RESUMEN
Adenomyosis is associated with dysmenorrhea and chronic pelvic pain; however, the triggering mechanisms of painful stimuli and the role of uterine nerve fibers in the manifestation of pain remain poorly understood. The objective of this study was to systematically review the role of uterine nerve fibers' presence and density in the occurrence of pain in patients with adenomyosis. An electronic search was performed using the Embase, PubMed/Medline, and Cochrane databases. We included all studies from inception to November 2023. A total of ten studies that compared uterine biopsies samples of women with and without adenomyosis were included. The biomarker antiprotein gene product 9.5 was decreased or absent in the endometrium of most included women with adenomyosis. None of the included studies observed a difference in neurofilament (NF) staining between the adenomyosis and non-adenomyosis groups. Studies that assessed nerve growth factor (NGF) staining were heterogeneous in design. One study reported no difference in immunohistochemistry staining in any endometrial layer between the adenomyosis and non-adenomyosis groups, while another reported increased staining in the adenomyosis functional endometrial layer, and a third study reported overexpression of NGF, synaptophysin (SYN), and microtubule-associated protein 2 mRNA in focal adenomyosis alone. Preliminary data from poor-quality studies suggest an increase in the uterine density of nerve fibers in patients with adenomyosis. Well-designed studies are essential to assess the cause-and-effect relationship between uterine nerve fibers and pain in patients with adenomyosis.
Asunto(s)
Adenomiosis , Útero , Humanos , Femenino , Adenomiosis/metabolismo , Adenomiosis/patología , Adenomiosis/complicaciones , Útero/inervación , Útero/patología , Útero/metabolismo , Dolor Pélvico/metabolismo , Dolor Pélvico/etiología , Dolor Pélvico/patología , Nervios Periféricos/patología , Nervios Periféricos/metabolismo , Endometrio/inervación , Endometrio/metabolismo , Endometrio/patología , Dismenorrea/metabolismoRESUMEN
OBJECTIVE: Biopsies of peripheral nerve tumors (PNTs) are often used to plan an efficient treatment strategy. However, performing a biopsy is controversial when the mass is likely to be a benign PNT (BPNT). The aim of this study was to evaluate the side effects of biopsies in patients with potential PNTs. METHODS: A retrospective and cross-sectional study was conducted on 24 patients who underwent biopsy of a mass of unknown origin potentially originating from a peripheral nerve (MUOPON), performed in nonspecialty services, and who were later referred to the authors' service for resection of their lesion between January 2005 and December 2022. The patients were evaluated for pain score, presence of a motor or sensory deficit, biopsy diagnosis, and definitive histopathological postsurgical diagnosis. RESULTS: The location of the tumor was supraclavicular in 7 (29.2%) patients, in the axillary region in 3 (12.5%), in the upper limb in 7 (29.2%), and in the lower limb in 7 (29.2%). Twenty-one (87.5%) patients were evaluated by MRI before biopsy, and 3 (12.5%) underwent ultrasound. One patient did not have an examination before the procedure. Based on the biopsy findings, 12 (50%) analyses had an inconclusive histopathological result. The preexisting pain worsened, as measured 1 week after biopsy, in all patients and had remained unchanged at the first evaluation by the authors (median 3 months, range 2-4 months). In 1 case, the open biopsy had to be interrupted because the patient experienced excruciating pain. Four (16.7%) patients developed motor deficits. Subsequent surgery was hampered by scar formation and intratumoral hemorrhage in 5 (20.8%) patients. The initial diagnosis obtained by biopsy differed from the final histopathological diagnosis in all patients, of whom 21 (87.5%) had BPNTs, 2 (8.3%) malignant peripheral nerve sheath tumors, and 1 (4.2%) an ancient schwannoma. CONCLUSIONS: Biopsies of PNTs are controversial and may result in misdiagnosis, neuropathic pain, or neurological deficit due to axonal damage, and they may also hinder microsurgical resection when if performed when not indicated. Indications for biopsy of an MUOPON must be carefully considered, especially if BPNT is a possible diagnosis.
