Presentación del caso Ghisi, Juan Pablo; Olmedo Plata, Carlos
Revista de la Asociación Argentina de Ortopedia y Traumatología,
05/2018, Volume:
83, Issue:
2
Journal Article
Peer reviewed
Open access
Se presenta el caso de un hombre de 78 años de edad que consulta por disfagia, especialmente para sólidos, y progresivos cambios en el tono de voz. Padece hipertensión arterial y diabetes tipo II en ...tratamiento con IECA y metformina como únicos antecedente patológicos de importancia.Al examen físico presenta rigidez de columna y dificultad para caminar con pérdida de fuerza a nivel de los miembros inferiores, a predominio distal, que también relata que van progresando en el tiempo.Se le solicitan estudios por imágenes
This paper presents the analysis of diagnostic policy of 72 patients with cervical osteochondrosis and cervicobrachial syndrome. All patients were examined according to a single program, which ...included a specially designed questionnaire containing address data, diagnosis, history of life and illness, patient complaints, with a mandatory examination by a neurologist for the presence of compression of neural structures of the cervical spine with a detailed description of the local status and clinical and neurological syndromes. Patients underwent general spondylography of the cervical spine in the anteroposterior and lateral projections. For the diagnosis of segmental instability, functional spondylography was performed in the position of maximum flexion and extension and functional spondylography with burdening, which is based on mathematical modeling of the distribution of the vector force load system in the cervical spine under conditions of inclination of the head at an angle of 45° (flexion) and 15° (extension) with the weight on the head weighing up to 500 grams (putting a special device on the head). A mathematical formula for calculating the index of instability of the vertebral motor segment in the cervical spine is proposed. Sagittal balance of the cervical spine was studied with the correlative dependence of its indicators with the intensity of the pain syndrome according to standard spondylography and magnetic resonance imaging. Identified marker indicator of electroneuromyographic studies of the upper extremities - F-wave. Based on the obtained fundamental knowledge, an algorithm for diagnosing osteochondrosis of the cervical spine and cervicobrachial syndrome has been developed and scientifically substantiated.
The article analyzes the data of 58 sources of literature on the treatment of cervicobrachial syndrome in patients with cervical osteochondrosis. The anatomical and topographic features of the ...cervical spine, which are predisposing factors for the development of the studied pathology, namely, the small size of the vertebral bodies and their increased mobility are noted in the work. A high incidence of degenerative-dystrophic diseases of the cervical spine was found in persons over 60years old (50 %) and aged 60years and older (75 %) with a predominance of the development of the pathological process at the level of the CV-CVI vertebral motor segment. According to the literature, the attitude to the problem of treating this pathology is contradictory. The main points of application of conservative treatment are the elimination of pain and muscle spasm, an increase in the volume of movements in the cervical spine. Despite the fact that significant progress has been achieved in recentyears in conservative treatment of patients with pathology of the cervical spine, many tasks remain unresolved and require further analysis, and therefore the problem of improving diagnosis and treatment remains relevant, socially significant and timely.
This book brings together the knowledge of eminent experts in the field of malignant mesothelioma, a highly invasive tumor of mesothelium that is the protective lining covering several body cavities. ...Malignant mesothelioma shows extremely poor progression and is refractory to almost any kind of therapy putting considerable challenges in its treatment. This book covers many important aspects of malignant mesothelioma like epidemiology, immunology, molecular mechanisms and clinical options and will be useful to anybody interested in its history, pathology, and treatment.
Cervikobrahijalni sindrom uvelike narušava nesmetano obavljanje aktivnosti svakodnevnog života i poslovnih aktivnosti te je predmet brojnih istraživanja. Kompresija neuroloških struktura zbog hernije ...diska u kralježnici s osjetno-motoričkim deficitom predstavlja indikaciju za operativno liječenje. Posljednjih godina poraslo je zanimanje za trakciju (dekompresiju) kao način liječenja te su razvijene brojne nove metode zasnovane na neurofiziološkim i biokemijskim načelima. Zbog toga se trakcija sve više primjenjuje u liječenju različitih stanja. Dekompresijska terapija kralježnice predstavlja neinvazivan pristup u liječenju cervikobrahijalnog sindroma.
Cilj je ovog istraživanja provjeriti uspješnost dekompresijske terapije kralježnice mjerene kao ishod na specifičnim neurodinamičkim testovima kod bolesnika s cervikobrahijalnim sindromom te utvrditi povezanost sociodemografskih čimbenika s uspješnošću dekompresijske terapije kralježnice kod cervikobrahijalnog sindroma.
U istraživanju je sudjelovalo 50 sudionika (54 % žena) s cervikobrahijalnim sindromom, dobnog raspona od 28 do 68 godina s prosjekom 50. Akutno trajanje simptoma zabilježeno je kod 62 % bolesnika, a kronično kod 38 %. Frekvencija dolazaka na terapiju kreće se od 3 do 8, s dominantnom vrijednošću 4. Za potrebe istraživanja primjenjivala su se tri specifična testa: Slump test, Spurlingov test i test cervikalne distrakcije.
Osobe s cervikobrahijalnim sindromom nakon provedene dekompresijske terapije kralježnice značajno se razlikuju u ishodu na Slump testu, Spurlingovu testu i testu cervikalne distrakcije u odnosu na stanje prije terapije: nakon terapije ima značajno više osoba koje uspješno prolaze navedene testove. Od promatranih sociodemografskih obilježja, značajna se pokazala dob sudionika: sudionici koji uspješno rješavaju Slump test i Spurlingov test nakon terapije znatno su mlađi od neuspješnih. Kronični bolesnici nakon terapije postižu znatno slabiji ishod na sva tri testa u odnosu na akutne bolesnike, a te se dvije skupine ujedno razlikuju i po dobi: kronični bolesnici znatno su stariji, dok po broju dolazaka na terapije nije nađena značajna razlika. U regresijskoj analizi trajanje oboljenja pokazalo se kao značajan prediktor, za razliku od dobi, koja nije značajna. Spol, tjelesna težina te broj dolazaka na terapije nisu povezani s učinkom na testovima.
The UK is now experiencing an epidemic of upper limb pain similar to that which affected Australia in the 1980s. The pain is often non-specific, and does not conform to the pattern of various ...well-recognized rheumatological entities. The syndrome is known by a number of terms, some of which imply an aetiological link to workplace activities unsubstantiated by hard evidence. The syndrome may well be largely psychosocial, and analogous to the chronic fatigue syndrome. It is currently the cause of many contentious and well-publicized medico-legal cases. Possible factors behind the epidemic will be discussed, and an approach to management suggested.
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