5 research outputs found
Evaluation of the Utility of Indocyanine Green Video Angiography in Cerebral Arteriovenous Malformation Surgery
No full textObjective: To assess the utility of intraoperative indocyanine green video angiography (ICG-VA) during microsurgical resection of arteriovenous malformations (AVMs). Methods: Data of the 24 patients, who were surgically treated for AVM using intraoperative ICG-VA, were reviewed retrospectively. Postoperative digital subtraction angiography (DSA) was performed in all patients before they regained consciousness and became fully awake, and the results were compared with those obtained with intraoperative ICG-VA. A scheduled DSA was performed in all patients in the third, sixth, and 12th postoperative months as well. Results: Authors retrospectively analyzed the records of intraoperative ICG-VA application of all 24 patients. Though the exposures were limited and the image qualities were poor at higher magnification on the surgical microscope within deep surgical fields, the AVM niduses, feeding arteries, draining veins, and their relations to normal vasculature were observed precisely with ICG-VA in all the procedures. Furthermore, the visualization was not qualified enough to identify these pathological vascular structures accurately before evacuating and irrigating the layer of blood clots that obscure the view in patients who presented with hemorrhage. In a patient in our series, a residual nidus in the tail of the caudate nucleus was detected with immediate postoperative DSA which was not revealed by terminal assessment with final intraoperative ICG-VA. Conclusions: Intraoperative ICG-VA is particularly effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus in cerebral AVM surgery. It may be a quick and safe technique for intraoperative imaging of the angioarchitecture of superficial AVMs, but it may be less helpful for deep-seated lesions. Furthermore, this method alone may not be useful in the identification of residual disease or improvement of the clinical outcomes. DSA has remained the gold standard for confirming AVM obliteration. Despite the technical limitations associated with ICG-VA, a combination of intraoperative ICG-VA and immediate postoperative DSA may advance the safety and efficacy of AVM surgery. © 2022 Elsevier Inc
Lhermitte–Duclos Disease Mimicking Cerebellopontine Angle Tumor: A Case Report
No full textLhermitte-Duclos disease (LDD) is dysplastic gangliocytoma of the cerebellum, which is rare, tends to grow slowly, usually has good prognosis, and wherein the cerebellar cortex becomes thick and the central white matter is not observed. On MRI of the brain, it has hyperintense and hypointense presentations on T2- and T1-weighted scans, respectively. It has nonhomogenous contrasting pattern on T1-contrast scans. LDD can be seen unilaterally or bilaterally in the cerebellum. When the disease is located at the cerebellopontine angle, it can be mistaken for the tumors located in this region. Recurrence can occur postoperatively, which is rare. The present case is a rare one because the tumor was located at the cerebellopontine angle and radiologically mimicked cerebellopontine angle tumors
Microendoscopic Discectomy for Lumbar Disc Herniations: A Series of 389 Cases
No full textObjective: Lumbar disc herniation is one of the discogenic causes of lower back pain. Patients with severe nerve root compression or progressive neurologic deficit who do not respond to conventional treatments require surgical intervention. These surgical treatments include minimally invasive and traditional methods. In this study, we have presented the clinical data of patients who underwent microendoscopic discectomy (MED)-a minimally invasive method.Methods: The surgical and clinical data of 389 adult patients who were operated through MED by a single surgeon between 2017 and 2022 were retrospectively evaluated. Parameters such as per-oppostop visual analog scale (VAS), follow-up time, duration of hospitalization, and amount of intraoperative blood loss were examined.Results: Of the 389 patients included in our study, 169 were female and 220 were male, and their mean age was 42.78 years. L4-L5 (n=205, 51.6%), L5-S1 (n=185, 46.8%), L3-L4 (n=4, 1%), and L2-L3 (n=2, 0%) were the most frequently operated levels, showing a sequentially decreasing frequency. Bilateral surgery was performed in two patients. Recurrence was observed in 11 patients (2.8%). Cerebrospinal fluid was detected in 2 (0.5%) patients. The mean pre-and post-op VAS scores were calculated as 7.45 and 1.14, with a significant difference of p<0.001. The mean blood loss during surgery was calculated as 9.6 +/- 5.8 mL, and the postoperative hospital stay was 17.2 +/- 8.5 hours.Conclusion: MED was comparable to conventional methods in terms of symptom relief, recurrence rate, recovery time after surgery, and intraoperative blood loss
