Alterações posturais e nível de dor em mães com bebês de colo: um estudo transversal / Postural changes and pain level in mothers with lap babies: a transversal study

INTRODUÇÃO: O período gestacional caracteriza-se como um momento de grandes eventos fisiológicos, assim como também o período puerperal, que traz consigo grandes mudanças físicas e psicológicas. OBJETIVO: Avaliar a prevalência de alterações posturais e nível de dor em mães com bebês de colo. MATERIAL E MÉTODOS: Pesquisa transversal, de caráter descritivo e abordagem quantitativa, que foi desenvolvida com mães que participavam do acompanhamento de puericultura e aleitamento materno durante novembro de 2018 numa frequência de três vezes por semana. Para coleta dos dados, utilizou-se um formulário sociodemográfico para colher algumas informações pessoais; o Instrumento de Avaliação Postural (IAP) a Escala Analógica Visual de Dor (EVA). Os dados categóricos foram apresentados através de frequência simples e absolutas, seguidos da utilização do teste Qui-quadrado (χ²) de Pearson para a associação entre o nível de dor com as variáveis dependentes. RESULTADOS: A idade das mães manteve-se entre 18 e 35 anos, com nível de escolaridade completo, e a maioria sem atividade ocupacional. Observou-se que, apesar do estudo não apresentar associação significativa entre os hábitos posturais e o nível de dor, este sintoma esteve presente em 73,5 % das mulheres e prevaleceu em níveis de moderada (n=26) à intensa (n=24), mantendo uma relação discreta com alguns tipos de desvios. A alteração postural mais prevalente foi a hiperlordose lombar (69,1%). CONCLUSÃO: Foi possível perceber que a dor e os desvios posturais estão presentes em mulheres com bebês de colo, sendo necessário pensar em intervenções com esse enfoque para este grupo.

INTRODUCTION: The gestational period is characterized as a time of great physiological events and the puerperal period, which brings with it great physical and psychological changes. OBJECTIVE: To evaluate the prevalence of postural changes and pain levels in mothers with babies in arms. MATERIAL AND METHODS: Cross-sectional research, descriptive and quantitative approach, which was developed with mothers who participated in monitoring childcare and breastfeeding during November 2018 at a frequency of three times a week. For data collection, a sociodemographic form was used to collect some personal information; the Postural Assessment Instrument (IAP) the Visual Analog Pain Scale (VAS). Categorical data were presented using simple and absolute frequencies, followed by Pearson's chisquare test (χ²) for the association between the level of pain and the dependent variables. RESULTS: The age of mothers remained between 18 and 35 years old, with a complete level of education, and most of them had no occupational activity. It was observed that, although the study did not show a significant association between postural habits and the level of pain, this symptom was present in 73.5% of women and prevailed in levels from moderate (n=26) to severe (n=24), keeping a discreet relationship with some types of deviations. The most prevalent postural change was lumbar hyperlordosis (69.1%). CONCLUSION: It was possible to see that pain and postural deviations are present in women with babies in arms, and it is necessary to think of interventions with this focus for this group.

Spinal pleomorphic xanthoastrocytoma: case report and literature review / Xantoastrocitoma pleomórfico espinal: reporte de caso y revisión de la literatura

El Xantoastrocitoma Pleomórfico Espinal (XAPE) es una neoplasia primaria infrecuente del sistema nervioso central, descrita por primer vez en 1979. De estirpe astrocítica y aunque clasificada como grado II por la OMS, pueden existir variantes anaplásicas o malignas. Con localización usualmente temporal, pocos casos espinales se han descrito a la fecha, debido probablemente a un subdiagnóstico o un subregistro. El pronóstico es generalmente bueno y depende en gran medida del tipo histológico y extensión de la resección quirurgica. Describimos el caso de un hombre de 30 años de edad con dorsalgiay paresia del miembro inferior izquierdo. Se encontró en imágenes de resonancia magnética una lesión aparentemente intradural, extraaxial en los segmentos T8-T9 que se llevó a resección. Se confirmó por histopatología la presencia de un XAPE primario. En la presente publicación realizamos una revisión de la literatura disponible.

