L'ostéoporose est une maladie du squelette caractérisée par une perte de la qualité osseuse qui entraîne un risque de fracture accru, notamment au niveau vertébral. Des modèles en éléments finis basés sur la tomodensitométrie permettent d'estimer la résistance vertébrale, et donc le risque de fracture, mais leur utilisation en routine clinique est limitée par le coût et l'irradiation engendrée par la tomodensitométrie. L'estimation la résistance vertébrale à partir d'un modèle en éléments finis basés sur l'imagerie basse dose, telle que l'absorptiométrie biphotonique à rayons X, ou la stéréo-radiographie EOS en double énergie, permettrait une utilisation en routine clinique. Cette thèse contribue au développement de la modélisation à partir de l'imagerie basse dose pour la prédiction du risque de fracture. Un modèle en éléments finis de résistance vertébrale y est évalué par rapport à un modèle basé sur la tomodensitométrie, et une étude de sensibilité identifie les facteurs importants du modèle sont analysés. Des méthodes de maillage hexaédrique morpho-réalistes à partir de la reconstruction 3D, et d'estimation de la distribution de densité à partir d'image 2D de densité y sont développées. De plus, profitant des possibilités du système EOS qui permet de radiographier le patient de la tête aux pieds, une méthode préliminaire est proposée pour estimer l'effort exercé sur les vertèbres in vivo. Nous espérons que nos méthodes pourront être utilisées très prochainement in vivo, et contribuer à l'estimation du risque de fracture ostéoporotique, et à la prise en charge des patients à risque de fracture. / Osteoporosis is a bone disease which decreases bone quantity and quality, and increases fracture risk, notably at the vertebral level. CT-scan-based finite element models allow predicting vertebral strength, and thus fracture risk, but their use in routine clinical practice is limited by the cost and accessibility of CT-scan. However, vertebral strength prediction from a finite element model based on low dose images, such as dual X-ray absorptiometry or EOS stereo-radiography in dual energy, would allow a wider use. This PhD thesis contributes to develop fracture risk estimation by such a model. The low dose approach is evaluated in comparison to CT-based finite element model, and a sensitivity study is performed to identify the most important parameters of the model. Hexahedral morpho-realistic meshing techniques from 3D reconstruction and estimation methods for the 3D bone mineral density distribution from low dose images are developed and evaluated. Moreover, taking advantage of EOS system's possibility to take full body radiographs in standing position, a preliminary method is proposed to estimate the load applied to vertebra in vivo. We hope those methods will be used soon in vivo, and will contribute to estimating osteoporotic fracture risk estimation in clinical situations.

Argulus foliaceus (Linnaeus, 1758) is a member of the branchiuran family Argulidae and has a worldwide distribution, causing major economic impacts for freshwater aquacultured fish species worldwide. In the UK, it has economic impacts for both aquaculture and sports fishing industries. Previous studies observed haemorrhagic and inflammatory responses after Argulus infection, which has been taken to support the idea that the parasite secretes chemicals during the feeding process to assist with the ingestion of blood and epithelial tissue. The present study suggests that the blood-feeding ectoparasite of fish, A. foliaceus, may use similar mechanisms for evading host immune responses to those used by sea lice and other haematophagous arthropods. No previous studies have directly investigated the nature of the bioactive compounds / proteins, assumed to be released from these ectoparasites, and which are considered to contribute to feeding processes and host-parasite interactions during infection. Thus, the work described in this thesis was undertaken with the objective of identifying, describing and characterising the secretory components that have previously been suggested to be secreted from glandular cells associated with the feeding appendages of Argulus foliaceus. The current study applied transcriptomic and proteomic techniques in conjunction with in situ methods to investigate known immunomodulatory genes that may serve a function in parasite-host interactions. Overall, the findings of this project have generated considerable additional knowledge concerning the biology of Argulus spp. and have provided a list of proteins that may be used by the parasite to facilitate feeding processes by secreting these active molecules into the host and hence modulating their immune defence mechanisms. This information can be used as a baseline for developing freshwater lice control strategies to help prevent the spread of Argulosis in aquaculture by applying vaccination as means of control using the candidate antigens described in this study to specifically target Argulus spp. Knowledge generated by the work described in this thesis can also contribute to the development of drugs for controlling Argulus or functional components of feed that may serve to protect fish against this parasite. Furthermore, data from this thesis enhances the knowledge of the distribution of toxin/venom or venom-like substances in crustaceans and arthropods in general.

