Efectividad de la fisioterapia para el dolor de espalda baja apoyada en recursos digitales / Effectiveness of physiotherapy for low back pain supported by digital resources

El número de intervenciones terapéuticas apoyadas en el uso de los recursos digitales aumenta cada día como vía para facilitar el acceso a cualquier tipo de atención sanitaria. Se realizó una revisión sistemática con el objetivo de analizar la efectividad (estado funcional, la intensidad del dolor y la adherencia al tratamiento) de la intervención de fisioterapia, apoyada en recursos digitales, frente a la fisioterapia convencional en pacientes adultos con dolor de espalda. Este estudio consultó las bases de datos científicas: PubMed, Biblioteca Virtual en Salud, Cochrane, Base de datos de Fisioterapia basada en la evidencia, Science Direct, Scopus, Episteminikos y Google Académico. La selección inicial de los estudios, la evaluación exhaustiva de los artículos completos y la extracción de las características necesarias para la investigación fueron realizadas por los seis investigadores y revisadas por dos revisores independientes. Se incluyeron 12 artículos (10 ensayos clínicos y dos estudios de cohorte). Los resultados de la revisión sistemática soportan el uso de los recursos digitales disponibles para el manejo de dolor de espalda baja, con una importante relación con la reducción de los niveles de dolor y la mejora en la funcionalidad. Es necesario realizar más estudios de alta calidad para evidenciar estos resultados, pues están por determinarse los criterios de la intervención(AU)

The number of therapeutic interventions supported by the use of digital resources is increasing every day as a way to facilitate access to any type of health care. A systematic review was carried out with the aim of analyzing the effectiveness (functional status, pain intensity and adherence to treatment) of the physiotherapy intervention, supported by digital resources, compared to conventional physiotherapy in adult patients with back pain. This study consulted the scientific databases such as PubMed, Virtual Health Library, Cochrane, Evidence-Based Physiotherapy Database, Science Direct, Scopus, Episteminikos, and Google Scholar. The initial selection of the studies, the exhaustive evaluation of the full articles and the extraction of the characteristics necessary for the investigation were carried out by the six research fellows and reviewed by two independent reviewers. Twelve articles were included (10 clinical trials and two cohort studies). The results of the systematic review support the use of available digital resources for the management of low back pain, with an important relationship with the reduction of pain levels and the improvement in functionality. It is necessary to carry out more high-quality studies to demonstrate these results, since the criteria for the intervention are yet to be determined(AU)

The Brazilian Portuguese version of the Pregnancy Mobility Index: Cross-cultural adaptation and psychometric evaluation - a validation study

ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

Study on spinal curvature changes in kung fu practitioners / Estudo sobre as mudanças de curvatura da coluna vertebral dos praticantes de kung fu / Estudio sobre los cambios de curvatura de la columna vertebral en practicantes de kung fu

