Fabiano Inácio de Souza

Lead Poisoning by Intradiscal Firearm Bullet: A Case Report

Study Design. The report of a rare case of lead poisoning by an intradiscal firearm bullet is presented. Objective. To describe and discuss the clinical and radiologic features (by computed tomography and magnetic resonance imaging) of a gunshot wound in the L2–L3 space which caused lead poisoning 5 years afterwards. Summary of Background Data. Lead poisoning from firearm bullets is rare, but the possibility should be investigated in the case of bullets lodged in the joints. Methods. A 30-year-old man presented to the emergency room with an intense lumbar pain complaint, colic, intestinal constipation, insomnia, and progressive headache for 20 days. He had a history of a gunshot wound 5 years previously, and the bullet was left in situ, in the intravertebral disc between L2 and L3, as confirmed by radiographs, computed tomography, and magnetic resonance imaging. The hypothesis of lead poisoning was confirmed by the laboratory results. Chelation treatment with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa (2) EDTA) was indicated. The patient was admitted and treated once again, before surgical removal of the bullet. Results. After removal of the bullet, the patient had an episode of recurrence, and a new chelation cycle was performed, with complete resolution. Conclusion. Lead poisoning can result in severe clinical disorders that require rapid treatment. In this case, both clinical and surgical treatments led to complete resolution of the symptoms.

Epidemiologia da escoliose idiopática do adolescente em alunos da rede pública de Goiânia-GO

OBJECTIVE: To investigate the prevalence of adolescent idiopathic scoliosis in school children from 10 to 14 years in public schools in Goiânia, GO, Brazil. METHODS: In a cross-sectional study, 476 students were randomly selected from 5 public schools, from a total of 33,343 students distributed in 162 schools. These subjects received the informed consent prior, which was returned after being signed by parents on physical examination day. We evaluated the symmetry of the shoulders, the scapulae, the triangle-cut, the hip evenness and the Adams test. In suspected cases, students were referred to panoramic radiographs of the spine. RESULTS: 418 students participated in the study (adjusted sampling error of 3.2%). Of this total, 31 students were suspected of scoliosis (17 males and 14 females). Twenty-eight students took radiographs, of which 18 were diagnosed with adolescent idiopathic scoliosis (11 female and 7 male), determining the prevalence of 4.3%. The chi-square test suggested no statistical difference in prevalence between the sexes. One student had congenital scoliosis. CONCLUSION: The prevalence of adolescent idiopathic scoliosis in the public schools of Goiânia is 4.3%. Level of Evidence III, Study of Nonconsecutive Patients.

Modelo experimental de lesão medular e protocolo de avaliação motora em ratos wistar

Objectives: To determine a standardized spinal cord contusion model and a method for motor assessment in rats with paraplegia. Methods: This study used 20 Wistar rats divided into 4 groups according to level of severity of spinal cord injury; standardized intermediate lesions were made through system MASCIS IMPACTOR (Multicenter Animal Spinal Cord Injury Study): group 1, 12.5mm (mild injury); group 2,25mm (moderate injury); group 3,50mm (severe injury; in the group 4 the animals suffered no injury (control group). Motor function was assessed after 48 hours, using the scale proposed by Basso, Beattie and Bresnahan. Results: Using the model, we observed that the mild contusions (12.5mm height) were effective, and the animals presented acute urinary tract infection one week after the injury. Moderate contusions (25mm height) were effective, and the animals presented urinary infection until 2 weeks after injury. The severe contusions (50mm height) were effective, and the animals presented urinary infection for 3 to 4 weeks and autophagy. Conclusion: The model of spinal cord injury using the system MASCIS IMPACTOR and the functional assessment proposed by Basso, Beattie and Bresnahan is reproducible and can be used, enabling information exchange among different researchers.