Abstract Earlier studies on lumbar degenerative imaging findings in magnetic resonance imaging (MRI) have been done mainly in adult populations and the associations of degenerative findings with low back pain (LBP) are controversial. Only a few studies have involved adolescents and young adults. Heritability has been acknowledged as the only explicit risk factor of disc degeneration (DD). This study investigated the prevalence and environmental determinant of lumbar degenerative findings in MRI and their association with low back symptoms among young adults. The data were based on two physical assessments, three questionnaires and one lumbar MRI that were executed on members of the Oulu Back Study (n=558), a subsample of Northern Finland Birth Cohort 1986, between 16 and 21 years of age. Prevalences of lumbar DD (54%), bulging (25%), protrusion (18%) and Schmorl’s node (17%) were high, whereas other degenerative findings were rare among young adults. Males had higher prevalence of DD and Schmorl’s nodes than females. DD and herniations were associated with low back symptoms. On the other hand, symptoms were present among subjects without DD or other abnormal findings on MRI. Of the environmental determinants, high body mass index and MRI-based obesity measurements of visceral adiposity were associated with lumbar DD among males. Waist circumference and smoking showed a comparable association with DD among males, but the level of physical activity was not associated with DD in either gender. Low back symptoms are more common among young adults with a higher degree of DD or presence of disc herniation. Smoking and overweight are associated with lumbar DD among young male adults. / Tiivistelmä Aikaisempia tutkimuksia magneettikuvantamisella (MK) todetuista lannerangan rappeumamuutoksista ja niiden yhteyksistä alaselkäkipuun on tehty lähinnä aikuisväestöllä ja tulokset ovat ristiriitaisia. Vain muutamia tutkimuksia on tehty alle 25-vuotiailla. Välilevyrappeuman mahdollisista riskitekijöistä vain perimästä on vahvaa näyttöä. Tässä tutkimuksessa tarkasteltiin MK:lla todettujen lannerangan rappeumamuutosten esiintyvyyttä, niihin vaikuttavia ympäristötekijöitä ja yhteyttä alaselkäoireisiin nuorilla aikuisilla. Tutkimuksen aineisto perustui kahteen kliiniseen tutkimukseen, kolmeen kyselyyn ja yhteen MK:een, jotka toteutettiin Pohjois-Suomen syntymäkohortti 1986:een kuuluville Oulun selkätutkimuksen koehenkilöille (n=558) 16-21 vuoden iässä. Lannerangan välilevyrappeumalla (54 %), välilevyn pullotuksilla (bulge; 25 %), sellaisilla välilevyn pullistumilla jotka eivät läpäisseet selkärangan takimmaista pitkittäissidettä (protruusio; 18 %) sekä päätelevyn läpi suuntautuvilla välilevyn pullistumilla (Schmorlin keräset; 17 %) oli korkea esiintyvyys nuorilla aikuisilla, kun taas muut kuvantamislöydökset olivat harvinaisia. Välilevyrappeuma ja Schmorlin keräset olivat yleisempiä miehillä. Sekä välilevyrappeuma että pullistumat olivat yhteydessä alaselkäoireisiin molemmilla sukupuolilla, mutta kaikilla oireisilla ei todettu poikkeavia löydöksiä MK:ssa. Ympäristötekijöistä korkea kehon painoindeksi ja MK:sta mitatut rasvan määrää mittaavat muuttujat olivat miehillä yhteydessä välilevyrappeumaan. Miehillä vyötärönympärys ja tupakointi olivat heikommin yhteydessä välilevyrappeumaan, kun taas liikunta-aktiivisuus ei ollut kummallakaan sukupuolella yhteydessä rappeumaan. Alaselkäoireet ovat yleisempiä nuorilla aikuisilla, joilla on vaikea-asteisempi välilevyrappeuma tai välilevyn pullistuma. Tupakointi ja ylipaino ovat yhteydessä lannerangan välilevyrappeumaan nuorilla aikuisilla miehillä.