Association of the Pituitary Gland Height With Variant Sella Morphology in Children
No full textUlku, Goktug/0000-0003-1430-2977Purpose To analyze the relationship of the height of the pituitary gland (HPG) with the heights of the dorsum sellae (HDS) and tuberculum sellae (HTS) on pediatric magnetic resonance imaging (MRI) views. Methods MRI slices of 180 healthy children (100 males and 80 females) aged 1-18 years were included in the study. Results Average HPG, HTS and HDS values were determined as 6.66 +/- 1.58 mm, 10.97 +/- 1.99 mm, 13.62 +/- 2.67 mm, respectively. No statistically significant difference was determined between the measurements in term of sex. All parameters correlated with pediatric ages. HPG increased up to the prepubescent period, and decreased after this period (p 0.001). HDS and HTS increased with an irregular pattern (p 0.001). There were six children (3.33%) with HPG > 10 mm. There was no child with HPG/HDS > 1 or HPG/HTS > 1. Conclusion This work provided three substantial additions to the literature as follows: (a) all pediatric HPGs were distinctly smaller than HDSs and HTSs, (b) some children (3.33%) at puberty (age range: 10-14 years), regardless of sex, might have a HPG > 10 mm, even though there was no pathology at the pituitary gland, and (c) to our knowledge, this retrospective MRI examination evaluated the relation of HPG with variant sella morphology in normal children for the first time in the literature
Manipulación manual de de cargas pesadas, dolor lumbar, cambios degenerativos lumbares, respuesta inflamatoria y condición cardiorrespiratoria en una población de coteros de Manizales
No full textIlustraciones, fotos, gráficasspa:Introducción: El dolor lumbar es considerado un problema de salud pública de origen
multifactorial y con alta prevalencia en la población general. Frecuentemente se reporta en
trabajadores, deportistas y adultos mayores. Los factores de riesgo descritos en la literatura para
padecer dolor lumbar son la edad, la afectación de las estructuras vertebrales, la ocupación que
implique posturas forzadas o manipulación manual de cargas, la condición cardiorrespiratoria
deficiente o un elevado porcentaje de grasa corporal. El dolor lumbar de origen ocupacional, es
una de las principales causas de incapacidad, ausentismo laboral y consulta médica. Una causa
común de dolor lumbar de origen ocupacional es la degeneración discal lumbar con o sin
afectación de otras estructuras vertebrales, como las articulaciones facetarias y las placas
terminales cartilaginosas. Los procesos degenerativos lumbares se acompañan de procesos
biológicos como la inflamación, intentos de regeneración celular, angiogénesis y regulación de la
matriz extracelular. El objetivo principal de este estudio fue determinar en una población de
coteros de la ciudad de Manizales, la prevalencia de dolor lumbar, los cambios degenerativos
lumbares, la respuesta inflamatoria y la condición cardiorrespiratoria asociados a la manipulación
de cargas pesadas.
Metodología: Se trata de un estudio descriptivo, no experimental, transversal de tipo correlacional.
Una población de 102 coteros de la plaza de mercado la ciudad de Manizales fue invitada a
participar. Los criterios de inclusión para el estudio fueron: ser de sexo masculino, entre los 20 y
60 años de edad, con al menos un año en la ocupación como cotero realizando levantamiento de
cargas con un peso igual o superior a 40 kg, capacidad de realizar esfuerzo físico intenso con
aceptación y firma el consentimiento informado. Se realizó un muestreo probabilístico
determinando una muestra de 58 sujetos que realizaron el proceso de evaluación para analizar las
siguientes variables: dolor lumbar por medio de una encuesta, cambios degenerativos lumbares
determinados por imágenes de Resonancia Magnética Nuclear lumbosacra de tipo simple,
respuesta inflamatoria determinada por la cuantificación mediante método ELISA de la citoquina
proinflamatoria IL1-β y antinflamatoria CCL5 RANTES, capacidad cardiorrespiratoria de acuerdo
al VO2max establecido con una prueba en cicloergómetro. El análisis estadístico se realizó de
acuerdo a categorías de edad y tiempo de ocupación en tres fases: análisis univariado para las
variables cualitativas y cuantitativas, bivariado estableciendo asociaciones entre las variables
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cualitativas, matrices de correlación entre las variables cuantitativas y pruebas de comparación de
medias para variables cualitativas y cuantitativas con una prueba post hoc (Test de Bonferroni).
