To assess the therapeutic value of a dopaminergic drug on abnormal ACTH secretion, we studied the effect of bromocriptine during short and long-term treatment in nine patients with active pituitary-dependent Cushing's syndrome. The single oral dose effect of bromocriptine (2.5 mg at 0800 h) on ACTH samples obtained every half hour for 3 h, was studied in six patients with Cushing's disease; in no case was suppression of ACTH observed. In five patients, the effect of bromocriptine was also investigated after its administration for two consecutive days (5 mg/d) with plasma samples taken every half hour for 12 h; in three cases no suppression of plasma ACTH was observed, while the other two showed a significant decrease. Three of our patients (a nonresponder to the single dose, a responder to the two-day treatment, and an untested patient) were subjected to prolonged bromocriptine administration (2-45 months). In the first two patients only, biochemical data and clinical symptoms showed improvement, while the other patient showed only initial benefit. These data show that bromocriptine may occasionally reduce ACTH secretion in pituitary-dependent Cushing's syndrome, and that a single oral dose bromocriptine test fails to identify the patients who will benefit from this treatment.

Objectives: Given the small amount of information regarding the pathological and degenerative changes of the spine, this study was carried out in order to evaluate and quantify the angular values of sagittal balance in the obese population. Methods: We measured the angles of pelvic incidence (PI), pelvic version (PV) and sacral slope (SS). Results: We evaluated 30 patients, 19 females and 11 males, in 2012, who were to be submitted tobariatric surgery. The mean age was 33 years old. The mean BMI was 41 kg/m2, the mean value for men being 43 kg/ m2 and 39 kg/m2 for women. The mean PI was 57°. The PV was 19°. The DS was 38°. The value of pelvic incidence and pelvic version was on average higher than those found in people with normal body mass index. Regarding the sacral slope the value were the same of those of the normal population. Conclusions: Increasingly the sagittal balance has gained importance in the evaluation of the spine. It is necessary further literature and increasing medical knowledge of diseases and comorbidities that may alter sagittal balance in patients, such as obesity.Keywords: Obesity; Postural balance; Posture; Pelvis; Body mass index. RESUMO Objetivo: Tendo em vista a pouca quantidade de informações a respeito das alterações degenerativas e patológicas da coluna vertebral realizou-se este estudo com objetivo de avaliar e quantificar os valores angulares do equilíbrio sagital na população obesa. Métodos: Foram medidos os ângulos de incidência pélvica (IP), versão pélvica (VP) e declive sacral (DS

Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

Spondylodiscitis due to Candida is a rare complication from hematogenic dissemination of infection caused by this fungus. We present an atypical case of spondylodiscitis caused by this germ that occurred after chest contusion and progressed with necrotizing fasciitis of the anterior region of the chest and osteomyelitis of the sternum. Through contiguity, it also affected the upper thoracic spine. The patient evolved with neurological alterations and recovered satisfactorily after appropriate treatment with surgical decompression of the spinal cord and specific antibiotic therapy.

Como citar este artigo: Kulcheski ÁL, et al. Espondilodiscite fúngica por Candida albicans: um caso atípico e revisão da literatura. Rev Bras Ortop. 2015. http://dx.doi.org/10.1016/j.rbo.2015.04.016 No. of Pages 4 r e v b r a s o r t o p . 2 0 1 5;x x x(x x):xxx-xxx w w w . r b o . o r g . b r Relato de caso Espondilodiscite fúngica por Candida albicans: um caso atípico e revisão da literatura ଝ informações sobre o artigo Histórico do artigo: Recebido em 18 de agosto de 2014 Aceito em 14 de novembro de 2014 On-line em xxx Palavras-chave: Candida albicans Discite Doenças da coluna vertebral r e s u m o A espondilodiscite por Candida albicans é uma rara complicação da disseminação hematogênica da infecção por esse fungo. Apresentamos um caso atípico de espondilodiscite por esse germe ocorrido após trauma contuso torácico que cursou com fasceíte necrotizante da região anterior do tórax, osteomielite de esterno e, por contiguidade, afetou a coluna vertebral torácica alta. O paciente evoluiu com alteração neurológica e recuperou--se satisfatoriamente após tratamento adequado com descompressão medular cirúrgica e antibioticoterapia específica. Discitis Spinal diseases a b s t r a c t Spondylodiscitis due to Candida is a rare complication from hematogenic dissemination of infection caused by this fungus. We present an atypical case of spondylodiscitis caused by this germ that occurred after chest contusion and progressed with necrotizing fasciitis of the anterior region of the chest and osteomyelitis of the sternum. Through contiguity, it also affected the upper thoracic spine. The patient evolved with neurological alterations and recovered satisfactorily after appropriate treatment with surgical decompression of the spinal cord and specific antibiotic therapy ARTICLE IN PRESS