ABSTRACT Introduction Kung fu exercise has a significant effect in treating lumbar disc herniation, effectively meeting the internal and external circulation of the human body functional system, the lumbar intervertebral disc movement function can be effectively repaired. Objective analyze and explore the effect of kung fu rehabilitation on symptoms of lumbar intervertebral disc herniation. Methods 85 patients with lumbar disc herniation were randomly divided into a control and a kung fu group. Results The comparison between the martial arts group before and after the experiment showed a very significant difference (p<0.05); there was no significant difference in the control group. The total effective rate in the kung fu group was 97.67%, and the relapse rate was 2.33%. The total effective rate of the control group was 90.48%, and the relapse rate was 21.43%. Conclusions Kung fu exercise is beneficial for the relaxation of waist muscles, relieves muscle tone, increases muscle strength, may improve clinical symptoms and signs of lumbar disc herniation. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução O exercício de kung fu tem um efeito significativo no tratamento da hérnia discal lombar, atendendo efetivamente à circulação interna e externa do sistema funcional corporal humano, a função de movimento do disco intervertebral lombar pode ser efetivamente reparada. Objetivo Analisar e explorar o efeito de reabilitação com kung fu nos sintomas da hérnia de disco intervertebral lombar. Métodos 85 pacientes com hérnia de disco lombar foram divididos aleatoriamente em um grupo de controle e um grupo de kung fu. Resultados A comparação entre o grupo de artes marciais antes e depois do experimento mostrou uma diferença muito significativa (p<0,05); não houve diferença significativa no grupo controle. A taxa efetiva total no grupo de kung fu foi de 97,67%, e a taxa de recidiva foi de 2,33%. A taxa efetiva total do grupo de controle foi de 90,48%, e a taxa de recidiva foi de 21,43%. Conclusões O exercício de kung fu é benéfico para o relaxamento dos músculos da cintura, alivia o tônus muscular, aumenta a força muscular; pode melhorar os sintomas clínicos e os sinais de hérnia de disco lombar. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción el ejercicio de kung fu tiene un efecto significativo en el tratamiento de la hernia discal lumbar, atendiendo eficazmente a la circulación interna y externa del sistema funcional del cuerpo humano, la función de movimiento del disco intervertebral lumbar puede repararse eficazmente. Objetivo Analizar y explorar el efecto de la rehabilitación con kung fu en los síntomas de la hernia discal intervertebral lumbar. Métodos 85 pacientes con hernia discal lumbar fueron divididos aleatoriamente en un grupo de control y un grupo de kung fu. Resultados La comparación entre el grupo de artes marciales antes y después del experimento mostró una diferencia altamente significativa (p<0,05); no hubo diferencia significativa en el grupo de control. La tasa de efectividad total en el grupo de kung fu fue del 97,67%, y la tasa de recaída fue del 2,33%. La tasa efectiva total del grupo de control fue del 90,48%, y la tasa de recidiva del 21,43%. Conclusiones El ejercicio de kung fu es beneficioso para la relajación de los músculos de la cintura, alivia el tono muscular, aumenta la fuerza muscular; puede mejorar los síntomas y signos clínicos de la hernia discal lumbar. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Análisis estadístico de los factores de riesgo asociados a las patologías de la columna lumbar para la población empleada / Statistical analysis of risk factors associated with lumbar spine pathologies for the employed population

Objetivo: Determinar los factores de riesgo de patologías lumbares en pacientes empleados y afiliados al sistema de salud, a partir de la exploración física, hábitos, antecedentes personales y factores de riesgo laborales. Material y Métodos: El diseño del estudio es retrospectivo, transversal. En una muestra de 668 adultos trabajadores del Ecuador, se aplicó y evaluó el modelo predictivo de respuesta binaria logit para identificar factores de riesgo y se usaron métodos de aprendizaje supervisado (árboles de clasificación) para clasificar a los pacientes según el grado de patología lumbar. Resultados: El modelo predictivo logístico presentó una sensibilidad del 62,5%, una especificidad del 63,7%, el área bajo la curva ROC fue 0,63 y se determinó una precisión del 63,4%.Conclusión: Los factores que aumentan el riesgo de la patología de columna lumbar más frecuente (lumbalgia) y en orden de importancia en los pacientes son: menor edad, sexo femenino, tienden a exponerse a factores de riesgo psicosocial en su trabajo

Objective: Determine the risk factors of lumbar pathologies in patients employed and affi-liated with the health system, based on physical examination, habits, personal history, and occupational risk factors.Materials and Methods: The study design is retrospective, cross-sectional. In a sample of 668 adult workers from Ecuador. The binary logit response predictive model was applied to identify risk factors and supervised learning methodology (classification trees) was used to classify patients according to the degree of lumbar pathology.Results: The logistic predictive model has a sensitivity of 62.5%, a specificity of 63.7%, the area under the ROC curve was 0.63, and precision of 63.4% was determined.Conclusion: The factors that increase the risk of the most frequent lumbar pathology (low back pain) in order of importance in patients are: younger age, female sex, tend to be expo-sed to psychosocial risk factors at work, and lower risk of having mechanical factors.