Finalmente se realizó un análisis multivariado en el que se realizó un análisis correlacional (modelo
predictivo) y un análisis clúster. Los valores de p < 0.05 fueron considerados estadísticamente
significativos.
Resultados: La prevalencia de dolor lumbar en la población de coteros fue del 55.2%, con una
duración promedio de 5.1 años. Esta condición no se encontró asociada con la edad, sin embargo,
si se comprobó una asociación entre el dolor lumbar y el tiempo de ocupación en los sujetos que
llevan entre 1 y 10 años en la labor como coteros. El índice de levantamiento promedio para los
sujetos en una tarea simple de levantamiento fue 15.9 ±3.7. El índice de discapacidad de Oswestry
demostró que el 90.6% de los sujetos presentó una discapacidad mínima por dolor lumbar. Los
cambios anatómicos lumbares fueron analizados desde el punto de vista anatómico por la
afectación de los discos intervertebrales, las articulaciones facetarias y las placas terminales
cartilaginosas reportada en las imágenes de RMN. Se identificaron cambios degenerativos en todos
los discos intervertebrales en diferente grado y en las articulaciones facetarias principalmente en
los niveles L4 a S1, por otro lado, las placas terminales cartilaginosas se encontraron sanas en el
82.8% de los sujetos. La IL1-β se reportó en concentraciones negativas en el 91% de los
participantes, mientras que la concentración de CCL5 RANTES demostró concentraciones
positivas en el 100% de los sujetos dentro de los rangos reportados por estudios similares. La
condición cardiorrespiratoria es deficiente en casi la totalidad de los sujetos. Se pudo demostrar
que la variable que mejor relación lineal tiene con el VO2max es el contenido de grasa corporal, por
lo que se propuso un modelo predictivo de VO2max para los sujetos que realizan manipulación
manual de cargas pesadas. Al realizar el análisis multivariado tipo clúster se encontraron dos
grupos de sujetos con características similares. El grupo de los sujetos de mayor edad conformado
por 26 sujetos, quienes reportaron mayor tiempo en la ocupación, menor capacidad
cardiorrespiratoria, tendencia al sobrepeso en su IMC y con mayor afectación en la unidad
vertebral. Un segundo grupo conformado por 32 sujetos mas jóvenes, con menor tiempo en la
ocupación como coteros, mejor condición cardiorrespiratoria y daños leves a moderados en la
unidad vertebral.
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Discusión: La prevalencia de dolor lumbar en coteros (55.2%) es inferior a la descrita en la
literatura para trabajadores en el área de la salud que alcanza el 69%, según lo descrito por García
(2014), (1) y 72% según los descrito por Mroczek en 2020 (2). El índice de levantamiento (IL)
descrito por Muraca (2007) para porteros hoteleros de sexo masculino, es muy inferior al reportado
por los coteros, 5 y 15.9 respectivamente. La discapacidad generada por dolor lumbar es mínima
o ninguna en el 90.6% en la población de coteros, muy diferente a lo reportado por Mroczek (2020)
que demostró discapacidad moderada a severa en enfermeros y paramédicos con una particular
afectación de la calidad de vida. La edad no se asocia con la prevalencia de dolor lumbar y en este
grupo poblacional los sujetos mayores de 46 años son los que reportaron menor prevalencia de
esta condición (15%), mientras que Alhowimel (2022), demostró que los adultos de sexo
masculino entre 35 y 55 años, son mucho más propensos al dolor lumbar que los niños y
adolescentes (3).
