Le SNC est doté de faibles capacités régénératives intrinsèques. Ses lésions se traduisent par l’apparition d’incapacités irréversibles invalidantes. Les traumas spinaux cervicaux (C1-C2) représentent la majorité des cas. Ils détruisent, les voies bulbo-spinales respiratoires interrompant ainsi les connexions synaptiques entre les pré-motoneurones et le pool de motoneurones phréniques causant un dysfonctionnement diaphragmatique. Ces lésions atteignent aussi les voies pyramidales commandant les neurones moteurs situés dans l'élargissement cervical qui innervent les extrémités supérieures impliquées dans les fonctions motrices, Les symptômes respiratoires consistent en une capacité vitale réduite et des infections pulmonaires. Les symptômes musculo-squelettiques comprennent la paraplégie, l'hémiplégie, l'hémiparésie, la tétraplégie. Peu d'études sont consacrées à l’évaluation du potentiel thérapeutique des cellules souches ecto-mésenchymateuses olfactives (OEMSCs) dans des modèles lésionnels chez les rongeurs. Celui-ci a été évalué sur notre modèle lésionnel compressif en C2 qui induit un déficit respiratoire et locomoteur persistant, reproductible et quantifiable. Elles présentent de fortes capacités prolifératives et neurogéniques et ne présentent aucun facteur co-morbide. Ces rats syngéniques nous ont permis d’évaluer la faisabilité, d’éviter l’utilisation d’anti rejet et de permettre une bonne intégration des OEMSCs dans le tissu hôte. Leur transplantation facilite une récupération substantielle des fonctions respiratoires et locomotrice, réduit la zone lésionnelle et l'inflammation et favorise l’axogénèse suite à une lésion cervicale en C2. / The CNS has weak intrinsic regenerative capabilities. Its lesions result in the appearance of irreversible incapacitating disabilities. Cervical spinal trauma (C1-C2) represents the majority of cases. They destroy the bulbo-spinal respiratory tract thus interrupting the synaptic connections between the pre-motoneurons and the phrenic motor neuron pool causing diaphragmatic dysfunction. These lesions also reach the pyramidal pathways controlling the motor neurons located in cervical enlargement that innervate the upper extremities involved in the motor functions. Respiratory symptoms consist of a reduced vital capacity and pulmonary infections. Musculoskeletal symptoms include paraplegia, hemiplegia, hemiparesis, quadriplegia. Few studies are devoted to assessing the therapeutic potential of olfactory ecto-mesenchymal stem cells (OEMSCs) in rodent models of injury. This one was evaluated on our model compressive lesion in C2 which induces respiratory and locomotor deficit persistent, reproducible and quantifiable. They have high proliferative and neurogenic capacities and have no co-morbid factor. The choice of a syngeneic strain allowed us to evaluate the feasibility, to avoid the use of anti rejection and thus to allow an integration of the OEMSCs in the host tissue. The transplantation of OEMSCs facilitates a substantial recovery of respiratory and locomotor functions, reduces lesion area and inflammation, and promotes axogenesis following cervical spinal cord injury in C2.

