International and Multicenter Prospective Controlled Study of Dysphagia After Anterior Cervical Spine Surgery.

BACKGROUND: In the context of anterior approach to the cervical spine, dysphagia is a common complication and still without a clear distinction of risk factors. OBJECTIVE: To analyze the risk factors of dysphagia after cervical spine surgery. METHODS: Multicenter prospective study evaluated patients who underwent anterior cervical spine surgery for degenerative pathologies, studying surgical, anesthesia, base disease, and radiological variables (preoperatively, 24 hours, 1 and 3 weeks, and 6 months after surgery), with control group matched. Postoperative dysphagia was assessed by Swallowing Satisfaction Index and Swallowing Questionnaire; besides, based on multiple logistic regression model, a risk factor analysis correlation was applied. RESULTS: In total, 233 cervical patients were evaluated; most common level approached was C5-C6 (71.8%). All showed same decreasing trade for dysphagia incidence-with more cases on cervical group ( P < .05); severe cases were rare. At postoperative day 1, identified risk factors were approach to C3-C4 (4.11, P < .01), loss of preoperative cervical lordosis (2.26, P < .01), intubation attempts ≥2 (3.10, P < .01), and left side approach (1.85, P = .02); at day 7, body mass index ≥30 (2.29, P = .02), C3-C4 (3.42, P < .01), and length of surgery ≥90 minutes (2.97, P = .005); and at day 21, C3-C4 were kept as a risk factor (3.62, P < .01). CONCLUSION: A high incidence level of dysphagia was identified, having a clear decreasing trending (number of cases and severity) through postoperative time points; considering possible risk factors, strongest correlation was the approach at the C3-C4 level-statistically significant at the 24 hours, 7 days, and 21 days assessment.

Stroke: epidemiology and outcomes / Acidente vascular cerebral: epidemiologia e desfechos

OBJECTIVE: To determine the frequency of mortality, length of stay and nosocomial pneumonia outcomes, as well as their distribution according to predictor variables, in stroke patients treated at the emergency room of a tertiary hospital. METHODS: A retrospective cohort study, with a sample of patients attended between January 1 and December 31, 2018. Based on the data collected in the medical records, the sample was characterized. Therefore, the frequency of each outcome was checked, as well as its distribution according to the predictor variables. RESULTS: The sample population consisted of 210 patients. The frequencies observed in death and nosocomial pneumonia were 17.6% and 17.1%, respectively. The general mean length of stay was 13.8 ±12.9 days. Statistically significant differences were observed both in the occurrence of nosocomial pneumonia and atrial fibrillation (AF); days of hospitalization in intensive care unit; total days of hospitalization; orotracheal intubation; use of nasoenteral tube and surgical procedure secondary to stroke. Morever, there was also the relation of total time of hospitalization regarding dyslipidemia; orotracheal intubation; use of nasoenteral tube and surgical procedure secondary to stroke. CONCLUSION: The results found in the frequency of mortality, nosocomial pneumonia and mean total number of days of hospitalization are comparable with other Brazilian studies. However, it is possible to optimize the time of care provided for patients who arrive in the emergency room. In addition, the decrease of hospitalization days in dyslipidemic patients and the increase of nosocomial pneumonia in AF patients require further studies to verify such findings