Recomendaciones: De acuerdo a los resultados obtenidos en el presente estudio, se sugiere: a)
realizar nuevos estudios con un mayor número de participantes y comparativo con otros grupos
poblacionales; b) diseñar una escala de medición funcional de la discapacidad por dolor lumbar
específica para sujetos que levantan cargas pesadas; c) considerar otros métodos diagnósticos y
biomarcadores como la electromiografía de superficie, la resonancia magnética dinámica o una de
mayor resolución; d) validar las hipótesis y modelo predictivo resultante en nuevos estudios.eng:Introduction: Low back pain is considered a public health problem with multifactorial origin and
high prevalence in the general population. This condition is reported in workers, athletes, and older
adultsfrequently. The risk factors described in the literature for low back pain are age, involvement
of vertebral structures, an occupation that involves forced postures or manual handling of loads,
poor cardiorespiratory condition, or a high percentage of body fat. Occupational low back pain is
one of the main causes of disability, absenteeism from work, and medical consultation. A common
cause of occupational low back pain is lumbar disc degeneration with or without the involvement
of other vertebral structures, such as facet joints and cartilaginous endplates. Lumbar degenerative
processes are accompanied by biological processes such as inflammation, attempts at cell
regeneration, angiogenesis, and regulation of the extracellular matrix. The main objective of this
study was to determine the prevalence of low back pain, lumbar degenerative changes,
inflammatory response, and cardiorespiratory conditions associated with handling heavy loads in
a population of coteros in the city of Manizales.
Methodology: This is a descriptive, non-experimental, cross-sectional correlational study. A
population of 102 coteros from the market square of Manizales was invited to participate. The
inclusion criteria for the study were: being male, between 20 and 60 years old, with at least one
year in the occupation as a cotero lifting loads with a weight equal to or greater than 40 kg, ability
to perform intense physical effort with acceptance and signing of the informed consent. A
probabilistic sampling was carried out determining a sample of 58 subjects who underwent the
evaluation process to analyze the following variables: low back pain by means of a survey, lumbar
degenerative changes determined by simple lumbosacral Magnetic Resonance Imaging images,
inflammatory response determined by the quantification by ELISA method of the proinflammatory cytokine IL1-β and anti-inflammatory CCL5 RANTES, cardiorespiratory capacity
according to the VO2max established with a cycloergometer test. The statistical analysis was
carried out according to categories of age and time of occupation in three phases: univariate
analysis for qualitative and quantitative variables, bivariate analysis establishing associations
between qualitative variables, correlation matrices between quantitative variables and tests of
comparison of means for qualitative and quantitative variables with a post hoc test (Bonferroni
test). Finally, a multivariate analysis was performed in which a correlational analysis (predictive
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model) and a cluster analysis were performed. P values < 0.05 were considered statistically
significant.
Results: The prevalence of low back pain in coteros population was 55.2%, with an average
duration of 5.1 years. This condition was not found to be associated with age, however, an
association between low back pain and occupation time was found in subjects who have been
working as coteros for between 1 and 10 years. The average lifting rate for subjects on a simple
lifting task was 15.9 ±3.7. The Oswestry Disability Index showed that 90.6% of the subjects had
minimal disability due to low back pain. Lumbar anatomical changes were analyzed from the
anatomical point of view by the involvement of the intervertebral discs, facet joints and
cartilaginous endplates reported in the MRI images. Degenerative changes were identified in all
intervertebral discs to different degrees and in facet joints mainly at levels L4 to S1, on the other
hand, cartilaginous endplates were found healthy in 82.8% of the subjects. IL1-β was reported at
negative concentrations in 91% of participants, while CCL5 RANTES concentration demonstrated
positive concentrations in 100% of subjects within the ranges reported by similar studies.
