Surgical Outcome of Microvascular Decompression for Hemifacial Spasm: Symptom Control and Quality of Life / Resultado Cirúrgico da Descompressão Microvascular no Espasmo Hemifacial: Controle de Sintomas e Qualidade de Vida

Introduction Hemifacial spasm (HFS) is characterized by a segmental myoclonus of the face muscles innervated by the ipsilateral facial nerve. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone associated with any neuro-vascular conflict. Aim Review the surgical results and outcome regarding spasm control, post-operative quality of life and morbidity of microvascular decompression (MVD) for HFS from a Brazilian neurosurgical team. Method An observational investigation was conducted with data collection from patients with hemifacial spasm treated with MVD from January 2000 to December 2015 in two different centers in the West of São Paulo State, Brazil. Results A total of 152 patients underwent MVD for the treatment of HFS, ninety-eight (64.5%) female. Eighty-seven (57.2%) patients presented right-side spasms. The most common offending vessel was the posterior inferior cerebellar artery (PICA) with 78 (51.3%) patients. According to clinical presentation, an amount of 144 (94.7%) patients presented total control of symptoms after 36 months of follow-up. Regarding quality of life, a total of 125 (82.2%) patients referred normal quality of life after MVD for HFS and 121 (96.8%) from then were able to return to work or previous occupation. Permanent facial paresis / palsy was observed in 6 (3.6%) patients. There was no surgical mortality. Conclusion MVD for the treatment of HFS is a safe and efficacious surgical procedure to control spasm. Neurosurgeons experience, adequate patient selection and good anatomical knowledge are fundamental to success of the treatment.

Introdução O espasmo hemifacial (EHF) é caracterizado por mioclonia segmentar dos músculos da face inervados pelo nervo facial ipsilateral. A fisiopatologia aceita da EHF sugere que é um processo da doença da zona de entrada da raiz nervosa associada a conflito neuro-vascular. Objetivo Revisar os resultados e desfechos cirúrgicos em relação ao controle de espasmo, a qualidade de vida pós-operatória e a morbidade da descompressão microvascular (DMV) para EHF de uma equipe de neurocirurgia brasileira. Método Realizada investigação observacional com coleta de dados de pacientes com espasmo hemifacial tratados com DMV entre janeiro de 2000 a dezembro de 2015, em dois diferentes centros do Oeste do Estado de São Paulo, Brasil. Resultados Um total de 152 pacientes foram submetidos a DMV, noventa e oito (64,5%) do sexo feminino. Oitenta e sete (57,2%) pacientes apresentavam espasmos no lado direito. O conflito mais comum foi com a artéria cerebelar inferior posterior (PICA) em 78 (51,3%) pacientes. Um total de 144 (94,7%) pacientes apresentou controle total dos sintomas após 36 meses de acompanhamento. Em relação à qualidade de vida, 125 (82,2%) pacientes referiram qualidade de vida normal após a MVD para HFS e 121 (96,8%) puderam retornar ao trabalho/ocupação anterior. Paresia/paralisia facial permanentes foram observadas em 6 (3,6%) pacientes. Não houve mortalidade cirúrgica. Conclusão DMV para o tratamento da EHF é um procedimento cirúrgico seguro e eficaz para o controle do espasmo. A experiência dos neurocirurgiões, a seleção adequada dos pacientes e o bom conhecimento anatômico são fundamentais para o sucesso do tratamento.

Transtentorial spread of glioblastoma multiforme to cerebellopontine angle - A rare case report.

BACKGROUND: Glioblastoma multiforme (GBM) is the most common central nervous system malignant tumor in adults with 48.3% of cases. Despite it, the presence of transtentorial spread is uncommon, with few patients reported in the literature. In this study, the authors report a case of GBM transtentorial spread to cerebellopontine angle after resection and adjuvant treatment. CASE DESCRIPTION: A 55-year-old male patient with GBM, previously submitted to surgical resection and adjuvant treatment with radiotherapy and quemotherapy. Fourteen months after the first surgery, he developed headaches associated with dysphagia and dysphonia. Magnetic resonance imaging showed a recurrence of the left parietal lesion and a new mass in the right cerebellopontine angle. The patient underwent successful surgical resection of both lesions. Chemotherapy was maintained after the surgery. CONCLUSION: To the best of our knowledge, there are few cases of GBM metastasis to the cerebellopontine angle reported in the literature. Surgical management should be considered in cases of intracranial hypertension and patients with good performance status.

Clinical and Radiological Differences in Patients Following Traumatic SCI at Different Ages.

BACKGROUND: Traumatic spinal cord injury (SCI) is a lesion that can affect several spinal structures, including the vertebrae, spinal cord, ligaments, and other adjacent parts of the spine. Traumatic spinal cord injury (SCI) can cause functional changes in patients of different ages. MATERIAL AND METHODS: The study aims to determine whether there are social, clinical, and radiological differences between young, middle-aged, and elderly adults with SCI caused by a ground-level fall. This retrospective study analyzed the records of patients with a clinical diagnosis of SCI. It enrolled patients with traumatic spinal cord injury after a ground-level fall divided as follows: young aged adults 18-35 years of age (G1); middle-aged adults aged 36-60 years (G2); and elderly adults aged over 60 years (G3). Their clinical, social, and radiological variables were analyzed. RESULTS: It is observed that low schooling level, being widowed, and being a homemaker were more frequently encountered among elderly adults, whereas being single was more common in middle-aged adults. The morphologic diagnosis of compression fracture and the associated injury of facial trauma occurred more frequently in elderly adults, with an increasing tendency with age. Conservative therapeutic management was most commonly encountered in elderly adults, compared to surgery from a posterior approach in middle-aged adults. Listhesis was better identified in middle-aged adults by computed tomography (CT). Spinal cord contusion and injury to the C1 vertebra were demonstrated in young adults by magnetic resonance imaging (MRI). CONCLUSIONS: 1. Elderly adults with low education level, widowed, and homemakers were more susceptible to SCI caused by a fall. 2. Single marital status was more frequently noted in young adults. 3. The most frequent clinical aspects were the morphological aspect of compression fracture and fa-cial trauma as an associated injury in elderly adults, with the occurrence of facial trauma increasing with age. 4. Conservative therapeutic management was more common in elderly adults than surgery from a po-sterior approach in middle-aged adults. 5. Re-garding the radiological aspects of CT, listhesis was better identified in middle-aged adults. Spi-nal cord contusions and C1 vertebra lesions were better identified in young adults by MRI.

