Angiografia no Síndrome do Desfiladeiro

The thoracic outlet syndrome is a changeable clinical syndrome caused by compression of the neurovascular bundle of the upper extremity, within the cervicoaxillary channel. From April 1980 through May 1995, 24 patients with clinical thoracic outlet syndrome were evaluated by selective arteriography. The diagnosis was confirmed in seven patients, in 14 the exam was normal and in the last three cases another arterial pathology was detected--subclavian artery occlusion, subclavian artery kinking and vertebral steal syndrome. The authors' aim is to emphasize arteriography as a diagnostic exam for thoracic outlet syndrome, very useful in the detection and localization of arterial compression. It also allows the diagnosis of other arterial entities.

Osteomielite Vertebral Tuberculosa. Revisão e Apresentação de um Caso Clínico Invulgar

A partir de uma invulgar apresentação clínica e radiológica de um caso de tuberculose (TB) vertebral, fazemos uma revisão da literatura sobre infecção tuberculosa da coluna. Destacam-se alguns aspectos epidemiológicos relativamente à infecção por Mycobacterium Tuberculosis em geral e à sua localização vertebral em particular, incluindo-se os dados disponíveis respeitantes ao nosso país. São ainda focados os mecanismos patogénicos da infecção óssea, considerando-se 3 padrões de lesão vertebral cada um com diferentes aspectos radiológicos e diferentes consequências clínicas.

Métrica Vertebral: a Aplicação de uma Nova Tecnologia na Análise da Coluna Vertebral

Objectivo: Apresentar os resultados da primeira aplicação da nova tecnologia – Métrica Vertebral – na análise da posição 3D do vértice de cada uma das apófises espinhosas, em mulheres grávidas. Material e Métodos: O Métrica Vertebral foi aplicado a mulheres, sem patologia associada, em quatro momentos da gravidez (12, 20, 32, 37 semanas de gestação). Aplicaram-se modelos lineares univariados. Resultados: Observou-se que as diferenças que ocorrem ao longo da gravidez são mais significativas ao nível da posição y (anteroposterior). Verificou-se, igualmente, que existe uma correlação biomecânica positiva entre a posição do vértice de cada uma das vértebras com a posição homóloga das restantes. Discussão/Conclusão: Através do Métrica Vertebral foi possível obter resultados inovadores na análise biomecânica da coluna vertebral. É um dispositivo que tem diferentes aplicações podendo ser facilmente adoptado em áreas como ortopedia, neurocirurgia, pediatria e reabilitação. É de realçar ainda que este instrumento não se esgota na amostra da presente investigação pois pode ser futuramente aplicada à população em geral.

Fractures in Children and Adolescents with Spina Bifida: The Experience of a Portuguese Tertiary-Care Hospital

AIM: The morbidity associated with osteoporosis and fractures in children and adolescents with spina bifida highlights the importance of osteoporosis prevention and treatment in these patients. The aim of this study was to examine the occurrence and pattern of bone fractures in paediatric patients with spina bifida. METHOD: We reviewed the data of all paediatric patients with spina bifida who were treated in our centre between 1999 and 2008. RESULTS: One hundred and thirteen patients were included in the study (63 females, 50 males; mean age 10y 8mo, SD 4y 10mo, range 6mo-18y). The motor levels were thoracic in six, upper lumbar in 22, lower lumbar in 42, and sacral in 43 patients. Of the 113 patients, 58 (51.3%) had shunted hydrocephalus. Thirty-six (31.8%) were non-ambulatory (wheelchair-dependent [unable to self-propel wheelchair] n=3, wheelchair-independent [able to self-propel wheelchair] n=33), 13 were partial ambulators, 61 were full ambulators, and three were below the age of walking. Forty-five fractures were reported in 25 patients. The distal femur was the most common fracture site. Statistical analyses showed that patients with higher levels of involvement and in wheelchairs had a significantly increased risk of having a [corrected] fracture (p<0.001). Spontaneous fractures were the principal mechanism of injury, and an association was identified between fracture mechanism, type of ambulation, and lesion level: the fractures of patients with higher levels of motor functioning and those in wheelchairs were mainly pathological (p=0.01). We identified an association between risk of a second fracture, higher motor level lesion, and non-ambulation. There was an increased risk of having a second fracture after a previous spontaneous fracture (p=0.004). INTERPRETATION: Data in this study indicate a high prevalence of fractures in patients with spina bifida.