The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and ...unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis.
Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and ...functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants.
Nontraumatic congenital neonatal skull depression is a rare condition resulting from external forces shaping the fetal skull. Typically, newborns are asymptomatic, and, usually, the condition ...resolves in a few months with no need for intervention. However, many newborns undergo a CT scan, an ionizing technique, to check for fractures or intracranial lesions. We report a case of congenital skull depression without neurological deficits, managed conservatively through clinical monitoring and ultrasound.
Spinal cord injury without radiological abnormality (SCIWORA) was first reported in 1974. The term was used to define "clinical symptoms of traumatic myelopathy without signs of fracture or spine ...instability on X-ray or CT scan." With the emergence of MRI, the gold standard method to identify spinal cord injuries, about two-thirds of former SCIWORA cases were found to have pathological findings, and, as such, the term has taken on an ambiguous meaning in the literature. We describe the clinical case of a 17-year-old boy who was admitted to the emergency department of a tertiary hospital after a fall during a soccer game. He suffered spinal and cranioencephalic trauma. A few minutes later, the boy began to show decreased strength in the right upper limb and lower limbs, as well as changes in sensation in the right hemibody. On objective examination, the boy presented a Glasgow Coma Scale score of 15 and the American Spinal Injury Association Impairment Scale D, with partial improvement of initial symptoms of monoparesis of the right lower limb. There were no other changes, specifically at the sensory level. The patient underwent a CT and MRI of the spine that showed no fractures, instability, or appreciable medullary signal changes. Electromyography was normal. Based on the clinical history and imaging findings, real SCIWORA was diagnosed. The patient was admitted to an inpatient rehabilitation program. At a follow-up visit two months later, a complete reversal of signs and symptoms was confirmed. The prognosis of this pathology depends on the extent of the spinal cord injury, as evidenced by MRI. Although neurological improvement when severe deficit is present at initial presentation is unlikely, most patients with incomplete neurological damage show good recovery. The absence of visible changes on MRI is associated with a better prognosis.
We report here the first Portuguese case of acute fatal granulomatous encephalitis attributed to Balamuthia mandrillaris, initially thought to be a brain tumor, which had a progressive and fatal ...outcome. Balamuthia mandrillaris is a free-living amoeba recognized as an uncommon agent of granulomatous encephalitis. Infections have been identified in immunocompromised hosts and in immunocompetent pediatric patients. Balamuthia infections are very rare, with only two reported cases in Europe. The case presented here occurred in a previously healthy boy who died 5 weeks after the onset of the symptoms. No evidence of immunological deficiency was noted, and testing for human immunodeficiency virus antibodies was negative. The symptoms were initially thought to be the result of a tumor, but histopathologic examination showed evidence of amoebic infection. Immunofluorescence staining of brain tissue identified B. mandrillaris as the infectious agent. The diagnosis was confirmed with PCR by detecting Balamuthia DNA in formalin-fixed brain tissue sections. Despite initiation of empirical antimicrobial therapy for balamuthiasis, the patient died 3 weeks after being admitted to the hospital. No source of infection was readily apparent.
Abstract Background Hydrocephalus develops in up to 90% of patients born with myelomeningocele. Although Endoscopic Third Ventriculostomy (ETV) is currently considered the preferred treatment for ...obstructive hydrocephalus, its results have been inconsistent in patients with myelomeningocele. This study focuses on clinical and radiological outcomes of ETV in children with hydrocephalus related to myelomeningocele. Methods Medical records of 18 paediatric patients with myelomeningocele submitted to ETV from 1998 to 2015, at the Centro Hospitalar S. João, Porto, Portugal, were retrospectively reviewed. Patients’ caregivers were contacted to evaluate their clinical manifestations prior and after surgery regarding Hydrocephalus and Chiari malformation’s symptoms. Control neuroradiological imaging of 9 patients was obtained and analysed. Success of ETV was defined by clinical resolution and radiological confirmation. Results ETV was successful in 8 of 18 cases (44,4%). Groups of patients were compared according to age at the time of surgery, with a 40% (2/5) success rate in new-borns and 50% (3/6) in children over 1 year old. Eight patients underwent ETV as a first option, with 37,5% success. Ten patients were submitted to the procedure after previous VPS (Ventriculo-Peritoneal Shunt), five for malfunction and five due to VPS infection with 60% and 40% success rates, respectively. Early post-operative complications occurred in 2 patients. Conclusions ETV can be performed in myelomeningocele and hydrocephalus’ patients, with success rates of almost 50%. A previous VPS, VPS malfunction or infection do not contraindicate ETV. If possible, the procedure should be delayed until the patient completes 1 month of age.
Craniopharyngiomas (CP) are tumors in the sellar region that, despite a high survival rate, are associated with significant morbidity, including hypothalamic, hormonal, and visual dysfunction. This ...study aimed to assess the quality of life (QoL) in pediatric patients with CP and to evaluate its relationship with various factors, with a focus on the impact of endocrine dysfunction.
