RESUMO
La solicitud de estudios de imagen en pacientes con trauma cervical es muy frecuente en la práctica diaria. Esa patología es causa relativamente frecuente de discapacidad en pacientes jóvenes junto con el trauma encéfalo craneano. En un porcentaje no despreciable de los casos, las lesiones traumáticas comprometen la unión cráneo- cervical y en esos pacientes, la morbi-mortalidad es más significativa. La transición entre el cráneo y el raquis se basa en un conjunto de estructuras óseas relacionadas por articulaciones muy móviles y estabilizadas por un grupo de ligamentos y músculos que le brindan al mismo tiempo gran solidez. Para una correcta interpretación de los estudios de imagen de uso corriente en la clínica, es fundamental un sólido conocimiento anatómico de la unión cráneo-cervical y sus componentes. Es el objetivo de esta revisión, sistematizar la anatomía de la unión cráneo-cervical con especial énfasis en sus ligamentos, analizar la fisiología de sus movimientos y el concepto de estabilidad para luego realizar una correlación con tomografía computada multi-detector y resonancia magnética.
The request of imaging techniques in patients with cervical spine trauma is very common in clinical practice. Cervical trauma is a relatively common cause of disability in young patients. In a significant percentage of cases traumatic injuries compromise the cranio-cervical junction with more important morbidity and mortality in this group of patients. The transition between the skull and the spine is based on a set of bony structures, high mobility joints, and stabilization mechanism formed by a group of ligaments and muscles. A solid anatomical knowledge of the cranio-cervical junction and its components is essential for a correct interpretation of current high resolution imaging studies. The goal of this review is highlight the anatomy of the cranio-cervical junction with special emphasis on the ligaments, analyze the biomechanics of their movements and the concept of stability. At last but not leastwe will establish a correlation with multidetector computed tomography and high-resolutionmagnetic resonance imaging.
Assuntos
Vértebras Cervicais/anatomia & histologia , Vértebras Cervicais/fisiologia , Vértebras Cervicais/lesões , Vértebras Cervicais/diagnóstico por imagem , Traumatismos do Sistema Nervoso/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Crânio/anatomia & histologia , Membrana Tectorial/anatomia & histologia , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X , Vértebras Cervicais/anatomia & histologia , Ligamentos Longitudinais/anatomia & histologia , Lesões do Pescoço/diagnóstico por imagem , Traumatismos do Sistema Nervoso/complicaçõesRESUMO
The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients' autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient's home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.
Assuntos
Pessoas com Deficiência/reabilitação , Alta do Paciente , Encaminhamento e Consulta , Traumatismos do Sistema Nervoso/reabilitação , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Sistema Nervoso/complicaçõesRESUMO
Resumo Trata-se de pesquisa de abordagem qualitativa realizada no segundo semestre de 2014, mediante entrevistas com 12 médicos e 13 enfermeiros gestores atuantes em Hospital de grande porte, referência na área de urgência e emergência para a Zona da Mata Mineira. Buscou identificar os critérios utilizados por médicos e enfermeiros para o preparo da alta de pessoas com lesão neurológica incapacitante e indicação para acesso a programa de reabilitação física. Para o tratamento dos dados, utilizou-se a técnica de Análise de Conteúdo, modalidade temática. Os resultados mostram que os gestores hospitalares ainda encontram dificuldades para proceder ao encaminhamento adequado dessas pessoas para serviços especializados de reabilitação, o que compromete a autonomia e independência para o autocuidado. Conclui-se que os gestores além de envolver cuidadores e familiares no preparo da alta de pessoas com lesão neurológica que resulta em incapacidades para o autocuidado, deveriam avaliar as condições de acessibilidade em seus domicílios e fazer encaminhamentos adequados para serviços de reabilitação disponíveis na comunidade, a despeito da pouca divulgação acerca dos fluxos da Rede de Cuidados da Pessoa com Deficiência.
