German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)

Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1–S126, 2006; or http://www.psoriasis-leitlinie.de)

Neurovascular risks of sacral screws with bicortical purchase: an anatomical study

The aim of this cadaver study is to define the anatomic structures on anterior sacrum, which are under the risk of injury during bicortical screw application to the S1 and S2 pedicles. Thirty formaldehyde-preserved human male cadavers were studied. Posterior midline incision was performed, and soft tissues and muscles were dissected from the posterior part of the lumbosacral region. A 6 mm pedicle screw was inserted between the superior facet of S1 and the S1 foramen. The entry point of the S2 pedicle screw was located between S1 and S2 foramina. S1 and S2 screws were placed on both right and the left sides of all cadavers. Then, all cadavers were turned into supine position. All abdominal and pelvic organs were moved away and carefully observed for any injury. The tips of the sacral screws were marked and the relations with the anatomic structures were defined. The position of the sacral screws relative to the middle and lateral sacral arteries and veins, and the sacral sympathetic trunk were measured. There was no injury to the visceral organs. In four cases, S1 screw tip was in direct contact with middle sacral artery. In two cases, S1 screw tip was in direct contact with middle sacral vein. It was observed that the S1 screw tips were in close proximity to sacral sympathetic trunk on both right and the left sides. The tip of the S2 screw was in contact with middle sacral artery on the left side only in one case. It is found that the tip of the S2 screw was closely located with the middle sacral vein in two cases. The tip of the S2 pedicle screw was in contact with the sacral sympathetic trunk in eight cases on the right side and seven cases on the left side. Lateral sacral vein was also observed to be disturbed by the S1 and S2 screws. As a conclusion, anterior cortical penetration during sacral screw insertion carries a risk of neurovascular injury. The risk of sacral sympathetic trunk and minor vascular structures together with the major neurovascular structures and viscera should be kept in mind

Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report Fixação lombopélvica e descompressão sacral para fratura em U do sacro: relato de caso

BACKGROUND: U-shaped sacral fractures are highly unstable, can cause significant neurological deficits, lead to progressive deformity and chronic pain if not treated appropriately. OBJECTIVE: To report a case of a U-shaped sacral fracture treated with lumbopelvic fixation and decompression of sacral roots in a 23-years-old man. METHOD: Decompression of the sacral roots combined with internal reduction and lumbopelvic fixation using iliac screws. RESULTS: Restitution of lumbosacropelvic stability and recovery of sphincter function. CONCLUSION: Lumbopelvic fixation is effective in restoring lumbosacralpelvic stability and allows full mobilization in the postoperative period. Good neurological recovery can be expected in the absence of discontinuity of the sacral roots.<br>INTRODUÇÃO: As fraturas sacrais em U são instáveis e podem causar significativa lesão neurológica, deformidade progressiva e dor crônica se não tratadas apropriadamente. OBJETIVO: Relatar caso de um homem de 23 anos com fratura em U do sacro tratada com fixação lombopélvica e descompressão das raízes sacrais. MÉTODO: Descompressão da cauda equina associada a redução interna e fixação lombopélvica usando parafusos ilíacos. RESULTADOS: Reconstituição da estabilidade lombosacropélvica e recuperação da continência esfincteriana CONCLUSÃO: A fixação lombopélvica é eficaz em restaurar a estabilidade lombo-sacro-pélvica e permite mobilização imediata no pós-operatório. Recuperação neurológica pode ser esperada na ausência de neurotmese das raízes sacrais