Délio Martins - Academia.edu (original) (raw)

Papers by Délio Martins

Coluna/Columna, 2010

... niveles de albúmina sérica después de cirugía de columna vertebral Rafael Paiva Luciano1 Marc... more ... niveles de albúmina sérica después de cirugía de columna vertebral Rafael Paiva Luciano1 Marcio Squassoni Leite1 Délio Eulálio Martins2 Marcelo Wajchenberg3 Eduardo Barros Puertas4 ... 9. Kudsk KA, Tolley EA, DeWitt RC, Janu PG, Blackwell AP, Yeary S, et al. ...

Annals of translational medicine, 2015

Global Spine Journal, 2014

Study Design Case report. Objective The purpose of this report is to discuss the management of a ... more Study Design Case report. Objective The purpose of this report is to discuss the management of a disk herniation during pregnancy and the indication and particularities of surgery in this situation. Methods We describe a case of diskectomy performed in a 35-year-old woman at 18 weeks of gestation. After 4 weeks of trying to manage the disk herniation with rest and medications without success, the muscle strength of the L5 right root decreased to grade 4, and the patient was not responding to intravenous analgesia. After discussion with the patient and family, a decision was made to perform the diskectomy. Results After surgery, the patient's pain lessened, and the Lasegue test became negative. Two weeks after the procedure, the patient's muscle strength was normal. In the 40th week of pregnancy, the patient gave birth without any complications. Conclusion When necessary, diskectomy can be indicated and performed during pregnancy. However, appropriate precautions must be taken. Awareness of these precautions is important for the success of the procedure and for the well-being of the mother and the newborn.

Sao Paulo Medical Journal, 2010

Context and objeCtive: There is controversy regarding which imaging method is best for identifyin... more Context and objeCtive: There is controversy regarding which imaging method is best for identifying early degenerative alterations in intervertebral discs. No correlations between such methods and histological finds are presented in the literature. The aim of this study was to correlate the thickness of intervertebral discs measured on simple radiographs with the degree of degeneration seen on magnetic resonance images and the histological findings relating to nerve ends inside the discs.

Coluna/Columna, 2011

Objetivo: Analisar a mensuração manual do ângulo de Cobb entre profissionais com diferentes exper... more Objetivo: Analisar a mensuração manual do ângulo de Cobb entre profissionais com diferentes experiências da área de Ortopedia e Traumatologia e Cirurgia da Coluna Vertebral, para observar se existem diferenças na avaliação das radiografias de pacientes portadores de escoliose idiopática intra e interobservadores, a ponto de influenciar no tratamento e seguimento desses pacientes. Métodos: Foram utilizadas para este estudo 22 radiografias simples da coluna toracolombar, póstero-anterior, de pacientes portadores de escoliose idiopática, em acompanhamento regular no ambulatório do Grupo da Coluna do Hospital São Paulo. Os exames foram avaliados por quatro diferentes categorias de profissionais ortopedistas e cirurgiões da coluna vertebral e realizada a mensuração das curvas escolióticas através do método de Cobb. As vértebras terminais das curvas não foram previamente marcadas. Somente foram mensuradas as curvas principais (consideradas as de maior valor angular) de cada radiografia. A reprodutibilidade das mensurações feitas pelos diferentes Observadores (inter-observadores) e entre as duas mensurações de cada Observador (intraobservador) foi analisada pelo Coeficiente de Correlação Intraclasse (CCI). Resultados: Foram observadas, quanto às medidas dos ângulos, concordâncias excelentes entre as avaliações intraobservadores, e observadas concordâncias excelentes entre as avaliações interobservadores, uma vez que o CCI em todas as situações manteve-se maior que 0,75, o que representa excelente reprodutibilidade. Conclusão: Concluímos que houve concordância excelente (CCI > 0,75) na avaliação dos ângulos nas mensurações das curvas escolióticas intra e interobservadores. Ao mesmo tempo, as mensurações apresentaram variação de até 13,58º intraobservadores, e de até 12,72º interobservadores.

Coluna/Columna, 2012

A escoliose idiopática do adolescente é uma doença frequente e sua etiologia permanece obscura. V... more A escoliose idiopática do adolescente é uma doença frequente e sua etiologia permanece obscura. Várias hipóteses foram formuladas, entre elas a possibilidade da transmissão genética. Estudos na literatura procuraram analisar a prevalência da doença em determinadas populações, as possíveis formas de transmissão, a localização dos genes responsáveis e as variações de determinados genes (polimorfismos) que podem influenciar o desenvolvimento da deformidade. O objetivo deste artigo é revisar e atualizar os conceitos sobre a influência genética na etiologia da escoliose idiopática do adolescente.