Spinal Pleomorphic Xanthoastrocytoma (SPXA) is a rare CNS primary neoplasm, first described in 1979. Although of astrocytic lineage and classified as a grade II neoplasm by the WHO, it may be have anaplastic or malignant variants. Usually located in the temporal lobe, few spinal cases have been described to date, probably due to underdiagnosis and underreporting. It usually has a good prognosis, but it depends on its histological type and extent of surgical resection. In this article, we describe the case of a 30-year old male who complained of low back pain and left lower limb paresis. The MRI showed an apparently intradural, extraaxial lesion at T8-T9 segments. The diagnosis of a primary SPXA was confirmed by histopathological studies. In this article, a review of the available literature is presented.

Prevalence of chronic spinal pain and identification of associated factors in a sample of the population of São Paulo, Brazil: cross-sectional study / Prevalência de dores de coluna crônicas e identificação de fatores associados em uma amostra da população da cidade de São Paulo, Brasil: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Chronic spinal pain, especially low-back pain and neck pain, is a leading cause of years of life with disability. The aim of the present study was to estimate the prevalence of chronic spinal pain among individuals aged 15 years or older and to identify the factors associated with it. DESIGN AND SETTING: Cross-sectional epidemiological study on a sample of the population of the city of São Paulo. METHOD: Participants were selected using random probabilistic sampling and data were collected via face-to-face interviews. The Hospital Anxiety and Depression Scale (HADS), EuroQol-5D, Alcohol Use Disorders Identification Test (AUDIT), Fagerström test for nicotine dependence and Brazilian economic classification criteria were used. RESULTS: A total of 826 participants were interviewed. The estimated prevalence of chronic spinal pain was 22% (95% confidence interval, CI: 19.3-25.0%). The factors independently associated with chronic spinal pain were: female sex, age 30 years or older, schooling level of four years or less, symptoms compatible with anxiety and high physical exertion during the main occupation. Quality of life and self-rated health scores were significantly worse among individuals with chronic spinal pain. CONCLUSION: The prevalence of chronic spinal pain in this segment of the population of São Paulo was 22.0%. The factors independently associated with chronic pain were: female sex, age 30 years or older, low education, symptoms compatible with anxiety and physical exertion during the main occupation.

RESUMO CONTEXTO E OBJETIVO: A dor de coluna crônica, especialmente dor lombar e cervical, é uma causa importante de anos de vida com incapacidade. O objetivo deste estudo foi estimar a prevalência de algias vertebrais crônicas em indivíduos com 15 ou mais anos de idade e identificar fatores associados. TIPO DE ESTUDO E LOCAL: Estudo epidemiológico de corte transversal em uma amostra da população da cidade de São Paulo. MÉTODO: A seleção de participantes foi feita por amostragem probabilística aleatória e a colheita de dados, por entrevistas presenciais. Foram utilizadas a escala hospitalar de ansiedade e depressão (HADS), o EuroQol-5D, o teste de identificação de desordens devido ao uso de álcool (AUDIT), o teste de Fagerström para dependência de nicotina e o critério de classificação econômica Brasil. RESULTADOS: Um total de 826 participantes foi entrevistado. A prevalência de algias vertebrais crônicas foi estimada em 22% (intervalo de confiança, IC 95%: 19,3-25,0). Os fatores independentemente associados com algias vertebrais crônicas foram: sexo feminino, 30 ou mais anos de idade, quatro anos ou menos de escolaridade, sintomas compatíveis com ansiedade e esforço intenso físico durante a ocupação principal. Participantes com algias vertebrais crônicas apresentaram escores de qualidade de vida e autoavaliação de saúde significativamente piores. CONCLUSÃO: A prevalência de algias vertebrais crônicas em um segmento da população de São Paulo foi de 22%. Os fatores independentemente associados à dor crônica foram: sexo feminino, idade igual ou superior a 30 anos, baixa escolaridade, sintomas compatíveis com ansiedade e esforço físico durante a ocupação principal.

Validación de un cuestionario para la cuantificación del dolor de espalda en escolares / Validation of a questionnaire for quantification of backache in school children