OBJETIVO: Averiguar a frequência dos desfechos mortalidade, tempo de internação e pneumonia nosocomial, bem como sua distribuição de acordo com variáveis preditoras, em pacientes vítimas de acidente vascular cerebral (AVC) atendidos na emergência de um hospital terciário. MÉTODOS: Estudo de coorte retrospectiva, com uma amostra de pacientes atendidos entre 1º de janeiro e 31 de dezembro de 2018. Com base nos dados coletados em prontuário, a amostra foi caracterizada. Desta forma, foi verificada a frequência de cada desfecho e sua distribuição conforme as variáveis preditoras. RESULTADOS: A população da amostra foi de 210 pacientes. A frequência observada em óbito e pneumonia nosocomial foi de 17,6% e 17,1%, respectivamente. O tempo médio geral de internação foi de 13,8 ±12,9 dias. Foram observadas diferenças estatisticamente significativas, tanto na ocorrência de pneumonia nosocomial quanto a fibrilação atrial (FA); dias de internação em unidade de terapia intensiva; total de dias de internação; intubação orotraqueal; uso de sonda nasoenteral e procedimento cirúrgico secundário ao AVC. Além disso, verificou-se também a relação de tempo total de internação quanto à dislipidemia; intubação orotraqueal; uso de sonda nasoenteral e procedimento cirúrgico secundário ao AVC. CONCLUSÃO: Os resultados encontrados na frequência de mortalidade, pneumonia nosocomial e média do número total de dias de hospitalização são comparáveis com outros estudos brasileiros. Entretanto, é possível otimizar o tempo de atendimento dos pacientes que chegam ao pronto-socorro. Ademais, a diminuição dos dias de hospitalização em pacientes dislipidêmicos e o aumento da pneumonia nosocomial em pacientes com FA necessitam mais estudos para verificar tais achados

Current Status of Worldwide Use of Patient-Reported Outcome Measures (PROMs) in Spine Care.

OBJECTIVES: Patient-reported outcome measures (PROMs) are the most widely accepted means of measuring outcomes after spine procedures. We sought to determine the current status of worldwide use of PROMs in Latin America (LA), Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) to determine the barrier to its full implementation. METHODS: A questionnaire survey was sent by e-mail to members of AOSpine to evaluate their familiarity and use of PROMs instruments and to assess the barriers to their use in spine care practice in LA, EU, AP, NA, and ME. RESULTS: A total of 1634 AOSpine members from LA, EU, AP, NA, and ME answered the electronic questionnaire. The percentage of spine surgeons who were familiar with the generic health-related quality of life questionnaire was 71.7%. In addition, 31.9% of respondents did not use any PROMs routinely. The main barriers to implementing PROMs were lack of time to administer the questionnaires (57%) followed by lack of staff to assist in data collection (55%), and the long time to fill out the questionnaires (46%). The routine use of questionnaires was more frequent in NA and EU and less common in LA and ME (P < 0.001). CONCLUSIONS: We found that 31.9% of spine surgeons do not use the PROMs questionnaire routinely. This appears to occur because of lack of knowledge regarding their importance, absence of reimbursement for this extra work, minimal financial support for clinical research, the cost of implementation, and lack of concern among physicians.

Trends in scientific publications of Indian spine surgeons over 14 years (2000-2013).

BACKGROUND: The number and quality of scientific publications reflects the standards of scientific research in a country. However, the contribution of Indian spine surgeons toward global publications is unknown. The goal is to study the publications of Indian spine surgeons between 2000 and 2013. MATERIALS AND METHODS: A literature search of the publications by Indian spine surgeons was performed using MEDLINE. The search terms used were India and several spine-related terminologies. The main information of the selected papers including the year of publication, scientific journal, type of pathology studied, Neurosurgical or Orthopedic Department where the study was done, type of study, and the type of article was analyzed. RESULTS: A total of 4459 articles were identified using MEDLINE and after exclusion, 507 articles were analyzed. A growth of 440% in the number of publications was observed in the period between 2009 and 2013, during which 60.15% of the articles were published. Clinical studies (n = 492; 97.04) were the most common types of articles, followed by experimental studies and other types. The Neurosurgery department published the majority of the articles (58.2%). The three most common pathologies studied were spinal tumors (17.35%), surgical technique (15.4%), and spinal infection (15.2%). CONCLUSION: The current study shows that publications in the field of spine surgery have been increasing in the last few years, although it is less. Further efforts such as research training of spine surgeons, inducing collaborations and formulation of multicenter projects and periodically allocating adequate funds are key factors to improve the scientific publications from India.

Analysis of scientific output by spine surgeons from Japan: January 2000 to December 2013.