Einstein (São Paulo), 2014

Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in... more Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment.

Reviews, 1996

Fractures and dislocations of the spine are among the most challenging in trauma clinic practice.... more Fractures and dislocations of the spine are among the most challenging in trauma clinic practice. Although vertebral column injuries occur in approximately 6% of trauma patients, half sustain spinal cord or nerve root neurologic deficit (Burney 1993). The causes for ...

Revista Brasileira de Ortopedia, 2010

Objetivo: Comparar a amplitude de flexão e de extensão de tronco por meio de goniometria em atlet... more Objetivo: Comparar a amplitude de flexão e de extensão de tronco por meio de goniometria em atletas e não atletas, relacionando estes dados com o teste do ângulo poplíteo e dos músculos isquiotibiais. Métodos: A amplitude de flexão e extensão de tronco foi avaliada em 50 indivíduos praticantes de esporte regularmente e 50 indivíduos não atletas, os quais não apresentavam nenhum tipo de sintomatologia dolorosa lombar, bem como algum sintoma que pudesse influenciar a realização dos testes. As mensurações foram realizadas por dois examinadores independentes consecutivamente por meio de goniometria. Os valores de flexão e extensão de tronco obtidos pela avaliação da goniometria foram correlacionados com o teste do ângulo poplíteo e de flexibilidade dos isquiotibiais, analisando-se a correlação estatística entre os mesmos. Resultados: Os valores médios obtidos foram 130,7 (101,9) para flexão e 40,2 (36,4) para extensão. Verificou-se diferença estatisticamente significante entre o grupo de atletas e não atletas em relação aos parâmetros: goniômetro em flexão com o avaliador 1, goniômetro em flexão com o avaliador 2 e teste dos isquiotibiais. Não foi verificada diferença estatisticamente significante entre o grupo de atletas e não atletas em relação aos parâmetros: goniômetro em extensão com o avaliador 1, goniômetro em extensão com avaliador 2 e teste do ângulo poplíteo. Conclusão: Observa-se que a flexão do tronco apresenta valores mais elevados em indivíduos praticantes de esporte. A utilização de goniometria para mensuração de amplitude de tronco indicou valores variáveis entre os examinadores.

Revista Brasileira de Ortopedia, 2010

Scoliosis, 2010

Background: The etiology of idiopathic scoliosis remains unknown and different factors have been ... more Background: The etiology of idiopathic scoliosis remains unknown and different factors have been suggested as causal. Hereditary factors can also determine the etiology of the disease; however, the pattern of inheritance remains unknown. Autosomal dominant, X-linked and multifactorial patterns of inheritances have been reported. Other studies have suggested possible chromosome regions related to the etiology of idiopathic scoliosis. We report the genetic aspects of and investigate chromosome regions for adolescent idiopathic scoliosis in a Brazilian family.

PLoS ONE, 2014

Background: Despite the small contribution of LA in the Science Citation Index (SCI), a growing c... more 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.

Patient Safety in Surgery, 2014

The thoracolumbar region is where most fractures of the spine are located. Segmental kyphosis is ... more The thoracolumbar region is where most fractures of the spine are located. Segmental kyphosis is an important factor for treatment decisions. There are various methods for measuring segmental kyphosis in thoracolumbar fractures. Our objective was to evaluate if the experience of the surgeon has any influence on kyphosis measurement by analyzing three different categories of orthopedic surgeons and evaluate possible clinical impacts. Material and methods: Six physicians separated into three categories according to the level of experience evaluated 30 lateral view radiographs of the thoracic spine of patients with single-level fracture taken during their outpatient follow-up visits. Images had segmental kyphosis measured by five distinct methods. The x-rays were evaluated twice and in a random order after an eight-week interval. The reproducibility of the measurements was analyzed by the intraclass correlation coefficient (ICC) and its respective 95% confidence interval. Results: The intraclass correlation coefficient (ICC) was calculated to evaluate the inter-and intra-examiner reliability for each method. The methods that disregard the fractured vertebra (1 and 4) achieved the highest intra and inter-observers reliability among the participants. The measurements from methods 3 and 5 were poorly reproducible between examiners. The difference between the averages of the measurements of the five methods studied was greater than 5 degrees in methods 1 and 2, suggesting risk for patient safety. Conclusion: Methods that exclude the fractured vertebra were more reproducible for the evaluation of segmental kyphosis in thoracolumbar fractures. The evaluation of the spine fracture must be coupled with other radiographic criteria, more complex image exams and the patient's clinical state to assist the surgeon in deciding between conservative or surgical treatment. The authors suggest that the measurements should be performed by methods that exclude the fractured vertebra and conducted by experienced doctors.