Monossialogangliosídeo transdérmico com laser no tratamento de lesão medular espinal de ratos

OBJECTIVES: To evaluate the effects of monosialoganglioside (GM1) administered transdermally with laser in the recovery of spinal cord injury in rats. METHODS: Forty male Wistar rats underwent spinal cord contusion using the NYU Impactor. In Group 1, the rats received 0,2 ml of saline intraperitoneally daily; in Group 2, GM1 was administered intraperitoneally at a concentration of 30 mg/kg per day; in Group 3, rats were treated daily with laser at low temperature on the skin, and in Group 4, the daily laser session also contained GM1. All the groups were treated for 42 days. The animals were evaluated by the Basso, Baettie and Bresnahan (BBB) functional scale on days 7, 14, 21, 28, 35 and 42 after the injury, and by histopathology and motor evoked potential after 42 days of injury. RESULTS: The animals in Group 4 had higher BBB scores compared with the other groups. There were no differences between the groups, or in the comparisons over time. Histological evaluation showed no differences, and no differences were found in the motor evoked potential tests either. CONCLUSION: GM1 associated with the use of low-temperature laser shows no superior functional, neurological or histological results in the treatment of spinal cord lesions in rats. Evidence Level I, Experimental, Controlled, Animal Study.

Estudo experimental da ação da metilprednisolona utilizada antes do traumatismo raquimedular em ratos Wistar

Objective: To evaluate the effects of methylprednisolone used prior to spinal injury, both in relation to possible beneficial ef fects and to possible associated complications. Materials and methods: The study subjects were 32 Wister rats, divided into 4 groups. Two groups received drugs A (placebo) and B (methylprednisolone) immediately after the injury. Another 2 groups received the same drugs 4 hours before the injury. They were all evaluated over a period of 28 days to verify locomotor function and associated complications. Results: The 4 groups were compared in terms of weight and age. No statistically significant dif ference was found between the study groups in relation to mean weight and age. In the comparison of intercurrences among the 4 groups a statistically significant difference was found in deaths (p = 0.047), where the Drug B T-0 group exhibited a significantly lower proportion of deaths (0%) than that found in the Drug B T-4 group (55.6%). There was no statistical difference among these groups in terms of motor and complication rates (p > 0.05 in all the comparisons). Conclusions: the animals treated with methylprednisolone four hours before the injury trauma presented a significantly higher number of deaths than the rats treated with the same drug after the injury.

Neuregulinas 1-alfa e 1-beta na regeneração de nervos periféricos

OBJECTIVE: to evaluate the effect of the neuregulins 1-alpha and 1-beta on the regeneration the sciatic nerves of male adult C57BL/6J mice, using the tubulization technique. METHODS: eighteen animals were used, divided into three groups. A polyethylene prosthesis was implanted in a 4.0 mm defect of the left sciatic nerve, as follows: group 1 containing only purified collagen (Vitrogen®); group 2, collagen with neuregulin 1-alpha; group 3, collagen with neuregulin 1-beta. The control group consisted of six segments of right sciatic nerves. After four weeks, the animals were sacrificed. A segment from the midpoint of the nerve regenerated inside the prostheses was extracted; histological sections were standardized, and slides were made up for histomorphometric analysis. RESULTS: the results were statistically compared using the Tukey multiple comparisons test and the Students t test. The animals treated with neuregulins had greater numbers of myelinized axons, with a statistically significant difference in relation to the collagen-only group. There was no statistical difference between the neuregulin 1-alpha and 1-beta groups. CONCLUSION: the addition of neuregulins provided a significant increase in the number of myelinized fibers.

