Discal Cyst: a Rare Cause of Neurologic Compression in the Young Adult

Introduction: discal cysts are rare pathology. Its clinical presentation can be mistaken for disc herniation, with back pain, radiculopathy and neurological defi cit. It is more common in male patients in their fourth life decade. Because they are rare, there is no consensus about the treatment. A great variety of procedures, from medication for the pain to endoscopic or microdiscectomy excision, have been described. Objetive: Describe a case of discal cyst on the l4-l5 level with compression of l5 right nerve root treated successfully with a minimal invasive procedure. Study design: Case report. Methods: Review medical records, pertinent images, interview with the patient and surgical team, intraoperative and histopathological fi ndings. The surgical technique used was minimally invasive. Results: Magnetic resonance imaging (MRI) demonstrated a cystic lesion imaging at the level of the L4-L5 disc. The cystic mass displaced the thecal sac dorsally compressed the L5 transversing root. The patient was submitted to a minimally invasive microendoscopic technique using a tubular retractor. He recovered completely after the procedure, presenting absence of leg pain and went back to his regular activities 3 weeks after the surgery. Histopathological examination of the cyst revealed thick fi brous connective tissue interspersed with areas of chronic infl ammation. Conclusion: Discal cysts are rare intraspinal lesions. They can trigger severe neurological symptoms, and should be differentiated from other forms of epidural cysts and tumors. There are many treatment options that can be chosen from but no consensus. We used a treatment that was less invasive than the ones described in the literature

Heparanase isoform expression and extracellular matrix remodeling in intervertebral disc degenerative disease

OBJECTIVE: To determine the molecules involved in extracellular matrix remodeling and to identify and quantify heparanase isoforms present in herniated and degenerative discs. INTRODUCTION: Heparanase is an endo-beta-glucuronidase that specifically acts upon the heparan sulfate chains of proteoglycans. However, heparanase expression in degenerative intervertebral discs has not yet been evaluated. Notably, previous studies demonstrated a correlation between changes in the heparan sulfate proteoglycan pattern and the degenerative process associated with intervertebral discs. METHODS: Twenty-nine samples of intervertebral degenerative discs, 23 samples of herniated discs and 12 samples of non-degenerative discs were analyzed. The expression of both heparanase isoforms (heparanase-1 and heparanase-2) was evaluated using immunohistochemistry and real-time RT-PCR analysis. RESULTS: Heparanase-1 and heparanase-2 expression levels were significantly higher in the herniated and degenerative discs in comparison to the control tissues, suggesting a possible role of these proteins in the intervertebral degenerative process. CONCLUSION: The overexpression of heparanase isoforms in the degenerative intervertebral discs and the herniated discs suggests a potential role of both proteins in the mediation of inflammatory processes and in extracellular matrix remodeling. The heparanase-2 isoform may be involved in normal metabolic processes, as evidenced by its higher expression in the control intervertebral discs relative to the expression of heparanase-1

QUALITY OF LIFE ANALYSIS ON PATIENTS AFTER ARTHROPLASTY OR LUMBAR ARTHRODESIS

ABSTRACT Objective: To perform a retrospective analysis of patients with degenerative disc disease of the lumbar spine undergoing arthrodesis or lumbar arthroplasty in terms of functional capacity and quality of life. Methods: Retrospective observational study analyzing the medical records of patients undergoing arthrodesis or lumbar arthroplasty, followed-up at an outpatient clinic from 2018 to 2020. Patient characteristics were evaluated; the quality of life through the results of the Short Form 36 Health Survey Questionnaire (SF-36) and the functional capacity using the Oswestry Disability Index (ODI) in the pre-surgical and post-surgical periods (6 months, 1 and 2 years). The criterion to establish statistical significance was p≤0.05. Results: Sixty-one patients were evaluated. After the surgical interventions, the individuals migrated from the classification of invalid (61.4%-64.6%) to minimal/moderate disability (17.7%-25.6%). There was a decline in ODI scores over time of follow-up (p≤0.001) as well as in SF-36 values (p≤0.001) for all surgical techniques. In this regard, evaluating the difference in means revealed the better performance of lumbar arthroplasty (p≤0.001). Conclusion: The data suggest that lumbar arthroplasty offers greater benefits to patients regarding functional capacity and quality of life. Level of Evidence III; Retrospective, descriptive, observational study

Craniofacial Fibrous Dysplasia Addressed Through the Intraoral and Nasal Access

Background: The Craniofacial Fibrous Dysplasia is a benign disease, pseudoneoplasic, rare and asymptomatic of slow growth promoting replacement of bone tissue by an amorphous connective tissue, promoting bone deformation that can invade and cause compression of important structures such as the skull base and facial orbital bone. This study aims to present a clinical case of a Craniofacial Fibrous Dysplasia, emphasizing an alternative of an aesthetic surgical access by an intraoral approach. Case Report: We report the clinical case of patient IMS, 21 years of age with craniofacial fibrous dysplasia presenting deformity of the left facial middle third in orbital, nasal and maxilla region who was submitted to surgery for facial recontouring. The surgical access was intraoral associated with access for rhinoplasty. A lesion scrape was realized for facial recontouring and nasal osteotomy for correction of deviation caused by the injury. Conclusions: It was concluded that the surgical technique associated with the intraoral access with nasal extension is an important tool in addressing these lesions, allowing a large surgical field and satisfactory aesthetic and functional results without facial scars

