Review of the diagnosis of gastrointestinal lanthanum deposition

Lanthanum carbonate is used for treatment of hyperphosphatemia mostly in patients with chronic renal failure. Although lanthanum carbonate is safe, recently, lanthanum deposition in the gastrointestinal mucosa of patients has been reported in the literature. This review provides an overview of gastroduodenal lanthanum deposition and focuses on disease’s endoscopic, radiological, and histological features, prevalence, and outcome, by reviewing relevant clinical studies, case reports, and basic research findings, to better understand the endoscopic manifestation of gastrointestinal lanthanum deposition. The possible relationship between gastric lanthanum deposition pattern and gastric mucosal atrophy is also illustrated; in patients without gastric mucosal atrophy, gastric lanthanum deposition appears as diffuse white lesions in the posterior wall and lesser curvature of the gastric body. In the gastric mucosa with atrophy, lanthanum-related lesions likely appear as annular or granular whitish lesions. Moreover, these white lesions are probably more frequently observed in the lower part of the stomach, where intestinal metaplasia begins

Âmbito de normatização das resoluções do tribunal superior eleitoral

A legislação eleitoral brasileira é complementada a cada ano eleitoral por resoluções expedidas pelo Tribunal Superior Eleitoral. Esse fato tem alterado a configuração das regras do jogo eleitoral via instrumentos normativos que são hierarquicamente inferiores à lei. Tem-se constatado nesse sentido comumente resoluções que assumem força de lei, cuja disposição extravasa o sentido e o conteúdo da norma eleitoral que visaria apenas explicitar, ou ainda, funciona como norma autónoma, a legislar inovando primariamente o ordenamento jurídico. O sistema constitucional vigente, não obstante, não provê suporte à normalização em matéria eleitoral, que envolve direitos fundamentais, por outro caminho que não seja a lei, produzida pelo Parlamento, via processo legislativo delineado na Carta, As resoluções além de abusivamente legislar em matéria eleitoral também têm se prestado a regulamentar matéria constitucional, com suporte no Supremo Tribunal Federal. Um exemplo marcante dessa tendência concerne o tema fidelidade partidária. As regras de fidelidade e disciplina partidária são, a partir do fundamento constitucional, determinantes dos estatutos dos partidos. A autonomia partidária autoriza a punição à infidelidade partidária, prevendo consequências interna corporis até a exclusão do partido. A Resolução n° 22.610/2007, ausente base legal, porém, inovou o ordenamento jurídico com o processo de perda de mandato elctivo por desfiliação partidária sem justa causa, que veda a Constituição, com arrimo nas decisões do Tribunal Superior Eleitoral e do Supremo Tribunal Federal, invadindo competências legislativas do Congresso Nacional. O estudo de alcance e limites da normalização por resolução revela que apesar de previsão na lei eleitoral desse instrumento autorizar apenas a edição de instruções à execução da lei, na realidade, tem-se veiculado normas que não comportam esse âmbito de competência, configurando-se, eventualmente, uma via oblíqua de legislação em matéria eleitoral e constitucional

Âmbito de normatização das resoluções do Tribunal Superior Eleitoral : alcance e limites

Orientadora: Prof. Eneida Desiree SalgadoMonografia (graduação) - Universidade Federal do Paraná, Setor de Ciências Jurídicas, Curso de Graduação em DireitoA legislação eleitoral brasileira é complementada a cada ano eleitoral por resoluções expedidas pelo Tribunal Superior Eleitoral. Esse fato tem alterado a configuração das regras do jogo eleitoral via instrumentos normativos que são hierarquicamente inferiores à lei. Tem-se constatado nesse sentido comumente resoluções que assumem força de lei, cuja disposição extravasa o sentido e o conteúdo da norma eleitoral que visaria apenas explicitar, ou ainda, funciona como norma autónoma, a legislar inovando primariamente o ordenamento jurídico. O sistema constitucional vigente, não obstante, não provê suporte à normalização em matéria eleitoral, que envolve direitos fundamentais, por outro caminho que não seja a lei, produzida pelo Parlamento, via processo legislativo delineado na Carta, As resoluções além de abusivamente legislar em matéria eleitoral também têm se prestado a regulamentar matéria constitucional, com suporte no Supremo Tribunal Federal. Um exemplo marcante dessa tendência concerne o tema fidelidade partidária. As regras de fidelidade e disciplina partidária são, a partir do fundamento constitucional, determinantes dos estatutos dos partidos. A autonomia partidária autoriza a punição à infidelidade partidária, prevendo consequências interna corporis até a exclusão do partido. A Resolução n° 22.610/2007, ausente base legal, porém, inovou o ordenamento jurídico com o processo de perda de mandato elctivo por desfiliação partidária sem justa causa, que veda a Constituição, com arrimo nas decisões do Tribunal Superior Eleitoral e do Supremo Tribunal Federal, invadindo competências legislativas do Congresso Nacional. O estudo de alcance e limites da normalização por resolução revela que apesar de previsão na lei eleitoral desse instrumento autorizar apenas a edição de instruções à execução da lei, na realidade, tem-se veiculado normas que não comportam esse âmbito de competência, configurando-se, eventualmente, uma via oblíqua de legislação em matéria eleitoral e constitucional