BACKGROUND: Over the last decade, the growing body of work on spine pathology has led to developments and refinements in the areas of basic science, diagnosis and treatment of a variety of spine conditions. Scientific publications have a global impact on the international scientific community as they share vital information that can be applied by physicians worldwide to solve their everyday medical problems. The historical background of scientific publication in journals in Japan on the subject of spine is unclear. METHODS: We performed a literature search for publications by Japanese spine surgeons regarding spine or spinal cord topics using an online database: Pubmed.gov (http://www.ncbi.nlm.nih.gov/pubmed/). The results were stored and analyzed at the Laboratory of Clinical Studies and Basic Models of Spinal Disorders of the University of Caxias do Sul. Results were limited to articles published from January 2000 to December 2013. The search terms used were "Japan" AND ("spine" OR "spinal diseases" OR "spinal cord" OR "spinal cord diseases" OR "vertebroplasty" OR "arthrodesis" OR "discectomy" OR "foraminotomy" OR "laminectomy" OR "denervation" OR "back injuries"). Japanese spine surgeons were defined as spine surgeons from orthopedic or neurosurgical specialties where the publication was affiliated with Japanese services. RESULTS: A total of 16,140 articles were identified by the Medline search. Most of the articles were excluded based on information provided in the title and abstract as they were not related to spine surgery. This study comprised 1768 articles published in the Medline database by Japanese spine surgeons from 2000 to 2013. The number of publications rose in a linear fashion, with the number of papers published increasing by 5.4 per year (p = 0.038). In recent years the publications were increasingly performed in conjunction with the neurosurgery and orthopedics specialties. CONCLUSIONS: This study showed a clear increase in publications (on Medline) by Japanese spine surgeons over the last 14 years. While this is a positive development, there is also cause for concern as there is some evidence that the number of young scientists is declining in Japan. Special attention to educating researchers and improving resources for research is crucial to further increase the number and quality of Japanese publications.

Dysembryoplastic neuroepithelial tumor originally diagnosed as astrocytoma and oligodendroglioma.

UNLABELLED: Dysembryoplastic neuroepithelial tumor (DNT), described in 1988 and introduced in the WHO classification in 1993, affects predominantly children or young adults causing intractable complex partial seizures. Since it is benign and treated with surgical resection, its recognition is important. It has similarities with low-grade gliomas and gangliogliomas, which may recur and become malignant. OBJECTIVES: To investigate whether DNT was previously diagnosed as astrocytoma, oligodendroglioma, or ganglioglioma and to determine its frequency in a series of low-grade glial/glio-neuronal tumors. METHODS: Clinical, radiological, and histological aspects of 58 tumors operated from 1978 to 2008, classified as astrocytomas (32, including 8 pilocytic), oligodendrogliomas (12), gangliogliomas (7), and DNT (7), were reviewed. RESULTS: Four new DNT, one operated before 1993, previously classified as astrocytoma (3) and oligodendroglioma (1), were identified. One DNT diagnosed in 2002 was classified once more as angiocentric glioma. Therefore, 10 DNT (17.2%) were identified. CONCLUSIONS: Clinical-radiological and histopathological correlations have contributed to diagnose the DNT.

Dysembryoplastic neuroepithelial tumor originally diagnosed as astrocytoma and oligodendroglioma / Tumor neuroepitelial disembrioplásico diagnosticado originalmente como astrocitoma ou oligodendroglioma

Dysembryoplastic neuroepithelial tumor (DNT), described in 1988 and introduced in the WHO classification in 1993, affects predominantly children or young adults causing intractable complex partial seizures. Since it is benign and treated with surgical resection, its recognition is important. It has similarities with low-grade gliomas and gangliogliomas, which may recur and become malignant. OBJECTIVES: To investigate whether DNT was previously diagnosed as astrocytoma, oligodendroglioma, or ganglioglioma and to determine its frequency in a series of low-grade glial/glio-neuronal tumors. METHODS: Clinical, radiological, and histological aspects of 58 tumors operated from 1978 to 2008, classified as astrocytomas (32, including 8 pilocytic), oligodendrogliomas (12), gangliogliomas (7), and DNT (7), were reviewed. RESULTS: Four new DNT, one operated before 1993, previously classified as astrocytoma (3) and oligodendroglioma (1), were identified. One DNT diagnosed in 2002 was classified once more as angiocentric glioma. Therefore, 10 DNT (17.2%) were identified. CONCLUSIONS: Clinical-radiological and histopathological correlations have contributed to diagnose the DNT.