Objetivo: validar un instrumento de medida fácil, rápido y fiable que permita el acceso a información cuantitativa sobre el dolor de espalda que pueda sufrir la población infantil. Métodos: estudio descriptivo cuantitativo, no experimental, de corte transversal. Participaron 153 escolares (80 niños y 73 niñas) del tercer ciclo de educación primaria y de enseñanza secundaria obligatoria, que contestaron un cuestionario sobre algias de espalda mediante una escala visual analógica. A todos los niños se les tomaron las medidas antropométricas y pesado los utensilios de transporte de material escolar. La fase de validez didáctica y de contenido fue realizada por jueces expertos y la consistencia interna del cuestionario, a de Cronbach, fue elevada (0,809). Resultados: las correlaciones entre los ítems fueron muy significativas (p< 0,001) excepto en un caso (p> 0,05). El índice de la Medida de Adecuación Muestral Kaiser-Meyer-Olkin (p< 0,0001) indicó la posibilidad de realizar un análisis factorial del que pudimos obtener un factor denominado Dolor de Espalda, que explicó el 58,46 por ciento de la varianza total, por lo que resulta un instrumento unidimensional. Conclusiones: el cuestionario creado se muestra como un instrumento válido y fiable para la recogida de información cuantitativa del dolor de espalda en el ámbito del área de educación física relacionada con la salud(AU)

Objective: to validate an easy, rapid and reliable measuring instrument that allows the access to quantitative information about backache that the child population could suffer. Methods: non-experimental, cross-sectional, quantitative and descriptive study in which 153 school children (80 boys and 73 girls) from the third cycle of primary education and secondary education participated. They answered a questionnaire about backache by using a visual analogue scale. All of them were taken their anthropometric measures and their means to carry the school materials. The phase of didactic and contents validation was performed by expert judges whereas the internal consistency of the questionnaire expressed as Cronbach's Alpha was high (0.809). Results: the correlations between the items were very significant (p< 0.001), except in one case (p> 0.05). The rate of the Kaiser-Meyer-Olkin's of Sampling Adequacy Measure (p< 0.0001), indicates the possibility of making a factor analysis from which we can obtain a factor called Backache, explaining 58.46 percent of the total variance, and this instrument finally was one-dimensional. Conclusions: the questionnaire proves to be a valid and reliable instrument for quantitative data collection about backache in the field of health-related physical education area(AU)

Osteomielitis vertebral por Bartonella henselae: a propósito de un caso / Bartonella henselae vertebral osteomyelitis: report of a case

Resumen: La enfermedad por arañazo de gato (EAG) causada por Bartonella henselae tiene prevalencia e incidencia desconocida en la población pediátrica chilena. La presentación como linfoadenopatía regional es la más frecuente, y sus formas atípicas constituyen un reto diagnóstico. Objetivo: Comunicar un caso de EAG con osteomielitis vertebral y entregar posibles lineamientos respecto al tratamiento. Cuadro clínico: Escolar de 8 años con síndrome febril prolongado y dolor dorsal con rigidez cervical. En estudio destaca IgG para Bartonella henselae positiva, ecotomografía abdominal con microabscesos esplénicos y resonancia magnética con lesiones vertebrales sugerentes de osteomielitis. Discusión: El diagnóstico de las formas atípicas requiere de un alto índice de sospecha, como en este caso, en que el paciente con síndrome febril manifiesta sintomatología musculoesquelética, lo que nos lleva a estudiar posibles complicaciones de la enfermedad. El conocimiento actual del tratamiento de EAG atípica o complicada se deriva de la observación de estudios de casos y no de ensayos aleatorios; se sugiere analizar de manera individual la terapia antimicrobiana y con ayuda de especialistas. Conclusión: Se discute y enfatiza la importancia de la alta sospecha clínica y se exponen algunas alternativas de tratamiento en función de la evidencia de la literatura actual.

Abstract: Cat scratch disease (CSD) is caused by Bartonella henselae, with unknown prevalence and incidence in the Chilean paediatric population. Regional lymphadenopathy is the most common presentation, while atypical forms constitute a diagnostic challenge. Objective: To report a case of CSD with osteomyelitis and present guidelines regarding treatment. Clinical case: An eight year-old patient, with prolonged febrile illness, back pain and neck stiffness. Laboratory studies highlight positive IgG for Bartonella henselae. The abdominal ultrasound showed splenic micro-abscesses, and the MRI showing vertebral lesions suggestive of osteomyelitis. Discussion: The diagnosis of atypical forms requires a high rate of suspicion, as in this case, in which the patient manifested the musculoskeletal symptoms simultaneously with the febrile syndrome, which led us to study possible complications of the disease. Current knowledge of the treatment of atypical or complicated CSD is derived from the observation of case studies, rather than randomized trials. It is suggested that antibiotic therapy is analysed individually, with the help of a specialist. Conclusion: The importance of high clinical suspicion are emphasised and discussed, as well presenting some treatment options based on the evidence from the current literature.

