Clinical management of dogs with presumptive diagnosis of thoracolumbar intervertebral disc disease: 164 cases (2006-2017) / Tratamento clínico de cães com diagnóstico presuntivo de doença do disco intervertebral toracolombar: 164 casos (2006-2017)

This study aimed to identify dogs with presumptive diagnosis of cervical intervertebral disc disease (IVDD) submitted to clinical management and to evaluate the outcomes. Data were obtained from the medical records of patients with neurological dysfunction assisted at a University Veterinary Hospital from 2006 to 2017. In addition to the patients' records, dog owners responded to a questionnaire on the success of therapy. Four hundred and thirteen neurological records were evaluated, and 164 met the inclusion criteria of the study. The most common breed was Dachshund, followed by mongrels. Classification of neurological dysfunction in the study sample was as follows: 15.9% with grade I, 25.6% with grade II, 26.8% with grade III, 8.5% with grade IV, and 23.2% with grade V. Outcome was satisfactory in 71.6% of the dogs and unsatisfactory in 28.4% of them. Recurrence was observed in 27.7% of those with satisfactory outcomes. The clinical treatment of dogs with thoracolumbar IVDD is satisfactory, particularly for animals with milder disease grades (I, II, and III). There is possibility of recurrence with conservative therapy and clinical signs may be more severe.(AU)

O objetivo desse estudo foi identificar cães com diagnóstico presuntivo de DDIV toracolombar submetidos ao tratamento clínico, a fim de avaliar a resposta à terapia instituída. Foram revisados os registros neurológicos de cães atendidos pelo Serviço de Neurologia e Neurocirurgia Veterinária no período de 2006 a 2017 de um Hospital Veterinário Universitário. Foi realizada coleta de dados a partir dos registros e por meio de um questionário respondido pelos tutores. Foram avaliadas 413 fichas neurológicas de cães e obtidas informações para inclusão no estudo em 164 delas. As raças mais frequentes foram dachshunds, seguido de cães sem raça definida. Quanto ao grau de disfunção neurológica foi definido como grau I para 15,9% dos cães, grau II para 25,6%, grau III para 26,8%, grau IV para 8,5% e grau V para 23,2%. A recuperação foi satisfatória em 71,6% dos cães e insatisfatória em 28,4%. Dos que se recuperaram satisfatoriamente, 27,7% tiveram recidivas. Com base nos resultados obtidos pode-se concluir que o tratamento clínico em repouso absoluto e administração de anti-inflamatórios e analgésicos opióides para cães com DDIV toracolombar é efetivo, principalmente para cães em graus mais leves da doença (grau I, II e III). Há possibilidade de recidiva com esse tipo de terapia cujos sinais clínicos poderão ser mais graves.(AU)

Ozonoterapia paravertebral en la patología de la columna vertebral lumbar / Terapia ozônio paravertebral na patologia da coluna lombar / Paravertebral ozone therapy in the pathology of the lumbar spine

Introducción: la búsqueda de alternativas terapéuticas para la atención al paciente con patología de la columna vertebral es una exigencia social, para lo cual se promueve el uso de la ozonoterapia. Objetivo: caracterizar la respuesta clínica de los pacientes con patología de la columna vertebral tratados con ozonoterapia paravertebral en el Hospital General Docente Dr Agostinho Neto de Guantánamo durante el período comprendido entre los meses de septiembre de 2017 y agosto de 2018. Método: se realizó un estudio observacional, prospectivo y transversal en el servicio de Neurocirugía en 78 pacientes con enfermedades de la columna vertebral, seleccionados intencionalmente y que participaron conscientemente en un preexperimento que consistió en la aplicación de un ciclo de diez sesiones de ozonoterapia por vía paravertebral durante un periodo de dos semanas. Se controlaron las siguientes variables: intensidad del dolor lumbar medida mediante la escala de evaluación analógica; incapacidad funcional evaluada mediante la escala de Oswestry. Resultados. la mayoría de los pacientes transitó a una categoría de dolor inferior y el 80,7 % se evaluó en la categoría leve­moderado después de la ozonoterapia. Esta posibilitó que en el mayor porcentaje disminuyera el grado de incapacidad funcional y la proporción con un grado mínimo de incapacidad función se incrementara en un 46,0 %. Conclusiones: la ozonoterapia paravertebral constituye una alternativa que puede ayudar en el tratamiento conservador del paciente con patología vertebral(AU)

