Introduction Odontoid diameter in some individuals may not be large enough to accommodate two 3.5-mm cortical screws for anterior odontoid fracture fixation. The study was performed to evaluate, in a Brazilian population, the diameter of the odontoid process and the feasibility of using two 3.5-mm cortical screws for anterior odontoid fracture fixation. Materials and methods Computed tomographic (CT) scans of 88 adult patients (aged 18-78 years) were analyzed; 40 patients (45%) were male (mean age: 43.08 years) and 48 (55%) were female (mean age: 43.39 years). The minimum external and internal anteroposterior and transverse diameters of the odontoid process on sagittal and coronal planes were measured on CT multiplanar reconstructions of the cervical spine. Results The mean value of the minimum external anteroposterior diameter was 10.83 ± 1.08 and 7.53 ± 1.10 mm for the minimum internal anteroposterior diameter. The mean value of the minimum external transverse diameter was 9.19 ± 0.91 and 6.07 ± 1.08 mm for the minimum internal transverse diameter. The mean AP diameter was significantly larger than the mean transverse diameter; 57 (65%) individuals had the minimum external transverse diameter [9.0 mm that would allow the insertion of two 3.5-mm cortical screws with tapping, and five (6%) individuals had the minimum internal transverse diameter [8.0 mm that would allow the insertion of two 3.5-mm cortical screws without tapping. Conclusions The insertion of two 3.5-mm cortical screws was possible for anterior fixation of odontoid fracture in 57 (65%) individuals of our study, and there was no statistical difference between males and females.

A ultra-sonografia e o Doppler representaram grande marco no diagnóstico da hipertensão portal. Este fato decorre do aspecto não-invasivo destes métodos, possibilitando o estudo do fígado, do baço e da circulação esplâncnica. Neste artigo os autores discutem alguns aspectos importantes avaliados pela ultra-sonografia e pelo Doppler na avaliação da hipertensão portal. Unitermos: Hipertensão portal; Fígado; Ultra-sonografia; Doppler. Doppler evaluation in portal hypertension.Ultrasonography and Doppler ultrasonography have dramatically improved the diagnosis of portal hypertension thanks to the noninvasive visualization of the liver, spleen and splanchnic blood flow. In this article the authors discuss some important issues raised by the use of ultrasound and Doppler in the evaluation of portal hypertension.

Study Design: Multicentric retrospective study, Level of evidence III. Objective: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. Methods: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. Results: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). Conclusion: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

OBJETIVO: avaliar se existe relação entre o número de parafusos pediculares (densidade de parafusos) e o percentual de correção da curva principal no tratamento cirúrgico das escolioses neuromusculares. MÉTODOS: foram avaliados, retrospectivamente, 55 pacientes portadores de escoliose neuromuscular submetidos ao tratamento cirúrgico por meio de artrodese exclusivamente pela via posterior. Foram analisados o valor da curva pré-operatória, o percentual de correção e o valor da curva pós-operatória nas radiografias no pré-operatório e no pós-operatório imediato. Foi calculada a densidade de parafuso (número de parafusos por pedículo na área correspondente à curva principal) e avaliada a sua relação com o percentual de correção pela análise de correlação de Spearman. RESULTADOS: dos 55 pacientes, 28 (51%) eram do sexo feminino e 27 (49%) do masculino, com média de idade de 16,04 anos (dp=4,45). A doença de base mais frequente foi a paralisia cerebral. O valor da escoliose pré-operatória foi, em média, de 81,96º (dp=25,49) e da escoliose residual de 33,82º (dp=19,02), com percentual de correção de 60,28% (dp=15,89). Houve uma relação positiva (r=0,266) e estatisticamente significante entre a densidade de parafusos e a correção da deformidade (p=0,045). CONCLUSÕES: no tratamento cirúrgico das deformidades neuromusculares existe uma relação positiva entre o maior número de parafusos dentro da área da curva principal e o percentual de correção.

