Paternal Obesity Induced by High-Fat Diet Impairs the Metabolic and Reproductive Health of Progeny in Rats.

Due to the increased incidence of obesity, it is of great importance to identify all the possible consequences in those who suffer from it and their descendants. This study aimed to investigate how paternal obesity, resulting from an 18-week high-fat diet (HFD), affects the metabolic and reproductive health of offspring. In the fathers (F0 generation), the HFD led to significant weight gain, primarily due to increased visceral fat. It also resulted in impaired glucose control and reduced insulin sensitivity. Furthermore, F0 males from the HFD group had reduced sperm concentration and lower sperm viability but were still able to sire litters. F1 offspring were monitored during 18 weeks; F1 offspring from obese fathers displayed increased body weight during the experimental window, especially in males, without significant metabolic disturbances. Additionally, F1 males showed reduced sperm viability, indicating potential reproductive implications. On the other hand, F1 females showed normal estrous cycle patterns but had a reduced number of primordial follicles, suggesting a decrease in their follicular reserve and reproductive potential. This study highlights that metabolic and reproductive issues may be passed down to future generations through the paternal line.

High-fat diet impairs glucose homeostasis by increased p16 beta-cell expression and alters glucose homeostasis of the progeny in a parental-sex dependent manner.

Introduction: Obesity consists in the accumulation of adipose tissue accompanied by low grade chronic inflammation and is considered a pandemic disease. Recent studies have observed that obesity affects females and males in a sex-dependent manner. In addition, several works have demonstrated that parental obesity increases the risk to develop obesity, insulin resistance, diabetes, and reproductive disorders. Considering that intergenerational effects of obesity may occur in a sex-dependent manner, we studied male Wistar rat progeny (F1) obtained from mothers or fathers (F0) fed on a high-fat diet (HFD). Methods: Five-week-old female and male Wistar rats were fed on a HFD (with 60% of calories provided by fat) for 18 weeks (F0). At the end of the treatment, animals were mated with young rats to obtain their progeny (F1). After weaning, F1 animals were fed on standard chow until 18 weeks of age. Body weight gain, fasting plasma glucose, insulin and leptin levels, glucose tolerance, insulin sensitivity, and adiposity were evaluated. In addition, beta-cell expression of nuclear p16 was assessed by immunofluorescence. Results and conclusions: HFD altered plasma fasting glucose, insulin and leptin levels, glucose tolerance, adiposity, and beta-cell expression of p16 in F0 rats. Particularly, HFD showed sexual dimorphic effects on body weight gain and insulin sensitivity. Moreover, we observed that parental HFD feeding exerts parental-sex-specific metabolic impairment in the male progeny. Finally, parental metabolic dysfunction could be in part attributed to the increased beta-cell expression of p16; other mechanisms could be involved in the offspring glucose homeostasis.

Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28 / Sinovitis y tenosinovitis subclínica evaluada por índice ultrasonográfico 7 en pacientes con artritis reumatoide tratados con fármacos sintéticos en remisión clínica por DAS-28

OBJECTIVE: To identify synovitis and tenosynovitis active by using the Ultrasound 7 (US 7) scoring system in patients with rheumatoid arthritis (RA) in clinical remission induced by synthetic disease-modifying antirheumatic drugs (DMARDs). METHODS: This is a multicentric, cross-sectional, observational study including 94 RA patients >18 years old who were in remission as defined by the 28-joints disease activity score (DAS28) <2.6 induced by synthetic DMARD during at least 6 months. Patients with a previous or current history of biologic DMARD treatment were not included in the study. Demographic and clinical data were collected by the local rheumatologist; the US evaluation was performed by a calibrated rheumatologist, who intended to detect grayscale synovitis and power Doppler (PD) using the 7-joint scale. Intra and inter-reader exercises of images between 2 ultrasonographers were realized. RESULTS: Patients' mean age was 49.1+/-13.7 years; 83% were women. The mean disease duration was 8+/-7 years and remission lasted for 27.5+/-31.8 months. The mean DAS28 score was 1.9+/-0.66. Grayscale synovitis was present in 94% of cases; it was mild in 87.5% and moderate in 12.5%. Only 12.8% of the patients had PD. The metatarsophalangeal, metacarpophalangeal, and carpal joints of the dominant hand were the joints more frequently affected by synovitis. Tenosynovitis by grayscale was observed in 9 patients (9.6%). The intra and inter-reading kappa value were 0.77, p < 0.003 (CI 95%, 0.34-0.81) and 0.81, p < 0.0001 (CI 95%, 0.27-0.83) respectively. CONCLUSIONS: Low percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission. This score has benefit because evaluate tenosynovitis, another element of subclinical disease activity