Abstract Osteoporotic vertebral fractures are common among ageing populations worldwide. Although small vertebral size has been established as an independent risk factor for vertebral fracturing, relatively few determinants of vertebral size are currently known. The present study aimed to reveal lifetime factors that associate with midlife vertebral size. Overall physical activity across the lifespan, sports participation in adulthood, occupational physical activities in adulthood, and physical growth in early life were investigated. A subsample of the Northern Finland Birth Cohort Study 1966 was used, with a 46-year follow-up (n = 1,540). Vertebral dimensions were obtained by magnetic resonance imaging of the lumbar spine at the age of 46. The present data showed that high lifelong leisure-time physical activity and active participation in high-impact sports in adulthood were associated with large midlife vertebral size among women, but no such association was detected among men. Occupational physical activities were not associated with vertebral size among either sex. Early-life weight gain predicted large midlife vertebrae among both sexes, and the effect of height gain on vertebral size seemed to be mediated by adult height. The present findings show that the female vertebra in particular seems to benefit from high leisure-time physical activity and active participation in high-impact sports. Regardless of sex, early development also seems to play a role in determining later-life vertebral size. Prospective studies should confirm the causality of the present findings, and further research is needed to shed light on other lifetime factors as determinants of vertebral size. / Tiivistelmä Selkänikaman osteoporoottiset murtumat ovat maailmanlaajuisesti yleinen ikääntyvän väestön vaiva. Pienen nikamakoon tiedetään lisäävän nikamamurtuman riskiä, mutta nikamakokoon vaikuttavia tekijöitä tunnetaan toistaiseksi varsin vähän. Tämän tutkimuksen tavoitteena on selvittää keski-iän nikamakokoon vaikuttavia elinaikaisia tekijöitä. Erityisesti tutkitaan vapaa-ajan liikunnallisuuden, lajikohtaisen harrastusaktiivisuuden, työn liikunnallisten piirteiden sekä lapsuuden ja nuoruuden fyysisen kehityksen yhteyttä nikamakokoon. Tutkimusjoukkona käytetään osaotosta Pohjois-Suomen vuoden 1966 syntymäkohortista (n = 1 540). Seuranta-aika on ollut 46 vuotta, ja selkänikaman koko on määritetty tutkittavista 46 vuoden iässä otetuista lannerangan magneettikuvista. Tutkimusaineistossa naisten elinaikainen vapaa-ajan liikunnallisuus sekä aktiivinen luustoa kuormittavien liikuntalajien harrastaminen ovat yhteydessä suureen nikamakokoon keski-iässä. Miesten liikunnallisuuden ja nikamakoon välillä ei sen sijaan havaittu vastaavaa yhteyttä, eivätkä työn liikunnalliset piirteet olleet yhteydessä nikamakokoon kummallakaan sukupuolella. Varhainen painon kasvu ennusti suurta keski-iän nikamakokoa sukupuolesta riippumatta, ja varhaisen pituuskasvun vaikutus nikamakokoon näytti välittyvän aikuispituuden kautta. Tutkimuksen tulosten perusteella siis erityisesti naiset näyttäisivät hyötyvän vapaa-ajan liikunnallisesta aktiivisuudesta ja luuta kuormittavien lajien harrastamisesta aikuisiällä. Sukupuolesta riippumatta myös lapsuuden ja nuoruuden fyysisellä kehityksellä näyttäisi olevan merkitystä keski-iän nikamakokoon. Tulevaisuudessa prospektiivisten tutkimusasetelmien tulisi vahvistaa tässä tutkimuksessa havaittujen yhteyksien kausaliteetti. Lisäksi tutkimusta tarvittaisiin jatkossa muiden nikamakokoon vaikuttavien elinaikaisten tekijöiden selvittämiseksi.