1. INTRODUCTION Injuries of the lower cervical spine can be among the most devastating injuries of the musculoskeletal system because of the increased risk of the injury to the spinal cord, and also because they so often occur to the younger members of the population (Jones A.A.M. et al., 2003; Sekhon H.S.L. et al., 2001; Ball P.A., 2001). The cervical spine is the most vulnerable spinal segment (Sekhon H.S.L. et al., 2001). The mechanism of cervical spine trauma is defined by the direction and magnitude of the forces that have been applied externally to the head and neck complex resulting in injury (Allen B.L.Jr., 1982). Common injury vectors include flexion, compression, rotation and extension (Allen B.L.Jr., 1982). The pattern of injury is related not only to the external applied force, but also to the initial position or posture of the head and neck at the time of injury (Allen B.L.Jr., 1982). One pattern of these injuries of the lower cervical spine is a facet dislocations (Allen B.L.Jr., 1982). The facet dislocation of the cervical spine result from a hyperflexion injury of the neck (Allen B.L.Jr., 1982). These injuries are characterized radiographically by anterolisthesis of one cervical vertebrae over the other and include the slide anteriorly of the inferior facet of the upper dislocated vertebra over the superior facet of the vertebra below (Allen B.L.Jr., 1982; Razack N. et al., 2000). The facet dislocations of the lower cervical spine represent from 4% to 50% of... [to full text]

Orientador: Yvens Barbosa Fernandes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T18:49:05Z (GMT). No. of bitstreams: 1 Cavalcante_RodrigoAlvesdeCarvalho_M.pdf: 47962870 bytes, checksum: 30187744bcc8d761f23631f51a4d472c (MD5) Previous issue date: 2012 / Resumo: Fraturas da coluna tóraco-lombar tem alta prevalência em todo mundo e, portanto, exige dos cirurgiões de coluna uma constante tomada de condutas no sentido de propor a melhor forma de tratamento para os doentes acometidos com essas fraturas. A melhor forma de tratar as mesmas seria então tentar agrupá-las, classificá-las e a definir a presença ou não de instabilidade, definindo uma conduta de tratamento clínico ou cirúrgico. Dentre os vários sistemas de classificações existentes para classificar essas fraturas, os mais utilizados na atualidade são o Thoracolumbar Injury Classification System (TLICS) escore e sistema de Classificação da ArbeitgemeinschaftOsteosynthesefragen (AO). Nesse estudo foi utilizado o escore TLICS recentemente publicado para avaliar retrospectivamente 49 doentes tratados cirurgicamente entre 2003 a 2009 no Hospital das Clínicas da Unicamp e no Hospital Dr. Mário Gatti em Campinas-SP, por fraturas em coluna tóraco-lombar. O TLICS recomendou tratamento em 47 de 49 pacientes operados (96%), sendo identificada correlação estatística significante do mesmo, com o sistema de classificação AO (p= 0.0088), com status neurológico( p=0.001) e a correlação da classificação AO com status neurológico( p=0.041), utilizando o teste de Fischer. Os resultados do presente estudo permitem concluir que esse escore é acurado para predizer a conduta cirúrgica no tratamento dessas lesões / Abstract: Fractures of the thoracic and lumbar spine have a high prevalence worldwide, therefore, requires the spine surgeons conduct a continuous decision to propose the best treatment for patients affected with these fractures. The best way to treat the same would then try to group and classify them and after that define its stability or instability, a defining conduct of clinical or surgical treatment. Among the various classification systems exist to classify these fracture, the most frequently used are TLICS score and Arbeitgemeinschaft fur Osteosynthesefragen (AO) classification system. We used the recently published TLICS score to evaluate retrospectively 49 patients treated surgically between 2003 to 2009 at the Hospital of UNICAMP and Dr. Mário Gatti Hospital in Campinas-SP, for fractures at the thoracolumbar spine. The TLICS score recommended treatment in 47 of 49 operated patients (96%), being identified a significance statistical analysis correlation between the same with the AO classification system (p=0.0088), the TLICS score and neurological status (p=0.001) and the AO classification system and neurological status (p=0.041); therefore, the results presented in this article show be accurate to predict the surgical treatment of these lesions / Mestrado / Neurologia / Mestre em Ciências Médicas