Multilevel Thoracolumbar Spondylolysis with Spondylolisthesis at L4 on L5

A 24-year-old male patient was initially evaluated for persistent back pain. The visual analogue scale (VAS) score was 7 points. Physical examination revealed a decreased range of lumbar spinal motion, which caused pain. Simple X-ray revealed Meyerding grade 1 spondylolisthesis at L4 on L5, with mild dome-shaped superior endplate and consecutive multilevel spondylolysis at T12-L5. Standing anteroposterior and lateral views of the entire spine revealed normal balance of sagittal and coronal alignment. A computed tomography scan revealed bilateral spondylolysis at T12-L4, left unilateral spondylolysis at L5, and spina bifida at L5 to sacral region. Magnetic resonance imaging revealed mild dural ectasia at the lumbar region. Due to the absence of any neurological symptoms, the patient was managed conservatively. He was rested a few weeks with corset brace and physiotherapy. After treatment, his back pain improved, VAS score changed from 7 to 2, and he was able to return to normal activity.

Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

PURPOSE: Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. MATERIALS AND METHODS: This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. RESULTS: The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. CONCLUSION: PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report / O cisto sinovial hemorrágico lombar pode causar compressão radicular aguda? Relato de caso

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Cistos sinoviais da coluna lombar são uma causa incomum de dor na coluna e radiculopatia, geralmente com evolução gradual dos sintomas, que são secundários ao comprometimento do canal vertebral. Raramente, há hemorragia intracística, que pode se manifestar de forma aguda com síndrome compressiva radicular ou mesmo medular. Habitualmente, os cistos sinoviais associam-se a doença degenerativa facetária, embora a patogênese não esteja completamente estabelecida. Relatamos aqui um caso em que uma complicação hemorrágica em um cisto sinovial no nível L2-L3, adjacente à interfacetária direita, causou dor lombar e radiculopatia em um paciente em terapia anticoagulante, sendo necessária a ressecção cirúrgica.

Caso 1/2013: homem de 69 anos com dor súbita em dorso e membro inferior direito e choque / Case 1/2013: 69-year-old male patient with sudden back and lower right limb pain and shock

MSM, homem, 69 anos, procurou atendimento médico por dor em dorso esquerdo e membro inferior direito. A radiografia de tórax revelou alargamento do mediastino. Estava em observação quando apresentou rebaixamento da consciência e choque. Foi observado enfisema subcutâneo em hemitórax esquerdo e abolição do murmúrio vesicular em base do mesmo pulmão. Foi feita a intubação orotraqueal e realizada drenagem de hemitórax esquerdo, com saída de líquido serossanguinolento. O ecocardiograma revelou ventrículo esquerdo (D/S): 44/29 mm; septo 12 mm; parede posterior 13 mm; discreta dilatação em raiz da aorta, presença de lâmina de dissecção e hematoma periaórtico. As valvas e pericárdio eram normais. O paciente foi transferido para o InCor. O exame físico (21 out 2004: 10h45) revelou paciente sedado, com intubação orotraqueal, com palidez cutânea, frequência cardíaca 90 bpm, pressão arterial 130 x 80 mmHg, drenagem torácica sanguinolenta do dreno tórax. Eletrocardiograma - frequência 90 bpm, ritmo sinusal, baixa voltagem no plano frontal e diminuição de voltagem em derivações esquerdas (fig. 1). A tomografia revelou enfisema subcutâneo bilateral, aorta torácica com contornos imprecisos na sua porção descendente (da artéria subclávia até porção média), colapso do pulmão esquerdo e grande coleção de características hemáticas em mesmo hemitórax e no mediastino médio e posterior. Pequeno pneumotórax à direita; pequeno derrame pleural à direita com alterações do parênquima subjacente. A análise do coração foi prejudicada pela presença do hemotórax. Durante a realização de tomografia apresentou ausência de pulsos, midríase, com assistolia, sem resposta às manobras de ressuscitação e faleceu (21 out 2011; 15h).

