Pedro Guarise da Silva

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.

Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study: clinical article.

OBJECT Deep wound infections are one of the most common and serious complications of spinal surgery. The impact of such infections on long-term outcomes is not well understood. The purpose of this study was to evaluate the functional status and satisfaction in patients who suffered a deep wound infection after undergoing lumbar arthrodesis for symptomatic degenerative disc disease. METHODS The authors conducted a prospective study in 13 patients with a clinical and radiological diagnosis of symptomatic degenerative lumbar stenosis and instability; after undergoing decompression and instrumentation-augmented arthrodesis, the patients suffered a deep wound infection (infection group). A 3:1 (39-patient) matched cohort was selected for comparison (control group). All surgeries were performed during the same period and by a single surgeon. The postoperative infections were all treated in a similar manner and the instrumentation was not removed. Both groups were followed up and assessed with validated outcome instruments: Numerical Rating Scale of pain, Oswestry Disability Index, 36-Item Short Form Health Survey, Beck Depression Inventory, and Hospital Anxiety and Depression Scale. Patient satisfaction was also determined. RESULTS The median follow-up duration was 22 months (range 6-108 months). The mean patient age was 62 ± 10 years, and 59.6% of the patients were female. There was no significant difference between the groups in pain, functional disability, quality of life, or depression and anxiety. However, 53.8% of the patients with infection were not satisfied with the procedure at the final evaluation, compared with 15.4% of the patients without a deep wound infection (p = 0.003). CONCLUSIONS Patients with successfully treated postoperative deep wound infections do not have a difference in functional outcome compared with patients who underwent an identical operation but did not suffer a complicating infection. Patients who suffered an infection were more likely to be unsatisfied with the procedure than patients who did not.

Twelve Years of Scientific Production on Medline by Latin American Spine Surgeons

Background Despite the small contribution of LA in the Science Citation Index (SCI), a growing contribution by LA research to international literature has been observed in recent years. Study Design Systematic review. Purpose To evaluate the scientific contribution of Latin American (LA) Spine Surgeons in the last decade. Methods A literature search of publications by LA spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. The quality of the publication was evaluated with the journal impact factor (IF), Oxford classification and number of citations. Results This study comprised 320 articles published in the Medline database by LA spine surgeons from 2000 to 2011. In recent years, there has been an increase in the number of publications by LA spine surgeons. It was observed that 38.4% of LA papers were published in LA journals. 46.6% of the articles were published in journals with an IF lower than 1, and there was no statistically significant difference in the number of articles published in journals with a higher IF during the period. Linear-by-linear association analysis demonstrated an improvement in the level of evidence provided by LA articles published in recent years. Conclusions This study showed a growth in the number of publications in last 12 years by LA spinal surgeons. It is necessary to discuss a way to increase quantity and quality of scientific publications, mainly through a better education in research.

Radiotherapy-induced tumors of the spine, peripheral nerve, and spinal cord: Case report and literature review

Background: The development of a secondary malignancy in the field of radiation is a rare but well-recognized hazard of cancer treatment. The radiotherapy-induced (RT-I) tumors are even more aggressive and potentially lethal than the primary tumor. To goal of this article is to report a case of RT-I neural tumor located in the peripheral nerve and spinal cord and to perform a literature review of the subject. Case Reports: Thirty-year male with symptoms of hypoesthesia and dysesthesia of the L5 nerve root distribution and previous treatment of a testicular seminoma 20 years previously. The lumbar magnetic resonance imaging showed the growth of a nerve root tumor. Surgery was performed, and a fusiform tumor was resected with clear margins. The anatomopathological and immunohistochemical studies were compatible with a malignant peripheral nerve sheath tumor. A total of 30 cases were included in the review. The mean age of the patients at diagnosis of the induced tumor was 39.36 (±16.74) years. Most were male (63.3%). The main type of primary disease was neural tumors (30%). The most common type of histology was fibrosarcoma (20.0%). No difference was found in age, gender, and time of diagnosis between neural and nonneural tumors. The mean survival after the diagnosis of the secondary tumor was 10.7 months (±13.27), and neural tumors had a longer survival period (P = 0.031). Conclusion: The current gold standard therapy is complete resection with clear margins, since most tumors do not respond to chemotherapy and RT. The neural type of RT-I tumor presented a longer survival period.