La dégénérescence discale lombaire (DDL) est caractérisée par un vieillissement prématuré du disque intervertébral (DIV) et une déshydratation progressive du nucleus pulposus (NP) entrainant in fine des lombalgies. L'objectif général de ce travail est d'établir des données précliniques afin de régénérer le DIV en cas de DDL modérée. Dans un premier chapitre, nous avons déterminé une association de facteur de croissance et un mode de culture visant à obtenir une prédifférentiation nucléopulpogénique de cellules stromales mésenchymateuses (CSMs) humaines issues de la moelle osseuse. Nos résultats montrent que la culture tridimensionnelle des CSMs en billes d'alginate en présence de TGF-β3, GDF-5 et BMP-7 les oriente vers un phénotype cartilagineux. Dans un deuxième chapitre, nous avons élaboré un modèle porcin de DDL induite par cryolésion et nous l'avons comparé aux techniques de référence. L'évaluation de l'importance de la DDL a été effectuée par scanner, IRM et histologiquement. Un score histologique de DDL porcine a été décrit et validé. La cryolésion a permis d'obtenir une DDL plus importante que les autres techniques. Dans un troisième chapitre, nous avons injecté les CSMs préorientées dans les DIV lésés. L'analyse IRM a montré une amélioration de l'intensité du signal et de la surface du NP après injection des cellules. L'analyse immunohistologique a montré une survie des CSMs dans les DIV porcins à 2 mois. Dans un quatrième chapitre, nous avons comparé les taux de fusion et de complication pour la RhBMP-2 et la greffe spongieuse autologue dans les arthrodèses lombaires par voie antérieure dans une même cohorte de patients. La RhBMP-2 était associée à un taux de fusion inférieur et un taux de complications radiologiques supérieur à l'autogreffe spongieuse. / Degenerative disc disease (DDD) is characterized by premature aging of the intervertebral disc (IVD) and gradual dehydration of the nucleus pulposus (NP), ultimately causing back pain. The general objective of this work is to establish preclinical data to regenerate the IVD in moderate DDD. In the first chapter, we have identified a growth factor association and a culture method to achieve nucleopulpogenic prédifférentiation of mesenchymal stromal cells (MSCs) derived from human bone marrow. Our results show that the three-dimensional culture of MSCs in alginate beads in the presence of TGF-β3, GDF-5 and BMP-7 directs them to a cartilaginous phenotype. In the second chapter, we developed a porcine model of DDD, induced by cryoinjury, and compared it to reference techniques. Assessing the importance of DDD was performed by CT, MRI and histologically. A histological score of porcine DDD has been described and validated. Cryoinjury yielded a higher DDD that other techniques. In a third chapter, we injected preoriented MSCs in cryo-injured IVDs. MRI analysis showed an improvement in the signal intensity and the surface of the NP after the injection. The immunohistological analysis showed a survival of the MSCs in the porcine IVD 2 months after injection. In a fourth chapter, we compared the rate of fusion and complication for rhBMP-2 and autologous cancellous graft in the anterior lumbar interbody fusion, in the same cohort of patients. RhBMP-2 was associated with a lower fusion rate and a higher rate of radiological complications than the cancellous autograft.

