Comparison of diaphragmatic mobility between COPD patients with and without thoracic hyperkyphosis: a cross-sectional study / Comparação da mobilidade diafragmática em pacientes com DPOC com e sem hipercifose torácica: um estudo transversal

ABSTRACT Objective: To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods: Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results: A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions: Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

RESUMO Objetivo: Comparar a mobilidade diafragmática, a função pulmonar e a força muscular respiratória em pacientes que apresentam DPOC com e sem hipercifose torácica; verificar a relação do ângulo da curvatura torácica com a mobilidade diafragmática, variáveis da função pulmonar e de força muscular respiratória dos pacientes com DPOC; e comparar a mobilidade diafragmática e a cifose torácica entre os gêneros nesses pacientes. Métodos: Foram realizadas as seguintes avaliações: antropometria, espirometria, mensuração do ângulo da curvatura torácica e mobilidade diafragmática. Resultados: Participaram do estudo 34 pacientes com DPOC. No grupo de pacientes com DPOC e hipercifose torácica, a mobilidade diafragmática foi estatisticamente menor quando comparada à do grupo DPOC sem hipercifose torácica (p = 0,002). Não houve diferenças estatisticamente significantes entre esses grupos em relação a variáveis de função pulmonar e de força muscular respiratória. Houve uma correlação negativa significante entre o ângulo da curvatura torácica e a mobilidade diafragmática (r = −0,47; p = 0,005). Quando comparados homens e mulheres da amostra geral, houve diferenças estatisticamente significantes em relação à massa corpórea (p = 0,011), estatura (p < 0,001) e ângulo da curvatura da cifose torácica (p = 0,036), mas não em relação à mobilidade diafragmática (p = 0,210). Conclusões: Os pacientes com DPOC e hipercifose torácica apresentaram menor mobilidade diafragmática quando comparados com os pacientes com DPOC sem hipercifose torácica. O ângulo da curvatura torácica se correlacionou negativamente com a mobilidade diafragmática. O grupo feminino apresentou um aumento significante no ângulo da curvatura torácica quando comparado ao grupo masculino.

Comparison of short-segment monoaxial and polyaxial pedicle screw fixation combined with intermediate screws in traumatic thoracolumbar fractures: a finite element study and clinical radiographic review

OBJECTIVES: No studies have compared monoaxial and polyaxial pedicle screws with regard to the von Mises stress of the instrumentation, intradiscal pressures of the adjacent segment and adjacent segment degeneration. METHODS: Short-segment monoaxial/polyaxial pedicle screw fixation techniques were compared using finite element methods, and the redistributed T11-L1 segment range of motion, largest maximal von Mises stress of the instrumentation, and intradiscal pressures of the adjacent segment under displacement loading were evaluated. Radiographic results of 230 patients with traumatic thoracolumbar fractures treated with these fixations were reviewed, and the sagittal Cobb's angle, vertebral body angle, anterior vertebral body height of the fractured vertebrae and adjacent segment degeneration were calculated and evaluated. RESULTS: The largest maximal values of the von Mises stress were 376.8 MPa for the pedicle screws in the short-segment monoaxial pedicle screw fixation model and 439.9 MPa for the rods in the intermediate monoaxial pedicle screw fixation model. The maximal intradiscal pressures of the upper adjacent segments were all greater than those of the lower adjacent segments. The maximal intradiscal pressures of the monoaxial pedicle screw fixation model were larger than those in the corresponding segments of the normal model. The radiographic results at the final follow-up evaluation showed that the mean loss of correction of the sagittal Cobb's angle, vertebral body angle and anterior vertebral body height were smallest in the intermediate monoaxial pedicle screw fixation group. Adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group but more likely to be observed in the intermediate monoaxial pedicle screw fixation group. CONCLUSION: Smaller von Mises stress in the pedicle screws and lower intradiscal pressure in the adjacent segment were observed in the polyaxial screw model than in the monoaxial pedicle screw fixation spine models. Fracture-level fixation could significantly correct kyphosis and reduce correction loss, and adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group.

Bilateral tibial hemimelia type 1 (1a and 1b) with T9 and T10 hemivertebrae: a novel association / Bilateral tibial hemimelia tipo 1 (1a e 1b) com hemivertebras T9 e T10: uma nova associacao

CONTEXT Congenital absence of the tibia is a rare anomaly with an incidence of one per 1,000,000 live births. It is mostly sporadic and can be identified as an isolated disorder or as part of malformation syndromes. CASE REPORT A male child, born to unaffected and non-consanguineous parents, presented with shortening of the legs and adduction of both feet. Physical examination at six months of age showed head circumference of 44.5 cm (75th percentile), length 60 cm (< 3rd percentile), weight 7,700 g (50th percentile), shortening of the left thigh and both legs with varus foot. There were no craniofacial dysmorphisms or chest, abdominal, genital or upper-extremity anomalies. Psychomotor development was normal. His workup, including renal and cranial ultrasonography, brainstem auditory evoked potential, and ophthalmological and cardiological examinations, was normal. X-rays showed bilateral absence of the tibia with intact fibulae, distally hypoplastic left femur, and normal right femur. In addition, spinal radiographs showed hemivertebrae at T9 and T10. CONCLUSION This novel association expands the spectrum of tibial hemimelia. Moreover, this observation highlights the usefulness of this inexpensive diagnostic method (X-rays) for characterizing the great clinical and radiological variability of tibial hemimelia. .