OBJETIVO: Identificar la sinovitis y tenosinovitis activa mediante el uso de ultrasonido en un índice de 7 articulaciones (US7) en pacientes con artritis reumatoide (AR) en remisión clínica inducida por fármacos antirreumáticos modificadores de la enfermedad sintética (DMARD). MÉTODOS: Se trata de un estudio observacional multicéntrico, transversal, que incluyó a 94 pacientes con AR mayores de 18 años que estaban en «remisión de acuerdo a DAS-28<2,6 inducida por DMARD sintético durante al menos 6 meses». Los pacientes con antecedentes previos o actuales de tratamiento biológico no fueron incluidos en el estudio. Los datos demográficos y clínicos fueron recogidos por el reumatólogo tratante; la evaluación de US fue realizada por un reumatólogo experimentado, para detectar sinovitis en escala de grises y power Doppler (PD) utilizando la escala de 7 articulaciones. Se realizaron ejercicios intra e inter-lector de imágenes entre 2 ultrasonografistas. RESULTADOS: La edad media de los pacientes fue de 49,1+/-13,7 años; el 83% eran mujeres. La duración media de la enfermedad fue de 8+/-7 años y la remisión duró 27,5+/-31,8 meses. La media de DAS-28 fue de 1,9+/-0,66. La sinovitis en escala de grises estuvo presente en el 94% de los casos; fue leve en el 87,5% y moderada en el 12,5%. Solo el 12,8% de los pacientes tenían PD. Las articulaciones metatarsofalángicas, metacarpofalángicas y carpales de la mano dominante fueron las articulaciones más frecuentemente afectadas por la sinovitis. La tenosinovitis en escala de grises se observó en 9 pacientes (9,6%). El valor de kappa intra e inter-lector fue 0,77, p < 0,003 (CI 95%: 0,34-0,81) y 0,81, p < 0,0001 (CI 95%: 0,27-0,83), respectivamente. CONCLUSIONES: Se observó un bajo porcentaje de sinovitis y tenosinovitis activa de acuerdo a PD por US7 en pacientes con AR tratados con DMARD sintéticos. Esta escala tiene ventaja porque evalúa tenosinovitis, otro elemento de la actividad inflamatoria subclínica

High risk of lumbar spine osteoporosis with the RANK rs3018362 polymorphism.

Osteoporosis is characterized by reduced bone mineral density (BMD) and quality, increasing the risk of fractures. A large number of genes involved in bone metabolism have been implicated in the genesis of osteoporosis; these include RANK and RANKL. Polymorphisms of these genes have been implicated in osteoporosis. The aim of this study was to determine the association of the RANK rs3018362 and RANKL rs12585014 polymorphisms with risk of osteoporosis. Four hundred Mexican women aged 40 years old or above were genotyped by real-time PCR and several demographic and risk factors were explored. The GA and AA genotypes of the rs3018362 polymorphism were associated with a high risk of osteoporosis in the dominant model (p=.0062; OR = 2.16, 95% CI: 1.24-3.78). In summary, the rs3018362 polymorphism in the RANK gene seems to be associated with osteoporosis of the lumbar spine while the RANKL rs12585014 is not, although more studies are needed to confirm these results.

Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28.

OBJECTIVE: To identify synovitis and tenosynovitis active by using the Ultrasound 7 (US 7) scoring system in patients with rheumatoid arthritis (RA) in clinical remission induced by synthetic disease-modifying antirheumatic drugs (DMARDs). METHODS: This is a multicentric, cross-sectional, observational study including 94 RA patients >18 years old who were in remission as defined by the 28-joints disease activity score (DAS28) <2.6 induced by synthetic DMARD during at least 6 months. Patients with a previous or current history of biologic DMARD treatment were not included in the study. Demographic and clinical data were collected by the local rheumatologist; the US evaluation was performed by a calibrated rheumatologist, who intended to detect grayscale synovitis and power Doppler (PD) using the 7-joint scale. Intra and inter-reader exercises of images between 2 ultrasonographers were realized. RESULTS: Patients' mean age was 49.1±13.7 years; 83% were women. The mean disease duration was 8±7 years and remission lasted for 27.5±31.8 months. The mean DAS28 score was 1.9±0.66. Grayscale synovitis was present in 94% of cases; it was mild in 87.5% and moderate in 12.5%. Only 12.8% of the patients had PD. The metatarsophalangeal, metacarpophalangeal, and carpal joints of the dominant hand were the joints more frequently affected by synovitis. Tenosynovitis by grayscale was observed in 9 patients (9.6%). The intra and inter-reading kappa value were 0.77, p<0.003 (CI 95%, 0.34-0.81) and 0.81, p<0.0001 (CI 95%, 0.27-0.83) respectively. CONCLUSIONS: Low percentage of synovitis and tenosynovitis active were founded according to PD US by 7 score in RA patients under synthetic DMARDs during long remission. This score has benefit because evaluate tenosynovitis, another element of subclinical disease activity.

Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis.

BACKGROUND: Musculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA. METHODS: Thirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen's kappa according to Landis and Koch. RESULTS: US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63-1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34-89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83-1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43-.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67-0.95, IC 95% 0.67-1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78-0.99, p.001), damage cartilage (0.89, IC 95% 0.78-0.99, p = 0.001), PD (0.66, IC 95% 0.39-1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53-.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58-.91, p = 004) was good. CONCLUSIONS: The intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.

Sonographic characterization of Hoffa's fat pad. A pilot study.

This study addresses a topic that was previously unaddressed in the literature: the normal sonographic appearance of the Hoffa's fat pad (HFP) in young, asymptomatic subjects. The aim of the study is to describe the sonoanatomical features of HFP, including its echostructure, echogenicity, elasticity, and vascularization, in subjects without knee pathology. Knees of healthy subjects were examined with grayscale ultrasound (US) to determine the sonographic characteristics of the HFP. Echogenicity was assessed by pixel intensity quantification. Vascularity was evaluated by color Doppler (CD) US. Elasticity of the adipose tissue was examined by sonoelastography. The absence of HFP pathology was confirmed clinically in all participants and by magnetic resonance imaging in randomly selected participants. Seventy-two knees from 36 subjects were assessed. The HFP presented a characteristic well-defined two-layered echostructure: the superficial adipose tissue was hypoechoic with respect to the nearby patellar tendon and contained septae, whereas the deeper layer was homogeneously hypoechoic and lacked connective tissue septae. Echogenicity differed between the superficial and deeper layers (the deeper layer was brighter), suggesting that the degree of acoustic impedance differed between layers. CD detected blood flow in 55.5% of HFPs. The superficial HFP layer presented greater elasticity than the deeper HFP layer (88.8 vs. 75.3 Kpa; p < .001). Our study provides a comprehensive description of the normal sonographic features of the HFP, which is useful to increase the potential of US for the discrimination of pathological findings involving this anatomical area.

Detección temprana de la escoliosis idiopática del adolescente: una estrategia en controversia / Early detection of adolescent idiopathic scoliosis: Strategy in controversy

Resumen La escoliosis idiopática del adolescente (EIA) consiste en una deformidad tridimensional de la estructura de la columna vertebral en los planos coronal, sagital y rotacional, que afecta a sujetos sanos a partir de los 10 años de edad hasta la madurez ósea o al término del crecimiento. Esta enfermedad puede comprometer el estado físico, emocional y, por lo tanto, la calidad de vida de quienes la padecen, por lo que debe ser considerada un problema de salud significativo. La EIA se puede sospechar con un examen físico de columna, mediante el cual se evalúa el nivel de los hombros, el nivel de las escápulas, el nivel de la pelvis, la prueba de Adams y el signo de Pitres. A pesar de que en México no se han establecido oficialmente programas para la detección temprana de la enfermedad, la prueba de Adams puede ser la pauta para identificar y prevenir el desarrollo de esta deformidad. La aplicación de esta prueba de tamizaje está al alcance de todos. A pesar de que se podría considerar que su detección oportuna desde etapas tempranas sería la mejor estrategia para combatirla a tiempo, existen grupos de investigación a nivel internacional que opinan distinto, lo que ha colocado a la detección temprana como un tema controversial. Por lo anterior, el objetivo de este trabajo es ofrecer al lector un panorama general y actualizado de las diferentes perspectivas del tema, esperando que sea de utilidad para la práctica profesional.

