Leonardo Gilmone Ruschel

Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery

OBJECTIVE To evaluate the accuracy of the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D) in spine surgery, comparing it to Beck Depression Inventory (BDI). METHODS In a cross-sectional study, the HADS-D and the BDI were applied to patients undergoing spine surgery for lumbar (n=139) or cervical spondylosis (n=17). Spearman correlation tests for HADS-D and BDI were applied. The internal consistency of HADS-D was estimated by Cronbachs alpha coefficient. RESULTS According to the BDI, the prevalence of depression was of 28.8% (n=45). The Spearman r coefficient between HADS-D and BDI was 0.714 (p<0.001). Cronbachs alpha for HADS-D was 0.795. The area of the ROC curve was 0.845. Using a cutoff for HADS-D >10, there was a sensitivity of 71.1%, specificity of 95.4%, and positive likelihood-ratio of 15.78. CONCLUSIONS HADS-D showed a strong correlation with BDI and good reliability. HADS-D is a good alternative for screening depression and assessing its severity.

Association between primary headaches and depression in young adults in southern Brazil

OBJECTIVE To verify the association between depression and headache in young adults, as well as to identify the features of headache associated with depression and the influence of this mood disorder on headache-related disability. METHODS A cross-sectional study with self-administered questionnaires about headache and depression was conducted at the Universidade de Caxias do Sul. Beck Depression Inventory (BDI) and Migraine Disability Assessment (MIDAS) were used to evaluate depressive symptoms and headache-related disability, respectively. Depression was considered if BDI ≥ 15. RESULTS A thousand and thirteen young adults were included in the study. A clear relationship was observed between headache and depression among the participants. Multivariate analyses demonstrated that nausea or vomiting related to headache and higher headache-related disability scores were independent factors associated with depression. Migraine was more associated with depression than the other types of headache. CONCLUSION The results demonstrate an association between headache and depression. Depressive symptoms are more likely to be found in young adults with more disabling headaches.

Staging of colorectal cancer in the private service versus Brazilian National Public Health System: what has changed after five years?

INTRODUCTION: Cancer is a disease that affects a large population, being the colorectal cancer one of the most prevalent. The early diagnosis of these neoplasms represents a better life expectancy. The high cost of diagnostic tests and the low socioeconomic status are considered factors leading to delayed diagnosis. OBJECTIVES: Assess the difference between colorectal cancer staging in patients of private clinics and patients of the Brazilian National Health Service (SUS) and assess the changes in cancer staging in the past five years. METHODS: This retrospective study was conducted with 53 patients divided in two groups (SUS and private clinic) diagnosed with colorectal cancer and treated in 2009. Staging of patients diagnosed in 2009 was compared with data from patients diagnosed in 2004, already published in 2005. RESULTS: Both groups were similar in gender and age. Regarding the staging of patients, no statistical difference was observed between the two groups (p=0.147). When comparing the staging of patients diagnosed in 2009 with that of patients studied in 2004, patients diagnosed in 2009 presented early stages (II and III) in relation to patients analyzed in 2004 (III and IV), p<0.001. CONCLUSION: No significant difference was observed in cancer staging between SUS and private clinic patients. The patients analyzed in 2009 were diagnosed with early stage tumors when compared to patients diagnosed in 2004.

Giant scalp arteriovenous malformation.

Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and neurological symptoms. Its origin can be congenital or traumatic. We present a case of giant scalp AVMs and its management, followed by a brief literature review on the subject. The diagnosis of scalp AVMs is based on physical examination and confirmed by internal and external carotid angiography or computed tomographic angiography (CTA). Surgical excision is especially effective in scalp AVMs, and is the most frequently used treatment modality.

Experimental Model of Spinal Cord Injury (SCI) in rats: management guidelines

La realizacion de experimentos quirurgicos con animales de laboratorio son necesarios para la investigacion medica. Estos estudios tienen por objeto aclarar el mecanismo de las enfermedades, investigar la accion de nuevos medicamentos y marcadores biologicos, asi como desarrollar y mejorar nuevas terapias y aplicar nuevas tecnicas. En cuanto a los modelos animales de lesion de la medula espinal (SCI), existen varios metodos diferentes que abordan el cuidado de estos animales, especialmente en relacion con el uso de analgesicos, antibioticos y manejo pre y post operatorio. La falta de uniformidad y estandarizacion entre los estudios no permite la comprension del modelo de SCI o el manejo adecuado del animal paraplejico, lo que dificulta la interpretacion y comparacion adecuada de los resultados. El objetivo de este estudio es establece un protocolo estandar de manejo de animales sometidos a modelos experimentales de SCI.