The patient, MSM, a 69-year-old man, sought medical care due to left dorsal and right lower limb pain. The chest x-ray showed mediastinal enlargement. He was undergoing examination when he lost consciousness and went into shock. Subcutaneous emphysema was observed in the left hemithorax, as well as abolition of breath sounds at auscultation. Tracheal intubation was performed with draining of blood-tinged fluid from the left hemithorax. Echocardiography showed left ventricle with 44/29 mm; septum, 12 mm; posterior wall, 13 mm; mild aortic root dilation, dissection of the lamina and periaortic hematoma. The valves and pericardium were normal. The patient was transferred to Instituto do Coraçao - InCor. Physical examination (21 Oct 2004: 10:45) showed that the patient was sedated with tracheal intubation, pale, heart rate at 90 bpm, blood pressure 130 x 80 mmHg, bloody drainage in the chest tube. Electrocardiogram - frequency 90 bpm, sinus rhythm, low voltage in the frontal plane and decreased voltage in left leads (Fig. 1). Computed tomography showed bilateral subcutaneous emphysema, thoracic aorta with inaccurate borders in its descending portion (from the subclavian artery to the middle portion), collapsed left lung and extensive collection of hematic characteristics in same hemithorax and middle and posterior mediastinum. Small right pneumothorax; small right pleural effusion with underlying parenchymal alterations. The analysis of the heart was impaired by the presence of hemothorax. While undergoing computed tomography, the patient showed no pulse, mydriasis, with asystole unresponsive to resuscitation and died (21 Oct 2011; 15:00 h).

Backache in pregnancy; role of physiotherapy in its relief

Backache is a common problem during pregnancy that is faced by almost one quarter of all pregnant women worldwide. To find an association between backache and pregnancy with respect to obesity and to evaluate the effect of physiotherapy for relief of pain. This longitudinal observational and randomized control study was conducted on pregnant females for a period of six months. 150 females fulfilling the inclusion criteria were enrolled into two groups i.e. obese patients [BMI >29.9] and non obese patients [BMI<29.9]. All information was recorded on a Performa that was later entered and analyzed using SPSS-11.5. The mean age of all patients was 33.67 +/- 6.73 years with overall average gestational age of 27.47 +/- 5.19 weeks. Flexed posture was observed in 90[60%] patients and 60[40%] had very bad sitting habit. There were 80 [53.3%] obese and 70 [46.7%] non-obese patients. Lordosis was observed in 50 cases, straight spine was observed in 90 cases while 60 patients had no straight spine. Most females reported that pain started during the 1[st] trimester [110] but only 40 females reported that they developed pain in the 2[nd] trimester.100 females reported that pain was continuous while 50 had intermittent. There were 50 [33%] patients who had severe backache while 100 [66.7%] had worse possible pain which was regressed to no pain in 140[93.3%] patients at final follow up visit and only 10 [6.7%] had moderate pain after physiotherapy. The difference between pre and post physiotherapy was statistically significant. Both obese and non-obese patients were reported to be benefited but better results were found in non-obese patients. We conclude that physiotherapy is effective in reducing the backache in pregnant females and has no side effects on fetus and mother. Also, more effective results can be achieved through physiotherapy in non-obese patients compared to obese patients. Thus, Physiotherapy can be recommended as the first line treatment for pregnant females

Backache due to alkaptonuria in a middle aged man

Alkaptonuria is a rare cause of backache. A 55 years old gentleman, a retired army personal had been having pain and stiffness in the spine for the last 15 years, accompanied by bluish black discolouration of face and hands. Kyphosis and reduced movement of spine were present. Other joints were spared. Osler spots were visible on the sclera. X-rays revealed calcification of intervertebral discs. Asymptomatic renal stone was identified. There was no cardiac involvement. Symptomatic care was provided.

Etiologies des dorsalgies non traumatiques en milieu rhumatologique en Cote d'Ivoire : a propos de 67 cas vus a Abidjan

Objectif : Determiner la prevalence des principales affections non traumatiques du rachis dorsal et identifier les principales causes des dorsalgies vues en milieu rhumatologique africain. Materiels et methode Etude retrospective transversale et descriptive menee au service de Rhumatologie du Chu de Cocody (Abidjan) sur une periode de 5 ans. Ont ete inclus les patients atteints d'affections non traumatiques du rachis dorsal. 67 patients repondaient a ces criteres. Une fiche d'enquete a permis de recueillir les donnees epidemiologiques; cliniques; paracliniques et diagnostiques. La recherche d'un lien entre des facteurs epidemiologiques et les etiologies a ete faite grace au test de Khi deux de Pearson. Le test etait significatif quand p etait strictement inferieur a 0;05. Resultats : La prevalence hospitaliere etait de 4;03 oit 67 parmi 1661 affections rachidiennes. Les femmes predominaient (60) avec une moyenne d'age de 46;1 ans. La pathologie inflammatoire (80;6) etait representee par le mal de pott (67;16); les tumeurs malignes (11;94) associant les metastases de cancers (7;44) et le myelome multiple (4;5) et enfin d'une pyomyosite paravertebrale (1;5). La pathologie mecanique (19;4) etait composee de la dorsarthrose (7;44); la hernie discale (1;5); la dorsalgie fonctionnelle (1;5); la maladie de Forestier (1;5); la scoliose (1;5) et l'osteoporose commune (5;96). Les infections et les tumeurs malignes etaient respectivement plus frequentes chez les sujets de moins de 40 ans (p=0;00) et ceux de plus de 40 ans (p=0;01). Conclusion : La pathologie non traumatique du rachis dorsal est rare en pratique rhumatologique a Abidjan. Elle est dominee par le mal de Pott