Genetic Variants Related to Cell Cycle and Stability of Telomere in Patients with Glioma.

Background: Glioma, most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. Evaluate the association of polymorphisms related of to the cell cycle, integrity and DNA repair with gliomas, as well as lifestyle habits, comorbidities, survival and response to treatment. Methods: Were studied 303 individuals distributed into: Study Group - 100 patients with gliomas, regardless of the degree of malignancy, and Control Group - 203 individuals without clinical signs of the disease. These polymorphisms were genotyped by TaqMan® SNP Genotyping Assay. Significance level was set at 5%. Results: Smoking, alcohol consumption, systemic arterial hypertension (SAH) and diabetes mellitus (DM) prevailed in patients, compared to controls (P=0.0088, P=0.0001, P=0.0001, P=0.0011, respectively). In the logistic regression analysis, alcohol consumption and SAH were identified as independent risk factors for gliomas (P=0.0001, P=0.0027, respectively). Patients with low-grade gliomas showed survival in one year (92.0±6.8%), compared to patients with high-grade gliomas (24.0±5.3; P=0.011). Conclusion: Polymorphisms involved in cell cycle, telomere protection and stability and DNA repair are not associated with gliomas. On the other hand, alcohol consumption and SAH stand out as independent risk factors for the disease. Low-grade gliomas, response to treatment and the combination of chemotherapy with Temozolomide and radiation therapy show increased survival of patients.

Desempenho ocupacional do paciente, percepção e sobrecarga do cuidador de idoso no processo demencial / Occupational performance of the patient, perception and burden of the elderly caregiver in the dementia process / Desempeño ocupacional del paciente, percepción y carga del cuidador anciano en el proceso de demencia

Objetiva-se caracterizar o perfil sociodemográfico de um idoso em processo demencial e de seu cuidador, avaliar o desempenho ocupacional desse idoso sob a percepção do respectivo cuidador, e o nível de sobrecarga desse cuidador. Como método, foi realizada pesquisa descritiva, qualitativa e quantitativa. Utilizou-se, para a coleta dos dados, um Questionário para a caracterização sociodemográfica e os instrumentos Questionário de desempenho ocupacional do paciente e Escala de sobrecarga Zarit. Constatou-se a prevalência em geral de cuidadores informais do sexo feminino (88,2%) com sobrecarga intensa (52,9%), em função dos cuidados prestados aos idosos em processo demencial, principalmente no que refere às atividades instrumentais de vida diária, visto que 88,2% destes residem com familiares cuidadores. Verifica-se que os resultados obtidos corroboram a necessidade da assistência à saúde e estratégias de intervenção junto ao cuidador informal de paciente em processo demencial, visando à minimização da sobrecarga, melhoria da qualidade de vida e a prevenção de aspectos mais agravantes da doença nesse idoso e, subsequentemente, a seu cuidador.

The objective is to characterize the sociodemographic profile of a demented elderly and their caregiver, to evaluate the occupational performance of the elderly under the perception of the respective caregiver, and the burden level of this caregiver. As a method, a descriptive, qualitative and quantitative research was performed. For data collection, a questionnaire for sociodemographic characterization and the instruments Occupational patient performance questionnaire and Zarit overload scale were used. The general prevalence of informal female caregivers (88.2%) with severe overload (52.9%) was found, due to the care provided to the elderly in dementia, especially regarding instrumental activities of daily living. , as 88.2% of these live with family caregivers. The results obtained corroborate the need for health care and intervention strategies with the informal caregiver of patients in dementia, aiming at minimizing the burden, improving the quality of life and preventing more aggravating aspects of the disease in this elderly. and subsequently to their caregiver.

El objetivo es caracterizar el perfil sociodemográfico de un anciano demente y su cuidador, evaluar el desempeño ocupacional de los ancianos bajo la percepción del cuidador respectivo y el nivel de carga de este cuidador. Como método, se realizó una investigación descriptiva, cualitativa y cuantitativa. Para la recolección de datos, se utilizó un cuestionario para la caracterización sociodemográfica y los instrumentos Cuestionario de desempeño del paciente ocupacional y escala de sobrecarga de Zarit. Se encontró la prevalencia general de las cuidadoras informales (88,2%) con sobrecarga severa (52,9%), debido a la atención brindada a los ancianos en demencia, especialmente en relación con las actividades instrumentales de la vida diaria. , ya que el 88.2% de estos viven con cuidadores familiares. Los resultados obtenidos corroboran la necesidad de atención médica y estrategias de intervención con el cuidador informal de pacientes con demencia, con el objetivo de minimizar la carga, mejorar la calidad de vida y prevenir aspectos más agravantes de la enfermedad en estos ancianos. y posteriormente a su cuidador.