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Submitted by (edna.saturno@ufrpe.br) on 2016-08-11T16:21:32Z No. of bitstreams: 1 Bruno Martins Araujo.pdf: 2084941 bytes, checksum: 63b9d4471e02acbbd35a879b95c57ae3 (MD5) / Made available in DSpace on 2016-08-11T16:21:32Z (GMT). No. of bitstreams: 1 Bruno Martins Araujo.pdf: 2084941 bytes, checksum: 63b9d4471e02acbbd35a879b95c57ae3 (MD5) Previous issue date: 2013-02-02 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Vertebral fractures and luxations (VFL) are one of the most common and severe neurological issues found in clinical practice, with an elevated risk of permanent damage to the spinal cord. Our objective was to study the characteristics and implications associated with thoracolumbar VFL in 37 dogs examined at the Veterinary Hospital of the Universidade Federal Rural de Pernambuco. Each patient had detailed history obtained, followed by clinical, neurologic and radiographic exams. The dogs were submitted to conservative or surgical treatment according to each case. The VFL were more common in intact males with access to the street. Regarding etiology, 32 dogs were involved in car accidents. Of the dogs included in this research, 14 had non-neurological issues in other systems. Radiographic exams were 100% effective in diagnosing VFL, but 42.8% of the dogs treated surgically had vertebral lesions that weren't detected radiographically. Mean time until initial neurologic exam was 35 days, and most dogs were reffered without external coaptation. There was a significant difference in recovery of the dogs when comparing a degree of dislocation of 0 – 25% and 76 – 100%. Presence of two or three severe neurological signs was associated with a poor prognosis, while lack or just one of these indicated a favorable prognosis. Deep pain perception (DPP) was present in 37.7% of the dogs. Twenty dogs received conservative treatment, 14 underwent surgery and three dogs died before treatment for the acute spinal trauma. Of the dogs with intact DPP, 100% recovered, while none of the dogs that lost DPP recovered voluntary motion (five developed spinal walk). Presence or absence of DPP is a reliable prognostic indicator. However, there was no significant difference in time for recovery of voluntary motion in dogs with intact DPP when comparing surgical versus conservative treatment. The percentage of euthanasia was less than in other reports, probably due to the greater awareness and protectiveness of owners nowadays. Of the dogs without DPP treated either surgically or conservatively, 31.25% recovered the ambulation without recovery of DPP. / Fraturas e luxações vertebrais (FLV) são uma das afecções neurológicas mais graves e comumente encontradas na prática clínica, com elevado risco de danos permanentes à medula espinal. Objetivou-se estudar as características e implicações associadas às FLV toracolombares em 37 cães atendidos no Hospital Veterinário da Universidade Federal Rural de Pernambuco. Cada paciente passou por anamnese, seguida por exames clínicos, neurológico e radiográfico. Os cães foram submetidos ao tratamento conservativo ou cirúrgico de acordo com cada caso. As FLV foram mais comuns em machos não castrados com acesso a rua. Dentre a etiologia, 32 cães foram acometidos por acidente automobilístico. Dos animais da pesquisa, 14 apresentaram lesões não neurológicas em outros sistemas. Por meio do exame radiológico se diagnosticou FLV em 100% dos casos, mas nos cães submetidos ao tratamento cirúrgico, observou-se uma grande quantidade destes apresentavam lesões vertebrais não detectadas nas radiografias convencionais (42,8%). O tempo médio ate o atendimento neurológico inicial foi de 35 dias, no qual a maioria foi encaminhada sem imobilização externa. Houve diferença estatisticamente significante ao se comparar os graus de deslocamento de 0 a 25% e de 76 a 100%. A presença de dois ou três sinais neurológicos graves esteve relacionada a prognóstico desfavorável, enquanto que a ausência ou presença de apenas um destes indicou um prognóstico favorável. A percepção de dor profunda (PDP) estava presente em 37,7% dos animais. Vinte animais foram submetidos ao tratamento conservativo, 14 ao tratamento cirúrgico e três animais faleceram antes de ser realizado o tratamento do traumatismo medular agudo propriamente dito. Dos animais que mantiveram a PDP intacta, a taxa de recuperação foi de 100%, enquanto que dos animais que perderam a PDP nenhum recuperou a deambulação voluntária (cinco adquiriram caminhar espinal). O parâmetro de ausência ou presença de PDP é um confiante indicativo do prognóstico desta afecção. Apesar de que nos animais que mantiverem a PDP intacta, independente do tratamento instituído e do grau de comprometimento neurológico, não houve diferença significante nas taxas nem no tempo de recuperação da deambulação voluntária. A taxa de eutanásia foi menor que em outros trabalhos descritos na literatura, provavelmente devido a conscientização e protecionismo dos tutores nos dias atuais. Dos animais sem PDP submetidos ao tratamento conservativo ou cirúrgico, 31,25% readquiriram a capacidade de caminhar sem recuperar a PDP.