Dolor lumbar relacionada con la ansiedad y depresión en policías de una comisaria en Lima / Low Back Pain Related To Anxiety And Depression In Police Officers At A Police Station In Lima

Introducción. El dolor lumbar es un problema de salud pública el cual conlleva algún tipo de limitación funcional en el individuo afectando la calidad de vida del personal policial. Objetivo. Relacionar el dolor lumbar con la ansiedad y depresión en policías de una comisaría en Lima. Material y Métodos. Es una investigación de enfoque cuantitativo, descriptiva, transversal analítica y correlacional, se tuvo la participación de 110 participantes, el cual se obtuvo a través de un muestro probabilístico donde todos los participantes tuvieron la misma oportunidad de participar, fue llevado a cabo en la comisaria de Monserrat, se utilizó para medir el dolor lumbar una encuesta cuestionario para medir dolor lumbar en el personal policial ¨CDLPP¨" cuya confiabilidad fue de 0,914 alfa de crombach y para medir la ansiedad y depresión el test de Zung. Resultados. Se evidenció un 75,5% de policías que padecen dolor lumbar. Así mismo se evidencio una relación estadísticamente significativa entre la ansiedad y el dolor lumbar (p=0,028). Asimismo, no se evidenció una asociación estadísticamente significativa entre el dolor lumbar y la depresión (P > 0,05). Conclusión. El dolor lumbar se asocia a la depresión en los policías una comisaría en Lima. Así mismo un alto porcentaje de policías que padecen dolor lumbar, teniendo en consideración que es un problema de salud pública, el cual podría conllevar a futuro algún tipo de discapacidad afectando su calidad de vida.

Introduction. Low back pain is a public health problem which entails some type of functional limitation in the individual, affecting the quality of life of police personnel. Objective. Relate lumbar pain with anxiety and depression in police officers from a police station in Lima. Material and methods. It is a research with a quantitative, descriptive, analytical and correlational cross-sectional approach, with the participation of 110 participants, which was obtained through a probabilistic sample where all participants had the same opportunity to participate, it was carried out at the commissary from Monserrat, a questionnaire survey to measure lumbar pain in police personnel ¨CDLPP¨ was used to measure low back pain, whose reliability was 0.914 crombach alpha and the Zung test to measure anxiety and depression. Results. 75.5% of police officers were found to suffer from lumbar pain. Likewise, a statistically significant relationship was evidenced between anxiety and low back pain (p = 0.028). Likewise, no statistically significant association was found between low back pain and depression (P> 0.05). Conclusion. Low back pain is associated with depression in police officers at a police station in Lima. Likewise, a high percentage of policemen who suffer from low back pain, taking into account that it is a public health problem, which could lead to some type of disability in the future affecting their quality of life.

Estenosis lumbar degenerativa: conceptos básicos, evaluación clínica y manejo / Degenerative lumbar spinal stenosis: basic concepts, clinical evaluation, treatment

La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente.

Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation. Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.

Cytologic Diagnosis of Chondrosarcoma on Fine Needle Aspiration Cytology: A Challenge.

Chondrosarcoma is a malignant tumour of cartilage,usually named and classified by anatomic location.Primary chondrosarcoma is the third most commonprimary tumour of bone, after myeloma andosteosarcoma. Commonest sites of presentation arepelvic bones, long bones and relatively rare in ribs. Herewe report a case of 75 year old male who presented witha swelling over the left lower lumbar region, whichincreased gradually in size in three months. Theswelling was not associated with pain or trauma. Afterinitial clinical workup, he was referred to the RadiologyDepartment, for Computerized Tomography (CT) scan.On correlating the findings in the CTscan report, he wasfurther referred to the Histopathology Department forFine Needle Aspiration Cytology (FNAC) in view ofdefinite diagnosis. Initial diagnosis on FNAC was givenas chondrosarcoma in favour of the location of theswelling. Furthermore excision biopsy was done. Thedefinitive diagnosis was given as dedifferentiatedchondrosarcoma. FNAC of dedifferentiated lesions dueto its rarity and limited experience poses a challenge tomany histopathologists.