Acta Ortopédica Brasileira, 2013

Objective: The I/D polymorphism of angiotensin-converting enzyme (ACE) and R577X of the α-actinin... more Objective: The I/D polymorphism of angiotensin-converting enzyme (ACE) and R577X of the α-actinin-3 (ACTN3) is related to changes in skeletal muscle function. The aim of this study was to evaluate the distribution of these polymorphisms in a family with multiple members with adolescent idiopathic scoliosis (AIS). Methods: Evaluated 25 subjects from a family with multiple members with AIS, by collecting 10mL of blood for DNA isolation. The genotyping of the I/D polymorphism of the ACE gene and the R577X of the ACTN3 gene was performed using two specific primers to classify individuals as homozygous or heterozygous. Results: Regarding the ACE polymorphism it was found that 19 (76%) subjects were DD and 6 (24%) ID. The prevalence of the D allele was 88% and the I allele was 12%. Regarding the ACTN3 polymorphism there were 6 subjects RR (24%), 11 RX (44%) and 8 XX (32%). The prevalence of the R allele was 23 (46%) and the X allele was 27 (54%). Conclusion: There was a difference between the distribution of the polymorphism of ACE and ACTN3 in the family studied. When assessing the ACE polymorphism a higher prevalence of the D allele was observed as compared with the I allele. Level of Evidence III, Cross-sectional, Clinical Trial.

Coluna/Columna, 2014

Objective: To evaluate the reliability and reproducibility of Farfan modified and Frobin methods ... more Objective: To evaluate the reliability and reproducibility of Farfan modified and Frobin methods to measure the intervertebral disc height in radiographs with inter-and intraobserver comparison. Method: Six radiographs of different patients treated for low back pain have been collected and digitized, and five lumbar disc of each patient were evaluated by six examiners with different levels of experience. The measures were done in Image Pro Plus 6.0 software. Results: When compared, both methods showed more than 95% concordance. In intraexaminer analysis, both also shown to be reliable and reproducible, with a high level of concordance. By comparing the correlation between classes of examiners, the higher the level of experience, the greater the agreement for both methods. Conclusion: Farfan modified and Frobin are reliable methods to measure the disc height in the lateral radiographs. The higher level of experience of the examiner, the higher was the correlation between measurements.

Coluna/Columna, 2010

... niveles de albúmina sérica después de cirugía de columna vertebral Rafael Paiva Luciano1 Marc... more ... niveles de albúmina sérica después de cirugía de columna vertebral Rafael Paiva Luciano1 Marcio Squassoni Leite1 Délio Eulálio Martins2 Marcelo Wajchenberg3 Eduardo Barros Puertas4 ... 9. Kudsk KA, Tolley EA, DeWitt RC, Janu PG, Blackwell AP, Yeary S, et al. ...

Annals of translational medicine, 2015

Global Spine Journal, 2014

Study Design Case report. Objective The purpose of this report is to discuss the management of a ... more Study Design Case report. Objective The purpose of this report is to discuss the management of a disk herniation during pregnancy and the indication and particularities of surgery in this situation. Methods We describe a case of diskectomy performed in a 35-year-old woman at 18 weeks of gestation. After 4 weeks of trying to manage the disk herniation with rest and medications without success, the muscle strength of the L5 right root decreased to grade 4, and the patient was not responding to intravenous analgesia. After discussion with the patient and family, a decision was made to perform the diskectomy. Results After surgery, the patient's pain lessened, and the Lasegue test became negative. Two weeks after the procedure, the patient's muscle strength was normal. In the 40th week of pregnancy, the patient gave birth without any complications. Conclusion When necessary, diskectomy can be indicated and performed during pregnancy. However, appropriate precautions must be taken. Awareness of these precautions is important for the success of the procedure and for the well-being of the mother and the newborn.

Sao Paulo Medical Journal, 2010

Context and objeCtive: There is controversy regarding which imaging method is best for identifyin... more Context and objeCtive: There is controversy regarding which imaging method is best for identifying early degenerative alterations in intervertebral discs. No correlations between such methods and histological finds are presented in the literature. The aim of this study was to correlate the thickness of intervertebral discs measured on simple radiographs with the degree of degeneration seen on magnetic resonance images and the histological findings relating to nerve ends inside the discs.