Abstract Adolescent idiopathic scoliosis (EIA), consists of a three-dimensional deformity of the structure of the spine in the coronal, sagittal and rotational planes affecting healthy subjects ranging from 10 years of age until skeletal maturity or term of growing. This disease can compromise physical and emotional state, therefore, the quality of life of those who suffer it, so the EIA must be considered as significant health problem. The EIA can be suspected by a physical examination of the spine on whichshoulders level, shoulder blades level, pelvis level, Adams Test and Pitres sign are evaluated. Even though, it hasn't been officially established a program for an early detection of the disease in Mexico, evidence through Adams Test can be a guideline to identify and prevent the development of this deformity. The application of this screening test is available to all. Although it could be considered that early detection of this deformity at young ages would be the best strategy to get on time for treatment, there are international research groups that have a different opinion, which has placed early detection of EIA as a controversy topic. Therefore, the aim of this paper is to provide a general and updated overview of the different perspectives of this issue, hoping it will be useful for the professional practice.

A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound.

The aim of this study is to characterize bone erosions in metatarsal heads (MTH) in rheumatoid arthritis (RA) and gout by grayscale ultrasound. In a descriptive, cross-sectional study, we evaluated 40 patients with RA and 40 with gout, both diagnosed according to the American College of Rheumatology/European League Against Rheumatism criteria, respectively. All patients had bone erosion demonstrated by ultrasound, which was used, following OMERACT criteria, to describe the shape, size, number, border definition, overhanging margin, topography (intra- or extra-articular), and distribution (over dorsal, medial, lateral, or plantar aspect) of the lesions in the MTH. Descriptive statistics were used and a concordance exercise between two ultrasonographers blinded to the diagnosis was performed. Bone erosions in RA were observed most frequently at the plantar and lateral aspect of the fifth MTH, round in 96 %, small-sized (2.43 ± 0.9 mm), intra-articular (100 %), and single (75 %). Few bone erosions had a well-defined border an overhanging margin while in gout were found most frequently in the medial and dorsal aspect of the first MTH, single in 71 %, intra-articular in 100 %, and of median size (4.0 ± 2.3). For shape, 51 % was round and 49 % was oval. A well-defined border was present in 39 %, and an overhanging margin in 62 %. Inter-rater reliability kappa was excellent (0.81, 95 % CI 0.56-1.00). Some characteristics of bone erosions in RA, including shape, size, ill-defined border, and localization in the fifth MTH could distinguish the lesions from gout. Grayscale US has excellent reliability to describe bone erosions in RA and gout.

Ultrasound in the interstitial pulmonary fibrosis. Can it facilitate a best routine assessment in rheumatic disorders?

Ultrasound (US) is increasing its potential in the assessment of several rheumatic disorders. Recently, different applications of this imaging technique have emerged. Interesting data supporting its utility and validity in the assessment of the lung to detect and quantify interstitial pulmonary fibrosis in rheumatic diseases, even in subclinical phases, have been reported. The main purpose of this review is to provide an overview of the role of US in the assessment of interstitial pulmonary fibrosis in rheumatic disorders and to discuss the current evidence supporting its clinical relevance in daily clinical practice.

Tendon involvement in patients with gout: an ultrasound study of prevalence.

The objective of the present study is to evaluate, by ultrasonography (US), the prevalence in the quadriceps, patellar, and Achilles tendon involvement of gout compared to that of patients with osteoarthritis and asymptomatic marathon runners. This is a multicenter, multinational, transverse cross-sectional, and comparative study comprising 80 patients with the diagnosis of gout according to the American College of Rheumatology (ACR) criteria, compared with two control groups: 35 patients with generalized osteoarthritis according to the ACR criteria and 35 subjects who were healthy marathon runners. Demographics and clinical characteristics, such as age, gender, comorbidity, disease duration, pain at the enthesis in the knee and ankle, frequency of disease exacerbations, uric acid level more than 7.2 mg at the time of evaluation, and type of treatment, were recorded. All participants were examined by ultrasound at the quadriceps, the patellar at its proximal and distal insertion, and the Achilles tendon to detect intra-tendinous tophus or aggregates according to the OMERACT definitions. Descriptive statistics and differences between groups were analyzed by chi-square test. Sensitivity and specificity by US were calculated. The prevalence of intra-tendinous aggregates and tophi in gout was significant compared with the other groups. Both lesions were the most frequent at the distal patellar insertion, followed by the quadriceps, Achilles, and proximal patellar insertion ones. In patients with osteoarthritis (OA), intra-tendinous hyperechoic aggregates were observed in 20 % of quadriceps tendons and in 11 % of patellar tendons at its proximal insertion, while in the healthy marathon runner group, the Achilles tendon had this kind of lesion in 17 % of the subjects. Neither the OA nor the healthy marathon runners had intra-tendinous tophi. The sensitivity and specificity of US to detect tophi or aggregates were 69.6 and 92 %, respectively, tendon involvement at the lower limbs in gout is very frequent, particularly in the patellar tendon, and US possesses good sensitivity and specificity for detecting intra-tendinous tophi.