Trigeminal Neuralgia Caused by Cerebellopontine Angle Tumors: Surgical Series

Introduction Cerebellopontine angle (CPA) tumors represent an important cause of persistent and refractory trigeminal neuralgia (TN). It is believed that between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by space-occupying lesions. Objective The objective of the present study is to describe the clinical and surgical experience of the operative management of patients presenting with secondary type TN associated with CPA tumors. Method An observational investigation was conducted with data collection from patients with secondary type TN associated with CPA tumors who were treated with surgical resection of the space-occupying lesion and decompression of the trigeminal nerve from January 2013 to November 2016 in 2 different centers in the western region of the state of São Paulo, Brazil. Results We operated on 11 consecutive cases in which TN was associated with CPA during the period of analysis. Seven (63.6%) patients were female, and 4 (36.4%) were male. Seven (63.6%) patients presented with right-side symptoms, and 4 (36.4%) presented with left-side symptoms. After 2 years of follow-up, we observed that 8 (72.7%) patients showed a complete improvement of the symptoms, with an excellent outcome, and that 3 (27.3%) patients showed an incomplete improvement, with a good outcome. No patient reported partial improvement or poor outcome after the follow-up. There was no operative mortality. Conclusion Cerebellopontine angle tumors represent an important cause of TNandmust be included in the differential diagnosis of patients presenting with refractory and persistent symptoms. Surgical treatment with total resection of the expansive lesion and effective decompression of the trigeminal nerve are essential steps to control the symptoms.

Genetic variants related to angiogenesis and apoptosis in patients with glioma.

BACKGROUND: Glioma, the most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. The objectives of this study were to evaluate the association of genetic polymorphisms related to angiogenesis and apoptosis with gliomas, as well as comorbidities, lifestyle, clinical profile, survival and response to treatment (temozolomide [TMZ] and radiotherapy [RT]) in patients with the disease. METHODS: In a total of 303 individuals, genotypes were performed by real-time PCR, and clinical data, lifestyle and comorbidities were obtained from medical records and questionnaires. The significance level was set at 5%. RESULTS: Smoking, alcohol consumption, systemic arterial hypertension, diabetes mellitus and body mass index prevailed among patients, compared to controls (p < 0.05). The heterozygous genotype rs1468727 (T/C) and the homozygous genotype rs2010963 (G/G) (p > 0.05) were observed in both groups. Lifestyle and comorbidities showed independent risk factors for the disease (p < 0.0001, p = 0.0069, p = 0.0394, respectively). Patients with low-grade gliomas had a survival rate of 80.0 ± 1.7% in three years. For the combination of TMZ+RT, survival was 78.7 ± 7.6% in 20 months, compared to TMZ only (21.9 ± 5.1%, p = 0.8711). CONCLUSIONS: Genetic variants were not associated with gliomas. Specific lifestyle habits and comorbidities stood out as independent risk factors for the disease. Low-grade gliomas showed an increase in patient survival with TMZ+RT treatment.

Genetic variants related to angiogenesis and apoptosis in patients with glioma / Variantes genéticas relacionadas à angiogênese e apoptose em pacientes com glioma

ABSTRACT Background Glioma, the most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. The objectives of this study were to evaluate the association of genetic polymorphisms related to angiogenesis and apoptosis with gliomas, as well as comorbidities, lifestyle, clinical profile, survival and response to treatment (temozolomide [TMZ] and radiotherapy [RT]) in patients with the disease. Methods In a total of 303 individuals, genotypes were performed by real-time PCR, and clinical data, lifestyle and comorbidities were obtained from medical records and questionnaires. The significance level was set at 5%. Results Smoking, alcohol consumption, systemic arterial hypertension, diabetes mellitus and body mass index prevailed among patients, compared to controls (p < 0.05). The heterozygous genotype rs1468727 (T/C) and the homozygous genotype rs2010963 (G/G) (p > 0.05) were observed in both groups. Lifestyle and comorbidities showed independent risk factors for the disease (p < 0.0001, p = 0.0069, p = 0.0394, respectively). Patients with low-grade gliomas had a survival rate of 80.0 ± 1.7% in three years. For the combination of TMZ+RT, survival was 78.7 ± 7.6% in 20 months, compared to TMZ only (21.9 ± 5.1%, p = 0.8711). Conclusions Genetic variants were not associated with gliomas. Specific lifestyle habits and comorbidities stood out as independent risk factors for the disease. Low-grade gliomas showed an increase in patient survival with TMZ+RT treatment.

RESUMO Introdução Glioma, tumor cerebral maligno, é altamente agressivo e associado a mau prognóstico. Os objetivos deste estudo foram avaliar a associação de polimorfismos genéticos relacionados a angiogênese e apoptose em pacientes com glioma, bem como suas comorbidades, hábitos de vida, perfil clínico, sobrevida e resposta ao tratamento (temozolomida [TMZ] e radioterapia [RT]). Métodos 303 indivíduos foram genotipados por PCR em tempo real, e foram coletados dados clínicos, hábitos de vida e comorbidades. Admitiu-se nível de significância para valor p < 0,05. Resultados Tabagismo, elitismo, hipertensão arterial sistêmica, diabetes mellitus e índice de massa corporal prevaleceram entre os pacientes, comprados aos controles (p < 0,05). O genótipo heterozigoto rs1468727 (T/C) e homozigoto rs2010963 (G/G) (p > 0,05) foram observados em ambos os grupos. Tabagismo, elitismo, hipertensão arterial sistêmica, diabetes mellitus e índice de massa corporal apresentaram fatores de risco independentes para a doença (p < 0.0001, p = 0.0069, p = 0.0394, respectivamente). Os pacientes com gliomas de baixo grau apresentaram sobrevida de 80,0 ± 1,7% em três anos. Para a combinação de RT e TMZ, a sobrevida foi de 78,7±7,6% em 20 meses, em comparação com TMZ (21,9 ± 5,1%, p = 0,8711). Conclusões As variantes genéticas não estiveram associadas aos gliomas. Hábitos de vida e comorbidades específicas destacaram-se como fatores de risco independentes para a doença. O tratamento com TMZ + RT mostrou aumento na sobrevida dos pacientes.