Etiologies des dorsalgies non traumatiques en milieu rhumatologique en Cote d'Ivoire : a propos de 67 cas vus a Abidjan

Objectif Determiner la prevalence des principales affections non traumatiques du rachis dorsal et identifier les principales causes des dorsalgies vues en milieu rhumatologique africain.Materiels et methode Etude retrospective transversale et descriptive menee au service de Rhumatologie du Chu de Cocody (Abidjan) sur une periode de 5 ans. Ont ete inclus les patients atteints d'affections non traumatiques du rachis dorsal. 67 patients repondaient a ces criteres. Une fiche d'enquete a permis de recueillir les donnees epidemiologiques; cliniques; paracliniques et diagnostiques. La recherche d'un lien entre des facteurs epidemiologiques et les etiologies a ete faite grace au test de Khi deux de Pearson. Le test etait significatif quand p etait strictement inferieur a 0;05.Resultats La prevalence hospitaliere etait de 4;03 soit 67 parmi 1661 affections rachidiennes. Les femmes predominaient (60) avec une moyenne d'age de 46;1 ans. La pathologie inflammatoire (80;6) etait representee par le mal de pott (67;16); les tumeurs malignes (11;94) associant les metastases de cancers (7;44) et le myelome multiple (4;5) et enfin d'une pyomyosite paravertebrale (1;5). La pathologie mecanique (19;4) etait composee de la dorsarthrose (7;44); la hernie discale (1;5); la dorsalgie fonctionnelle (1;5); la maladie de Forestier (1;5); la scoliose (1;5) et l'osteoporose commune (5;96). Les infections et les tumeurs malignes etaient respectivement plus frequentes chez les sujets de moins de 40 ans (p=0;00) et ceux de plus de 40 ans (p=0;01).ConclusionLa pathologie non traumatique du rachis dorsal est rare en pratique rhumatologique a Abidjan. Elle est dominee par le mal de Pott

Incidence of back pain following spinal anesthesia and its relationship to various factors in 176 patients

After neuraxial anesthesia, back pain is the most common complaint. The back pain may be related to needle trauma or surgical positioning or transient neurotoxicity of concentrated local anesthetics. The goal of this study was to compare the incidence of back pain following spinal anesthesia with hyperbaric lidocaine 5% and bupivacaine 0.5% and spinal needle insertion spaces. In this clinical trial after approving ethics committee and obtaining patients consent, we included 176 adult patients with physical status of I- II ASA from May 2006 to May 2008 undergoing various elective urologic surgeries under spinal anesthesia in Imam Hospital in Tabriz, Iran. Patients were allocated randomly in two equal groups. Group lidocaine, a nesthetized with hyperbaric 5% lidocaine and group bupivacaine. All patients were interviewed 6, 24, 48 hours after surgery for back pain. This study indicated no statistically significance difference in the incidence of back pain following spinal anesthesia considering age and frequency of needle puncture during spinal anesthesia. Incidence of back pain was higher in lidocaine group than bupivacaine group [31.82% vs. 18.18%; respectively; P<0.001].Incidence of back pain was higher in L3-4 interspace of needle insertion than L4-5 [23.7% vs. 12.8%, respectively; P<0.001]. The intensity of back pain was slight and tolerable in 77% of the cases, and the back pain in all the patients lasted not more than 48 hours. This study implies that the area of needle insertion and type of anesthetics have effects on the back pain following spinal anesthesia

A comparison study between newly-designed pencil-point and cutting needles in spinal anesthesia.