Molecular dynamics simulations of 2-(dimethylamino)ethanol (DMEA).

We develop a multipurpose force field to investigate the properties of the condensed phases of 2-(dimethylamino)ethanol (DMEA). We use ab initio computations at the HF/6-311++G(2d,2p) level to derive partial charges, obtain force constants, and compute the electrostatic potential of the DMEA. We find that the HF predictions for the dipole moment are in excellent agreement with the experimental result (2.6 D). The computations also show the strong preference of DMEA to form intramolecular hydrogen bonds between the hydrogen in the alcohol group and nitrogen. We have tested the accuracy of our force field by computing coexistence and interfacial properties as well as thermal conductivities in wide range of thermodynamic states. In all these instances we find excellent agreement with the available experimental data. We have further investigated the structure of the liquid by computing pair correlations. Our results indicate a clear preference for DMEA to form low-dimensional structures, such as linear and bifurcated chains, which are driven by the association of the DMEA molecules via the alcohol group. Overall, our force field provides a good basis to compute the bulk and interfacial properties of DMEA.

[Transpedicular dynamics stabilization in the treatment of lumbar stenosis. Fourth years follow-up]. / Estabilización dinámica transpedicular en el tratamiento del conducto lumbar estrecho. Seguimiento cuatro años.

INTRODUCTION: We need to evaluate the efficacy and safety of the use of dynamic fixation in patients with narrow lumbar through comparing the assessment of two years with 4 years of follow-up. METHODS: Prospective, longitudinal, autocontrol deliberately and sequential intervention, in lumbar stenosis patients who made treatment with dynamic stabilization posterior type Acuflex. An evaluation of four of final follow-up. RESULTS: 18 patients who completed follow-up two years results as a basis for comparison: 18 patients, 14 female and 4 male, average age 44.05 years. Pain evaluated with numerical visual scale was found in the lower back at 24 months in an average of 2.84 and 48 months in 3.26. We measured the functional level of Oswestry at two years to be 24% and at four years 22.44%, with a p = 0.373. In the magnetic resonance for classification of patients 15 Pfirrmann without changes and three with increase of a degree. According to patients 2 Modic changes one of type 0 to type III and another to type I. We have observed that five patients have required second surgery for removal of material findings. CONCLUSIONS: There is no change between 2 and 4 years in the scale of Oswestry and pain with visual numerical scale functionality. The average height in discs had change with statistical significance, in the comparative period. The intervertebral discs had changes in 3 patients with direct relationship between scale of Pfirrmann and Modic. The rest of patients keep rehydration and normal disc height.

[Use of the PEEK cage in cervical spondylosis treatment]. / Uso de caja de PEEK (Poli-ether-ether-ketona) parael tratamiento de la espondilosis cervical.

BACKGROUND: Decompression and fusion with autograft is the gold standard technique in the treatment of cervical canal strait. Using PEEK cages or boxes of non-absorbable polymer with elasticity similar to bone, radiolucent, reduces morbidity and same degree of fusion. METHODS: A case series, prospective, longitudinal, deliberate intervention, evaluation panel before and after 2 years follow-up. Discectomy and PEEK housing placement with autologous graft. Arthrodesis were evaluated, cervical lordosis, intervertebral space height, pain evaluated with Visual Analogue Scale, Neck Disability Index, operative time, intraoperative bleeding, hospital stay and complications. Statistical analysis with t Sudent, Wilcoxon and Fisher's exact text. RESULTS: Of 17 patients studied, 9 (53%) were female. Average age 62 years. The most affected level was C5-6, C6-7 with 5 patients. Melting was found at 100%. There was no sag or migration of the box, space height was conserved, but segmental lordosis was not retained. Clinical improvement in all patients as well as disability index was seen. Bleeding was on average 187 mL. CONCLUSION: With regard to symptom improvement, conservation of interspace height and back, no segmental lordosis conservation and fusion using PEEK box is consistent with the literature. We suggest using anterior plate to maintain cervical lordosis. We found a melt index of 100%. We found clinical improvement of symptoms, pain and disability, and a global loss of cervical lordosis.