Efficacy and safety of lumbar arthroplasty in degenerative disc disease / Eficácia e segurança da artroplastia lombar na doença do disco degenerativo / Eficacia y seguridad de la artroplastia lumbar en la enfermedad degenerativa de disco

ABSTRACT Objective: The objective of this longitudinal retrospective study is to assess the efficacy and safety of total lumbar disc replacement in patients with degenerative discopathy (L3-L4, L4-L5, L5-S1). Methods: One hundred and forty-three patients with low back pain, with or without radiculopathy, who met the radiographic criteria underwent anterior arthroplasty between 2000 and 2016. The Oswestry disability index (ODI), the visual analog scale (VAS), patient satisfaction, success criteria, disc height, and range of motion of the operated segment were evaluated preoperatively and at 3, 6, 12, and 24 months following surgery. Results: There were 50 men and 93 women, with an average age of 39.5 years, 13 patients (9%) with previous discectomy. The arthroplasty was performed at level L5-S1 in 97 patients (67.8%), at level L4-L5 in 45 patients (31.5%), and at level L3-L4 in 1 patient. Between the preoperative period and 24 months following surgery, the ODI decreased by 53.86%, the VAS for low back pain decreased by 63.83%, and low back pain with radiculopathy decreased by 60.20%, all statistically significant (p ≤ 0.5). Eighty-two percent of the patients were completely satisfied and 18% were satisfied. There was an average increase in disc height of 12 mm (p <0.001). The range of motion of the affected segment increased by 4° to 7° after surgery (p <0.004). Conclusions: Lumbar arthroplasty of a segment is recommended as an effective treatment for patients with degenerative disc disease with low back pain with or without a root component who meet the inclusion criteria. Level of Evidence III, Systematic reviewb of Level III studies.

RESUMO Objetivo: Para avaliar a eficácia e a segurança da reposição do disco lombar total em pacientes com discopatia degenerativa (L3-L4, L4-L5, L5-S1). Método: 143 pacientes com dor lombar com ou sem radiculopatia, os quais obedecem a critérios radiográficos, foram submetidos à artroplastia anterior entre 2000 e 2016. Avaliamos antes e após a cirurgia, três, seis, 12 e 24 meses, a Doença de Oswestry (ODI), escala analógico-visual (EVA), satisfação do paciente, critérios de sucesso, altura do disco e amplitude de movimento do segmento operado. Resultados: 50 homens e 93 mulheres. A idade foi de 39,5. 13 pacientes (9%) com dissectomia prévia. Nível L5-S1 97 pacientes (67,8%). Nível L4-L5 45 pacientes (31,5%) e um paciente L3-L4 nível (0,6%). A ODI entre o pré-operatório e os 24 meses pós-operatórios reduziu 53,86%. O EVA na dor lombar reduziu 63,83% nos 24 meses depois, em comparação com dor lombar, e pré-operatória com radiculopatia diminuiu 60,20%,mudança estatisticamente significativa (p ≤ 0,5). 82% completamente satisfeitos e satisfeitos 18%. A altura do disco aumentou 12mm em média (p <0.001). O movimento do segmento afetado aumentou de 4° para 7°, após a cirurgia (p <0,004). Conclusão: A artroplastia lombar de um segmento é recomendada como um tratamento eficaz para pacientes com doença degenerativa do disco, que atendem aos critérios de inclusão e lumbalgia sozinhos ou com um componente radicular. Nível de Evidência III: Revisão sistemáticab de Estudos de Nível III.

