9 research outputs found
Meningiomas mĂșltiplos e neurofibromatose: relato de trĂȘs casos
Meningiomas mĂșltiplos «verdadeiros" geralmente nĂŁo constituem entidade patolĂłgica especĂfica. Em geral, associam-se a neurofibromatose. As clĂĄssicas lesĂ”es externas, descritas por von Recklinghausen, associadas Ă neurofibromatose, podem nĂŁo estar presentes. Isto poderia ser possĂvel devido Ă penetrĂąncia variĂĄvel de aberraçÔes cromossĂŽmicas ligadas ao cromossomo 22. Estudos moleculares desses tumores confirmam esta hipĂłtese. Em nossa sĂ©rie de 108 pacientes com diagnĂłstico de meningioma intarcraniano, apenas trĂȘs eram mĂșltiplos. Apenas em um caso, estigmas externos de neurofibromatose foram encontrados. Os dois casos que nĂŁo apresentavam qualquer estigma foram considerados como meningiomas mĂșltiplos «verdadeiros". Na ausĂȘncia de manifestaçÔes cutĂąneas habitualmente associadas Ă neurofibromatose, Ă© extremamente difĂcil distinguir meningiomas mĂșltiplos associados a neurofibromatose dos assim chamados meningiomas mĂșltiplos verdadeiros. Em nossa opiniĂŁo nĂŁo hĂĄ justificativa para se considerar meningiomas mĂșltiplos como entidade patolĂłgica independente
The long-term functional outcome of type II odontoid fractures managed non-operatively
Odontoid fractures currently account for 9â15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients >65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients <65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union