CONTEXTO Ausência congênita da tíbia é uma anomalia rara, com incidência em 1 por 1.000.000 de nascidos vivos, é principalmente esporádica e pode ser identificada como um distúrbio isolado ou como parte de síndromes de malformações. RELATO DO CASO Criança do sexo masculino, nascida de pais não afetados e não consanguíneos, apresentou-se com encurtamento das pernas e adução de ambos os pés. O exame físico realizado com seis meses de idade mostrou perímetro cefálico 44,5 cm (percentil 75), comprimento de 60 cm (percentil < 3), peso 7.700 g (percentil 50), encurtamento da coxa esquerda e as duas pernas com o pé varo bilateralhavia. Não houve dismorfismos craniofaciais, nem tórax, abdômen, genitais e anomalias das extremidades superiores. O desenvolvimento psicomotor foi normal. Os exames, incluindo ultrassonografia renal e da cabeça, potenciais auditivos evocados de tronco cerebral e exames oftalmológicos e cardiológicos, estavam normais. Raios-X revelou ausência bilateral da tíbia com fíbula intacta, hipoplasia distal do fêmur esquerdo e fêmur direito normal. Além disso, as radiografias de coluna mostraram hemivértebras em T9 e T10. CONCLUSÃO Esta associação nova expande o espectro de hemimelia tibial. Além disso, esta observação destaca a utilidade de tal método diagnóstico barato (raios-X), caracterizando a grande variabilidade clínica e radiológica de hemimelia tibial. .

Hernia hiatal gigante: reporte de un caso / Giant hiatal hernia: a case report

La hernia de hiato es una situación patológica que se da cuando parte del estómago se introduce hacia el tórax. El esófago entra en el abdomen desde el tórax a través de un agujero o hiato que se encuentra en el diafragma. El estómago protruye a través de este hiato debilitado y produce ardores (pirosis) y dolor torácico. La persistencia en el tiempo de esta hernia, puede provocar una metaplasia de la mucosa esofágica dando al lugar al esófago de Barret el cual puede malignizar produciéndose cáncer de esófago. (1) La hernia de hiato es relativamente frecuente, afectando hasta un 20 por ciento de la población. Del total de pacientes con el trastorno, cerca del 10 por ciento son asintomáticos, dependiendo del grado de protrución estomacal y de que tanto esté afectado el esfinter esofágico inferior (EEI). Un 40 por ciento de las hernias de hiato son hernias deslizantes, en las que el EEI protruye conjuntamente con una porción del estómago y solo un 5 por ciento son paraesofágicas, en la que solo una porción del estómago se hace intratorácica mientras tanto que el EEI permanece intraabdominal. Los síntomas más comunes de una hernia de hiato incluyen pirosis, dolor torácico, disfagia, palpitaciones y ocasionalmente regurgitación o reflujo gastroesofágico. El diagnóstico de una hernia hiatal comienza con el éxamen físico por razón de la sintomatología. Los estudios radiográficos y la endoscopia digestiva demuestran la hernia hiatal y ayudan a descartar otras causas de molestias digestivas altas. (2) Se recomienda un procedimiento quirúrgico conocida como fundoplicación de Nissen, (3) Cuando los síntomas causados por una hernia de hiato son tan severas que pueden resultar en lesiones al esófago o incluso cáncer del esófago. (6) Se trata de lactante mayor de seis meses de edad quien es natural de la localidad y procedente de Cordero, quien inicia enfermedad actual el día de hoy en la madrugada según refiere la madre, caracterizado por vómitos en número incontables.

Abcesso epidural pós-traumático / Epidural post-trauma abscess

Abcessos epidurais são formas incomuns de infecção na coluna, com complicações graves em decorência de seu difícil diagnóstico e tratamento. Apesar dos avanços em métodos diagnósticos e de tratamento medicamentoso e cirúrgico, a taxa de mortalidade encontrada na literatura varia de 5 a 32 por cento. Os autores apresentam um caso de fratura de coluna torácica, que evoluiu com abcesso epidural, num paciente portador de espondilite anquilosante. Houve déficit neurológico rapidamente progressivo, que regrediu após descompressão de emergência e fixação cirúrgica da fratura. Apesar do curso longo de antibioticoterapia, houve recidiva da infecção, só controlada após remoção do material de síntese. Em casos de fratura de coluna em pacientes imunocomprometidos, a hipótese de abcesso epidural, quando houver dor de difícil controle ou déficit neurológico progressivo, deve ser lembrada.