Objective : To develop a consensus for translation of the most relevant terms used in the study of Adult Spinal Deformity, from their original languages into Brazilian Portuguese. Methods : A panel of 12 experts in spine surgery from the five Brazilian regions was constituted. To obtain the standardization of terminology, the Delphi method with an electronic questionnaire was administered to participants about their opinion on the translation of 13 relevant terms chosen by literature review. Each term was considered standard when there was consensus, that is, concordance higher than 80% among participants as to the suggestion to be adopted, and then on the acceptance of the term and its abbreviation in Portuguese. Results : Initially there was consensus (over 80% concordance) on the translation of seven terms in the electronic questionnaire. The other six terms that have not reached consensus were discussed at a meeting among the participants, relying on the opinion of a specialized professional in simultaneous translation of orthopedic terms in Portuguese and other professional majored in Portuguese language. It was decided how these terms should be translated and there was a consensus among all participants regarding their acceptance. Finally, there was consensus among the participants, who agreed with the translation and abbreviation of the 13 propose terms, defining its standardization for Brazilian Portuguese. Conclusion : We present a standard terminology used in the study of Adult Spinal Deformity through consensus among experts, seeking uniformity in the use of these terms in Brazilian Portuguese.

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ResumoA degeneração discal é uma condição que compromete as funções do disco intervertebral, podendo levar a vários processos patológicos importantes, como hérnias discais e estenoses de canal. Apesar de sua etiologia ainda ser desconhecida, cada vez mais estudos têm demonstrado o papel preponderante de fatores genéticos em detrimento de fatores ambientais. Com o objetivo de revisar o conhecimento atual sobre os genes associados à degeneração do disco intervertebral, foi realizada uma revisão narrativa da literatura inglesa nos últimos 10 anos sobre o tema. Concluímos que há uma série de genes que foram associados à degeneração discal em seres humanos, incluindo genes codificando colágeno I α-1 (COL1A1), colágeno IX (COL9A2 e COL9A3), colágeno XI (COL11A2), interleucina 6 (IL-6), agrecano (AGC1), receptor de vitamina D (VDR), metaloproteinase de matriz 3 (MMP-3), além de microRNAs. Dessa forma, a presente revisão enfatiza os últimos avanços na associação de genes com fenótipos de discos degenerados específicos, polimorfismos de nucleotídeos únicos, hereditariedade e interações genético-ambientais em relação à degeneração discal, com o intuito de permitir ao clínico entender esse mecanismo de degeneração e estar preparado para as novas terapêuticas que estão por vir baseadas na genética.

169The autonomic nervous system (ANS) plays a fundamental role in the control of arterial blood pressure and heart rate, and, therefore, may be considered an important pathophysiologic factor in the development of arterial hypertension 1 . Currently, the status of autonomic action of the heart may be known through the study of heart rate variability. Heart rate varies per beat as a consequence of the constant adaptations promoted by the ANS to maintain cardiovascular system balance. These alterations may be assessed through the variations in R-R intervals, therefore, constituting the heart rate variability 2 . The integration between the sympathetic and parasympathetic modulations determines heart rate variability 3 . As a research tool, assessment of heart rate variability has provided a better understanding of the participation of the ANS in different physiological and pathological situations of the cardiovascular system. The assessment of heart rate variability has stimulated a large number of observations, indicating the potential value of that approach in the diffusion of knowledge about the alterations in the mechanisms of blood pressure control involved in hypertension 4-6 .The existence of sympathetic hyperactivity has been frequently associated with arterial hypertension 7,8 . Evidence exists indicating that the sensitivity of baroreceptor control, impaired in some hypertensive individuals 9-11 , involves mainly parasympathetic mechanisms 12-14 .Although several studies indicate that sympathetic and parasympathetic alterations are simultaneously involved in the pathogenesis and development of arterial hypertension, the results obtained using heart rate variability are controversial. Populationbased studies have reported reduced heart rate variability in patients with long-term arterial hypertension, despite treatment with antihypertensive drugs 15 . However, one does not know whether abnormal autonomic cardiovascular regulation is a primary characteristic preceding the onset of hypertension, or whether it may be reversed with antihypertensive therapy. In addition, it is not known whether the improvement in autonomic regulation is related to a reduction in blood pressure or whether it is an immediate effect of the drug 16 . The present study aimed at analyzing and comparing heart rate variability in normotensive and hypertensive individuals and at observing the behavior of the ANS after administration of ACE inhibitors to these hypertensive patients. Original Article Analysis of Heart Rate Variability in Hypertensive Patients Before and After Treatment with Angiotensin II-Converting Enzyme Inhibitors ResultsThe SDNN and PNN50 parameters (TD), and the LF spectrum (FD)