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.

Trends in scientific publications of Indian spine surgeons over 14 years (2000-2013).

Background: The number and quality of scientific publications reflects the standards of scientific research in a country. However, the contribution of Indian spine surgeons toward global publications is unknown. The goal is to study the publications of Indian spine surgeons between 2000 and 2013. Materials and Methods: A literature search of the publications by Indian spine surgeons was performed using MEDLINE. The search terms used were India and several spine-related terminologies. The main information of the selected papers including the year of publication, scientific journal, type of pathology studied, Neurosurgical or Orthopedic Department where the study was done, type of study, and the type of article was analyzed. Results: A total of 4459 articles were identified using MEDLINE and after exclusion, 507 articles were analyzed. A growth of 440% in the number of publications was observed in the period between 2009 and 2013, during which 60.15% of the articles were published. Clinical studies (n = 492; 97.04) were the most common types of articles, followed by experimental studies and other types. The Neurosurgery department published the majority of the articles (58.2%). The three most common pathologies studied were spinal tumors (17.35%), surgical technique (15.4%), and spinal infection (15.2%). Conclusion: The current study shows that publications in the field of spine surgery have been increasing in the last few years, although it is less. Further efforts such as research training of spine surgeons, inducing collaborations and formulation of multicenter projects and periodically allocating adequate funds are key factors to improve the scientific publications from India.

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.

Avaliação das publicações de cirurgiões de coluna brasileiros na última década

OBJETIVO: Evaluar la contribucion cientifica de cirujanos de columna brasilenos, no solamente en numero de publicaciones, sino en relacion a la calidad, entre enero de 2000 y diciembre de 2011. METODOS: Se realizo una investigacion de las publicaciones de cirujanos de columna brasilenos en relacion a la columna o medula espinal, utilizando una base de datos online: Pubmed.gov. Las busquedas se limitaron a articulos publicados entre enero de 2000 y diciembre de 2011. Se encontraron 1.778 articulos en la investigacion en el Medline. Luego de criterios de exclusion, se seleccionaron 206. La calidad de los periodicos se midio a traves del Factor de Impacto (FI) y del Qualis CAPES, y la calidad del articulo, por la clasificacion de Oxford. RESULTADOS: Se observo un aumento en el numero de publicaciones de cirujanos de columna brasilenos, siendo que el 45,1% de las publicaciones se hicieron en los ultimos 4 anos (2008 - 2011). Estudios clinicos y relatos de caso fueron el tipo de articulos publicados con mas frecuencia (37,5% vs 31,1%). Hubo aumento en el numero de publicaciones brasilenas en periodicos no brasilenos en los ultimos anos (linear-by-linear association: 5,449, P = 0,020). Arquivos de Neuro-Psiquiatria fue o periodico en que los articulos se publicaron con mas frecuencia (n = 67, 32%). El factor de impacto de las publicaciones tuvo una variacion de 0,021 a 8,017. El analisis de la calidad de las publicaciones demostro que la mayoria de ellas alcanzo nivel de evidencia 4 (N = 113, 54,9%) o 5 (N = 45, 21,8%). CONCLUSIONES: Hubo un aumento en el numero y en la calidad de las publicaciones de cirujanos de columna brasilenos en los ultimos anos. Ademas, el numero de publicaciones de brasilenos ha aumentado a lo largo de los ultimos anos.

Chondromyxoid fibroma of C1: first case report

Background: Chondromyxoid fibroma (CMF) is a rare, benign primary bone tumor. The cervical spine is an uncommon site for this tumor, with only 10 reported cases to date and none involving the first cervical vertebra (C1). Case Report: Female patient, 25-year-old monozygotic female twin, presented with cervical pain. Radiographic imaging demonstrated a contrast-enhanced, right-sided lytic lesion of the insufflated type in C1, with a punched-out appearance and extending to the anterior arch. A postero-lateral and a posterior approach were performed in two steps to resect the tumor followed by occipitocervical fixation. Pathology confirmed the diagnosis of CMF. At one year, the patient remains disease free with excellent spinal stability. Conclusion: Spinal surgeons may need to treat rare spinal tumors. Despite the proximity to neural and vascular structures, the goal of surgery is always a radical resection due to high recurrence rates.