Sobrecarga no cuidado de paciente idoso com demência / Burden in elderly patient care with dementia / Sobrecarga en el cuidado del paciente mayor con demência

Com o envelhecimento populacional, as doenças crônico-degenerativas aumentaram. As demências destacam-se devido à perda cognitiva progressiva que compromete o desempenho nas atividades cotidianas, reduzindo a autonomia e a independência. A responsabilidade pelo cuidado modifica o cotidiano dos cuidadores, causando desgaste físico e emocional. Objetiva-se avaliar o nível de sobrecarga dos cuidadores dos pacientes com demência e seus fatores, caracterizar a amostra de pacientes e cuidadores e identificar as atividades cotidianas comprometidas pela demência. Como método, o estudo descritivo, exploratório, aprovado pelo Comitê de Ética em Pesquisa/FAMERP parecer n.o 358.178, realizado de setembro a dezembro de 2013, com 31 cuidadores de pacientes com demência, atendidos no ambulatório de um hospital de referência. Os cuidadores assinaram o Termo de Consentimento Livre e Pós-Esclarecimento, sendo submetidos à aplicação dos questionários: Escala de Sobrecarga do Cuidador de Zarit e entrevistas semi-estruturadas. Os resultados mostraram que, conforme o quadro de demência progride, há redução da autonomia e independência do idoso. O Teste de Qui-Quadrado de Fisher mostrou significância estatística na redução da realização de atividades de lazer, pelos idosos, antes e após o quadro de demência (p=0,0181). Dentre os cuidadores avaliados, prevaleceu o gênero feminino, com média de idade de 53±12,4 e redução da realização de atividades de lazer, pelos cuidadores, antes e após de assumirem o papel de cuidador informal (p=0,0402)...A análise estatística, utilizando a análise de correlação de Spearman, mostrou correlação entre o aumento de sobrecarga e redução da prática de atividade de lazer (p=0,0078). Como conclusões: a redução ou anulação da atividade de lazer na vida cotidiana implica na qualidade de vida desses cuidadores, o que pode ser evidenciado pela sobrecarga apresentada. Os dados indicam necessidade de atenção da equipe multiprofissional de saúde para esses cuidadores, dentre eles o terapeuta ocupacional, e possibilita uma reflexão sobre um tema relevante: o cuidado ao cuidador.

Due to the population ageing, the chronic- degenerative diseases have grown. The dementias have been highlighted because of the cognitive progressive loss that compromises the performance on the daily activities, reducing the autonomy and the independence matter. The responsibility for the care provided changes the caregivers' routine, causing physical and emotional distress. Objectives: evaluate the level of burden taken by the caregivers of patients with dementia and its factors, characterize the patients and caregivers' samples and identify the daily activities compromised by the dementia. Method: descriptive report, exploratory, approved by the Ethic Committee in Research/ FAMERP statement #358.178, held from September to December in 2013, with 31 caregivers of patients with dementia, assisted in a reference hospital ambulatory. The caregivers signed the Open Consent and Post Clarification Form, being submitted to questionnaires appliances: Caregiver from Zarit Overburden Scale and semi-structured interviews. Results: As the framework of dementia increases, there is an elderly autonomy and independence reduction. Fisher Exact Test showed a significant statistic in the reduction of leisure activities performance, by the elderly, before and after the state of dementia (p=0,0181). Among the evaluated caregivers, the feminine genre prevailed, with an average of 53±12,4 and the reduction of leisure activities performance, by the caregivers, before and after they undertook the position of informal caregiver (p=0,0078). Conclusion: the reduction or cancellation of the leisure activity on the daily life implies in these caregivers quality of life, which can be emphasized by the presented burden. The data points to a necessity of attention from the health multidisciplinary team to these caregivers, including the occupational therapist, and enables a reflection about a relevant subject: the care for the caregiver.

Con el envejecimiento poblacional, las enfermedades crónico-degenerativas aumentaron. Las demencias se destacan debido a la pérdida cognitiva progresiva que compromete el desempeño en las actividades cotidianas, reduciendo la autonomía y la independencia. La responsabilidad por el cuidado modifica el cotidiano de los cuidadores, causando desgaste físico y emocional. Se pretende evaluar el nivel de sobrecarga de los cuidadores de los pacientes con demencia y sus factores, caracterizar la muestra de pacientes y cuidadores e identificar las actividades cotidianas comprometidas por la demencia. Como método, el estudio descriptivo, exploratorio, aprobado por el Comité de Ética en Investigación / FAMERP, se consideró 358.178, realizado de septiembre a diciembre de 2013, con 31 cuidadores de pacientes con demencia, atendidos en el ambulatorio de un hospital de referencia. Los cuidadores firmaron el Término de Consentimiento Libre y Post-Aclaración, siendo sometidos a la aplicación de los cuestionarios: Escala de Sobrecarga del Cuidador de Zarit y entrevistas semiestructuradas. Los resultados mostraron que, conforme el cuadro de demencia progresa, hay reducción de la autonomía e independencia del anciano. La prueba de Qui-cuadrado de Fisher mostró significancia estadística en la reducción de la realización de actividades de ocio, por los ancianos, antes y después del cuadro de demencia (p = 0,0181). Entre los cuidadores evaluados, prevaleció el género femenino, con una media de edad de 53 ± 12,4 y reducción de la realización de actividades de ocio, por los cuidadores, antes y después de asumir el papel de cuidador informal (p =0,0402). El análisis estadístico, utilizando el análisis de correlación de Spearman, mostró correlación entre el aumento de sobrecarga y reducción de la práctica de actividad de ocio (p = 0,0078). Como conclusiones: la reducción o anulación de la actividad de ocio en la vidacotidiana implica la calidad de vida de esos cuidadores, lo que puede ser evidenciado por la sobrecarga presentada. Los datos indican necesidad de atención del equipo multiprofesional de salud para esos cuidadores, entre ellos el terapeuta ocupacional, y posibilita una reflexión sobre un tema relevante: el cuidado al cuidador.

Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery.

OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI) undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n = 92). The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.

OBJETIVO: Identificar as características de pacientes com traumatismo raquimedular (TRM) submetidos à cirurgia. MÉTODOS: Previamente, 321 pacientes com TRM foram selecionados. As variáveis clínicas e sócio-demográficas foram coletadas. RESULTADOS: Um total de 211 pacientes foram submetidos a cirurgia. A queda e lesões nas regiões cervical superior e lombosacral foram associadas com tratamento conservador. Pacientes com lesões nas regiões cervical inferior, pior status neurológico e lesões instáveis foram associados com cirurgia. Indivíduos operados foram associados com complicações após tratamento. Posteriormente, os autores avaliaram se idade influenciava as características dos pacientes submetidos à cirurgia. Sujeitos com < 60 anos foram associados com acidente motociclístico e o diagnóstico de fratura-luxação. Subsequentemente, analisaram-se as características dos sexos nestes pacientes. Mulheres que sofreram acidente automobilístico foram associadas com cirurgia. Mulheres foram associadas com paraparesia e diagnóstico morfológico de fratura explosão, principalmente nas regiões de transição tóraco-lombar e lombo-sacral. Homens que apresentaram traumatismo crânio-encefálico e torácico foram relacionados a cirurgia. Estes indivíduos tiveram um pior status neurológico e foram associados à complicação. Homens e região cervical foram mais afetadas; portanto, estes pacientes foram analisados isoladamente (n = 92). A presença de complicações aumentou a permanência hospitalar. A presença de diagnósticos morfológicos simultaneamente, pior status neurológico, tetraplegia, alteração sensório-motora foram associados com complicações. Pneumonia e traumatismo torácico foram associados com mortalidade. CONCLUSÃO: Estes fatores possibilitam investimentos em prevenção, reabilitação e tratamento.

Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery / Caracterização e aspectos clínicos de pacientes com traumatismo raquimedular submetidos a cirurgia

ABSTRACT OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI) undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n= 92). The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.

RESUMO OBJETIVO: Identificar as características de pacientes com traumatismo raquimedular (TRM) submetidos a cirurgia. MÉTODOS: Foram selecionados 321 pacientes com TRM. As variáveis clínicas e sociodemográficas foram coletadas. RESULTADOS: Foram submetidos a cirurgia 211 pacientes. A queda e as lesões nas regiões cervical superior e lombossacral foram associadas com tratamento conservador. Pacientes com lesões nas regiões cervical inferior, pior status neurológico e lesões instáveis foram associados com cirurgia. Indivíduos operados foram associados com complicações após tratamento. Posteriormente, os autores avaliaram se idade influenciava as características dos pacientes submetidos a cirurgia. Sujeitos com < 60 anos foram associados com acidente motociclístico e o diagnóstico de fratura-luxação. Subsequentemente, analisaram-se as características dos sexos nesses pacientes. Mulheres que sofreram acidente automobilístico foram associadas com cirurgia. Mulheres foram associadas com paraparesia e diagnóstico morfológico de fratura explosão, principalmente nas regiões de transição toracolombar e lombossacral. Homens que apresentaram traumatismo crânioencefálico e torácico foram relacionados a cirurgia. Esses indivíduos tiveram um pior status neurológico e foram associados à complicação. Homens e região cervical foram mais afetados; portanto, esses pacientes foram analisados isoladamente (n = 92). A presença de complicações aumentou a permanência hospitalar. A presença de diagnósticos morfológicos simultaneamente, pior status neurológico, tetraplegia, alteração sensório-motora foi associada com complicações. Pneumonia e traumatismo torácico foram associados com mortalidade. CONCLUSÃO: Esses fatores possibilitam investimentos em prevenção, reabilitação e tratamento.

Spinal cord injury in elderly patients admitted to a tertiary hospital.

BACKGROUND: Spinal cord injury (SCI) has a negative impact on quality of life and healthcare costs. In recent years with the age pyramid inversion, there has been a high prevalence of SCI in the elderly. These patients must be studied in order to invest in the prevention and treatment of SCI in these patients. OBJECTIVE: To identify the characteristics and clinical aspects of spinal cord injury (SCI) in the elderly. METHODS: Retrospective study of elderly patients (≥ 60 years of age) with a clinical diagnosis of SCI. Clinical and socio-demographic variables were collected from medical records. RESULTS: Sixty-two elderly patients were studied (56% men). The patients were analyzed according to gender. Women presented compression fractures associated with thoracolumbar transition, while men presented with listhesis associated with cervical lesions and increased complications. It was found that the need for surgical intervention was higher in men. Among many characteristics that differed between the elderly and younger people (< 60 years; n = 259), in the morphological diagnosis, we observed that compression fractures and dislocation fractures were more highly associated with ages ≥ 60 and < 60, respectively. After SCI, the elderly have a higher risk for late hemodynamic instability. CONCLUSION: Elderly individuals with SCI have distinct characteristics and clinical factors related to gender and age.

Prognosis Factors in Patients with Spinal Cord Trauma / Fatores de prognóstico em pacientes com trauma raquimedular

Objective Analyze the predictors of prognosis in patients with spinal cord trauma (SCT) in a tertiary hospital. Method Study prospective with 321 patients. The analysis focused on patient-related data, cause of accident, anatomical distribution, neurologic status, associated injuries, length of hospital stay, and in-hospital complications/mortality. Results The SCT was more common in men, but women older than 50 years presented a higher risk than men of the same age. Automobile accidents, motorcycle accidents, and gunshots resulted in more injuries associated. The cervical spine involvement was directly related to an increase in the number of associated injuries, complications, and mortality. Already, the neurologic status ASIA-A was associated with an increase in the number of complications, length of stay, and mortality. Conclusion The predictive factors of prognosis in these patients included age, sex, cause of injury, anatomic distribution, and neurologic status.