RESUMEN Objetivo: Evaluar la eficacia y la seguridad del reemplazo total de disco lumbar en pacientes con discopatía degenerativa (L3-L4, L4-L5, L5-S1), mediante un estudio longitudinal retrospectivo. Métodos: Ciento cuarenta y tres pacientes con lumbalgia, con o sin radiculopatía, cumpliendo criterios radiográficos fueron sometidos a artroplastia por vía anterior entre 2000 y 2016. Se evaluaron antes y tres, seis, 12 y 24 meses después de la cirugía el Índice de Discapacidad de Oswestry (ODI), escala analógica visual (EVA), satisfacción del paciente, criterios de éxito, altura discal y rango de movimiento del segmento operado. Resultados: Cincuenta hombres y 93 mujeres. Edad promedio 39,5, 13 pacientes (9%) con discectomía previa. Nivel L5-S1 97 pacientes (67,8%). Nivel L4-L5 45 pacientes (31,5%) y un paciente nivel L3-L4 (0,6%). El ODI entre el preoperatorio y 24 meses postoperatorios redujo 53,86%. La EVA en la lumbalgia redujo 63,83% 24 meses después en comparación con el preoperatorio y lumbalgia con radiculopatía disminuyó 60,20%. Cambio estadísticamente significativo (p ≤ 0,5). El 82% completamente satisfecho y satisfecho 18%. La altura discal aumentó 12 mm promedio (p <0,001). El movimiento del segmento afectado aumentó 4° a 7° después de la cirugía (p <0,004). Conclusión: La artroplastia lumbar de un segmento se recomienda como tratamiento eficaz para pacientes con enfermedad degenerativa discal que cumplen con los criterios de inclusión y lumbalgia sola o con componente radicular. Nivel de Evidencia III; Revisión sistemáticab de Estudios de Nível III.

Dolor lumbar y su relacion con el indice de discapacidad en un hospital de rehabilitacion / Lumbar pain and its relationship with the disability index in a rehabilitation hospital

Introducción: El dolor lumbar es un problema de salud pública, debido a diferentes factores ergonómicos, posturales, emocionales, etc. el cual podría conllevar a una limitación funcional afectando la calidad de vida del individuo. Objetivo: Determinar la relación que existe entre el dolor lumbar y la discapacidad física en los pacientes con lumbalgia que acudieron al servicio de terapia física del Hospital de Rehabilitación del Callao, Lima- Perú. Material y Métodos: Es un estudio descriptivo de tipo transversal y observacional. Tamaño de la muestra fue de 68 pacientes con diagnóstico de dolor lumbar de ambos sexos y una edad comprendida entre los > 18 años, El instrumento utilizado para medir el grado discapacidad fue el cuestionario de Roland-Morris. Resultados: Se observó que existe relación entre la cronicidad del dolor lumbar, la ocupación ama de casa (p=0,002) y el sexo femenino (p=0.005) guardan relación con el grado de discapacidad. Así mismo, la mayor parte de los pacientes presentaron dolor lumbar crónico y presentaron discapacidad física de moderado a severo 82.35%.Asì mimo la variable ocupación existe la presunción que las amas de casa sufran mayor nivel de discapacidad entre moderado 43.8% y severo 53.1%. Conclusiones: Los hallazgos proponen la necesidad de desarrollar programas preventivos asistenciales, mejorando así la calidad de vida y la aparición de algún tipo de discapacidad física, juntamente con la promoción de higiene postural.

Introduction: Low back pain is a public health problem, due to different ergonomic factors, postural, emotional, etc. which could lead to a functional limitation affecting the quality of life of the individual. Objective: To determine the relationship between low back pain and physical disability in patients with low back pain who attended the physical therapy service of the Hospital de Rehabilitación del Callao, Lima-Peru. Material and Methods: It is a descriptive study of transversal and observational type. Sample size was 68 patients with a diagnosis of low back pain of both sexes and an age between 18 and over. The instrument used to measure the degree of disability was the Roland-Morris questionnaire. Results: It was observed that there is a relationship between the chronicity of low back pain, the housewife occupation (p = 0.002) and the female sex (p = 0.005) are related to the degree of disability. Likewise, most of the patients presented chronic low back pain and presented physical disability of moderate to severe 82.35%. Thus, the occupancy variable is presumed that housewives suffer a higher level of disability between moderate 43.8% and severe 53.1%. Conclusions: The findings propose the need to develop preventive care programs, thus improving the quality of life and the appearance of some type of physical disability, together with the promotion of postural hygiene.