OBJECTIVES: The goal of this single blinded randomized study was to compare the use of routine cutting-tip spinal needle and newly-designed pencil-point Pajunk(AE) in terms of success rate, complications and satisfactions in priests undergoing spinal anesthesia for orthopedic, general and urological surgery at Priest Hospital, Thailand. MATERIAL AND METHOD: After Institutional Review Board approval and patients' signed consent, from August 2006 to October 2007, 91 priests were randomly assigned to have 27-gauge Quincke (control group, C) or 25-gauge Pajunk(AE) (study group, S) spinal needles used in their spinal anesthesia. The number of attempts to successful cerebrospinal fluid return and the success rate of the spinal blockade were documented. Postoperatively, an investigator blinded to the study interviewed patients daily. RESULTS: The first-time needling success rate for Quincke was 79% but for Pajunk(AE) only 46%, lower than reported. The incidence of minor complications was small, even there were 2 postoperative dead cases not related to anesthesia. Over 80% of both groups still preferred the same technique and surgeon satisfaction was good to excellent. CONCLUSIONS: The newly-designed, pencil-point spinal needle was another example on the development of more refined towards quality anesthesia. To be cost-effective, it should be selected for patients at risk of CSF leakage-related complications.

Notalgia parestésica / Notalgia paresthetica

La notalgia parestésica es una neuropatía sensorial caracterizada clínicamente por una mancha hiperpigmentada bien circunscrita localizada en la espalda, que afecta las áreas correspondientes a los dermatomos D2 a D6. El prurito es el síntoma más común, aunque algunos pacientes describen otras sensaciones, incluyendo ardor, parestesia, hiperestesia o dolor. Los hallazgos histopatológicos son inespecíficos. Su etiología no ha sido claramente demostrada, pero en algunos casos existe una llamativa correlación con patología de la columna vertebral, incluyendo cambios degenerativos y/o hernias del núcleo pulposo. El diagnóstico diferencial incluye la neurodermitis y la amiloidosis macular. No existe un tratamiento definitivo para la enfermedad. Se han empleado diversas terapias incluyendo capsaicina tópica, bloqueo anestésico para vertebral, oxcarbazepina, gabapentina y toxina botulínica.

Notalgia paresthetica is a sensory neuropathy characterizd clinically by a well-circumscribed hyperpigmented patch located on the back, affecting the areas corresponding to dermatomes D2-D6. Pruritus is its most common symptom, but some patients describe other sensations including burning, paresthesia, hypeesthesia or pain. Histopathological findings are not specific. The etiology of this condition has not be en clearly demonstrated but in some cases there exists a striking correlation with spinal pathology, including degenerative changes or a herniated nucleous pulposus. Differential diagnoses include neurodermitis and maclular amyloidosis There is no definitive treatment for the disease diverse therapies have been employed including topical capsaicin paravertebral local anesthetic block, oxcarbazepine, gabapentir and botulinum toxin type A.

Extramedullary Plasmacytoma Involving the Bilateral Adrenal Glands on MR Imaging

We report here on a 64-year-old woman with extramedullary plasmacytoma involving the bilateral adrenal glands. Primary adrenal extramedullary plasmacytoma is extremely rare and only three cases of extramedullary plasmacytoma in the unilateral adrenal gland have currently been reported on. This case is of interest in that the bilateral adrenals were involved. In this article, we present the MRI findings and we briefly review the relevant literature.

Quiste óseo aneurismático de la columna vertebral: reporte de un caso / Aneurysmal bone cyst of the spine: case report

El quiste óseo aneurismático es un tumor de naturaleza neoplásica indefinida, de comportamiento benigno, crecimiento rápido y ocasionalmente de comportamiento agresivo, cuyo tratamiento de elección es la resección completa, aunque existe el riesgo de sangrado transquirúrgico excesivo. Se presenta el caso de una paciente con deformidad en columna torácica, con parestesias y debilidad muscular progresivas en extremidades inferiores, que evolucionó hasta la parálisis de dichas extremidades e incontinencia de ambos esfínteres. Mediante estudios de gabinete se localizaron lesiones líticas en cuerpos vetebrales T7 a T9 e invasión a conducto raquídeo. Los estudios electrofisiológicos identificaron bloqueo completo de la vía somatosensorial. Previa biopsia incisional, se realizó resección de la lesión y estabilización de la columna toracolumbar. La paciente evolucionó sin mejoría de la función medular. Los hallazgos morfológicos correspondieron a quiste óseo aneurismático en T8. Esta lesión se localiza principalmente en huesos largos y con mucho menor frecuencia en la columna vertebral, donde puede provocar inestabilidad y compresión de la médula espinal. Es posible confundirla con otras neoplasias, por lo que el diagnóstico definitivo mediante biopsia es imprescindible a fin de establecer el plan terapéutico adecuado, que elimine el riesgo de recurrencia o secuelas neurológicas asociadas, y lograr la estabilidad adecuada de los segmentos vertebrales afectados.