Objetivo Analisar os preditores de prognóstico em pacientes vítimas de trauma raquimedular (TRM) em um hospital terciário. Método Estudo prospectivo com 321 pacientes. A análise foi direcionada aos dados relacionados aos pacientes, causa do acidente, distribuição anatômica, status neurológico, lesões associadas, tempo de permanência hospitalar e complicações e mortalidade no hospital. Resultados O TRM foi mais comum em homens, mas mulheres com idade superior a 50 anos apresentaram mais risco que homens da mesma faixa etária. Ferimento por arma de fogo, acidentes automobilísticos e de motocicleta resultaram em maior número de lesões associadas. O trauma na coluna cervical foi diretamente relacionado

Analysis of patients with spinal cord trauma associated with traumatic brain injury / Análise de pacientes com trauma raquimedular associado a traumatismo cranioencefálico / Análisis de los pacientes con traumatismos vertebrales asociados con traumatismos encefálicos

Objective: Characterize victims of spinal cord injury (SCI) associated with traumatic brain injury (TBI) and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%), aged between 21-30 years (25%), civil status stable union (56%), low level of education (69%) and the Roman Catholic religion (77%) presented the greater number of victims. Motor vehicle accidents (58%) were the main etiology. The cervical segment had higher injury risk (RR=3.48, p<0.0001). The neurological status ASIA-E (52%), the syndromic neck pain (35%) and the rate of mild TBI (65%) were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%). The length of hospital stay was significantly higher (20±28 days) and 17% of patients died. Men (RR=2.14, p=0.028) and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022) showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p<0.01) higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, ...

Objetivo: Caracterizar vítimas de trauma raquimedular (TRM) associado a traumatismo cranioencefálico (TCE) e fatores de risco. Métodos: Estudo realizado com 52 vítimas de TRM associado a TCE. Foram estudadas as variáveis: sexo; idade; estado civil; profissão; escolaridade; religião; etiologia e região do TRM; condição neurológica pela escala da ASIA; lesões associadas e fatores de risco em potencial. Resultados: O sexo masculino (85%), a faixa etária entre 21-30 anos (25%), o estado civil de união estável (56%), o baixo nível de escolaridade (69%) e a religião Católica Apostólica Romana (77%) apresentaram um maior número de vítimas. O acidente automobilístico (58%) foi a principal etiologia. O segmento cervical teve maior risco de lesão (RR=3,48; p<0,0001). O estado neurológico ASIA-E (52%), o quadro sindrômico de cervicalgia (35%) e o índice de TCE leve (65%) foram os mais frequentes. As complicações atingiram 13 pacientes, sendo pneumonia a de maior frequência (62%). O tempo de internação foi significativamente maior (20 ± 28 dias), e 17% dos pacientes foram a óbito. Os homens (RR=2,14; p=0,028) e indivíduos expostos a acidentes com veículo automotor (RR=1,91; p=0,022) apresentaram maior risco de sofrer essas lesões ...

Objetivo: Caracterizar las víctimas de traumatismos vertebrales (TV) asociados con traumatismos encefálicos (TE) y los factores de riesgo. Métodos: Estudio realizado con 52 víctimas de TV asociados con TE. Se estudiaron las siguientes variables: sexo; edad; estado civil; profesión; educación; religión; etiología y el área de la lesión; condición neurológica por la escala ASIA; lesiones asociadas y factores de riesgo potenciales. Resultados: El varón (85%), con edades comprendidas entre 21-30 años (25%), estado civil de relación estable (56%), bajo nivel de educación (69%) y la religión católica (77%) presentaron un mayor número de víctimas. Los accidentes de tráfico (58%) fueron la principal etiología. El segmento cervical presentó mayor riesgo de lesión (RR = 3,48, p<0,0001). El estado neurológico ASIA-E (52%), cuadro sindrómico de dolor del cuello (35%) y la tasa de TE leve (65%) fueron las más frecuentes. Las complicaciones ocurrieron en 13 pacientes, con una mayor frecuencia de la neumonía (62%). La estancia hospitalaria fue significativamente mayor (20 ± 28 días) y el 17% de los pacientes murió. Los hombres (RR=2,14, p=0,028) y los individuos expuestos a accidentes de tráfico (RR = 1,91, p=0,022) mostraron un mayor riesgo de estas lesiones ...

Patients with chronic headache tend to have more psychological symptoms than those with sporadic episodes of pain.

UNLABELLED: There are controversial associations between headaches and psychological symptoms. OBJECTIVE: To design a profile of neuroticism, a term that groups variables related to negative personality traits, in patients with chronic daily headache (CDH) when compared to episodic migraine (EM) patients, applying the Factorial Scale of Emotional Adjustment/Neuroticism (NFS). METHOD: One hundred adult patients with CDH and forty with EM answered the NFS. RESULTS: Comorbidities of subtypes of neuroticism (p=0.006) were more common in chronic daily headache patients, with three or more disorders (p=0.0002): dependent personality disorder (p=0.0001), anxiety, reduced concentration and production (p=0.0008), depression (p<0.0001), suicidal ideation (p=0.0008) and hopelessness even without depression (p<0.0001). CONCLUSION: Patients with CDH tend to have dependent personality disorder, low production and concentration, anxiety, depression, suicidal ideation and hopelessness, superimposing two or more psychological disorders. These factors should be pondered for a better resolution in the treatment of CDH.