The purpose of this study was to explore the psychosocial problems encountered by Black patients with tetralpegia once discharged from the hospital. Phenomenology as a research strategy was used with the aim of understanding the worldview of patients. The medical aspects of spinal cord injury were discussed, firstly with emphasis placed on the incidence of spinal cord injury, causes of spinal cord injury, different levels of tetraplegia and the management of patients with tetraplegia. The psychosocial problems encountered by black patients with tetralpegia once discharged from the hospital were discussed. The emphasis was placed on the patients’ emotional reaction to the injury, adjustment towards the injury and the guidelines for social work intervention with regard to the patient with tetraplegia. Ten respondents participated in the study after they were selected by using availability sampling and the study revealed the following. Tetraplegia results in a variety of psychosocial problems for both the patient and his/her family, which are: Negative marital relationships and desertion by the healthier spouse. Disturbed family relationships. Negative self-esteem and lack of self-confidence due to physical limitations. Poor quality of life, stigmatization by the community and inaccessibility in as far as public transport is concerned. Tetraplegia triggers psychological, social and financial problems. It is therefore concluded that social work intervention in the initial phase of the injury will ensure that the patients’ psychosocial problems are explored and attended to, to prepare the patients for the difficult life thereafter. / Dissertation (MA (SW) Health Care)--University of Pretoria, 2007. / Social Work and Criminology / MA (SW) / unrestricted

Submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background In sport, competitive athletes are required to perform to the best of their ability, with some athletes seeking the use of chiropractic treatment to improve performance. For example, hockey players are required to perform at peak physical function whilst executing a drag flick. The action of a drag flick involves a player hunched over low down in front of the ball and the hook of the hockey stick makes contact with the ball, which is then ball is pushed along the ground with the ball moving slightly up the shaft of the stick. The player then performs ‘slinging’ action, which means they ‘flick’ the ball towards the goal posts. The drag flick is an explosive sequential movement involving the player’s pelvis, trunk and upper limbs, requiring the use of the spine to generate the speed of the stick and ball. As a result any decreased spinal movement could reduce performance. Therefore this study attempted to assess the use of spinal manipulative therapy (SMT) in improving the drag flicking performance of hockey players. SMT has been shown to be a safe and effective way of increasing spinal joint mobility Objectives To determine and compare the effect of placebo and spinal manipulative therapy in terms of subjective and objective measurements on drag flicking performance of premier league field hockey players. Methods A comparative, experimental study of forty asymptomatic premier league hockey drag flickers were divided into two groups of twenty each. Group A received SMT of fixated joints of the spine (cervical, thoracic and lumbar) as determined by motion palpation by an experienced qualified chiropractor. Group B received sham manipulation. Pre and post intervention ROM of the spine and drag flicking speed where measured using CROM, Inclinometer, BROM II and Speed TracX Speed Sport Radar. The subject’s perception of a change in drag flicking speed post intervention was also recorded. SPSS version 21 was used to analyse the data. A p value of 0.05 was considered statistically significant. Results Significant differences in ROM were noticed in the inter-group analysis in cervical: extension; LLF; RR PA, thoracic: extension; LLF, RLF, lumbar: extension, LLF, RLF. There was a significant increase in drag flicking speed post SMT, but between the SMT and sham manipulation groups were not significantly different. A significant correlation was seen between subjects’ perception of change in drag flicking speed post intervention and the objective results obtained. Conclusion The immediate effect of SMT on drag flicking performance of hockey players was inconclusive. The outcomes of this study suggests that SMT results in an increase in the average speed of drag flicking, however further larger studies are required to confirm this. / M

