Relación de la aterosclerosis carotídea con la osteoporosis de columna lumbar y caderas en el infarto agudo de miocardio / Relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in acute myocardial infarction

OBJETIVO: determinar en pacientes con infarto agudo del miocardio, la existencia de asociación entre la aterosclerosis carotídea y la osteoporosis de la columna lumbar y caderas. MÉTODOS: se exploraron 104 pacientes con diagnóstico clínico y de laboratorio de infarto agudo del miocardio. A cada paciente se les realizó ultrasonido doppler carotídeo, en el que se describió grosor íntima-media, localización y tipo de placas ateromatosas, grado de estenosis e índice aterogénico; seguido de densitometría de columna lumbar y caderas. Se clasificaron los niveles de densidad mineral ósea en normal, osteopenia y osteoporosis, según T score. RESULTADOS: no se encontró correlación entre el valor de la densidad mineral ósea y la magnitud del daño aterosclerótico del sector carotídeo. La mayoría de los factores de riesgo se asociaron con valores normales de grosor íntima-media, índice aterogénico aumentado y baja prevalencia de estenosis significativa, así como de osteopenia densitométrica; el envejecimiento y la hipertensión resultaron los predominantes. CONCLUSIONES: más allá de la existencia de factores de riesgo en común, no hubo asociación entre la osteoporosis y la aterosclerosis carotídea en los pacientes con infarto agudo del miocardio.

OBJECTIVE: determine the relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in patients with acute myocardial infarction. METHODS: a study was conducted of 104 patients with a clinical and laboratory diagnosis of acute myocardial infarction. All patients underwent carotid Doppler ultrasonography for intima media thickness, location and type of atheromatous plaques, stenosis degree and atherogenic index, followed by lumbar spine and hip densitometry. Bone mineral density levels were classified as normal, osteopenia or osteoporosis, according to the T-score. RESULTS: no correlation was found between bone mineral density values and the extent of atherosclerotic damage to the carotid sector. Most risk factors were associated with normal intima media thickness values, an increased atherogenic index, a low prevalence of significant stenosis, and densitometric osteopenia. Aging and hypertension were the predominant risk factors. CONCLUSIONS: except for the existence of common risk factors, no association was found between osteoporosis and carotid atherosclerosis in patients with acute myocardial infarction.

Experiencia en tratamiento quirúrgico de cinco casos de siringomielia / Experience in surgical treatment of five cases of syringomyelia

Siringomielia, cavidades quísticas dentro del cordón espinal. Con incidencia baja de 8.4 por 100000 por año, Presentamos nuestra experiencia en tratamiento quirúrgico de 5 casos de siringomielia. Se presenta serie clínica, sin distinción de edad ni sexo, con diagnostico de siringomielia y que cumplan con los criterios quirúrgicos establecidos por el grupo. Estudiamos 5 pacientes, la totalidad de los casos presentaron síndrome disociativo medular por siringomielia, 4 casos sexo femenino, promedio de edad de 40,8 años, rango de seguimiento de 6 años a 6 meses, 5 casos procedentes del estado Mérida, 100% diagnostico por resonancia, 3 caso localización cervical, 1 caso la etiología es hemangioma capilar, a los 5 se les realizo derivación siringosubaracnoidea con mejoría clínica y en el postoperatorio tardío un 20% presento recidiva, manejada conservadoramente.

Syringomyelia, cystic cavities within the spinal cord. With low incidence of 8.4 per 100000 per year, present our experience in surgical treatment of 5 cases of syringomyelia. We present clinical series, regardless of age, sex diagnosed with syringomyelia and meet surgical criteria established by the grupo. We studied 5 patients, all cases had spinal cord syndrome and syringomyelia dissociative 4 cases female, mean age of 40.8 years, range 6-year follow-up to 6 months, 5 cases from the state of Merida, 100% resonance diagnosis, 3 cases cervical lesion, 1 case of capillary hemangioma etiology, to 5 were conducted with clinical improvement siringosubaracnoidea bypass and postoperative period by 20% for 1 case of recurrent, conservatively managed.

Discectomía cervical anterior con artrodesis intersomática con cesta de titanio: experiencia en 102 casos (2002-2008)

La elevada frecuencia de pacientes con trastornos cervicales, ha llevado a estudiar estas afecciones, cuya diferenciación de otras enfermedades en muchas ocasiones resulta difícil. En la práctica neuroquirúrgica las enfermedades cervicales y degenerativas son unas de las más frecuentes, las hernias de columna cervical representan el segundo lugar de frecuencia de la patología discal. Este trabajo está basado en la revisión de la técnica de artrodesis cervical anterior posdiscectomía y fusión utilizando la cesta roscada de titanio, sin uso de injertos óseos, placas o tornillos, el cual es continuación de una revisión realizada dada la experiencia del autor en el 2004. Se analizan los procedimientos diagnósticos más frecuentemente utilizados y los criterios para la selección del tratamiento quirúrgico. Se presenta la experiencia en 102 casos. Las principales ventajas que ofrece esta técnica son: menor instrumentación; acortamiento del tiempo quirúrgico; estabilización inmediata de la columna cervical con recuperación y deambulación precoz de los pacientes, con retorno precoz a sus actividades normales, con mínimas complicaciones y reducción de costos