Patients with chronic headache tend to have more psychological symptoms than those with sporadic episodes of pain / Pacientes com cefaleia crônica tendem a ter mais sintomas psicológicos que aqueles com episódios esporádicos de dor

There are controversial associations between headaches and psychological symptoms. Objective To design a profile of neuroticism, a term that groups variables related to negative personality traits, in patients with chronic daily headache (CDH) when compared to episodic migraine (EM) patients, applying the Factorial Scale of Emotional Adjustment/Neuroticism (NFS). Method One hundred adult patients with CDH and forty with EM answered the NFS. Results Comorbidities of subtypes of neuroticism (p=0.006) were more common in chronic daily headache patients, with three or more disorders (p=0.0002): dependent personality disorder (p=0.0001), anxiety, reduced concentration and production (p=0.0008), depression (p<0.0001), suicidal ideation (p=0.0008) and hopelessness even without depression (p<0.0001). Conclusion Patients with CDH tend to have dependent personality disorder, low production and concentration, anxiety, depression, suicidal ideation and hopelessness, superimposing two or more psychological disorders. These factors should be pondered for a better resolution in the treatment of CDH. .

Há associações controversas entre cefaleia e sintomas psicológicos. Objetivo Traçar um perfil de neuroticismo em portadores de cefaleia crônica diária (CCD) quando comparados aos portadores de migranea episódica (ME), utilizando-se a Escala Fatorial de Ajustamento Emocional/Neuroticismo (EFN). Método Cem pacientes adultos com CCD e quarenta com ME, responderam à EFN. Resultados Comorbidades de subtipos de neuroticismo (p=0,006) destacaram-se na CCD, ultrapassando três transtornos (p=0,0002): transtorno de personalidade dependente (p<0,0001), ansiedade, concentração e produção diminuídas (p=0,0008), depressão (p<0,0001), ideação suicida (p=0,0008) e desesperança (p<0,0001), mesmo sem depressão (p<0,0001). Conclusão Paciente com CCD apresentaram indícios de transtorno de personalidade dependente, baixa capacidade de concentração e produção, ansiedade, depressão, ideação suicida e desesperança, superpondo dois ou mais transtornos psicológicos. Esses fatores devem ser ponderados para maior resolutividade no tratamento da CCD. .

Predictors of clinical complications in patients with spinomedullary injury / Preditores de complicações clínicas em pacientes com trauma raquimedular / Predictores de complicaciones en pacientes con trauma raquimedular

Objective: To analyze individuals with spinal cord injury who developed secondary clinical complications, and the variables that can influence the prognosis. Methods: A prospective study of 321 patients with spinal cord injury. The variables were collected: age, sex, cause of the accident, anatomical distribution, neurological status, associated injuries, in-hospital complications, and mortality only in patients who developed complications. Results: A total of 72 patients were analyzed (85% male) with a mean age of 44.72±19.19 years. The individuals with spinal cord injury who developed clinical complications were mostly male, over 50 years of age, and the main cause was accidental falls. These patients had longer hospitalization times and a higher risk of progressing to death. Pneumonia was the main clinical complication. With regard to the variables that can influence the prognosis of these patients, it was observed that spinal cord injury to the cervical segment with syndromic quadriplegia, and neurological status ASIA-A, have a higher risk of developing pneumonia, the most common complication, as well as increased mortality. Conclusion: Clinical complications secondary to spinal cord injury are influenced by demographic factors, as well as characteristics of the injury contributing to an increase in mortality.

Objetivo: Analisar pacientes de um hospital terciário com trauma raquimedular que evoluíram com complicações clínicas intra-hospitalares, bem como as variáveis que podem interferir no prognóstico. Métodos: Estudo prospectivo de 321 pacientes vítimas de trauma raquimedular, que coletou dados sobre as seguintes variáveis: idade, sexo, etiologia do acidente, distribuição anatômica, estado neurológico, lesões associadas, complicações clínicas e mortalidade. Foram analisados apenas os pacientes que evoluíram com complicações. Resultados: Foram analisados 72 pacientes (85% do sexo masculino), com média de idade de 44,72±19,19 anos. Esses indivíduos com trauma raquimedular evoluíram com complicações clínicas intra-hospitalares, sendo a maioria do sexo masculino e com idade superior a 50 anos, sendo a principal causa a queda acidental. Além disso, esses pacientes apresentaram maior tempo de permanência hospitalar e risco de evoluir para o óbito. A pneumonia foi a principal complicação clínica. Com relação às variáveis que podem interferir no prognóstico desses pacientes, observa-se que o trauma raquimedular no segmento cervical com quadro sindrômico de tetraplegia e o estado neurológico ASIA-A apresenta maior risco de desenvolver complicações clínicas, sendo a pneumonia a mais frequente, assim como maior risco de aumentar a mortalidade. Conclusão: As complicações clínicas secundárias ao trauma raquimedular são influenciadas por fatores demográficos, assim como por características relacionadas com a lesão, interferindo no aumento da mortalidade.

Objetivo: Analizar los pacientes en un hospital de tercer nivel con lesión de la médula espinal que tuvieron complicaciones clínicas, así como las variables que pueden influir en el pronóstico. Métodos: Estudio prospectivo de 321 pacientes con lesiones de la médula espinal, que recopiló datos sobre las siguientes variables: edad, sexo, causa del accidente, distribución anatómica, estado neurológico, lesiones asociadas, complicaciones clínicas y mortalidad. Sólo se analizaron los pacientes que desarrollaron complicaciones. Resultados: Se analizaron 72 pacientes (85% varones) con una edad media de 44,72±19,19 años. Aquellos individuos con lesión de la médula espinal progresaron con complicaciones clínicas intrahospitalarias, en su mayoría varones y mayores de 50 años, siendo la caída accidental la principal causa. Además, estos pacientes tenían una estancia hospitalaria más prolongada y riesgo de progresar a la muerte. La neumonía fue la principal complicación clínica. En cuanto a las variables que pueden influir en el pronóstico de estos pacientes, se observa que la lesión de la médula espinal en el segmento cervical con cuadro sindrómico de tetraplejía y el estado neurológico ASIA-A aporta un mayor riesgo de desarrollar complicaciones clínicas, siendo la neumonía la más frecuente, así como mayor riesgo de aumento de la mortalidad. Conclusión: Las complicaciones clínicas secundarias a la lesión de la médula espinal se ven afectadas por factores demográficos, así como por las características relacionadas con la lesión, que influyen en el aumento de la mortalidad.