Abordagem cirúrgica posterior e posterolateral para neurinomas cervicais em ampulheta da raiz de C2

OBJETIVO: os autores describen la experiencia quirurgica de 11 neurinomas en reloj de arena de la raiz de C2 comparando el camino de acceso posterior y el postero-lateral. METODOS: se trataron con cirugia 11 pacientes con neurinoma en reloj de arena de raiz cervical de C2. El camino de acceso utilizado para la retirada de los tumores fue la aproximacion posterior en siete pacientes, y la aproximacion postero-lateral, en 4. RESULTADOS: hubo predominio del sexo femenino (n=6), siendo la edad promedio de 55,9 ± 8,16 anos. El tiempo medio de los sintomas hasta su diagnostico fue de 16,3 meses (±8,02 meses). Hubo reseccion completa del tumor en todos los pacientes. El tiempo quirurgico promedio en el abordaje posterior fue de 180 minutos (± 39.15) y 192 minutos (± 22,17) a traves de posterolateral (p = 0,52). No hubo diferencia del volumen de sangrado transoperatorio entre los grupos (posterior: 70,71±16,93; posterolateral: 65,00±24,15; p=0.64). Hubo una complicacion por el camino posterior que fue la presencia de fistula licuorica, siendo necesaria reintervencion y colocacion de fascia lata. CONCLUSION: la eliminacion completa del tumor en la raiz de reloj de arena C2 es posible mediante el abordaje posterior y posterolateral, sin embargo, el abordaje posterior se demostro preferible por ser un camino de acceso de mayor familiaridad para el cirujano.

5-Aminolevulinic acid fluorescence-guided surgery for spinal cord melanoma metastasis: a technical note

BackgroundAccording to our research, just few studies described 5-Aminolevulinic acid (5-ALA) use for spinal injuries resection. 5-ALA is known to be especially useful in certain spinal tumor entities such as meningiomas, ependymomas, hemangiopericytomas, and metastasis of central nervous system primary tumors. In contrast, 5-ALA has limited value in other histopathological tumoral entities, as neurinomas and carcinoma metastasis.MethodWe describe a microsurgical resection of a spinal cord melanoma through fluorescence-guided technique using 5-ALA in a 36-year-old man.ResultsStrong 5-ALA tumor enhancement was evidenced, resulting in gross-total resection.ConclusionTo our knowledge, this is the first case of nonglial intramedullary metastasis with 5-ALA positive staining. We believe that this tool, 5-ALA, could aid in the resection, identification, and differentiation of medullary metastasis.

Alternative option for osteogenesis imperfecta and trigeminal neuralgia

Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year-old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.

Spontaneous intracranial epidural hematoma during rivaroxaban treatment

According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.

Modelo Experimental de Lesão Medular (SCI) em ratos: diretrizes de manejo

La realizacion de experimentos quirurgicos con animales de laboratorio son necesarios para la investigacion medica. Estos estudios tienen por objeto aclarar el mecanismo de las enfermedades, investigar la accion de nuevos medicamentos y marcadores biologicos, asi como desarrollar y mejorar nuevas terapias y aplicar nuevas tecnicas. En cuanto a los modelos animales de lesion de la medula espinal (SCI), existen varios metodos diferentes que abordan el cuidado de estos animales, especialmente en relacion con el uso de analgesicos, antibioticos y manejo pre y post operatorio. La falta de uniformidad y estandarizacion entre los estudios no permite la comprension del modelo de SCI o el manejo adecuado del animal paraplejico, lo que dificulta la interpretacion y comparacion adecuada de los resultados. El objetivo de este estudio es establece un protocolo estandar de manejo de animales sometidos a modelos experimentales de SCI.