Coluna/Columna, 2011

Objetivo: Analisar a mensuração manual do ângulo de Cobb entre profissionais com diferentes exper... more Objetivo: Analisar a mensuração manual do ângulo de Cobb entre profissionais com diferentes experiências da área de Ortopedia e Traumatologia e Cirurgia da Coluna Vertebral, para observar se existem diferenças na avaliação das radiografias de pacientes portadores de escoliose idiopática intra e interobservadores, a ponto de influenciar no tratamento e seguimento desses pacientes. Métodos: Foram utilizadas para este estudo 22 radiografias simples da coluna toracolombar, póstero-anterior, de pacientes portadores de escoliose idiopática, em acompanhamento regular no ambulatório do Grupo da Coluna do Hospital São Paulo. Os exames foram avaliados por quatro diferentes categorias de profissionais ortopedistas e cirurgiões da coluna vertebral e realizada a mensuração das curvas escolióticas através do método de Cobb. As vértebras terminais das curvas não foram previamente marcadas. Somente foram mensuradas as curvas principais (consideradas as de maior valor angular) de cada radiografia. A reprodutibilidade das mensurações feitas pelos diferentes Observadores (inter-observadores) e entre as duas mensurações de cada Observador (intraobservador) foi analisada pelo Coeficiente de Correlação Intraclasse (CCI). Resultados: Foram observadas, quanto às medidas dos ângulos, concordâncias excelentes entre as avaliações intraobservadores, e observadas concordâncias excelentes entre as avaliações interobservadores, uma vez que o CCI em todas as situações manteve-se maior que 0,75, o que representa excelente reprodutibilidade. Conclusão: Concluímos que houve concordância excelente (CCI > 0,75) na avaliação dos ângulos nas mensurações das curvas escolióticas intra e interobservadores. Ao mesmo tempo, as mensurações apresentaram variação de até 13,58º intraobservadores, e de até 12,72º interobservadores.

Coluna/Columna, 2012

A escoliose idiopática do adolescente é uma doença frequente e sua etiologia permanece obscura. V... more A escoliose idiopática do adolescente é uma doença frequente e sua etiologia permanece obscura. Várias hipóteses foram formuladas, entre elas a possibilidade da transmissão genética. Estudos na literatura procuraram analisar a prevalência da doença em determinadas populações, as possíveis formas de transmissão, a localização dos genes responsáveis e as variações de determinados genes (polimorfismos) que podem influenciar o desenvolvimento da deformidade. O objetivo deste artigo é revisar e atualizar os conceitos sobre a influência genética na etiologia da escoliose idiopática do adolescente.

Einstein (São Paulo), 2014

Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in... more Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment.

Reviews, 1996

Fractures and dislocations of the spine are among the most challenging in trauma clinic practice.... more Fractures and dislocations of the spine are among the most challenging in trauma clinic practice. Although vertebral column injuries occur in approximately 6% of trauma patients, half sustain spinal cord or nerve root neurologic deficit (Burney 1993). The causes for ...

Revista Brasileira de Ortopedia, 2010

Objetivo: Comparar a amplitude de flexão e de extensão de tronco por meio de goniometria em atlet... more Objetivo: Comparar a amplitude de flexão e de extensão de tronco por meio de goniometria em atletas e não atletas, relacionando estes dados com o teste do ângulo poplíteo e dos músculos isquiotibiais. Métodos: A amplitude de flexão e extensão de tronco foi avaliada em 50 indivíduos praticantes de esporte regularmente e 50 indivíduos não atletas, os quais não apresentavam nenhum tipo de sintomatologia dolorosa lombar, bem como algum sintoma que pudesse influenciar a realização dos testes. As mensurações foram realizadas por dois examinadores independentes consecutivamente por meio de goniometria. Os valores de flexão e extensão de tronco obtidos pela avaliação da goniometria foram correlacionados com o teste do ângulo poplíteo e de flexibilidade dos isquiotibiais, analisando-se a correlação estatística entre os mesmos. Resultados: Os valores médios obtidos foram 130,7 (101,9) para flexão e 40,2 (36,4) para extensão. Verificou-se diferença estatisticamente significante entre o grupo de atletas e não atletas em relação aos parâmetros: goniômetro em flexão com o avaliador 1, goniômetro em flexão com o avaliador 2 e teste dos isquiotibiais. Não foi verificada diferença estatisticamente significante entre o grupo de atletas e não atletas em relação aos parâmetros: goniômetro em extensão com o avaliador 1, goniômetro em extensão com avaliador 2 e teste do ângulo poplíteo. Conclusão: Observa-se que a flexão do tronco apresenta valores mais elevados em indivíduos praticantes de esporte. A utilização de goniometria para mensuração de amplitude de tronco indicou valores variáveis entre os examinadores.