Antecedentes: la descompresión y artrodesis con auto-injerto es el patrón de referencia para el tratamiento del conducto cervical estrecho. El uso de cajas de PEEK polímero no reabsorbible, con elasticidad similar al hueso, radiolúcido, y mismo grado de fusión reduce la morbilidad. aterial y métodos: estudio de serie de casos, prospectivo, longitudinal, de intervención deliberada, evaluación en grupol antes y después, seguimiento a dos años. Discoidectomía y colocación de caja de PEEK con injerto autólogo. Se evaluaron artrodesis, lordosis cervical, altura del espacio intervertebral, dolor mediante escala visual análoga, índice de discapacidad cervical, tiempo quirúrgico, sangrado transoperatorio, estancia intrahospitalaria y complicaciones. Análisis estadístico con t de Student, Wilcoxon y exacta de Fisher. Resultados: de 17 pacientes estudiados, 9 (53%) eran del sexo femenino. La edad promedio 62 años. Sangrado promedio de 187 mL. El nivel más afectado fue C5-C6, C6-C7 en cinco pacientes. Se encontró fusión al 100% sin hundimiento ni migración de la caja, altura del espacio conservada, pero no se conservó la lordosis segmentaria. Mejoría clínica en todos los pacientes, y del índice de discapacidad. Conclusión: la disminución de los síntomas, la conservación de la altura del espacio anterior y posterior, la no conservación de la lordosis segmentaria y la fusión con caja de PEEK fueron congruentes con lo reportado en la bibliografía. Se sugiere utilizar la placa anterior para mantener la lordosis cervical. El índice de fusión encontrado fue de 100%, con disminución de los síntomas de dolor y discapacidad. Pérdida de lordosis cervical global.

Resultados de biopsia guiada por tomografía axial computarizada en el síndrome de destrucción vertebral, evaluados en dos instituciones distintas / Resultados de biópsia guiada por tomografia computadorizada axial na síndrome de destruição vertebral, avaliados em duas instituições distintas / Results of computerized axial tomography-guided biopsy in the vertebral destruction syndrome, evaluated at two different institutions

OBJETIVO: Comparar resultados de biopsias vertebrales guiadas por tomografía axial computarizada, reportados por dos servicios de Anatomía Patológica distintos en pacientes con síndrome de destrucción vertebral para confirmar confiabilidad y utilidad en el diagnóstico. MÉTODOS: Se obtuvieron muestras de tejido de 21 pacientes en el periodo comprendido del 1 de marzo al 15 de julio del 2011 con el diagnóstico del síndrome de destrucción vertebral y a quienes se les realizó biopsia guiada por tomografía axial computarizada. Las muestras se enviaron en forma cegada a dos servicios de patología distintos. Los resultados fueron analizados con el método de comparación de dos proporciones. RESULTADOS: 14 pacientes fueron del género masculino (67%) y 7 del femenino (23%), edades de 28-82, con afección principalmente lumbar (48%) y torácica (38%); afectados en una vértebra en 62%, en dos en un 33% y en 3 o más niveles en 5%. Las vértebras más afectadas fueron L1, L2 y L3 (12/30 [40%]), T4 (3/30 [10%]) y T9 (3/30 [10%]). Los resultados se agruparon en categorías: 1. Osteomielitis (9/21 [43%]), 2. Tumores (7/21 [33%]), 3. Metástasis (3/21 [14%]), 4. Tejido normal (2/21 [10%]), 5. Inflamación (0/21 [0%]), 6. Muestra inadecuada (0/21 [0%]), 7. Mal de Pott (0/21 [0%]). CONCLUSIONES: De acuerdo a los valores de Z obtenidos mediante la prueba de comparación de dos proporciones no se encontró diferencia significativa entre los resultados reportados por dos los dos servicios de patología en el síndrome estudiado, determinándose que esta parte del proceso es confiable y útil en un 90%.