Asunto(s)
Neoplasias de la Vaina del Nervio , Neoplasias del Sistema Nervioso Periférico , Humanos , Neoplasias de la Vaina del Nervio/cirugía , Estudios Retrospectivos , Estudios Transversales , Biopsia/efectos adversos , Neoplasias del Sistema Nervioso Periférico/diagnóstico por imagen , Neoplasias del Sistema Nervioso Periférico/cirugía , Nervios Periféricos/patología , Errores Diagnósticos , DolorRESUMEN
El Schwannoma o Neurilemoma es un tumor benigno de derivación neuroectodérmica que se origina en las células de Schwann, que constituyen la envoltura de los nervios. Es el tumor benigno más común de los nervios periféricos, tiene predisposición a originarse a partir de nervios periféricos sensoriales y puede presentarse como tumores en tejidos blandos. La presentación intraósea del Schwannoma es rara y corresponde al 0,2% de los tumores óseos primarios. Se presenta caso clínico de paciente masculino de 36 años de edad con tumor en cóndilo femoral medial de rodilla derecha de 4 años de evolución, cursando con dolor intermitente moderado a quien se le practicó el protocolo oncológico, imagenológico e histológico, de la Unidad de Oncología Ortopédica del estado Monagas. Se diagnosticó Schwannoma intraóseo, se procedió a realizar resección marginal y reconstrucción con alloinjerto y fijación con placa y tornillos con excelente evolución postoperatoria. El Schwannoma intraóseo es extraordinariamente raro y su ubicación en el fémur lo es aún más. El objetivo del presente trabajo es reportar un caso de Schwannoma Intraóseo, mostrar las estrategias para su diagnóstico y los tratamientos aplicados, así como la revisión de los datos al respecto existentes en la literatura(AU)
Schwannoma or Neurilemoma is a benign tumor of neuroectodermal derivation that originates in Schwann cells, which constitute the nerve sheath. It is the most common benign tumor of the peripheral nerves, has a predisposition to originate from peripheral sensory nerves, and can present as soft tissue tumors. The intraosseous presentation of Schwannoma is rare and corresponds to 0,2% of primary bone tumors. A clinical case of a 36-yearold male patient with a tumor in the medial femoral condyle of the right knee of 4 years of evolution is presented, presenting with moderate intermittent pain who underwent the oncological, imaging and histological protocol of the Oncology Unit. Monagas State Orthopedic. Intraosseous Schwannoma was diagnosed, marginal resection and allograft reconstruction and plate and screw fixation were performed with excellent postoperative evolution. Intraosseous Schwannoma is extraordinarily rare and its location in the femur is even more so. The objective of this paper is to report a case of Intraosseous Schwannoma, show the strategies for its diagnosis and the treatments applied, as well as the review of the existing data in the literature(AU)
Asunto(s)
Humanos , Masculino , Adulto , Nervios Periféricos/patología , Neoplasias Óseas , NeurilemomaRESUMEN
Emerging evidence has revealed a cross-talk in the etiopathogenesis of burning mouth syndrome (BMS) related to peripheral nerve fibers (NF) and neuropeptides secreted by mast cells. Here, we investigated the S-100+ density and PGP 9.5+ integrity of peripheral NF and the tryptase+ mast cell density in the oral mucosa of BMS patients and healthy individuals. A total of 23 oral mucosa specimens (12 BMS and 11 controls) were evaluated. The clinical diagnosis of BMS was based on a careful examination, excluding other local and systemic causes. Samples were taken from an incisional biopsy of the tongue mucosa of individuals with symptomatic BMS, while the margins of the non-neoplastic tongue biopsy served as controls of healthy individuals. Immunohistochemistry was performed to determine the density/mm2 of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells. Similar densities of S-100+, PGP 9.5+ peripheral NF, and tryptase+ mast cells were found in cases of BMS, with a median value of 3.70, 0.70, and 29.24/mm2, respectively, and in the control group, with a median value of 2.60, 0.80, and 26.01/mm2, respectively (p > 0.05). Moreover, the relationship between S100+ and PGP 9.5+ peripheral NF was the same in both groups (p = 0.70). This study demonstrated that there were no alterations in the density and integrity of peripheral NF in the tongue of symptomatic BMS patients. However, the sensitization of peripheral NF in this disease may not depend on mast cell density.
Asunto(s)
Síndrome de Boca Ardiente , Mastocitos , Humanos , Mastocitos/patología , Síndrome de Boca Ardiente/diagnóstico , Síndrome de Boca Ardiente/etiología , Síndrome de Boca Ardiente/patología , Triptasas , Lengua , Nervios Periféricos/patologíaRESUMEN
Abstract Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; p< 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; p» 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI» 2.00-5.71; p< 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.
Resumo As lesões nervosas periféricas são uma causa importante de busca por atendimento médico. Elas ocorrem quando há a interrupção da continuidade das estruturas e do bloqueio da propagação dos impulsos nervosos, afetando a capacidade funcional dos indivíduos. Para avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos, foi realizada uma revisão sistemática da literatura. Foram incluídos artigos publicados até setembro de 2018, que se propunham avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração nervosa e neuroproteção, disponíveis nas bases de dados MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database e LILACS. A pesquisa analisou um total de 56 artigos, dos quais 22 foram para metanálise. A análise estatística sugere o efeito protetor do tacrolimus na regeneração do número de axônios mielinizados (intervalo de confiança [IC] 95%: 0,93-2,39; p< 0,01); todavia tal efeito não foi observado em relação à ciclosporina (IC95%: - 0,38-1,18; p» 0,08). Ela também sugere haver uma relação significativa entre o uso do tacrolimus e a espessura da mielina (IC95%: 2,00-5,71; p< 0,01). O uso de imunossupressores na regeneração de lesão nervosa periférica promove um aumento no número de axônios mielinizados de forma geral, independentemente da dose administrada. Além disso, garante uma maior espessura da mielina, um maior peso muscular e restabelecimento do índice da função do nervo ciático. Todavia, a heterogeneidade foi alta na maioria das análises realizadas.
