RCAAP Repository

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

No summary/description provided

Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients.Results:513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG.Conclusion:The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

Objectives:To evaluate the accuracy and the operative complications of implanting pedicle screws in the thoracic and lumbar spine, using computer-assisted surgery compared to the implantation technique using fluoroscopy.Methods:A retrospective study was conducted at the Hospital Universitário Cajuru PUC-PR from January 2000 to January 2009. Two groups of patients undergoing implant pedicle screws were analyzed (n=80). Group I received implant pedicle screws through fluoroscopy technique and group II, through neuronavigation technique. The accuracy of positioning of pedicle screws was evaluated using rating scales.Results:The accuracy was higher in group II, where 77.5% of the screws were correctly positioned, whereas there were only 28.5% in group I (p=0.001). There was a reduction of 95% (CI: 80-97%) in the risk of screws misplacement in group II. The average operation time was 312.2±78.1 minutes in group I and 270.3±41.4 in group II (p=0.004). Blood transfusion was needed in 28 patients in group I and 10 patients in group II (p=0.005), resulting in 64% risk reduction of blood transfusion in group II. Eight patients in group I underwent revision surgery whereas only one patient in the group II, that is, 75% of surgical revision risk reduction.Conclusion:The implantation technique of pedicle screws using neuronavigation is a more accurate method and has less operative complications compared with the technique that uses fluoroscopy.

Objective:To correlate obesity with radiographic parameters of spinal and spinopelvic balance in patients undergoing spinal arthrodesis, and to correlate obesity with clinical outcome of these patients.Methods:Observational retrospective study including patients who underwent spinal arthrodesis, with minimum follow-up period of three months. We measured waist circumference, as well as height and weight to calculate body mass index (BMI) and obtained radiographs of the total column. The clinical parameters studied were pain by visual analog scale (VAS) and the Oswestry questionnaire (ODI). Obesity correlated with radiographic parameters of the sagittal and spinopelvic balance and postoperative clinical parameters.Results:32 patients were analyzed. The higher the BMI, the greater the value of VAS found, but without statistical significance (p=0.83). There was also no correlation between BMI and the ODI questionnaire. Analyzing the abdominal circumference, there was no correlation between the VAS and ODI. There was no correlation between BMI or waist circumference and the radiographic parameters of global spinopelvic sagittal alignment. Regarding the postoperative results, there was no correlation between the mean BMI and waist circumference and the postoperative results for ODI and VAS (p=0.75 and p=0.7, respectively).Conclusions:The clinical outcomes of patients who undergone spinal fusion were not affected by the BMI and waist circumference. Also, there was no correlation between radiographic parameters of spinal and spinopelvic sagittal balance with obesity in patients previously treated with arthrodesis of the spine.

Objectives:The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients.Method:Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine.Results:Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5) vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum.Conclusion:The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

Objective:To evaluate a method to reduce high degree spondylolisthesis in adults with monosegmental fixing preserving the adjacent level and the improvement of sagittal balance.Methods:A prospective study, with 12 adult patients with high degree spondylolisthesis (III and IV) in adults who underwent surgery by the same team. We included 7 women and 5 men with a mean age of 37 years and lombosciatalgy that had no improvement with conservative treatment. The surgical technique used was total or partial reduction by Spondylolisthesis Reduction Instrument (SRI) system, with instrumentation only in the affected level, thus sparing the adjacent level, associated with 360ofusion.Results:The L5-S1 level was involved in nine patients, L4-L5 in two, and VT-S1 in one patient. The isthmic type predominated in nine patients, followed by dysplastic type in two, and one iatrogenic spondylolisthesis. These patients were assessed by the Oswestry scale, which showed a preoperative average of 59% and postoperative average of 12.4% (P<0.05). A significant improvement in the average slip angle from 54.66% to 9.5% (35% to 0%) was found. No major complications such as infection, neurological damage or material breaks were observed.Conclusion:The reduction of high degree listhesis instrumenting only the affected level produces good results, with good control of pain and functional improvement of patients. However, a larger follow-up is required to better evaluation.

Objective:To evaluate the quality of life of patients after spine surgery related to the return to work activities.Methods:Retrospective review of medical records of patients operated for degenerative spinal disease and application of questionnaire about quality of life (SF-36) in the preoperative and postoperative periods at one month, six months, one year and two years. Patients were divided into three groups: those who returned to work, who were away from work and retired patients. Then the statistical analysis was conducted and the evolution of quality of life was assessed according to the return to activity.Results:Evaluating patients for the variable return to activity, it was found statistically significant difference in the time for the variables: functional, physical, pain, vitality, social and mental. For patients who did not return to activity, the evolution was statistically significant for the variables: functional, physical, pain, vitality and social. For retired patients the outcome was statistically significant for all domains, except for "General".Conclusion:The quality of life has improved in all groups postoperatively, being observed more significant results in the group that returned to their work activities.