OBJETIVO: Comparar resultados de biópsias vertebrais guiadas por tomografia axial computadorizada, relatados por dois serviços de Anatomia Patológica distintos em pacientes com síndrome de destruição vertebral para confirmar a confiabilidade e a utilidade no diagnóstico. MÉTODOS: Foram obtidas amostras de tecido de 21 pacientes no período de 1 de março a 15 de julho de 2011, com diagnóstico de síndrome de destruição vertebral, que foram submetidos a biópsia guiada por tomografia axial computadorizada. As amostras foram enviadas de modo cego a dois serviços de patologia distintos. Os resultados foram analisados pelo método de comparação de duas proporções. RESULTADOS: 14 pacientes eram do sexo masculino (67%) e 7 do feminino (23%), com idades entre 28 e 82 e afecção predominantemente lombar (48%) e torácica (38%); 62% tinham comprometimento em uma vértebra, 33% em duas e 5% em três ou mais níveis. As vértebras mais afetadas foram L1, L2 e L3 (12/30 [40%]), T4 (3/30 [10%]) e T9 (3/30 [10%]). Os resultados foram agrupados em categorias: 1. Osteomielite (9/21 [43%]), 2. Tumores (7/21 [33%]), 3. Metástases (3/21 [14%]), 4. Tecido normal (2/21 [10%]), 5. Inflamação (0/21 [0%]), 6. Amostra inadequada (0/21 [0%]), 7. Mal de Pott (0/21 [0%]). CONCLUSÕES: De acordo com os valores de Z obtidos pela prova de comparação de duas proporções, não se encontrou diferença significante entre os resultados relatados pelos dois serviços de patologia na síndrome estudada, ficando determinado que essa parte do processo tem confiabilidade e utilidade de 90%.

OBJECTIVE: To compare results of vertebral biopsy guided by computerized axial tomography scan, reported by two different Departments of Pathology in patients with vertebral destruction syndrome to confirm the reliability and utility in the diagnosis. METHODS: Tissue samples from 21 patients were obtained March 1 to July 15, 2011, with a diagnosis of the vertebral destruction syndrome and who underwent computerized axial tomography-guided biopsy. The samples were blindly sent to two different pathology services. The results were analyzed using the two-proportion z-test. RESULTS: 14 patients were male (67%) and 7 females (23%), aged between 28 and 82, with condition predominantly lumbar (48%) and thoracic (38%); 62% had one vertebra affected, 33% ha two and 5% had three or more levels involved. The most affected vertebrae were L1, L2 and L3 (12/30 [40%]) and T9 (3/30 [10%]). The results were grouped into categories: 1. Osteomyelitis (9/21 [43%]), 2. Tumors (7/21 [33%]), 3. Metastases (3/21 [14%]), 4. Normal tissue (2/21 [10%]), 5. Inflammation (0/21 [0%]), 6. Inadequate sample (0/21 [0%]), 7. Pott's disease (0/21 [0%]). CONCLUSIONS: According to the values obtained by the two-proportion z-test, there was no significant difference between the results reported by the two departments of pathology for the syndrome studied, being determined that this part of the process has reliability and usefulness of 90%.

Evaluación de una nueva sistematización de estudios para el diagnóstico del síndrome de destrucción vertebral / Avaliação de nova sistematização de exames para o diagnóstico da síndrome de destruição vertebral / Evaluation of a new systematization of tests for the diagnosis of vertebral destruction syndrome

OBJETIVO: Explorar la efectividad de un conjunto de pruebas de diagnósticos, sistematizadas en hoja de protocolo, para la determinación del Síndrome de Destrucción Vertebral en pacientes de nuestro servicio. MÉTODOS: Analizamos una propuesta de sistematización mediante un estudio piloto de 20 pacientes a quienes se realizaron 10 diferentes pruebas de laboratorio y gabinete, además del estudio histopatológico de biopsia percutánea. Se describieron las características demográficas y clínicas, con los resultados obtenidos mediante estadística descriptiva, media y desviación estándar para las variables cuantitativas y porcentajes para las cualitativas. RESULTADOS: Edad promedio de 53,3 años ± 16,56 años; 10 hombres y 10 mujeres. 30 vértebras afectadas en los 20 pacientes, 8 de ellos tuvieron afección de dos o más vértebras. El nivel más afectado fue el Lumbar en 18 casos, seguido por el Torácico en 12. El Mal de Pott se diagnosticó en 7 casos (35%), Osteomielitis en 4 (20%), Mieloma Múltiple en 2 (10%), y Espondilodiscitis, Metástasis de Adenocarcinoma, Linfoma y Osteoporosis en un caso respectivamente (5%). En 3 casos (15%) no se obtuvo un diagnóstico específico. CONCLUSIONES: Esta propuesta de sistematización fue útil para llegar al diagnóstico etiológico definitivo del SDV en 85% de los casos, con la reducción en la cantidad de estudios realizados. Es necesario mayor número de pacientes para aumentar la evidencia de su utilidad.