Analysis of COVID-19 mortality and case-fatality in a low- income region::an ecological time-series study in Tocantins, Brazilian Amazon

Introduction: Inserted in the vulnerable context of the Brazilian Amazon, the state of Tocantins has suffered damages with the dissemination of COVID-19 in its territory; however, little evidence is published from this state. Objective: This study aims to analyze the case-fatality, mortality, and incidence of COVID-19 in Tocantins. Methods: This is an ecological study, population-based, time-series analysis of COVID-19 cases and deaths in the state of Tocantins from March 2020 to August 2021. Results: During the examined period, 219,031 COVID-19 cases, and 3,594 deaths were registered due to disease. Two possible occurrence peaks were characterized in this time-series analysis. Remarkably, the Second Wave had the highest lethality rates (3.02% - April 2021), mortality (39.81 deaths per 100,000 inhabitants – March 2021), and incidence (1,938.88 cases per 100,000 inhabitants – March 2021). At the end of the period, mortality, incidence, and lethality showed flat trends, suggesting a positive outcome of the vaccination program. Conclusion: The prevention, surveillance, and control actions of COVID-19 cases in Tocantins State have been directed to mitigate the deleterious effects of the pandemic. Nevertheless, efforts are still needed to decrease lethality, mortality, and incidence trends, and ultimately to achieve control of the COVID-19 pandemic in the region.Introdução: Inserido em vulnerável contexto da Amazônia Brasileira, o estado de Tocantis tem sofrido danos com a disseminação da COVID-19 em seu território; entretanto, escassas evidências têm sido publicadas sobre este estado. Objetivo: O objetivo deste estudo é analisar a letalidade, mortalidade e incidência da COVID-19 em Tocantins. Método: Este é um estudo ecológico, de base populacional, com análises de séries temporais de casos e óbitos de COVID-19 no estado do Tocantins de março de 2020 a agosto de 2021. Resultados: No período examinado, foram registrados 219.031 casos de COVID-19 e 3,594 óbitos devido a doença. Foram caracterizadas nesta análise de série temporal a formação de duas possíveis ondas. Notavelmente, a segunda onda apresentou as maiores taxas de letalidade (3,02% - abril de 2021), mortalidade (39,81 óbitos por 100.000 habitantes - março de 2021) e incidência (1.938,88 casos por 100.000 habitantes - março de 2021). No final do período, a mortalidade, incidência e letalidade apresentaram tendências estacionárias, sugerindo um resultado positivo do programa de vacinação. Conclusão: As ações de prevenção, vigilância e controle dos casos de COVID-19 no Estado do Tocantins têm sido direcionadas para mitigar os efeitos deletérios da pandemia. No entanto, esforços ainda são necessários para diminuir as tendências da letalidade, mortalidade e, em última instância, para alcançar o controle da pandemia de COVID-19 na região

Cut Out Complications and Anisomelia of the Lower Limbs In Surgery With Valgus Reduction for Intertrochanteric Fractures

Background: The proximal fractures of the femur are counted among the group of orthopedic and traumatic pathologies which consume most of the financial resources set aside for health worldwide. Surgical treatment continues to be the treatment of choice for intertrochanteric fractures of the femur. However, although the surgical treatment of the proximal fracture of the femur is widely known and accepted in the orthopedic field, it is not without risk with the cut out being the most feared complication. Objective: This paper describes the complications of cut out or the anisomelia of the lower limbs of patients with intertrochanteric fractures who underwent valgus reduction surgery. Method: Sixty-one patients with 3rd and 4th degree, according to Tronzo classification, intertrochanteric fractures underwent surgery with the use of Dynamic hip screw type sliding screw and valgus reduction. The data were analyzed one year after surgery, when a functional assessment was made by scanometry, Tip-Apex Distance index diaphyseal cervical angle and the modified Merle d'Aubigné & Postel questionnaire. Kruskal-Wallis and Mann-Whitney tests were used for the statistical analysis, Spearman’s correlation test for the quantitative variables and the chi-squared test for the qualitative variables. Results: The correlation between the Tip-Apex Distance index and the diaphyseal cervical angle was statistically significant (rho=0.391, p=0.002), while the correlations between the Tip-Apex Distance index and the scanometry and the diaphyseal cervical angle and the scanometry were not significantly correlated. In accordance with the modified Merle d’Aubigné & Postel questionnaire, 23 patients (37.7%) achieved a very good result, 29 patients (47.5%) had a good result, five patients (8.2%) obtained a moderately good result, one patient (1.6%) presented a reasonable result and three patients (4.9%) obtained a poor result. Conclusion: No cut out complications occurred in the 3rd and 4th degree intertrochanteric fractures with a Baumgaertner index ≥ 25 mm, when the reduction and valgus fixation of the intertrochanteric fracture was performed with the Dynamic hip screw type sliding pin, as there was also, in the majority of patients, no anisomelia of the lower limbs