Hematoma subcapsular hepático en síndrome de HELLP: reporte de dos casos / Hepatic subcapsular hematoma in HELLP syndrome. Report of 2 cases

Resumen OBJETIVO Reportar el tratamiento clínico-quirúrgico y en la unidad de cuidados intensivos obstétricos de dos pacientes con síndrome de HELLP y hematoma subcapsular hepático. CASO CLINICO A Paciente de 29 años en curso de las 36.1 semanas de embarazo, con ausencia de movimientos fetales, choque hipovolémico, desprendimiento prematuro de placenta normoinserta y óbito. Hemoperitoneo de 2000 mL y hematoma subcapsular del lóbulo hepático izquierdo. Se le colocó un empaquetamiento Miculicz durante 48 horas. Permaneció en la unidad de cuidados intensivos durante nueve días. Reporte de tomografía axial computada de hematoma subcapsular hepático. CASO CLINICO B Paciente de 15 años, con embarazo de 38.6 semanas, dolor epigástrico y lumbar, bradicardia fetal y síndrome de HELLP. Hemoperitoneo de 300 cc, feto de 2400 g, Apgar 1-5, desprendimiento de placenta del 100%, hematoma hepático subcapsular contenido por el ligamento triangular sin necesidad de empaquetamiento. Atención en la unidad de cuidados intensivos obstétricos durante tres días. Reporte de tomografía axial computada de hematoma hepático subcapsular. CONCLUSIÓN El síndrome de HELLP puede originar complicaciones hepáticas graves, como: rotura hepática o hematoma subcapsular roto o no roto. La mortalidad es de 18 a 86% en caso de rotura del hematoma. Las pacientes deben tratarse en hospitales de tercer nivel. La intervención temprana, la atención multidisciplinaria, el soporte hemodinámico y el seguimiento con estudios de imagen son decisivos para reducir su elevada morbilidad y mortalidad.

Abstract OBJECTIVE Report clinical-surgical management and in the Obstetric Intensive Care Unit of the HELLP Syndrome and hepatic subcapsular hematoma of two clinical cases. CLINICAL CASE A 29 years of age, 36.1 weeks of gestation, absence of fetal movements, hypovolemic shock, premature detachment of normoinserta placenta, stillbirth. Hemoperitoneum finding of 2000 mL and subcapsular hematoma of the left hepatic lobe; Miculicz packaging is placed for 48 hours. Management in the Obstetric Intensive Care Unit for 9 days. Computed Axial Tomography reports hepatic subcapsular hematoma. CLINICAL CASE B 15 years of age, 38.6 weeks of gestation, pain in the hypogastrium and lumbar region, fetal bradycardia and HELLP syndrome; hemoperitoneum finding of 300 cc, product of 2,400 gr, Apgar 1-5, placental abruption of 100%, hepatic subcapsular hematoma contained by triangular ligament without the need for packaging. Management in the Obstetric Intensive Care Unit for 3 days. Computed Axial Tomography reports hepatic subcapsular hematoma. CONCLUSION The HELLP syndrome can present serious hepatic complications such as ruptured hepatic or subcapsular hematoma. Mortality is 18 to 86% in case of hematoma rupture. They require management in highly complex centers. Early intervention, multidisciplinary management, hemodynamic support and follow-up with imaging studies are essential to reduce their high morbidity and mortality.