O tumor neuroepitelial disembrioplásico (DNT), descrito em 1988 e incorporado na classificação da OMS em 1993, acomete predominantemente crianças ou adultos jovens, causando crises convulsivas parciais complexas farmacorresistentes. Como é benigno e tratável com ressecção cirúrgica, seu reconhecimento é importante. Tem semelhanças com gliomas de baixo grau e gangliogliomas, que podem recidivar e malignizar. OBJETIVOS: Investigar se o DNT foi originalmente diagnosticado como astrocitoma, oligodendroglioma ou ganglioglioma e determinar sua frequência numa série de neoplasias gliais/glioneuronais de baixo grau. MÉTODOS: Foram revistos aspectos clínicos, radiológicos e histológicos de 58 neoplasias operadas entre 1978 e 2008, classificadas como astrocitomas (32, sendo 8 pilocíticas), oligodendrogliomas (12), gangliogliomas (7) e DNT (7). RESULTADOS: Foram identificados quatro novos DNT, um operado antes de 1993, originalmente diagnosticado como astrocitoma (3) e oligodendroglioma (1). Um DNT diagnosticado em 2002 foi reclassificado como glioma angiocêntrico. Portanto, 10 DNT (17,2%) foram identificados. CONCLUSÕES: Correlações clínico-radiológicas e histopatológicas contribuíram para o diagnóstico do DNT.

Traumatic lesions of internal saphenous nerve and branches.

OBJECTIVE: To show a rare lesion that sometimes simulates vascular disorder of the lower extremities. METHOD: Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches. RESULTS: In two cases there were almost total pain resolution, and in other case improvement only. CONCLUSION: Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

Traumatic lesions of internal saphenous nerve and branches / Lesões traumáticas do nervo safeno interno e seus ramos

OBJECTIVE: To show a rare lesion that sometimes simulates vascular disorder of the lower extremities. METHOD: Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches. RESULTS: In two cases there were almost total pain resolution, and in other case improvement only. CONCLUSION: Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

OBJETIVO: Apresentar lesões raras do nervo safeno interno interno, que muitas vezes, simulam doenças vasculares dos membros inferiores. MÉTODO: Três pacientes foram operados e acompanhados por um período de oito meses. A técnica cirúrgica consistiu na neurotomia dos ramos infrapatelar e descendente do nervo safeno interno. RESULTADOS: Nos dois primeiros casos houve quase desaparecimento total da dor em pouco tempo e no terceiro apenas melhora. CONCLUSÃO: O tratamento cirúrgico dá bons resultados neste tipo de lesão do nervo safeno interno e poderia ser útil como alternativa ao tratamento conservador.

Neuropatias traumáticas: aspectos cirúrgicos / Traumatic neuropathies: surgical aspects

Objetivos: apresentar a nossa série de pacientes e a nossa experiência com os vários tipos de lesões dos nervos periféricos. Métodos: foi feito um estudo retrospectivo com análise de 114 pacientes operados de 15 anos. Os pacientes foram divididos em dois grupos segundo a etiologia da lesão do nervo, lesões compressivas e outros tipos de lesões. Resultado: dos 114 pacientes operados obtivemos 76% de bons resultados, 21% de resultados regulares e 12% de maus resultados. Conclusão: obtivemos bons resultados devido ao fato de que 39% dos casos eram de neuropatias compressivas, nas quais o traamento cirúrgico é o ideal. Esses bons resultados originam-se do fato de que nossos pacientes foram selecionados e operados em até 60 dias após a lesão.

Failed back surgery syndrome: casuistic and etiology.

OBJECTIVE: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD: The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS: From the 121 patients submitted to spine surgical intervention, 47 (38.8%) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7%) had presented FBSS; of the 83 with disc herniation, 31 (37.3%) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3%) had failure of the back surgery. CONCLUSION: The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.