Epidural abscesses are uncommon forms of spinal infection, presenting severe complications due to its difficult diagnosis and management. Although diagnosis and management have evolved, mortality rates are still high, ranging from 5 to 32 percent according to literature. The authors present a case of thoracic spine fracture, evolving with an epidural abscess, in a patient suffering from ankylosing spondylitis, with longstanding steroid therapy. A rapidly progressive neurological deficit developed, which resolved after emergency decompression and fracture fixation. Despite of the long-term antibiotic treatment, the infection recurred, being controlled only after hardware removal. In cases of spine fractures associated to immunossupression, the hypothesis of epidural abscess, especially with intense pain or progressive neurological deficit, must be considered.

Operative results of adolescent idiopathic scoliosis in Lerdsin Hospital.

OBJECTIVE: Evaluate the results of the posterior instrumentation for the correction of adolescent idiopathic scoliosis (AIS) in Lerdsin Hospital. MATERIAL AND METHOD: A retrospective study was conducted to determine the effectiveness of surgical treatment of idiopathic scoliosis in Lerdsin Hospital. The pre-operative, immediate post operative, and the most recent follow-up (minimum 2 years) x-ray of 17 patients were evaluated for curve correction and spinal balance. RESULT: The present study found that the curvatures in thoracic King type II and III were corrected by about 58% post operatively. The curve progressed 3 degrees (5%) at the end of 2 years. For lumbar curve in King types I and II, there was the correction of 51% and 59%. After 2 years, the curve progressed around 6 degrees (7%) and 8 degrees (14%). Trunk balance was corrected by 60% in King type III. Degrees of thoracic kyphosis was decreased about 4 degrees. CONCLUSION: Frontal and sagittal thoracic and lumbar curve correction can be satisfactorily obtained by posterior spinal correction with instrumentation.

Treatment of adolescent idiopathic scoliosis using Cotrel-Dubousset spinal instrumentation.

Eighteen patients with idiopathic scoliosis who underwent posterior spinal correction and fusion using Cotrel-Dubousset instrumentation between 1991 and 1996, were evaluated for curve correction and complications. Age at surgery averaged 14.7 years. Follow-up averaged 3.7 years. Thoracic curve correction averaged 65 per cent in those with King type III/IV curves and 51 per cent in those with King type II curves. At the recent follow-up, correction loss averaged 12 per cent and 8 per cent, respectively. Lumbar curve correction averaged 31 per cent after instrumentation in type II curves, with a loss of approximately 3 per cent correction at follow-up. Thoracic sagittal contour improved 14 degrees for hypokyphotic patients. Apical vertebral rotation improved an average of 37 per cent after derotation maneuver of the left side rod. No neurologic complications or deep infection occurred. In conclusion, frontal and sagittal thoracic curve correction can be satisfactorily achieved using Cotrel-Dubousset instrumentation.

Achados otoneurológicos na escoliose idiopática / Otoneurological findings in idiopathic scoliosis

Dez pacientes do sexo feminino, de 11 a 19 anos de idade, com escoliose idiopática nas vértebras torácicas e lombar foram submetidas à avaliaçäo otoneurológica realizada com vecto-eletronistagmografia, verificando-se que este distúrbio ostopédico näo afeta o funcionamento do sistema vestibular.

Metástasis óseas: informe de 117 casos con alteraciones biomecánicas musculoesqueléticas / Bone mestatases cancer with biomechanical muscle-scheletical alterations: report of 117 cases

Los casos clínicos de 117 pacientes con tumores óseos metastásicos y alteraciones biomecánicas fueron analizados retrospectivamente a partir de un enfoque interdisciplinario (ortopédia y oncológico). El 55 por ciento de los pacientes de esta serie fueron masculinos. El 50 por ciento del total cursaron con fractura, 23 por ciento con inminencia de fracturaq y 19 por ciento con compresión medular-radicular. Los carcinomas de mama, próstata, tiroides y pulmón fueron los tumores primarios que más frecuentemente diseminaron a los huesos; en 50 de los 117 casos no se determinó el sitio del tumor primario. El adenocarcinoma fue la estirpe histopatológica en 18 por ciento de los casos. El tercio proximal del fémur y las vértebras toracolumbares fueron los sitios más frecuentemente afectados. Se registraron 17 variables clínicas con sus agregados específicos en cada uno de los casos. Los datos encontrados fueron similares a los reportados en la literatura occidental, a excepción de que las metástasis óseas provocadas por cáncer pulmonar fueron menos frecuentes.

Vértebra plana tóraco-lombar generalizada: inusitada forma de apresentaçäo de linfoma na infância: relato de um caso / The generalized flat thorax-lumbar vertebra: an uncommon presentation of infancy lymphoma

É apresentado um caso de linfoma linfoblástico da infância, cujo diagnóstico foi suspeitado a partir das alteraçöes radiológicas esqueléticas. O achado de vértebra plana generalizada, pouco mencionado na literatura pertinente, levou os autores à publicaçäo do caso