SAMMANFATTNING Den prehospitala vården börjar när samtalet inkommer till SOS och avslutas när patienten avlämnas på mottagande enhet. Den prehospitala vården innefattar undersökning, övervakning och behandling av skadade och sjuka. Kompetensen det senaste årtiondet har förändrats från att ha varit enbart en transportorganisation till att utföra avancerade medicinska bedömningar och åtgärder. I Sverige drabbas ca 4000 personer varje år av skador i hals-, bröst- och ländrygg. Dessa frakturer orsakas ofta av hög energi och uppkommer samtidigt med andra svåra skador. Ryggradsskador innebär stort lidande för patienten och även höga kostnader för samhället. När den prehospitala personalen kommer fram till en patient med misstänkt skada på kotpelaren så är spinal immobilisering den åtgärd som utförs. Spinal immobilisering innebär att patienten påförs en hård nackkrage och sedan läggs och spänns fast på en spineboard. Detta i syftet att minimera rörelse i kotpelaren under transport in till mottaganade enhet. Syftet med studien var att belysa påverkan av att vara spinalt immobiliserad. Den metod som användes var litteraturstudie. Tjugo vetenskapliga artiklar valdes ut och sammanställdes efter sökning i olika databaser. Artiklarnas kvalitet har bedömts utifrån ett protokoll för att värdera dess kvalitet. Resultatet presenteras under fyra kategorier. Det främsta resultatet som framkom var att spinal immobilisering är obekväm och framkallar smärta. Detta på grund av att metoden framkallar kraftigt ökat tryck på vissa utsatta områden av kroppen så som bakhuvudet, skuldror och rumpa. Spinal immobilisering ger även en negativ påverkan på andningen och minskar cirkulationen till hjärnan och den hud och vävnad som utsätts för tryck. Slutsatsen var att många negativa effekter finns av att spinalt immobilisera patienterna på spineboard. Få studier eller inga studier visar att det faktiskt är en åtgärd som har någon positiv effekt eller ens den effekt som eftersträvas med spinal immobilisering.

Lyginant su kitomis užsienio šalimis, Lietuvoje stuburo sužalojimai patiriami dažniau. Dažnai stuburo sužalojimą patyręs asmuo lieka neįgalus visą likusį gyvenimą. Valstybė ir artimieji patiria didelius nuostolius dėl prarastų pajamų, išlaidų gydymui ir išlaikymui. Paciento patyrusio stuburo sužalojimą tolimesnė gydymo ir sveikatos grąžinimo perspektyvos labai priklauso ir nuo pirmosios pagalbos teikimo ikistacionariniame etape. Tyrimo tikslas – įvertinti greitosios medicinos pagalbos tarnybų galimybes teikti pagalbą, kai yra stuburo sužalojimai. Tyrimą sudarė trys etapai. Tirta greitosios medicinos pagalbos tarnybų medikų teorinis ir praktinis pasiruošimas, materialinė techninė bazė ir procedūros taikomos pacientams patyrusiems didelės kinetinės energijos traumas. Tyrimo uždaviniai: 1. Įvertinti greitosios medicinos pagalbos darbuotojų teorinį ir praktinį pasirengimą teikti pagalbą pacientams, kuriems įtariamas stuburo sužalojimas po patirtos didelės kinetinės energijos traumos. 2. Įvertinti greitosios medicinos pagalbos materialinę ir techninę bazę, reikalingą teikiant pagalbą stuburo sužalojimų atvejais. 3. Nustatyti klinikinių procedūrų, atliekamų asmenims, patyrusiems stuburo sužalojimus, rūšį ir dažnį. 4. Nustatyti teikiamos pagalbos, asmenims su įtariamu stuburo sužalojimu, atitikimą pasaulio sveikatos organizacijų rekomendacijoms. / Spinal cord injuries incidence is higher in Lithuania than in other countries. Patient after experienced spinal cord injury often remains disabled for the rest of its life. Community and relatives have to suffer big losses for the lost incomes and expenses related to treatment and maintenance. Patient treatment and heath retain prognosis strongly depends on firs medical aid supplied at prehospital level. The aim of study – evaluate emergency medicine services abilities to provide first medical aid in cases of spinal injuries. The study consisted of three stages. We investigated the theoretical and skill readiness of emergency medicine services personnel, physical resources provision and procedures applied to the patients which have undergone high energy traumas. The objectives of the study: 1. To evaluate the theoretical knowledge level and skills required to provide first medical aid for patients which undergone high energy trauma and are suspected for spinal injury. 2. To evaluate physical resources of the emergency medicine institutions which are used for the first medical aid supplied to the patients with spinal injury. 3. To determine the availability of emergency medicine services and the kind and extent of clinical procedures applied to patients with spinal injury suspected. 4. To evaluate the conformance of the clinical procedures applied to patients with spinal injury to the recommendations of the world health institutions.