Failed back surgery syndrome: casuistic and etiology / Síndrome pós-laminectomia: casuística e etiologia

OBJECTIVE: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD: The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS: From the 121 patients submitted to spine surgical intervention, 47 (38.8 percent) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7 percent) had presented FBSS; of the 83 with disc herniation, 31 (37.3 percent) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3 percent) had failure of the back surgery. CONCLUSION: The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.

OBJETIVO: Relatar nossos dados sobre a síndrome pós-laminectomia (SPL) e as causas cirúrgicas e não-cirúrgicas. MÉTODO: Foram revisados 121 prontuários de pacientes submetidos a laminectomia, hemilaminectomia combinadas com discectomia e/ou foraminotomia realizadas no Instituto de Neurologia Deolindo Couto entre janeiro de 1997 e outubro de 2004. RESULTADOS: Dos 121 pacientes que sofreram intervenção cirúrgica lombar, 47 (38,8 por cento) apresentaram critérios para a SPL. Dos 26 pacientes que apresentaram diagnóstico pré-operatório de estenose lombar, 8 (30,7 por cento) apresentaram SPL; dos 83 com hérnia de disco, 31 (37,3 por cento) tiveram a síndrome; e dos 12 pacientes com estenose lombar associada com hérnia de disco, 7 (58,3 por cento) tiveram a SPL. CONCLUSÃO: A síndrome pós-laminectomia permanece um desafio para os cirurgiões. Há uma busca incessante pelas causas e os mecanismos de ação desta síndrome e o melhor método de tratamento.

Lesões traumáticas do nervo ciático (conduta e resultados) / Traumatic sciatic nerve injuries (management and results)

Este é um estudo retrospectivo cujo objetivo é avaliar as condutas e resultados obtidos com esta série de 21 casos operados e acompanhados por nosso grupo. Conclui-se que nesta série tivemos graus variados de recuperação com neurólise externa, interna e colocação de enxerto.

This is a restrospective study of which object is to evaluate the conduct and results in this series of 21 cases operate on for us. The conclusion is that we get many degree of recuperation, with internal and external neurolysis and nerve graft.

Exploração de bases de dados médicas através de redes neurais artificiais / Medical data base exploration through artificial neural networks

O objetivo deste trabalho é a implementação de técnicas utilizadas no processo de aprendizagem em Redes Neurais Artificiais Auto-organizáveis (RNA's). Inicialmente a rede será treinada a partir do simulador da Neurosciences - ActiveX que utiliza o algoritmo padrão de Kohonen com a aprendizagem competitiva e não supervisionada. O resultado da simulação será comparado com o algoritmo que utiliza aprendizagem supervisionada através da técnica Learning Vector of Quantization (LVQ1). O domínio escolhido para a implementação dos algoritmos de aprendizagem foi a aplicação no Diagnóstico Clínico das Crises Convulsivas, baseado na Classificação International League Against Epilepsy - ILAI/81. De acordo com os resultados encontrados do simulador e do algoritmo que utiliza a técnica LVQ1 em uma matriz (2x2) as bases de treinamento e teste da rede mostraram um índice de convergência de 71,31 por cento e 100 por cento; em uma matriz (5x5) as bases de treinamento e teste apresentaram 84,4 por cento e 100 por cento respectivamente. A partir destes resultados observou-se que, com a utilização da técnica LVQ1 em ambas as topologias de rede ocorreu uma melhora significativa no reconhecimento dos padrões

Validação de um sistema especialista de apoio ao diagnóstico médico / Validation of a expert system to support the medical diagnosis

Sistemas Especialistas Médicos são projetados para o profissional da saúde no auxílio ao suporte à decisão aplicados ao diagnóstico ou prognóstico do paciente. Estimaðse que, aproximadamente 90 por cento de todos os Sistemas Especialistas Médicos não foram avaliados no ambiente clínico. Pesquisas estão demonstrando que existem diversas técnicas de avaliação de Sistemas Especialistas, entre elas o desempenho ð feedback na tomada de decisão e a aplicação de medidas estatísticas. Este artigo descreve as diferentes estratégias de pesquisas utilizadas na avaliação de Sistemas Especialistas Médicos e identifica um método utilizado para avaliar o desempenho de um Sistema Especialista Probabilístico no laboratório e no ambiente clínico