Cardiorespiratory fitness is deficient in almost all subjects. It was possible to demonstrate that the
variable with the best linear relationship with VO2max is body fat content, so a predictive model of
VO2max was proposed for subjects who perform manual handling of heavy loads. When performing
the cluster-type multivariate analysis, two groups of subjects with similar characteristics were
found. The group of older subjects made up of 26 subjects, who reported longer time in occupation,
lower cardiorespiratory capacity, tendency to overweight in their BMI and with greater
involvement in the vertebral unit. A second group consisted of 32 younger subjects, with less time
in the occupation as coteros, better cardiorespiratory fitness and mild to moderate damage to the
vertebral unit.
Discussion: The prevalence of low back pain in coteros (55.2%) is lower than that described in
the literature for health workers, which reaches 69%, as described by García (2014), (1) and 72%
as described by Mroczek in 2020 (2). The lifting index (IL) described by Muraca (2007) for male
hotel porters is much lower than that reported by coteros, 5 and 15.9 respectively. Disability caused
by low back pain is minimal or none in 90.6% of the population of coteros, very different from
what was reported by Mroczek (2020) who demonstrated moderate to severe disability in nurses
and paramedics with a particular impact on quality of life. Age is not associated with the
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prevalence of low back pain and in this population group, subjects over 46 years of age are the
ones who reported the lowest prevalence of this condition (15%), while Alhowimel (2022), showed
that male adults between 35 and 55 years of age are much more prone to low back pain than
children and adolescents (3).
Recommendations: According to the results obtained in this study, it is suggested: a) to carry out
new studies with a greater number of participants and comparison with other population groups;
b) design a functional scale for measuring disability due to low back pain specific to subjects who
lift heavy loads; c) consider other diagnostic methods and biomarkers such as surface
electromyography, dynamic magnetic resonance imaging or a higher resolution one; d) validate
the hypotheses and resulting predictive model in new studies.Introducción / SECCIÓN I. ASPECTOS BIOMÉDICOS / Capítulo 1. Manipulación manual de cargas pesadas (MMC) / 1.1 Descripción de las tareas de MMC realizadas por los coteros / Capítulo 2. Dolor lumbar / Capítulo 3. Cambios degenerativos lumbares y respuesta inflamatoria / 3.1 Resonancia Magnética Nuclear (RMN) / 3.2 Cambios degenerativos lumbares / 3.3 Respuesta inflamatoria / 3.4 Interleuquina 1- beta (IL-1β) / 3.5 Quimiocina CCL5-RANTES / 3.6 Inmunoensayo Enzimático ligado a Enzimas (ELISA) / Capítulo 4. Condición cardiorrespiratoria / SECCIÓN II. ASPECTOS METODOLÓGICOS / Capítulo 5. Consideraciones metodológicas / 5.1 Objetivo general / 5.2 Objetivos específicos / 5.3 Hipótesis / 5.4 Aspectos éticos / 5.5 Diseño del estudio / 5.6 Análisis estadístico / 5.7 Aspectos técnicos / 5.8 Pruebas de laboratorio / 5.9 Almacenamiento y manejo de muestras / 5.10 Prueba VIH / 5.11 Análisis de citoquinas / 5.12 Resonancia Magnética Nuclear (RMN) / 5.13 Prueba de cicloergómetro (V̇ O2max) / SECCIÓN III. RESULTADOS, DISCUSIÓN, CONCLUSIONES, RECOMENDACIONES, LIMITACIONES DEL ESTUDIO / Capítulo 6. Resultados / 6.1 Prevalencia de dolor lumbar / 6.2 Cambios anatómicos lumbares / 6.3 Respuesta inflamatoria / 6.4 Consumo máximo de oxígeno (V̇ O2max) / 6.5 Asociación entre las variables / 6.6 Análisis correlacional (Modelo Predictivo V̇ O2max) / 6.7 Análisis Clúster / 6.8 Análisis de correlación entre variables cuantitativas / Capítulo 7. Discusión / Capítulo 8. Conclusiones y recomendaciones / 8.1 Conclusiones / 8.2 Recomendaciones / Capítulo 9. Limitaciones del estudio / MECANISMOS DE SOCIALIZACIÓN DE LOS RESULTADOS / REFERENCIAS BIBLIOGRAFICAS ANEXOSDoctoradoDoctor(a) en Ciencias Biomédica