Introduction: the search for therapeutic alternatives for patient care with pathology of the spine is a social requirement, for which the use of ozone therapy is promoted. Objective: to characterize the clinical response of patients with spinal pathologies treated with paravertebral ozone therapy at the Dr Agostinho Neto Guantanamo General Teaching Hospital during the period between September 2017 and August 2018. Method: a observational, prospective and cross-sectional study in the Neurosurgery service in 78 patients with diseases of the spine, intentionally selected and consciously involved in a preexperiment that consisted in the application of a cycle of ten sessions of ozone therapy by paravertebral route, during a period two weeks The following variables were controlled: lumbar pain intensity measured by the analogical evaluation scale; functional disability assessed by the Oswestry scale. Results: the majority of patients went to a lower pain category and 80.7% were evaluated in the mild-moderate category after ozone therapy. This made it possible for the highest percentage to decrease the degree of functional disability and the proportion with a minimum degree of disability function increased by 46.0%. Conclusions: Paravertebral ozone therapy is an alternative that can help in the conservative treatment of patients with vertebral pathology(AU)

Introdução: a busca de alternativas terapêuticas para o cuidado do paciente com patologia da coluna vertebral é uma exigência social, para a qual o uso da ozonioterapia é promovido. Objectivo: para caracterizar a resposta clínica de pacientes com patologia vertebral tratados com terapia de ozono paravertebral no Agostinho Neto Geral Teaching Hospital Dr Guantánamo durante o período de setembro 2017 a Agosto de 2018. Método: foi realizado um estudo de observação, em perspectiva e em corte transversal, no departamento de neurocirurgia em 78 pacientes com doenças da coluna vertebral, seleccionados intencionalmente e conscientemente participaram num preexperimento que consistia na aplicação de um ciclo de dez sessões de terapia de ozono através paravertebral, ao longo de um período duas semanas As seguintes variáveis foram controladas: intensidade da dor lombar medida pela escala de avaliação analógica; incapacidade funcional avaliada pela escala de Oswestry. Resultados: a maioria dos pacientes foi para uma categoria de dor mais baixa e 80,7% foram avaliados na categoria leve-moderada após a terapia com ozônio. Isso permitiu que o maior percentual diminuísse o grau de incapacidade funcional e a proporção com um grau mínimo de incapacidade aumentasse 46,0%. Conclusões: A terapia com ozônio paravertebral é uma alternativa que pode ajudar no tratamento conservador de pacientes com patologia vertebral(AU)

Case report of vancomycin-induced pancytopenia

Abstract: Vancomycin is the first-line agent for the treatment of bacteremia, endocarditis, pneumonia, cellulitis, and osteomyelitis. Pancytopenia is an uncommon adverse effect of vancomycin therapy, with only a few cases of vancomycin-related neutropenia and pancytopenia described in the literature. We describe a case of a 56-year-old man who was diagnosed with chronic paraspinal abscess and started on intravenous vancomycin. He was re-admitted two weeks later with new-onset pancytopenia. Discontinuation of vancomycin resulted in improved cell counts. Physicians should monitor cell counts in patients who are on long-term intravenous vancomycin.

Management of spinal infection

This review of spinal infections was conducted to better define the population at risk, the affected levels, presentation, causative organisms, duration of antibiotic treatment and indications for surgery. A retrospective analysis of 70 consecutive patients with primary spinal infection [epidural abscess and/or vertebral osteomyelitis] that presented between January 2001 and August 2004 was performed. These patients had not undergone immediate prior spinal surgery. We analyzed patient demographics, co-morbidities, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and white blood cell count [WBC], management and outcomes. The mean age at presentation was 56.4 years [range 8 to 85], with 69% over the age of 50. Over half [56%] were male and 44% were female. Over a quarter [27%] presented with vertebral osteomyelitis, 40% with spinal epidural abscess, and 33% with both. Pain was the most common symptom, occurring in 77% at presentation. Co-morbid diseases included hypertension [41%], diabetes [33%], heart disease [27%] and pulmonary disease [20%]. Forty-one percent were treated with antibiotics alone while 59% underwent a surgical procedure. Ten percent failed initial medical management and required surgery. Time from diagnosis to surgery ranged from 3 to 10 weeks. Surgery was undertaken for decompression or stabilization. All but one patient improved at last follow-up. Declines in ESR and CRP correlated strongly with treatment success while WBC had less correlation. Parenteral antibiotic therapy averaged 8 weeks. This retrospective study further defines the population at risk for spinal infection, outlines current strategies of medical and surgical management, demonstrates the usefulness of laboratory values and conveys outcomes

Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis

To analyze the painkilling effect of ozone-oxygen injection on joint and spine osteoarthritis. This prospective study was completed at the Ozone Clinic, Rashid Hospital, Dubai, United Arab Emirates on 220 mainly local patients [122 women, mean age 47.05 years; 98 men, mean age 52.8 years] with radiographic documented spine or extremities osteoarthritis. The patients were treated over 3 years [September 2002 to August 2005] by ozone-oxygen injection twice a week for at least 12 sessions. Using the 6 faces pain scale; the patients' pain was recorded at the beginning and at the 4th, 8th, and 12th sessions. They were followed for a mean of 8.48 months and their pain scale was recorded at that time too. Comparison of the patients' 1st day pains with their 4th, 8th, and 12th sessions' pains showed a significant decrease [1st day to 4th session p=0.005, 1st day to 8th week p=0.005, 1st day to 12th session p=0.0043]. Comparison of the 1st day pain with the final follow-up pain, which was around 10 months from the first treatment, showed a meaningful decrease of pain [p=0.0048]. This study validates the painkilling effect of ozone-oxygen injection on osteoarthritis of the joints and spine. Its long term effect on pain advocates the likelihood of some histological changes as mechanism of its action

Electro-acupuncture and Chinese herbs for treatment of cervical intervertebral disk disease in a dog

A non-ambulatory dog with tetraparesis following a pain episode that had evolved over 2 months was submitted for medical treatment and diagnosed with intervertebral disk disease at C3-C4 and dorsal extradural compression at C1-C2 and C3-C4 using myelography and computed tomography. The dog experienced ambulation recovery after 15 days of treatment with only electroacupuncture and Chinese herbal medicine, with marked improvement occurring after only 10 treatments. Six months of followup demonstrated that the dog was stable and had no recurrence of symptoms. Therefore, it was concluded that the combination of electroacupuncture and Chinese herbal medicine was responsible for motor rehabilitation.

Ad/CMV- hTGF-beta1 treats rabbit intervertebral discs degeneration in vivo / 华中科技大学学报（医学）（英德文版）

To investigate therapeutic efficiency of Ad/CMV- hTGF-beta1 gene for rabbit intervertebral disc degeneration model. 60 Japanese white rabbits were selected to form the 1.5-L6 Anterior-Lateral-Anulus-Fibrosus-Incision-Induced model in order to simulate human intervertebral disc degeneration. 36 rabbits, whose corresponding intervertebral discs were injected with 20 microl (10 x 10(6) pfu) of Ad/CMV- hTGF-beta1 gene, constituted the therapy group, 12 were injected with 20 microl (10 x 10(6) pfu)of Ad/CMV-LacZ gene as comparison group, while 12 were only injected with equivalent capacity of saline for empty comparison group, 3 weeks after injection, examples were taken for investigation of HE staining, MRI, Western Blotting and immunohistochemical research TGF-beta1. Wide distribution of TGF-beta1 was detected by immunohistochemical research in the degenerated annulus fibrosus after injection. Western Blotting research showed significant increase of TGF-beta1 content in intervertebral discs treated with TGF-beta1 gene than comparison groups. MRI signal transformed from low to comparatively high and that intervertebral disc pathological degree improved. Ad/CMV- hTGF-beta1 gene transfection is a potential method to increase TGF-beta1 content and reverse intervertebral disc degeneration.