The role of dynamic susceptibility contrast-enhanced perfusion MR imaging in differentiating between infectious and neoplastic focal brain lesions: results from a cohort of 100 consecutive patients.

BACKGROUND AND PURPOSE: Differentiating between infectious and neoplastic focal brain lesions that are detected by conventional structural magnetic resonance imaging (MRI) may be a challenge in routine practice. Brain perfusion-weighted MRI (PWI) may be employed as a complementary non-invasive tool, providing relevant data on hemodynamic parameters, such as the degree of angiogenesis of lesions. We aimed to employ dynamic susceptibility contrast-enhanced perfusion MR imaging (DSC-MRI) to differentiate between infectious and neoplastic brain lesions by investigating brain microcirculation changes. MATERIALS AND METHODS: DSC-MRI perfusion studies of one hundred consecutive patients with non-cortical neoplastic (n = 54) and infectious (n = 46) lesions were retrospectively assessed. MRI examinations were performed using a 1.5-T scanner. A preload of paramagnetic contrast agent (gadolinium) was administered 30 seconds before acquisition of dynamic images, followed by a standard dose 10 seconds after starting imaging acquisitions. The relative cerebral blood volume (rCBV) values were determined by calculating the regional cerebral blood volume in the solid areas of lesions, normalized to that of the contralateral normal-appearing white matter. Discriminant analyses were performed to determine the cutoff point of rCBV values that would allow the differentiation of neoplastic from infectious lesions and to assess the corresponding diagnostic performance of rCBV when using this cutoff value. RESULTS: Neoplastic lesions had higher rCBV values (4.28±2.11) than infectious lesions (0.63±0.49) (p<0.001). When using an rCBV value <1.3 as the parameter to define infectious lesions, the sensitivity of the method was 97.8% and the specificity was 92.6%, with a positive predictive value of 91.8%, a negative predictive value of 98.0%, and an accuracy of 95.0%. CONCLUSION: PWI is a useful complementary tool in distinguishing between infectious and neoplastic brain lesions; an elevated discriminatory value for diagnosis of infectious brain lesions was observed in this sample of patients when the rCBV cutoff value was set to 1.3.

Nullity of GSTT1/GSTM1 related to pesticides is associated with Parkinson's disease.

Genetic and environmental factors affect the pathogenesis of Parkinson's disease (PD). Genetic variants of the enzyme glutathione S-transferases (GST) may be related to the disease. This study aimed to evaluate the influence of genetic variants of GST (GSTT1/GSTM1) and their association with the exposure to environmental toxins in PD patients. We studied 254 patients with PD and 169 controls. The GSTM1/GSTT1 variants were analyzed by polymerase chain reaction. We applied the Fisher's exact test and the χ2 test for statistical analysis (p<0.05). The present and absence for GSTT1 and GSTM1 were similar in patients and controls. The null for GSTT1 and GSTM1 (0/0) and exposure to pesticides prevailed in patients (18%) compared to controls (13%, p=0.014). This study suggests the association between PD and previous exposure to pesticides, whose effect may be enhanced in combination with null for GSTT1/GSTM1.

Nullity of GSTT1/GSTM1 related to pesticides is associated with Parkinson's disease / Nulidade de GSTT1/GSTM1 relacionada a pesticidas associa-se com doenca de Parkinson

Genetic and environmental factors affect the pathogenesis of Parkinson's disease (PD). Genetic variants of the enzyme glutathione S-transferases (GST) may be related to the disease. This study aimed to evaluate the influence of genetic variants of GST (GSTT1/GSTM1) and their association with the exposure to environmental toxins in PD patients. We studied 254 patients with PD and 169 controls. The GSTM1/GSTT1 variants were analyzed by polymerase chain reaction. We applied the Fisher's exact test and the χ2 test for statistical analysis (p<0.05). The present and absence for GSTT1 and GSTM1 were similar in patients and controls. The null for GSTT1 and GSTM1 (0/0) and exposure to pesticides prevailed in patients (18%) compared to controls (13%, p=0.014). This study suggests the association between PD and previous exposure to pesticides, whose effect may be enhanced in combination with null for GSTT1/GSTM1.

Fatores genéticos e ambientais influenciam a patogênese da doença de Parkinson (DP). Variantes genéticas das enzimas glutationa S-transferases (GST) parecem estar envolvidas com a doença. Os objetivos deste estudo foram avaliar a influência de variantes genéticas de GST (GSTT1/GSTM1) e sua associação com exposição a toxinas ambientais em pacientes com DP. Foram estudados 254 pacientes com DP e 169 controles. As variantes para GSTM1/GSTT1 foram analisadas por reação em cadeia da polimerase. Para análise estatística foram aplicados os testes de Fisher e do χ2 (p<0,05). Tanto a presença quanto a nulidade para GSTT1 e GSTM1 foram semelhantes em pacientes e controles. A nulidade para GSTT1 e GSTM1 (0/0) e contato com agrotóxicos prevaleceu nos pacientes (18%) em relação aos controles (13%, p=0,014). Este estudo sugere associação entre DP e contato prévio com agrotóxicos, cujo efeito parece potencializado em combinação com nulidade para GSTT1/GSTM1.