Asunto(s)
Nervios Periféricos/patología , Tacrolimus/uso terapéutico , Ciclosporina/uso terapéutico , Inmunosupresores/uso terapéutico , Regeneración Nerviosa/efectos de los fármacosRESUMEN
Adult polyglucosan body disease (APBD) represents a complex autosomal recessive inherited neurometabolic disorder due to homozygous or compound heterozygous pathogenic variants in GBE1 gene, resulting in deficiency of glycogen-branching enzyme and secondary storage of glycogen in the form of polyglucosan bodies, involving the skeletal muscle, diaphragm, peripheral nerve (including autonomic fibers), brain white matter, spinal cord, nerve roots, cerebellum, brainstem and to a lesser extent heart, lung, kidney, and liver cells. The diversity of new clinical presentations regarding neuromuscular involvement is astonishing and transformed APBD in a key differential diagnosis of completely different clinical conditions, including axonal and demyelinating sensorimotor polyneuropathy, progressive spastic paraparesis, motor neuronopathy presentations, autonomic disturbances, leukodystrophies or even pure myopathic involvement with limb-girdle pattern of weakness. This review article aims to summarize the main clinical, biochemical, genetic, and diagnostic aspects regarding APBD with special focus on neuromuscular presentations.
Asunto(s)
Sistema de la Enzima Desramificadora del Glucógeno/genética , Enfermedad del Almacenamiento de Glucógeno/genética , Enfermedad del Almacenamiento de Glucógeno/fisiopatología , Enfermedades del Sistema Nervioso/genética , Enfermedades del Sistema Nervioso/fisiopatología , Adulto , Encéfalo/patología , Enfermedad del Almacenamiento de Glucógeno/patología , Humanos , Músculo Esquelético/patología , Enfermedades del Sistema Nervioso/patología , Nervios Periféricos/patología , Fenotipo , Médula Espinal/patologíaRESUMEN
Background: Malignant tumors of the peripheral nerve sheath (MTPNS`s) are considered rare tumors that can affect soft tissues. In dogs, the occurrence is more common in the nerves of the brachial plexus, but they can affect the lumbosacral plexus and cranial nerves. Rarely, they can affect spinal nerves and nerve roots and the urinary tract, especially in kidneys. The present report aims to describe a clinical case of a 10-year-old sterilized female whippet, who had a history of persistent hematuria for months, with subsequent diagnosis of MTPNS as the cause of hematuria. Case: The patient came for evaluation with a history of persistent hematuria. Evaluation of abnormal elements and sedimentation, showed the description of numerous red blood cells and the presence of proteinuria. The abdominal ultrasound revealed a left kidney with enlarged dimensions, irregular contour, loss of corticomedullary definition. The urinary vesicle showed an increase in cellularity. On physical examination, the patient had vital parameters within the normal range. A Snap 4DX® Plus exam was requested, which showed a reaction for Dirofilaria immitis. With this result, it was initially suspected that renal vasculitis. After starting the treatment, the patient started to present normal colored urine. However, after the end of this period, the patient returned to hematuria. After six months of treatment and without justification for the permanence of hematuria, urethrocystoscopy was indicated, which revealed a urinary vesicle with a hemorrhagic focus. A urinary bladder wall biopsy was performed, which showed no changes. Four months after the urethrocystoscopic exam, the patient had her first azotemic crisis. This time that the left renal neoformation observed on ultrasound examination. With the discovery of the origin of the problem, a therapeutic approach could be instituted, consisting of the left...(AU)
Asunto(s)
Animales , Femenino , Perros , Nervios Periféricos/patología , Neoplasias de la Vaina del Nervio/veterinaria , Riñón/patología , Enfermedades Renales/veterinaria , Inmunohistoquímica/veterinariaRESUMEN
Background: Malignant tumors of the peripheral nerve sheath (MTPNS`s) are considered rare tumors that can affect soft tissues. In dogs, the occurrence is more common in the nerves of the brachial plexus, but they can affect the lumbosacral plexus and cranial nerves. Rarely, they can affect spinal nerves and nerve roots and the urinary tract, especially in kidneys. The present report aims to describe a clinical case of a 10-year-old sterilized female whippet, who had a history of persistent hematuria for months, with subsequent diagnosis of MTPNS as the cause of hematuria. Case: The patient came for evaluation with a history of persistent hematuria. Evaluation of abnormal elements and sedimentation, showed the description of numerous red blood cells and the presence of proteinuria. The abdominal ultrasound revealed a left kidney with enlarged dimensions, irregular contour, loss of corticomedullary definition. The urinary vesicle showed an increase in cellularity. On physical examination, the patient had vital parameters within the normal range. A Snap 4DX® Plus exam was requested, which showed a reaction for Dirofilaria immitis. With this result, it was initially suspected that renal vasculitis. After starting the treatment, the patient started to present normal colored urine. However, after the end of this period, the patient returned to hematuria. After six months of treatment and without justification for the permanence of hematuria, urethrocystoscopy was indicated, which revealed a urinary vesicle with a hemorrhagic focus. A urinary bladder wall biopsy was performed, which showed no changes. Four months after the urethrocystoscopic exam, the patient had her first azotemic crisis. This time that the left renal neoformation observed on ultrasound examination. With the discovery of the origin of the problem, a therapeutic approach could be instituted, consisting of the left...