Abstract The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients’ autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient’s home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Alta do Paciente , Encaminhamento e Consulta , Pessoas com Deficiência/reabilitação , Traumatismos do Sistema Nervoso/reabilitação , Traumatismos do Sistema Nervoso/complicações , Avaliação da DeficiênciaRESUMO
BACKGROUND: The human T-Cell Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP). Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals. METHODOLOGY: We studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient's clinical history and examinations of the patient's reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed. MAIN FINDINGS: The prevalence of neurological disturbances-altered reflexes and skin tactile sensitivity and increased risk of falling-was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects. CONCLUSIONS: The neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection.
Assuntos
Pé/fisiopatologia , Infecções por HTLV-I/fisiopatologia , Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/fisiologia , Pressão , Traumatismos do Sistema Nervoso/fisiopatologia , Traumatismos do Sistema Nervoso/virologia , Adulto , Feminino , Infecções por HTLV-I/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Sistema Nervoso/complicações , Traumatismos do Sistema Nervoso/patologiaRESUMO
Os autores discutem a aplicação da classificação AO e do conceito de Denis na qualificação dos traumatismos raquimedular e raquidiano, com ênfase nas indicações de cirurgia da coluna vertebral, expondo um quadro prático para tomada de decisão, que engloba todas as situações. Citam que embora tais classificações, as mais usadas na atualidade, sejam úteis para alicerçar o raciocínio clínico e cirúrgico dos casos de traumatismo raquimedular (TRM) e traumatismo raquidiano (TR), independente da forma de classificação empregada, ou mesmo que surjam outras classificações para os mesmos propósitos, duas questões serão sempre as mais importantes a serem respondidas pelos médicos assistentes na tomada de decisão: Há déficit neurológico? Há instabilidade da coluna vertebral?
The authors discuss the application of the AO classification and the concept of Denis, in qualifying of spinal cord injury, with emphasis on indications of spine surgery, exposing a practical framework for decision making, which includes all situations. Although these ratings, the most used are useful to support the clinical reasoning and surgical cases, two questions must always be answered by attending physicians for making decisions: Is there neurological deficit? Is there instability of the spine?
Assuntos
Humanos , Traumatismos da Coluna Vertebral/classificação , Traumatismos da Coluna Vertebral/complicações , Traumatismos do Sistema Nervoso/complicaçõesRESUMO
BACKGROUND: Neuropathic pain is associated with disease or injury to the peripheral or central nervous system, which is considered particularly difficult to treat due to its diverse etiology and underlying physiopathological mechanisms. Recent experimental and clinical data support the potential of pharmacotherapy using a combination of drugs for neuropathic pain. METHODS: In order to assess a possible synergistic anti-hyperalgesic interaction, the anti-hyperalgesic effects of morphine and gabapentin, single-dose administered either separately or in combination, were determined using the von Frey test in a rat model of neuropathic pain (Bennett model). RESULTS: Time course analysis showed that morphine (3.2 mg/kg s.c.) and gabapentin (17.8 mg/kg s.c.) individually reached their maximum effect at 60 min after treatment, producing an anti-hyperalgesic effect of 51.7+/-10.5% and 55.0+/-11.7%, respectively, whereas the combination morphine + gabapentin (3.2+17.8 mg/kg s.c.) produced an almost total anti-hyperalgesic effect at 30 min (96.7+/-2.1%) and at 60 min showed 100% anti-hyperalgesia. This anti-hyperalgesic effect remained during 180 min of observation. Analysis of global effects as area under the curve of time course showed that the nature of the anti-hyperalgesic interaction of the analyzed dose had an additive effect. There was no significant difference observed in the theoretical sum of anti-hyperalgesic effect produced by each drug alone (225.4+/-29.1 area units, au) compared with the corresponding effects produced by the combination of drugs (263.33+/-3.3 au). CONCLUSIONS: These findings are useful in determining the type of interaction that these drugs produce using this combination ratio in neuropathic pain.