There is a trend towards computed tomography (CT) guidance due to a perceived reduction in the risk of spinal canal intrusion by instrumentation causing neurological injury. Due to limited access to CT guidance, there is a need for safe fluoroscopy-guided percutaneous access to the thoracic spine.
Purpose To evaluate the safety of a strict radio-anatomical protocol in avoiding access-related neurological complications due to tool misplacement in fluoroscopy-guided percutaneous procedures on the thoracic
spine.
Method A combined two-surgeon prospective case series of 444 procedures (biopsy, vertebroplasty or kyphoplasty) covering all thoracic vertebral levels T1-T12. Clinical examination and routine observations were used to identify access-related complications including neurological, vascular and visceral injury using physiological parameters.
Results
No patient in our series Small molecule library datasheet was identified to have sustained a neurological deficit or deterioration of preoperative neurological status.
Conclusion Percutaneous access to the thoracic spine using fluoroscopic guidance is safe. The crucial step of the protocol is Oligomycin A datasheet not to advance the tool beyond the medial pedicle wall on the anterior-posterior projection until the tip of the instrument has reached the posterior vertebral cortex on the lateral projection.”
“Despite the prevalence of syphilis worldwide, little is known about its manifestations when associated with other Sexually Transmitted Infections (STI), specifically the Human Papilloma Virus (HPV). Current epidemiological studies show that there is a high incidence of both diseases in ambulatory clinics all over Brazil. This study aims Nec-1s in vivo to estimate the incidence of syphilis-HPV co-infections, among patients from the STI ambulatory clinic at the Santa Casa da Misericordia Hospital, Rio de Janeiro, Brazil. Two-hundred and seven
patients were seen in the clinic between March and December 2005, of which 113 (54.6%) sought care for an HPV infection. Blood samples were taken from all patients to check syphilis serology using the flocculation and the non-treponemic test or VDRL (Venereal Disease Research Laboratory) and the TPHA (Treponema Pallidum Hemagglutination Assay) treponemic and confirmatory method. Of the 207 patients, 113 (54.6%) consulted referring to HPV as their primary complaint, and of these, 18 (15.9%) also presented with positive syphilis serology, demonstrating a high incidence of co-infection. The average age of the patients varied between 20 and 25 years, 203 (98.1%) were male and 4 (1.9%) were female. The predominance of the male sex in this sample confirms the profile usually treated in STI clinics across the country, and the age range is that of typically high sexually activity.