Evaluation of Two Novel Integrated Stand-Alone Spacer Designs Compared with Anterior and Anterior-Posterior Single-Level Lumbar Fusion Techniques: An In Vitro Biomechanical Investigation

STUDY DESIGN: In vitro biomechanical investigation. PURPOSE: To compare the biomechanics of integrated three-screw and four-screw anterior interbody spacer devices and traditional techniques for treatment of degenerative disc disease. OVERVIEW OF LITERATURE: Biomechanical literature describes investigations of operative techniques and integrated devices with four dual-stacked, diverging interbody screws; four alternating, converging screws through a polyether-ether-ketone (PEEK) spacer; and four converging screws threaded within the PEEK spacer. Conflicting reports on the stability of stand-alone devices and the influence of device design on biomechanics warrant investigation. METHODS: Fourteen cadaveric lumbar spines were divided randomly into two equal groups (n=7). Each spine was tested intact, after discectomy (injured), and with PEEK interbody spacer alone (S), anterior lumbar plate and spacer (AP+S), bilateral pedicle screws and spacer (BPS+S), circumferential fixation with spacer and anterior lumbar plate supplemented with BPS, and three-screw (SA3s) or four-screw (SA4s) integrated spacers. Constructs were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Researchers performed one-way analysis of variance and independent t-testing (p≤0.05). RESULTS: Instrumented constructs showed significantly decreased motion compared with intact except the spacer-alone construct in FE and AR (p≤0.05). SA3s showed significantly decreased range of motion (ROM) compared with AP+S in LB (p≤0.05) and comparable ROM in FE and AR. The three-screw design increased stability in FE and LB with no significant differences between integrated spacers or between integrated spacers and BPS+S in all loading modes. CONCLUSIONS: Integrated spacers provided fixation statistically equivalent to traditional techniques. Comparison of three-screw and four-screw integrated anterior lumbar interbody fusion spacers revealed no significant differences, but the longer, larger-diameter interbody spacer with three-screw design increased stabilization in FE and LB; the diverging four-screw design showed marginal improvement during AR.

Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression

STUDY DESIGN: Cross-sectional retrospective study designed to assess interobserver agreement. PURPOSE: To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). OVERVIEW OF LITERATURE: The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. METHODS: Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. RESULTS: Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). CONCLUSIONS: Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.

Melanoma lentiginoso acral en una paciente adulta / Acral lentiginous melanoma in an adult patient

Se presenta el caso clínico de una paciente ecuatoriana de 58 años, blanca, con antecedentes de hernias discales en regiones cervical y lumbar, quien hace 2 años asistió a la Consulta de Dermatología por presentar cambio de coloración en la uña del tercer dedo de la mano derecha, síntomas que se correspondían con un lentigo simple. En esta ocasión acude con destrucción de la lámina ungueal y aumento de la coloración que se extiende a todo el pulpejo del dedo, por lo cual se le realizó otra biopsia y se confirmó el diagnóstico histológico de melanoma lentiginoso acral (in situ).

The case report of a 58 years white patient is presented with a history of disk herniation in cervical and lumbar regions, who 2 years ago attended the Dermatology Service due to a color change in the fingernail of the third finger of her right hand, symptoms that belonged to a lentigo simplex. In this occasion she presented destruction of the ungueal bed and increase of color which covers the whole fingertip, so another biopsy was carried out and the histological diagnosis of acral lentiginous melanoma (in situ) was confirmed.

Influence of pilates exercises on soil stabilization in lumbar muscles in older adults / Influência de exercícios de pilates no solo nos músculos estabilizadores lombares em idosas

The practice of regular physical activity is recognized as a strong ally of active aging, healthy, or successful, whose hallmark is the independent and effective performance of activities of daily living. The Pilates Method (MP) has emerged as a good alternative physical activity in older adults with the main objective of strengthening and stretching the muscles simultaneously, raising body awareness. The aim of this study was to analyze the effects of MP on the strength and conductivity of the electrical stimulation of the lumbar paraspinal muscles as well as muscle contraction transversus abdominis (TrA) in older women before and after performing Pilates exercises on the ground. The instruments used were surface electromyography, force transducer and pressure biofeedback unit. Participants were aged 13, who underwent 12 sessions of Pilates exercises on the ground with an average duration of 50 minutes, are reviewed at the end of the intervention protocol. The participants had increased strength and electrical activation of the lumbar paraspinal muscles, as well as increased ability to contract the transversus abdominis muscle. Based on the results obtained we can conclude that there was a significant improvement of strength and electrical conductivity of the stabilizing muscles of the lumbar voluntary and therefore training with MP positively influenced this musculature.