OBJETIVO: Explorar a efetividade de um conjunto de exames diagnósticos sistematizados em folha de protocolo para determinação da síndrome de destruição vertebral em pacientes atendidos em nosso serviço. MÉTODOS: Analisamos uma proposta de sistematização por meio de estudo piloto de 20 pacientes que foram submetidos a dez exames laboratoriais e de imagens distintos, além do estudo histopatológico de biópsia percutânea. Foram descritas as características demográficas e clínicas e os resultados foram obtidos por estatística descritiva, média e desvio padrão para as variáveis quantitativas e porcentagens para as qualitativas. RESULTADOS: Média de idade de 53,3 ± 16,56 anos; 10 homens e 10 mulheres. Trinta vértebras afetadas nos 20 pacientes; 8 deles tinham afecção em duas ou mais vértebras. O nível mais afetado foi o lombar em 18 casos, seguido pelo torácico em 12. A tuberculose da coluna vertebral (doença de Pott) foi diagnosticada em 7 casos (35%), a osteomielite, em 4 (20%), o mieloma múltiplo, em 2 (10%) discite, metástase de adenocarcinoma, linfoma e osteoporose, cada um em um caso (5%). Em 3 casos (15%) não se obteve diagnóstico específico. CONCLUSÕES: Esta proposta de sistematização foi útil para chegar ao diagnóstico etiológico definitivo da SDV em 85% dos casos, com redução da quantidade de exames realizados. É preciso estudar um número maior de pacientes para aumentar a evidência de sua utilidade.

OBJECTIVE: To explore the effectiveness of a systematic set of diagnostic tests in a protocol sheet for determination of vertebral destruction syndrome in patients treated in our service. METHODS: We analysed a proposal for systematization through a pilot study of 20 patients who underwent 10 different laboratory and imaging tests, as well as the histopathological study through percutaneous biopsy. We described the demographic and clinical characteristics and likewise the results obtained by means of descriptive statistics, mean and standard deviation for quantitative variables and percentage for qualitative variables. RESULTS: Average age of 53.3 ± 16.56 years; 10 men and 10 women. Thirty vertebrae affected in 20 patients; 8 patients had disease in two or more vertebrae. The most affected level was the lumbar in 18 cases, followed by thoracic in 12. The spinal tuberculosis (Pott's disease) was detected in 7 cases (35%), osteomyelitis in 4 (20%), multiple myeloma, in 2 (10%), and discitis, metastasis of adenocarcinoma, lymphoma and osteoporosis in one case (5%). In 3 cases (15%) there was no specific diagnosis. CONCLUSIONS: This proposal of systematization was useful to reach the final etiological diagnosis of the VDS in 85% of cases, with the reduction in the number of tests. It is necessary to study a larger number of patients to increase the evidence of its usefulness.

Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up.

Decompression surgery for lumbar spinal stenosis is a common procedure. After surgery, segmental instability sometimes occurs, therefore, different methods for restabilization have been developed. Dynamic stabilization systems have been designed to improve segmental stability. In this study, clinical results of patients with lumbar spinal stenosis that underwent decompression and stabilization with the Accuflex dynamic system are presented; clinical, radiographic, and magnetic resonance imaging (MRI) findings are fully described. Improvements in all clinical measurements, including visual analog scale for back and leg pain, Oswestry disability index, and SF-36 health status survey were noticed. At a 2-year follow-up, 22.22% of patients required hardware removal due to fatigue while in 83% of them no progression of disk degeneration was observed after implantation of the Accuflex system. Additionally, as demonstrated by the MRI images at follow up, three patients (16%) showed disk rehydration with one grade higher on the Pfirmann classification. Although a relatively high hardware failure was observed (22.22%), the use of the dynamic stabilization system Accuflex posterior to decompression procedures, showed clinical benefits and stopped the degenerative process in 83% the patients.

Postoperative spinal wound infections treated by external spinal fixator. Review of three cases.

BACKGROUND: external fixation in the spine has been used with different objectives: to determine the prognosis of spinal fusion, improve stabilization after decompression in cases of trauma and for the progressive correction of scoliosis. Currently, we have not found any reports about its use in the case of postoperative infection with surgical wound dehiscence. CLINICAL CASES: this is a retrospective study of three patients with postoperative infection of the spine and wound dehiscence. All three patients were male and had an average age of 57 years (range: 32-77 years). The infection started at an average of 7 weeks prior to the application of the external fixator (range: 2-12 weeks). Surgical wound dehiscence was on average 7 cm (range: 2-10 cm). The external fixator, on average, was used for 69 days (range: 36-125 days). There were no complications associated with the use of the external fixator. The external fixator was used as definitive treatment in one patient and as a temporary treatment in two patients. CONCLUSIONS: the external fixator may be a useful implant for the treatment of patients with postoperative infections of the spine with surgical wound dehiscence and instability.