Development of Dysphagia and Trismus Developed after C1-2 Posterior Fusion in Extended Position

Cervical misalignment after upper cervical fusion including the occipital bone may cause trismus or dysphagia, because the occipito-atlanto joint is associated with most of the flex and extended motion of the cervical spine. There are no reports of dysphagia and trismus after C1-2 fusion. The purpose of this paper is to demonstrate the potential risk of dysphagia and trismus even after upper cervical short fusion without the occipital bone. The patient was a 69-year-old man with myelopathy caused by os odontoideum and Klippel-Feil syndrome, who developed dysphagia and trismus immediately after C1-2 fusion and C3-6 laminoplasty. Radiographs and CT revealed that his neck posture was extended, but his symptoms still existed a week after surgery. The fixation angle was hyperextended 12 days after the first surgery. His symptoms disappeared immediately after revision surgery. The fixation in the neck-flexed position is thought to be the main cause of the patientʼs post-operative dysphagia and trismus. Dysphagia and trismus may occur even after short upper cervical fusion without the occipital bone or cervical fusion in the neck-extended position. The pre-operative cervical alignment and range of motion of each segment should be thoroughly evaluated

Segmental Pedicle Screw Fixation for a Scoliosis Patient with Post-laminectomy and Post-irradiation Thoracic Kyphoscoliosis of Spinal Astrocytoma

Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis. Hooks and wires are ineffective in such patients who undergo laminectomy, and there are also high perioperative risks with insertion of pedicle screws because landmarks have been lost. Here, we report on the 5-year follow-up of a 13-year-old male patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis after surgical treatment of spinal astrocytoma. Posterior segmental pedicle screw fixation was performed safely using a computer-assisted technique. The authors present the first case report for treatment of this condition using a navigation system

Dominant Vertebral Artery Injury during Posterior Atlantoaxial Transarticular Screw Fixation in a Juvenile Rheumatoid Arthritis Patient with Atlantoaxial Subluxation

Many authors have reported on iatrogenic vertebral artery (VA) injury, but, to our knowledge, this is the first report of a dominant VA injury with compensatory blood flow from the hypoplastic VA. A 23-year-old woman with juvenile rheumatoid arthritis and atlantoaxial subluxation sustained injury to her dominant VA after occipitocervical fusion using transarticular screws. This did not result in lethal consequences due to compensation from her hypoplastic contralateral VA. Postoperative angiography, however, illustrated occlusion of the dominant left side, while the hypoplastic VA of the right side was enlarged. The patient experienced vertigo and loss of consciousness several times during rehabilitation. At the 4-year follow-up exam, bony fusion was observed, with no neurological deficits or correction loss. She had had no episodes of unconsciousness and no recurrence of any symptoms over the previous 3 years

Management of Lumbar Artery Injury Related to Pedicle Screw Insertion

We report on 2 patients who experienced injury to one of their lumbar arteries related to pedicle screw misplacement. In this report, the lumbar pedicle screw holes were made laterally with resultant injury to the lumbar artery. During surgery, arterial bleeding was controlled with pressure and gauze; however, the patients experienced vital shock after surgery. Vital shock ensued and they were rescued by catheter embolization. If patients receiving lumbar instrumentation surgery experience severe anemia or vital shock postoperatively, the surgeon should assume lumbar artery injury as a differential diagnosis

A Case of Surgery for Kyphosis of the Thoracolumbar Spine in an Elderly Patient with Dysphagia

Here we report a case of surgery for kyphosis of the thoracolumbar spine in an elderly patient, in whom surgery was performed because the patient had developed intractable digestive symptoms. The case was that of a 76-year-old female with complaints of back pain and dysphagia. When videofluoroscopic examination (VF) of swallowing was performed in the cardia of the stomach, images that indicated stagnation and the reflux of food were observed. It was easier for the patient to swallow food in the extension position. We performed corrective fusion of the posterior spine. After the surgery, the kyphosis angle was improved to 27°, the patient's back pain was alleviated, and it became easier for the patient to swallow food. VF also showed that the patient's difficulties with the passage of food had improved. We believe that surgery is a good treatment option for cases of kyphosis with digestive symptoms and deteriorating activities of daily living (ADL), even in the absence of pain and paralysis. VF is also useful for performing evaluations before and after surgery

Surgical Treatment for Congenital Kyphosis Correction Using Both Spinal Navigation and a 3-dimensional Model

An 11 year-old girl had 66 degrees of kyphosis in the thoracolumbar junction. For the purpose of planning for kyphosis correction, we created a 3-D, full-scale model of the spine and consulted spinal navigation. Three-dimensional models are generally used as tactile guides to verify the surgical approach and portray the anatomic relations specific to a given patient. We performed posterior fusion from Th10 to L3, and vertebral column resection of Th12 and L1. Screw entry points, directions, lengths and diameters were determined by reference to navigation. Both tools were useful in the bone resection. We could easily detect the posterior element to be resected using the 3D model. During the anterior bony resection, navigation helped us to check the disc level and anterior wall of the vertebrae, which were otherwise difficult to detect due to their depth in the surgical field. Thus, the combination of navigation and 3D models helped us to safely perform surgery for a patient with complex spinal deformity