Orientador: Alberto Cliquet Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T12:33:02Z (GMT). No. of bitstreams: 1 Medeiros_RodrigoCastrode_M.pdf: 1107012 bytes, checksum: 8c4a2b98916bf061db40e20d0c7d01a6 (MD5) Previous issue date: 2011 / Resumo: Nas últimas décadas, a reabilitação nos lesado-medulares vem evoluindo através do uso da estimulação elétrica funcional (EEF). Apesar dos inegáveis ganhos cardiovasculares, psicológicos e na densidade mineral óssea advindos desta técnica, o ortostatismo e a deambulação destes pacientes sob estímulo elétrico ainda dependem do suporte fornecido pelos membros superiores. A literatura pertinente aos estudos biomecânicos sobre EEF para ortostatismo em paraplégicos está baseada em teoremas matemáticos fundamentados na física mecânica referente aos braços de alavanca musculoesqueléticos. Contudo, percebe-se uma falha conceitual nestes teoremas a medida que desconsideram os princípios de regulação do reflexo postural observados nos indivíduos sem alterações neurológicas. Nos indivíduos saudáveis, o princípio da conservação de energia exige que, na posição ortostática, a cabeça e tronco estejam alinhados sobre a pelve e centrados em relação aos pés. Para obtenção de uma postura adequada, o organismo utiliza primariamente o reflexo postural espinopélvico, através do qual as curvaturas sagitais da coluna são adaptadas à posição da pelve e dos quadris. O objetivo deste estudo é descrever os aspectos radiográficos do perfil sagital obtidos em pacientes paraplégicos em postura bipedal através da estimulação elétrica funcional dos quadríceps complementados com apoio bimanual. Dez pacientes paraplégicos que participam do ambulatório de reabilitação foram selecionados. Após serem submetidos a radiografias panorâmicas em perfil, foram analisados as médias e os desvios-padrão dos vários parâmetros geométricos descritos na literatura referentes ao equilíbrio sagital em indivíduos saudáveis. Os valores obtidos para cifose torácica e lordose lombar foram semelhantes a dos pacientes saudáveis descritos na literatura. Os parâmetros pélvicos revelaram inversão do tilt pélvico, aumento do slop sacral e diminuição do ângulo sacrofemoral. Nos parâmetros espinopélvicos, foram observados aumentos nas distâncias horizontais entre as vértebras e a bacia e/ou quadris. Estes aspectos traduzem a presença de uma importante anteversão da bacia associada à flexão dos quadris com consequente translação anterior da linha de prumo da coluna expressada através de um intenso desequilíbrio sagital anterior. Para quem deseja optimizara postura bipedal dos paraplégicos sob EEF, este estudo inédito lança uma nova e importante visão sobre a compreensão das alterações ergonômicas presentes no balanço sagital. Tal fato possivelmente servirá de base para o desenvolvimento de novas configurações de EEF / Abstract: In recent decades, the rehabilitation of injured spinal cord-has been evolving through the use of functional electrical stimulation (FES). Despite the undeniable gains cardiovascular, psychological and bone mineral density resulting from this technique, the standing and ambulation of these patients still depend on electrical stimulation of the support provided by the upper limbs. The literature pertaining to the biomechanical studies on FES for standing in paraplegics is based on mathematical theorems based on the physical mechanics related to musculoskeletal lever arms. However, we find a conceptual flaw in these theorems as they disregard the principles of regulation of postural reflex observed in subjects without neurological damage. In healthy subjects, the principle of conservation of energy requires that, in standing position, head and torso are aligned in the pelvis and centered over the feet. To obtain a proper posture, the body uses primarily espinopélvico postural reflex, whereby the sagittal curvatures of the spine are adapted to the position of the pelvis and hips. The aim of this study is to describe the radiographic features of the sagittal profile obtained in bipedal posture in paraplegic patients by functional electrical stimulation of the quadriceps supplemented with bimanual support. Ten paraplegic patients participating in outpatient rehabilitation were selected. After being subjected to panoramic radiography in profile, we analyzed the means and standard deviations of various geometrical parameters described in the literature for the sagittal balance in healthy subjects. The values obtained for thoracic kyphosis and lumbar lordosis were similar to healthy patients in the literature. The parameters revealed pelvic tilt reversal of pelvic, sacral and increase the slop angle reduction sacrofemoral. The spinopelic parameters increases were observed in the horizontal distances in relation to vertebrae and pelvis and/or hips. These aspects reflect the presence of a significant anteversion of the pelvis associated with hip flexion with subsequent anterior translation of the plumb line of the column expressed through an intense anterior sagittal imbalance. For those who want to optimize the bipedal posture of paraplegic patients under FES, this new study sheds new and important insight into the understanding of these ergonomic changes in sagittal balance. This fact possibly serve as the basis for the development of new configurations of FES / Mestrado / Fisiopatologia Cirúrgica / Mestre em Cirurgia