In this observational cross-sectional study, patients with CP aged between 0 and 18 years, currently followed up in a tertiary hospital by a multidisciplinary team, were included. QoL was assessed using the validated PEDS-QL4.0 questionnaire, which was administered to parents. This tool estimates Global QoL (QoL-G), further divided into Physical (QoL-P) and Psychosocial (QoL-PS) dimensions, including Emotional (QoL-Em), Social (QoL-S), and School (QoL-Sc) aspects. In Portugal, the estimated average QoL-G is 79.8, QoL-P is 83.5, and QoL-PS is 78.2. Variables studied included gender, current and diagnostic age, follow-up time, presence of hydrocephalus, hypothalamic involvement, type of resection (total or subtotal), radiotherapy, visual impairment, hormonal deficits, and therapy.
The study included 11 patients with a median age of 15.2 years (interquartile ratio (IQR), 9.7-17.9 years) and a mean age at diagnosis of 9.3±4.1 years. Of these patients, 54.5% were male, and 36.4% were obese. Subtotal resection was performed in 72.7% of cases. Hydrocephalus was present in 54.5% of the patients, hypothalamic involvement in 63.7%, radiotherapy was received by 81.8%, and visual impairment was noted in 54.5%. All patients presented with at least one hormonal deficit. The average QoL-G was 69.9±22.5, with QoL-P at 66.9±30.0 and QoL-PS at 70.9±21.4. A worse QoL-S was associated with female gender (p=0.030) and subtotal resection (p=0.048). Worse QoL-G, QoL-P, QoL-Em, and QoL-PS were linked to hypothalamic involvement (p values 0.008, 0.025, 0.015, and 0.009, respectively). Irradiated patients had worse QoL-G (p=0.006). Treatment with sexual hormones enhanced QoL-Global (p=0.035) and QoL-Emotional (p=0.020), while treatment for adrenal insufficiency and diabetes insipidus improved QoL-Emotional (p=0.021 and p=0.013). No significant associations with visual deficit or obesity were found.
Pediatric patients with CP appear to have poorer QoL-G, QoL-P, and QoL-PS compared to the healthy Portuguese population. However, the small sample size limits statistically significant associations with many of these variables. Predictors of worse QoL include female gender, hypothalamic involvement, subtotal resection, and radiotherapy. The results may be biased due to the small sample size, questionnaire administration to parents, and possible inadequacy of the questionnaire for the studied population. There is a need for a more suitable tool to enable a more precise assessment of QoL in these patients.
Resumo Partindo de estudos sobre a experiência de tempo no capitalismo tardio, o artigo concentra-se nos temas de tempo de trabalho e renda básica, vinculando-os às crises social e econômica que ...vivenciamos atualmente. Com base na análise desses dois temas relacionados, eu lido com o debate a respeito dos mesmos desde os anos 1970 até o momento presente. Argumento que a opção neoliberal por fundamentalismo de mercado levou ao crescimento da pobreza e da desigualdade social, situação agravada pela atual pandemia de Covid-19. Para combater as extremas pobreza e desigualdade social, concluo propondo a adoção de uma renda básica universal não apenas durante a pandemia, mas como estratégia permanente para proteger o tecido social dos efeitos destrutivos de uma expansão descontrolada da lógica de mercado sobre a vida das pessoas.
Abstract Drawing on researches that diagnosis the experience of time in Late Capitalism the article focus on the themes of labor time and basic income, connecting them to the social and economic crises we live nowadays. Based on the analysis of these two related themes, I deal with the debate of these subjects from the 1970’s to the present moment. I argue here that the neoliberal option for a market fundamentalism lead to an increase in poverty and social inequality, situation aggravated by the actual Covid-19 Pandemic. In order to fight poverty and extreme social inequality, I conclude by proposing the adoption of a universal basic income, not only as an emergency measure during the Pandemic, but as a permanent strategy to protect the social tissue from the destructive effects of an uncontrolled widespread market logic on peoples’ life.
O artigo começa com uma definição do conceito de esquerda a partir de sua luta histórica contra a desigualdade social, para discutir, em seguida, a crise contemporânea da esquerda, relacionando-a com ...os temas da igualdade e da justiça. Por fim, com base na literatura contemporânea pertinente, articula uma agenda de temas capazes de resgatar a esquerda da crise atual.WHAT IS LEFT? Critical note on inequality and justice The article starts by presenting a definition of the concept of the Left founded on its historical struggle against social inequality. Secondly, the article deals with the contemporary crisis of the Left by relating it to an analysis of the themes of equality and justice. In conclusion, based on the literature about the subject, it articulates a thematic agenda capable of rescuing the Left from the nowadays crisis.Key-words: Left. Crisis. Equality. Justice. Brazil.WHAT IS LEFT? Note critique sur inégalité et justice L’article commence avec une définition de la gauche à partir de leur lutte historique contre l’inégalité sociale, pour discuter en suite la crise contemporaine de la gauche en relation avec les thèmes de l’égalité et de la justice. En conclusion, s’appuyant sur la literature contenporaine sur le sujet, l’article articule une agenda de thèmes capable de faire la gauche sortir de la crise actuel.Mots-clés: Gauche. Crise. Egalite. Justice. Brésil.
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