ratos Wistar foram alocados em 4 grupos: controle+DEX (CTRL+DEX), artrite+DEX (AR+DEX), artrite+DEX+sham-ETCC (AR+DEX+sham-ETCC) e artrite+DEX+ETCC (AR+DEX+ETCC). O modelo de artrite foi induzido pela administração de complete Freund's adjuvant (CFA) na pata. Edema na pata e a alodínia mecânica foram avaliadas por pletismômetro e teste de von Frey, respectivamente. 14 dias após injeção de CFA, ratos foram tratados por 8 dias (DEX e/ou ETCC). Atividade locomotora foi avaliada pelo teste do campo aberto. TNF-alfa (hipocampo e medula espinal) e BDNF (córtex e tronco) foram mensurados por ELISA. RESULTADOS: Nas medições pré-tratamento, ratos com artrite exibiram aumento de o inchaço articular e alodínia mecânica comparados ao grupo controle, confirmando o estabelecimento de modelo de dor crônica. Também se observou discreto efeito antinociceptivo da dexametasona combinada com ETCC no modelo de artrite. O modelo de dor induziu um aumento no comportamento de grooming e reduziu os níveis de TNF-alfa no hipocampo; estes efeitos foram revertidos nos grupos sham- e ETCC ativo. Entretanto, não foram observados efeitos da DEX ou ETCC nos níveis de BDNF no córtex cerebral ou no tronco encefálico. CONCLUSÃO: Apesar dos discretos efeitos observados, não se pode descartar a ETCC como uma abordagem terapêutica não farmacológica para o manejo da dor crônica inflamatória na artrite reumatoide.

18.
Article in Chinese | WPRIM | ID: wpr-847191

ABSTRACT

BACKGROUND: Cervical spondylotic myelopathy is a common degenerative disease of the cervical spine in spinal surgery. Surgical decompression is the most effective method to prevent the further development of the disease. However, patients are often accompanied by residual neurological symptoms such as sensory and motor dysfunction after surgery. Currently, the drug treatment for postoperative neurological recovery of patients is still unclear clinically. OBJECTIVE: To investigate the effect of mecobalamine combined with mouse nerve growth factor on the recovery of nerve function after cervical spondylotic myelopathy surgery. METHODS: A total of 82 cases of cervical spondylotic myelopathy from June 2017 to September 2018 in the Affiliated Hospital of Xuzhou Medical University were enrolled in this study. All the patients were randomly divided into observation group and control group with 41 cases in each. Mouse nerve growth factor injection was applied to the control group, and mecobalamine injection was added to the research group. All the patients were treated for 2 weeks. The symptoms and signs in both groups were respectively recorded before and after the treatment, and postoperative residual neurological symptoms were evaluated by Neck Disability Index (NDI) scores and Japanese Orthopedic Association scores. RESULTS AND CONCLUSION: At 1 month, 3 months, 6 months and 1 year after the operation, the NDI scores of the two groups were lower than those before the treatment, and the JOA scores were both getting higher than those before the treatment. The NDI scores in the observation group at 6 months and 1 year after the operation were significantly lower than those in the control group, and as well, the Japanese Orthopedic Association scores were significantly higher than those in the control group. These findings indicate that the combination of mecobalamine and mouse nerve growth factor is helpful to the recovery of nerve function in patients after cervical spondylotic myelopathy surgery, and the effect is better than that of mouse nerve growth factor alone.

19.
Article in Chinese | WPRIM | ID: wpr-847184

ABSTRACT

BACKGROUND: One of the main causes of high disability rate of secondary spinal cord injury is oxidative stress and inflammatory response. How to suppress secondary spinal cord injury is a hot topic of current research. OBJECTIVE: To explore the improvement effect of triptolide on motor dysfunction after spinal cord injury and its possible mechanism. METHODS: Forty-eight healthy male Sprague-Dawley rats were randomly divided into sham operation group, spinal cord injury group and triptolide group, 16 rats in each group. The modified Allen method was used to establish the rat spinal cord injury model. Rats in the triptolide group received intraperitoneal injection of triptolide (0.1 mg/kg per day) 30 minutes after spinal cord injury. Both the sham operation group and spinal cord injury group were given the same amount of normal saline containing 1% dimethyl sulfoxide via the same route for 10 consecutive days. The sham operation group only underwent laminectomy without damaging spinal cord. Basso-Beattie-Bresnahan scoring method was used to evaluate hindlimb function of Sprague-Dawley rats at 7, 14, 21, 28, and 35 days after surgery. The thoracic spinal cord (T8-11) of the rats was collected on the 10th day after surgery for histological detection, western blot, and real-time quantitative PCR analysis. RESULTS AND CONCLUSION: The behavioral scores in the spinal cord injury group and triptolide group increased with increasing days from injury, and the behavioral scores in the triptolide group were significantly higher than that in the spinal cord injury group at 14, 21, 28, and 35 days after surgery (P < 0.05). Hematoxylin-eosin staining results of the T8-11 sections at 10 days after surgery revealed severe edema, bleeding, and inflammatory cell infiltration in the longitudinal section of the thoracic spinal cord core area of the spinal cord injury group, and these abnormalities could be significantly reduced by triptolide treatment (P < 0.05). RT-PCR results showed that compared with the spinal cord injury group, the expression levels of tumor necrosis factor-α, p-STAT3 and p-JAK2 mRNAs in the spinal cord was significantly decreased (P < 0.05), and the levels of superoxide dismutase and catalase mRNAs were significantly increased in the triptolide group (P <0.05). Findings from this study confirm that intraperitoneal injection of triptolide can moderately improve motor dysfunction after spinal cord injury. Its mechanism may be related to the abnormal activation of JAK/STAT signaling pathway regulated by triptolide.

20.
Article in Chinese | WPRIM | ID: wpr-847120

ABSTRACT

OBJECTIVE: Mesenchymal stem cells transplantation is a promising treatment for spinal cord injury. Most of studies focused on small animal models. In large animal experiments, there are still controversies in selection of stem cells and therapeutic effect. This article analyzed the effects of mesenchymal stem cells orelated indicators of spinal cord injury in large animal models and evaluated their effects on spinal cord injury repair. METHODS: PubMed, Cochrane, OVID, Web of Science and CNKI databases were retrieved before December 2019. A series of studies on the treatment of spincord injury in large animal models by mesenchymal stem cells were collected. According to the inclusion criteria, two researchers independently completed literature screening, data extraction and methodological quality evaluation, and meta-analysis was conducted with Stata16.0. RESULTS: A total of 10 articles were included. The results of meta-analysis showed that: (1) Mesenchymal stem cells could significantly improve motor functioafter spinal cord injury [I2=97.73%, MD=3.94, 95%CI (2.15, 5.72), P 0.05). (2) The injury size in mesenchymal stem cells treatment group was significantly smaller than that in the control group [I2=98.05%, MD=-1.00, 95%CI (-1.95,-0.04), P=0.04]. (3) There was no significant difference in the relative expression of glial fibrillary acidic protein between the mesenchymal stem cells treatment group and the control group [I2=99.48%, MD=80.61, 95%CI (-27.48, 188.70), P=0.14]. CONCLUSION: Mesenchymal stem cells transplantation has a significant improvement on the motor function and injury repair of spinal cord injury in large animals, and the security is high. Due to the limitation of the quality of the included literature, the above conclusions need to be validated by high-quality and large-sample randomized controlled trials.

SELECTION OF CITATIONS
SEARCH DETAIL