Este trabalho avaliou a incidência de pacientes com lesão traumática da coluna cervical causada por mergulho em águas rasas, que foram atendidos nos Hospitais da cidade de Ribeirão Preto-SP, entre janeiro de 1989 a dezembro de 1996. O estudo epidemiológico foi realizado mediante investigação feita nos prontuários médicos desses pacientes. Complementou-se as informações por meio de uma entrevista realizada com 12 deles. Com base nos números apresentados, elaborou-se um programa de prevenção decorrente desses traumatismos a implantou-se uma Campanha de prevenção das lesões cervicais por mergulho em águas rasas em Ribeirão Preto. Um Programa de Campanha foi encaminhado à Assembléia Legislativa do Estado e transformado em Projeto de Lei. Os resultados mostraram que, dos 355 casos estudados, 69 deles foram por acidentes em águas rasas, a dentre estes, 58% tiveram danos neurológicos. Os locais mais freqüentes dos acidentes foram rios, córregos, lagos, cachoeiras,com a ocorrência de 75,4% dos casos, enquanto que a incidência em piscinas foi de 24,6%. A média de idade variou entre 10 a 30 anos, havendo diferença significativa com outras faixas etárias. Quanto ao sexo, 92,8% ocorreram em homens a 7,2% com mulheres. Em relação ao estado civil, 68,2% eram solteiros e 31,9% eram casados. O período do ano em que houve um número mais elevado dos traumatismos da coluna cervical causado pelo mergulho nas chamadas águas rasas foi nos meses de estações mais quentes na região (primavera, verão a outono). Dos 17,4% dos pacientes entrevistados de um total de 40 que tiveram lesão medular, todos mostraram desconhecimento desse tipo de acidente, bem como suas conseqüências. A Campanha de prevenção teve início em setembro de 1996 e está em fase de desenvolvimento em Ribeirão Preto. O Projeto de Lei estadual nº 183 aguarda aprovação da Assembléia. Conclui-se que, a incidência de acidentes com lesão traumática da coluna cervical por mergulho em águas rasas é elevada, sendo a terceira causa de danos traumáticos. A desinformação da população no que diz respeito ao perigo de um mergulho em águas rasas é elevado. A redução deste tipo de acidente pode acontecera partir de um processo educacional da população a da atuação decisiva do poder público. / This study is an evaluation of the incidence of patients treated in the hospitals in Ribeirão Preto - SP for traumatic injury of the cervical cord caused by diving in shallow waters. The epidemiological study was held by means of an investigation of the medical charts of patients who underwent treatment from January 1989 to December 1996. The information on the charts was complemented through interviews held with 12 of these patients. Based on the results of these investigations, a campaign to prevent cervical injury caused by diving into shallow waters was elaborated and sent to the State Legislature, where it was transformed into a bill. The study revealed that in the 355 cases of cervical injury investigated, 69 were the result of accidents in shallow waters, and of these, 58% suffered neurological dysfunction. Rivers, lakes and waterfalls were most frequently cited as locations for the occurrence of these injuries (75,4% of the cases), with the incidence of accidents in swimming pools at 24,6%. The average age of patients varied between 10 to 30 years of age, with a significant difference in other age groups. In relation to sex, 92,8% of the accidents occurred in men, and only 7,2% in women. As to marital status, 68,2% were single and only 31,9% were married. The greatest number of cases of trauma of the cervical cord caused by diving in shallow waters occurred in the warmer seasons of the year (spring summer and fall). 17,4% of the patients interviewed out of a total of 40 with medullar injury, claimed not to know about this kind of accident and its consequences. The Prevention Campaign began in September 1996 and is presently being carried out in the city of Ribeirão Preto. The Bill of Law no. 183 awaits approval from the State Legislature. One may conclude that the incidence of traumatic injury of the cervical cord due to diving in shallow waters is high (third place as the cause of injury). The lack of information on the part of the population regarding the dangers of this type of accident may be one of the reasons behind these high statistics. The reduction of this type of accident may occur as the result of an educational process involving the population as well as decisive action on the part of the government.

This project was undertaken with the following aims: 1) To generate a data base concerning the management of children with congenital spinal anomalies, who are known to form a significant proportion of the patients being treated in the Department of Paediatric Urology at Red Cross Hospital. 2) To assess the results of the management of these children, with special attention to the goals of therapy, namely preservation of renal function, establishment of urinary continence and protection from urinary tract infection. 3) To compare the treatment methods and results obtained to those reported in the literature. 4) To evaluate critically the treatment methods and results obtained with a view to identifying areas where improvements are possible.