A prática regular de exercícios físicos é reconhecida como forte aliada do envelhecimento ativo, saudável, ou bem-sucedido, cuja marca distintiva é o desempenho independente e eficaz de atividades de vida diária. O Método Pilates (MP) vem surgindo como uma boa alternativa na prática de atividade física em idosos tendo como objetivo principal o fortalecimento e alongamento simultâneo da musculatura, despertando a consciência corporal. O objetivo foi analisar a influência do MP sobre a força e condutibilidade do estímulo elétrico dos músculos paravertebrais lombares, bem como a contração do músculo transverso do abdômen (TrA) em idosas antes e após a realização de exercícios de Pilates no solo. Os instrumentos utilizados foram eletromiógrafo de superfície, transdutor de força e a unidade de Biofeedback Pressórico. Participaram do estudo 13 idosas, que foram submetidas a 12 sessões de exercícios de Pilates no solo com duração média de 50 minutos, sendo reavaliadas no término do protocolo de intervenção. As participantes obtiveram aumento da força e da ativação elétrica dos músculos paravertebrais lombares, bem como aumento na capacidade de contração do músculo transverso do abdômen. Com base nos resultados observou-se uma melhora significativa da força e da condutibilidade elétrica dos músculos estabilizadores lombares das voluntárias e, portanto, o treinamento com o MP influenciou positivamente essa musculatura.

Risk Factors for Recurrent Lumbar Disc Herniations

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future.

Surgical versus Conservative Treatment for Lumbar Disc Herniation with Motor Weakness

OBJECTIVE: The aim of this study is to assess outcomes during first one year for patients with severe motor weakness caused by lumbar disc herniation that underwent surgical or nonsurgical treatment. METHODS: The 46 patients with motor weakness because of lumbar disc herniation who were treated at neurosurgical department and rehabilitation in our hospital from 2006 to 2010, retrospectively. Each group had 26 surgical treatments and 20 conservative treatments. We followed up 1, 3, 6 months and 12 month and monitored a Visual Analogue rating Scale (VAS) of back and leg pain, Oswestry Disability Index (ODI) and degree of motor weakness. We analyzed the differences between surgical and nonsurgical groups using Mann-Whitney U test and repeat measure ANOVA in each follow-up periods. RESULTS: In the recovery of motor weakness, surgical treatment uncovered a rapid functional recovery in the early periods (p=0.003) and no difference between groups at the end of follow-up period was found (p>0.05). In VAS of back and leg, the interaction between time and group was not found (p>0.05) and there was no difference between groups (p>0.05). In ODI, the interaction between time and group was not found (p>0.05) and there was no difference between groups (p>0.05). CONCLUSION: Surgical treatment for motor weakness caused by herniated intervertebral disc resulted in a rapid recovery in the short-term period, especially 1 month. We think early and proper surgical treatment in a case of motor weakness from disc herniation could be a good way for providing a chance for rapid alleviation.

Tumoral Calcinosis at Lumbar Region: A Case Report / 대한척추외과학회지

Tumoral calcinosis is a rare disease involving the ectopic calcifications in the major juxtaarticular sites that was first described by Inclan Alberto in 1943. The etiology of tumoral calcinosis is still obscure. A disturbance of the phosphate metabolism in the kidney has been considered a major cause. However, some patients have no laboratory abnormalities. Tumoral calcinosis in the spine has not been reported in Korea. Recently, we encountered a case of tumoral calcinosis in the lumbar region. The clinical and pathological findings are discussed with a review of the relevant literature.