Cephalic spreading levels after volumetric caudal epidural injections in chronic low back pain

The volumetric caudal epidural steroid injection has been advocated to facilitate the delivery of medications to the lesion site. This study was aimed to examine the actual spreading patterns of this technique, using epidurogram. A total of 32 patients with chronic low back pain accompanied by radiculopathy of various causes (degenerative spondylosis, herniated nucleus pulposus, spondylolisthesis, and spinal stenosis) were included. The volumetric caudal epidural injection of the 10 mL mixture of contrast medium 5 mL, 0.5% bupivacaine 1 mL, triamcinolone 1.5 mL (60 mg) and normal saline 25 mL was performed. Immediately after the cessation of the first spread, the subsequent solution of another 10 mL of contrast medium 5 mL, 0.5% bupivacaine 1 mL and normal saline 4 mL was injected. This procedure was repeated serially until the total volume to be 50 mL. Continuous fluoroscopic imaging was obtained after each injection. Average time taken to complete the study was 37 sec per every 10 mL. The spreading levels of the mixture were distributed mainly at mid to lower lumbar area in the majority of the patients. During the subsequent injections, the levels were not changed significantly. This was thought to be due to the minimal resistance in cephalad direction, anatomic variations and Starling effect of epidural space.

Comparison of therapeutic efficacy of nimesulide and diclofenac in patients with degenerative joint diseases.

The efficacy and tolerability profiles of nimesulide and diclofenac were evaluated in 180 patients suffering from various degenerative joint diseases. The clinical evaluations were performed at 0, 2 and 4 weeks. Nimesulide (100 mg) tablets were administered twice daily and diclofenac (50 mg) tablets were administered thrice daily. The principal efficacy parameters were the improvement in pain assessed through verbal scoring. Evaluation of tolerance was also established through similar method. Final judgment on efficacy was made by the physician. In all evaluations nimesulide showed improved efficacy parameters over diclofenac.

Abscesos espinales epidurales. Tratamiento combinado médico-quirúrgico. A propósito de 4 casos / Spinal epidural abscesses. Combined medicaland surgical treatment. Report of 4 cases

Los abscesos epidurales espinales (AEE), constituyen una enfermedad de presentación poco frecuente en la atención neuroquirúrgica de nuestro medio, con una morbilidad por déficits neurológicos muy elevada, si las medidas terapéuticas precisas no se toman con celeridad. Esta afección debe ser objeto de estudio, ante todo paciente que la manifieste con dolor en región dorso-lumbar, déficit neurológico y fiebre. Se muestran a 4 pacientes con AEE no tuberculosos ni relacionados con procedimientos quirúrgicos, 2 al nivel lumbar y 2 con inclusión de la región dorso-lumbar, de los cuales 3 presentaron una mala recuperación posoperatoria (entre ellos un fallecido), y uno se recuperó completamente, lo que evidencia la necesidad de tomar una conducta enérgica, desde que se sospeche el diagnóstico. Los autores consideran que la combinación de un tratamiento quirúrgico y médico enérgicos, desde que se comprueba el diagnóstico, independientemente de la severidad del cuadro, es la única garantía de una recuperación adecuada

Granuloma eosinofílico solitário de coluna cervical: relato de caso e revisäo da literatura / Solitary eosinophilic granuloma in the cervical spine: case report and literature review

Os autores apresentam relato de caso de criança portadora de granuloma cosinofílico solitário localizado em coluna cervical ao nível de C3. Realizam ainda revisão da literatura, salientando aspectos como características clínicas, diagnóstico e tratamento desse tipo de lesão.

Síndrome cervical: ensaio com vasodilatador coadjuvando o tratamento físico / Cervical syndrome: test with vasodilator besides physical treatment

O autor faz uma revisäo na fisiopatologia das desordens na coluna cervical e apresenta casuística de 119 pacientes portadores de injúrias cervicais com múltipla sintomatologia. Os pacientes foram divididos em dois grupos: no grupo controle utiliza traçäo cervical e ondas curtas e no grupo teste introduz substância alfa-adrenolítica (Nicergolina), além do tratamento fisiátrico, com o qual obtém melhores resultados na reduçäo de zumbidos e alteraçöes do equilíbrio