Avaliação do emprego do GM1 após lesão medular experimental em ratos

OBJETIVO: Evaluar la eficacia del GM1, administrado por via intraperitoneal, despues de la lesion medular experimental en ratones. METODOS: se utilizaron 20 ratones de la raza Wistar, machos, adultos jovenes, con una edad promedio de 20 semanas, peso de 350 gramos, aproximadamente, que se dividieron en dos grupos de 10 animales. En el grupo 1 se uso solamente suero fisiologico por via intraperitoneal. En el grupo 2, se administro por via intraperitoneal 30 mg/kg de GM1 por dia. Las lesiones fueron producidas siguiendose el protocolo internacional MASCIS (estudio multicentrico de lesion de medula espinal en animales) por sistema NYImpactor. Los animales se evaluaron funcionalmente por la escala BBB en los dias 14, 28 y 42 despues de la lesion. El potencial evocado se realizo en todos los animales a los 42 dias despues del traumatismo. RESULTADOS: se utilizo un modelo de variancia de dos factores (ANOVA) y la prueba t de Student. Las evaluaciones funcionales y de los potenciales evocados no mostraron diferencias estadisticamente significativas entre los dos grupos. CONCLUSION: El uso de GM1 intraperitoneal no demostro resultados satisfactorios despues de la lesion medular experimental.Objective: To evaluate the efficacy of GM1, administered intraperitoneally after experimental spinal cord injury in rats. Methods: A total of 20 Wistar rats, young adults, males, with a mean age of 20 weeks, weighting about 350g were divided into two groups of 10 animals. The group 1 was given only saline intraperitoneally. Group 2 received GM1 30mg/kg daily, also intraperitoneally. The lesions were produced by following the international protocol MASCIS (Multicenter Animal Spinal Cord Injury Study), using the system NY Impactor. The animals were evaluated functionally by the BBB scale at days 14, 28 and 42 after injury. The evoked potential was performed on all animals 42 days after trauma. Results: We used a two-factor variance model (ANOVA) and the Student t test. The functional assessments as well as those by evoked potential showed no statistically significant difference between the two groups. Conclusion: The use of intraperitoneal GM1 was not efficient after experimental spinal cord injury.

Avaliação histológica da neurorrafia término-lateral: estudo experimental em ratos

OBJECTIVE: The aim of this study was to histologically compare the axonal sprouting after end-to-side neurorrhaphy with or without epineurotomy. METHODS: twenty male Wistar rats were used, divided into two groups of 10 rats each. A 1.0cm segment of the tibial nerve E was dried and sutured on the opposite side, where it was sutured into the sciatic nerve D. In Group I, the suture was made directly in the epineurium and in Group II, epineurotomy was performed. After 4 weeks, histological evaluation was carried out of the transposed segment and the sciatic nerve distal to the suture. RESULTS: the results showed a small number of remyelinated fibers, varying from 7 to 51 fibers in Group I and from 10 to 91 fibers in Group II. The Mann-Whitney U test was used, with p=0.311, showing there is no statistically significant difference between the two groups. There was no positive relation between the number of remyelinated fibers in the graft and in the suture site distal to the sciatic lesion. CONCLUSION: lateral-ending neurorrhaphy, with or without epineural window, does not promote efficient remyelinization. Level of Evidence: Level II, prospective comparative study.

Emprego do músculo gastrocnêmio no tratamento das lesões infectadas do joelho

OBJECTIVE: to prospectively evaluate the use of gastrocnemius muscle flap in the treatment of knee infected injuries. METHODS: twelve patients were operated on: eleven males with ages ranging from 19 to 78 years, mean: 55 years. Coverage of injuries with medial gastrocnemius muscle was accomplished in 11 patients and a lateral in 1. The mean number of preoperative surgical debridement procedures was 3.2, ranging from 1 to 9. RESULTS: all flaps survived. The most common etiological agent was S. aureus, in 54.5%. After a mean follow-up of 20.08 months (13 to 31), all patients show stable coverage without recurrence of infection signs or symptoms. CONCLUSION: gastrocnemius muscle use in knee infected injuries treatment presented good results and low morbity rates.

Avaliação artroscópica e macroscópica do complexo da fibrocartilagem triangular do punho. Estudo em cadáveres

O complexo da fibrocartilagem triangular tem importante papel na biomecânica do punho. O diagnostico preciso das lesoes e fundamental para se obter sucesso no tratamento. Ha controversias acerca da especificidade e sensibilidade dos metodos de imagem empregados atualmente. A artroscopia de punho e um metodo pouco empregado para o diagnostico das lesoes do CFCT em nosso meio, embora apresente grandes vantagens, como possibilidade de visao direta das lesoes e tratamento no mesmo tempo cirurgico. O objetivo deste estudo foi o de avaliar o papel da artroscopia de punho na inspecao do CFCT, bem como na deteccao de possiveis lesoes, comparando os dados com a disseccao macroscopica. Foram avaliados 15 punhos de cadaveres sexo masculino, media de idade de 56,1 anos. A artroscopia demonstrou presenca de lesoes em 33,3% dos punhos avaliados. Estes achados foram coincidentes apos estudo anatomico com ampla disseccao. Concluimos que houve absoluta correlacao entre o exame artroscopico e a disseccao macroscopica na deteccao de lesoes do CFCT.