Revista Brasileira de Ortopedia, 2010

Scoliosis, 2010

Background: The etiology of idiopathic scoliosis remains unknown and different factors have been ... more Background: The etiology of idiopathic scoliosis remains unknown and different factors have been suggested as causal. Hereditary factors can also determine the etiology of the disease; however, the pattern of inheritance remains unknown. Autosomal dominant, X-linked and multifactorial patterns of inheritances have been reported. Other studies have suggested possible chromosome regions related to the etiology of idiopathic scoliosis. We report the genetic aspects of and investigate chromosome regions for adolescent idiopathic scoliosis in a Brazilian family.

PLoS ONE, 2014

Background: Despite the small contribution of LA in the Science Citation Index (SCI), a growing c... more 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.

Patient Safety in Surgery, 2014

The thoracolumbar region is where most fractures of the spine are located. Segmental kyphosis is ... more The thoracolumbar region is where most fractures of the spine are located. Segmental kyphosis is an important factor for treatment decisions. There are various methods for measuring segmental kyphosis in thoracolumbar fractures. Our objective was to evaluate if the experience of the surgeon has any influence on kyphosis measurement by analyzing three different categories of orthopedic surgeons and evaluate possible clinical impacts. Material and methods: Six physicians separated into three categories according to the level of experience evaluated 30 lateral view radiographs of the thoracic spine of patients with single-level fracture taken during their outpatient follow-up visits. Images had segmental kyphosis measured by five distinct methods. The x-rays were evaluated twice and in a random order after an eight-week interval. The reproducibility of the measurements was analyzed by the intraclass correlation coefficient (ICC) and its respective 95% confidence interval. Results: The intraclass correlation coefficient (ICC) was calculated to evaluate the inter-and intra-examiner reliability for each method. The methods that disregard the fractured vertebra (1 and 4) achieved the highest intra and inter-observers reliability among the participants. The measurements from methods 3 and 5 were poorly reproducible between examiners. The difference between the averages of the measurements of the five methods studied was greater than 5 degrees in methods 1 and 2, suggesting risk for patient safety. Conclusion: Methods that exclude the fractured vertebra were more reproducible for the evaluation of segmental kyphosis in thoracolumbar fractures. The evaluation of the spine fracture must be coupled with other radiographic criteria, more complex image exams and the patient's clinical state to assist the surgeon in deciding between conservative or surgical treatment. The authors suggest that the measurements should be performed by methods that exclude the fractured vertebra and conducted by experienced doctors.

Acta Ortopédica Brasileira, 2013

Objective: The I/D polymorphism of angiotensin-converting enzyme (ACE) and R577X of the α-actinin... more Objective: The I/D polymorphism of angiotensin-converting enzyme (ACE) and R577X of the α-actinin-3 (ACTN3) is related to changes in skeletal muscle function. The aim of this study was to evaluate the distribution of these polymorphisms in a family with multiple members with adolescent idiopathic scoliosis (AIS). Methods: Evaluated 25 subjects from a family with multiple members with AIS, by collecting 10mL of blood for DNA isolation. The genotyping of the I/D polymorphism of the ACE gene and the R577X of the ACTN3 gene was performed using two specific primers to classify individuals as homozygous or heterozygous. Results: Regarding the ACE polymorphism it was found that 19 (76%) subjects were DD and 6 (24%) ID. The prevalence of the D allele was 88% and the I allele was 12%. Regarding the ACTN3 polymorphism there were 6 subjects RR (24%), 11 RX (44%) and 8 XX (32%). The prevalence of the R allele was 23 (46%) and the X allele was 27 (54%). Conclusion: There was a difference between the distribution of the polymorphism of ACE and ACTN3 in the family studied. When assessing the ACE polymorphism a higher prevalence of the D allele was observed as compared with the I allele. Level of Evidence III, Cross-sectional, Clinical Trial.

Coluna/Columna, 2014

Objective: To evaluate the reliability and reproducibility of Farfan modified and Frobin methods ... more Objective: To evaluate the reliability and reproducibility of Farfan modified and Frobin methods to measure the intervertebral disc height in radiographs with inter-and intraobserver comparison. Method: Six radiographs of different patients treated for low back pain have been collected and digitized, and five lumbar disc of each patient were evaluated by six examiners with different levels of experience. The measures were done in Image Pro Plus 6.0 software. Results: When compared, both methods showed more than 95% concordance. In intraexaminer analysis, both also shown to be reliable and reproducible, with a high level of concordance. By comparing the correlation between classes of examiners, the higher the level of experience, the greater the agreement for both methods. Conclusion: Farfan modified and Frobin are reliable methods to measure the disc height in the lateral radiographs. The higher level of experience of the examiner, the higher was the correlation between measurements.