Cervical spinal degenerative and discal diseases are among the most common conditions encountered in medical practice. Herniated discs are more common in patients under 40 years of age and degenerative processes are more common after that age. In this study, the most common diagnostic methods and the current criteria for surgical management are reviewed. The author presents his experience of 102 cases with cervical discal and degenerative disease treated by discectomy and fusion through anterior approach, using the titanium cage without use of bone grafts, plates or screws. The main advantages of this technique include shortening of surgical time and fewer instrumentation, immediate stabilization of the cervical spine, early functional recovery and return to normal activities within two weeks with minimal complications, and lower cost

Utilidad de la biopsia vertebral percutánea en neurocirugia / Percutaneous vertebral biopsy utility in neurosurgery

La biopsia vertebral percutánea es un procedimiento que brinda una adecuada, rápida y costo efectiva ayuda a los neurocirujanos para el diagnóstico de lesiones vertebrales benignas y malignas. En pacientes con hallazgos físicos, imagenológicos y de laboratorio inespecíficos, la biopsia vertebral percutánea conduce a un adecuado diagnóstico y a la implementación de una terapia oportuna. Este tipo de biopsia puede ser realizada utilizando anestesia local o sedación. Según diversas series podemos obtener certeza diagnóstica entre un 70-100 por ciento en unión con una experta interpretación citopatológica. Presentamos el análisis de una pequeña muestra de pacientes a quienes en el servicio de neurocirugía de la Universidad de Cartagena los hemos sometido a biopsia vertebral percutánea.

Spontaneous reduction of a traumatic L2-L3 subluxation without fracture in a 14-year-old boy

To report a rare case of lumbar vertebral subluxation associated with spontaneous reduction in an adolescent treated conservatively. A 14-year-old male victim of a snowboard accident, which caused a lumbar spinal injury, was referred to the emergency room with significant lumbar pain. Neurologic examination was normal. Radiographic assessment at admission showed a unilateral left lateral subluxation of the L2-L3 vertebrae without associated fractures. These findings were confirmed by CT scan and a surgical management was decided. The preoperative MRI performed 24 h after the accident, however, revealed the spontaneous reduction of the subluxation, and an associated tear of the quadratus lumborum and the psoas muscles on the right side at the level of L2, L3 and L4. Following these findings conservative treatment with a plaster brace for 2 months was carried out. The brace was removed after 2 months. The patient had no pain and the range of motion of his lumbar spine was normal. Three months after injury, sports activities were resumed. At follow-up of 24 months, the patient was free of pain and radiographs showed a right positional bending without rotational or translation anomaly. To date, this is the first case of subluxation without fracture in a child, presenting without neurological deficit and where spontaneous reduction occurred. In this case, conservative treatment was effective and the outcome at 2-year follow-up was excellent

The application of radiological imaging in the forensic pathology about cervical part / 法医学杂志

Multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) are useful to analyze cervical injury. Especially in injury of skeleton and soft tissue, it has equal value with conventional autopsy. Even they can reparation some shortcoming consisted in the cervical part autopsy. In some difficult postmortem examination of decomposed, charred or highly infectious cadavers and in some religion country, they should be a useful alternative way to examine injury in cervical part of cadaver such as mechanical asphyxia, whiplash injury, vertebra injury, or vascular injury.

Video assisted thoracoscopic surgery for spinal conditions.

Video-assisted thoracoscopic surgery (VATS) has become an alternative treatment tool for a variety of spinal conditions in the last two decades. This endoscopic or "keyhole" approach minimizes the chest wall morbidity related to the traditional thoracotomy. The current indications for VATS are the same as in any open anterior spinal surgery. This article reviews the outcomes of VATS treatments in thoracic disc diseases, fractures, tumors and vertebral osteomyelitis. In addition, we have described our "learning curve" and surgical techniques using video-assisted thoracoscopic spinal releases and instrumentation in the treatment of 50 patients with adolescent idiopathic scoliosis.

Fraturas da coluna toracolombar / Spinal fractures

Nos dias atuais, temos um número, cada vez maior, de lesões complexas e graves da coluna vertebral, devido ao crescente aumento de acidentes industriais e automobilísticos graves. Nos politraumatizados existe também a freqüente associação neurológica, gerando muitas vezes seqüelas permanentes. Assim, é de extrema importância o conhecimento quanto ao diagnóstico e tratamento dos traumatismos da coluna dorsal

rare cause of low back pain in a multiparous woman bipedicular stress fractures of the third lumbar vertebra without spondylolysis

We present a 34-year old mother of 12 children with stress fracture of pedicles third lumbar vertebra due to stress of repeated pregnancies in short interval. Such fractures are reported in association with unilateral spondylolysis and also in competitive sports persons. To our knowledge, such an injury is not reported in a non-sporting individual

Coluna vertebral: repercussoes agudas e cronicas dos acidentes de trabalho / Spine column: acute and chronic repercussions of the labor accidents

O autor faz uma revisao das consequencias do acidente de trabalho para o trabalhador, particularmente em relacao a coluna vertebral, citando dados estatisticos regionais e estudos internacionais para ratificar a importancia do assunto. E comentado um terceiro tipo de contracao muscular denomminada isocinetica, desenvolvida em um aparelho computadorizado e que podera, no futuro, ser disseminado nos diferentes locais de trabalho, bem como um estudo sobre as diversas formas de tratamento para os pacientes de fabricas, utilizando padroes semelhantes aos realizados em seus locais de trabalho.