Objectives:To compare the clinical outcomes between patients with degenerative lumbar stenosis who were treated by decompression with those awaiting the same kind of treatment for the disease.Methods:Retrospective study which divided patients with degenerative lumbar stenosis with surgical indication in 2 groups, operated and awaiting the procedure. The Oswestry Disability Index (ODI) questionnaire, visual analog scale and SF36 were applied.Results:Twelve operated patients and 18 awaiting the procedure were included. The average age of those operated was 59 years (43-70), and 55 (37-82) (p=0.3) for those awaiting surgery. The operated group had a mean ODI of 38.67 against 59.72 (p<0.05) in the non-operated group. The pain analog scale had lumbar result of 5.33 and pain radiating to the lower limbs of 3.83 in operated patients, against 6.78 (p>0.05) and 7.22 (p<0.05) in the awaiting surgery patients, respectively. As for the SF36 scale, functional capacity, limitations due to physical aspects and pain had an average score of 36.25, 19.58 and 21.67 in the operated group against 35.94, 27.50 and 32.61 in the awaiting group (p>0.05), respectively.Conclusion:The operated patients showed improvement of referred pain in the lower limbs (leg VAS) and improved function (Oswestry), however showed no significant change in quality of life according to SF36 scale and low back pain (lumbar VAS) were found.

No summary/description provided

No summary/description provided

No summary/description provided

Abstract The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship - emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology.

Abstract Background: Data on the prevalence of dyslipidemia in Brazil are scarce, with surveys available only for some towns. Objective: To evaluate the prevalence of the self-reported medical diagnosis of high cholesterol in the Brazilian adult population by use of the 2013 National Health Survey data. Methods: Descriptive study assessing the 2013 National Health Survey data, a household-based epidemiological survey with a nationally representative sample and self-reported information. The sample consisted of 60,202 individuals who reported a medical diagnosis of dyslipidemia. The point prevalence and 95% confidence interval (95%CI) for the medical diagnosis of high cholesterol/triglyceride by gender, age, race/ethnicity, geographic region and educational level were calculated. Adjusted odds ratio was calculated. Results: Of the 60,202 participants, 14.3% (95%CI=13.7-14.8) never had their cholesterol or triglyceride levels tested, but a higher frequency of women, white individuals, elderly and those with higher educational level had their cholesterol levels tested within the last year. The prevalence of the medical diagnosis of high cholesterol was 12.5% (9.7% in men and 15.1% in women), and women had 60% higher probability of a diagnosis of high cholesterol than men. The frequency of the medical diagnosis of high cholesterol increased up to the age of 59 years, being higher in white individuals or those of Asian heritage, in those with higher educational level and in residents of the Southern and Southeastern regions. Conclusion: The importance of dyslipidemia awareness in the present Brazilian epidemiological context must be emphasized to guide actions to control and prevent coronary heart disease, the leading cause of death in Brazil and worldwide.

Abstract Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Brazil, and primary prevention care may be guided by risk stratification tools. The Framingham (FRS) and QRISK-2 (QRS) risk scores estimate 10-year overall cardiovascular risk in asymptomatic individuals, but the instrument of choice may lead to different therapeutic strategies. Objective: To evaluate the degree of agreement between FRS and QRS in 10-year overall cardiovascular risk stratification in disease-free individuals. Methods: Cross-sectional, observational, descriptive and analytical study in a convenience sample of 74 individuals attending the outpatient care service of a university hospital in Brazil between January 2014 and January 2015. After application of FRS and QRS, patients were classified in low/moderate risk (< 20%) or high risk (≥ 20%). Results: The proportion of individuals classified as at high risk was higher in FRS than in QRS (33.7% vs 21.6%). A synergic effect of male gender with systemic arterial hypertension was observed in both tools, and with for geriatric age group in QRS (p < 0.05) in high-risk stratum. The Kappa index was 0.519 (95%CI = 0.386-0.652; p < 0.001) between both instruments. Conclusion: There was a moderate agreement between FRS and QRS in estimating 10-year overall cardiovascular risk. The risk scores used in this study can identify synergism between variables, and their behavior is influenced by the population in which it was derived. It is important to recognize the need for calibrating risk scores for the Brazilian population.