The aneurysmal bone cyst (ABC) is a fast-growing tumor of undefined neoplastic nature. It is occasionally an aggressive benign lesion whose treatment of choice is a complete resection, even though the risk of profuse transoperative bleeding exists. We present a female patient with thoracic spine deformity, with progressive paresthesias and muscle weakness of lower extremities that evolved to paralysis of both lower extremities and sphincter incontinence. Based on radiographic films, lytic lesions were identified at T7 to T9 vertebrae as well as medullary space invasion. In electrophysiologic tests, a complete somatosensorial pathway block was reported. Prior to resection of the neoplastic lesion and thoracolumbar stabilization, an incisional biopsy was performed. There was no postoperative medullary functional improvement. Morphological findings corresponded to an aneurysmal bone cyst at T8. This lesion is mainly located in the long bones and less frequently of the spine, where instability and medullary compression may occur. It is possible to confuse this neoplasia with other lesions. Hence, definite diagnosis with biopsy is necessary for determining an adequate therapeutic plan to eradicate recurrence risk or associated neurologic sequelae, as well as to gain proper stability at the involved vertebral segments.

Failed back surgery syndrome: casuistic and etiology / Síndrome pós-laminectomia: casuística e etiologia

OBJECTIVE: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD: The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS: From the 121 patients submitted to spine surgical intervention, 47 (38.8 percent) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7 percent) had presented FBSS; of the 83 with disc herniation, 31 (37.3 percent) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3 percent) had failure of the back surgery. CONCLUSION: The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.

OBJETIVO: Relatar nossos dados sobre a síndrome pós-laminectomia (SPL) e as causas cirúrgicas e não-cirúrgicas. MÉTODO: Foram revisados 121 prontuários de pacientes submetidos a laminectomia, hemilaminectomia combinadas com discectomia e/ou foraminotomia realizadas no Instituto de Neurologia Deolindo Couto entre janeiro de 1997 e outubro de 2004. RESULTADOS: Dos 121 pacientes que sofreram intervenção cirúrgica lombar, 47 (38,8 por cento) apresentaram critérios para a SPL. Dos 26 pacientes que apresentaram diagnóstico pré-operatório de estenose lombar, 8 (30,7 por cento) apresentaram SPL; dos 83 com hérnia de disco, 31 (37,3 por cento) tiveram a síndrome; e dos 12 pacientes com estenose lombar associada com hérnia de disco, 7 (58,3 por cento) tiveram a SPL. CONCLUSÃO: A síndrome pós-laminectomia permanece um desafio para os cirurgiões. Há uma busca incessante pelas causas e os mecanismos de ação desta síndrome e o melhor método de tratamento.

Does Paget's disease exist in India?: A series of 21 patients.

OBJECTIVE: Paget's disease of bone has been described as a few case reports from India. The aim of the present study is to document the existence of Paget's disease (PD) in India. MATERIAL AND METHODS: We describe demography, clinical manifestations, biochemical and radiological profile and the treatment outcome of 21 patients of PD. RESULTS: Mean (+/-SD) age of these patients at presentation was 49.2 +/- 17.6 years and the male to female ratio was 2.5:1. Common clinical manifestations included backache, headache and bone pains. Others were fracture, joint pain, deafness, gait ataxia, visual impairment and difficulty in biting. Two patients presented with hydrocephalus and one had recurrent paraparesis. Fifteen (71.4%) patients had polyostotic and six (28.6%) had monoostotic Paget's disease. More commonly involved bones were skull and spine (61.9%) followed by pelvis (38.1%), femur (33.3%), tibia (9%) and ulna (9%). Mean (+/-SD) serum alkaline phosphatase at diagnosis was 1514 +/- 1168 IU/L and nine months after treatment with bisphosphonates decreased to 454 +/- 406 IU/ L(P<0.03). CONCLUSION: This illustrates that Paget's disease does exist in India and a high index of suspicion is required to clinch the diagnosis.