Asunto(s)
Femenino , Animales , Perros , Neoplasias de la Vaina del Nervio/veterinaria , Nervios Periféricos/patología , Riñón/patología , Inmunohistoquímica/veterinaria , Enfermedades Renales/veterinariaAsunto(s)
Células Intersticiales del Testículo , Células de Sertoli , Tumor de Células de Sertoli-Leydig/diagnóstico , Tumores de los Cordones Sexuales y Estroma de las Gónadas , Neoplasias Testiculares , Testículo , Adulto , Vasos Sanguíneos/patología , Humanos , Inmunohistoquímica , Hallazgos Incidentales , Células Intersticiales del Testículo/metabolismo , Células Intersticiales del Testículo/patología , Imagen por Resonancia Magnética/métodos , Masculino , Estadificación de Neoplasias , Orquiectomía/métodos , Nervios Periféricos/patología , Pronóstico , Células de Sertoli/metabolismo , Células de Sertoli/patología , Tumores de los Cordones Sexuales y Estroma de las Gónadas/diagnóstico , Tumores de los Cordones Sexuales y Estroma de las Gónadas/patología , Tumores de los Cordones Sexuales y Estroma de las Gónadas/cirugía , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugía , Testículo/diagnóstico por imagen , Testículo/patología , Testículo/cirugía , Carga TumoralRESUMEN
BACKGROUND: Fibrosis in the peripheral nerve is the end stage of leprous neuropathy and the cause of the resulting permanent neural function impairments. Preventive measures to avoid this irreversible pathological state are a relief strategy for leprosy sufferers. OBJECTIVES: The present study describes the frequency of fibrosis along with its characterisation and pathogenic development. METHODS: Six-hundred-and-thirteen nerve samples were sorted from 278 neural leprosy (NL) and 335 non-leprosy neuropathy patients (ON). The total number of samples was histologically examined by routine staining methods (haematoxylin-eosin, Wade staining and Gomori's trichrome) and fibrosis was evaluated via semi-quantitative estimation. FINDINGS: Fibrosis was most frequent in the NL group (33% against 0.4% in ON) while fibrosis in association with endoneurial microfasciculation was found in 38 (41.3%) of the NL samples in the examination of semithin sections. Pericytic activation in the perivascular environment was confirmed to be the source of the fibroblasts and perineurial cells delimiting microfascicles. End-stage fibrosis in leprosy displays an arrangement of microfascicles devoid of neural components (i.e., Schwann cells and axons) lined by an intermediate phenotype of fibroblastic-perineurial cells filled with bundles of collagen fibres. MAIN CONCLUSIONS: The present study underscores that fibrosis is frequently the severe end stage of neural leprosy NL pathogeny after analysing the notably distinct development of fibrosis within the neural environment.
Asunto(s)
Fibrosis/patología , Lepra Tuberculoide/patología , Nervios Periféricos/patología , Biopsia , Humanos , Inmunohistoquímica , Enfermedades del Sistema Nervioso Periférico/patología , Células de Schwann/patologíaRESUMEN
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This disease is characterized by skin and peripheral nerve trunk damage. The mechanisms responsible for the observed nerve damage in leprosy could be directly related to the ability of M. leprae to infect Schwann cells, leading to triggering of signaling events. Therefore, we hypothesize that in response to M. leprae infection, activation of the Notch signaling pathway in Schwann cells could play a crucial role in glial cell dedifferentiation. On the other hand, nerve damage evidenced in this disease may be additionally explained by indirect mechanisms such as the immune response and genetic susceptibility of the host. The understanding of the mechanisms leading to nerve damage induced by M. leprae infection will allow us to generate valuable tools for the early detection of leprosy as well as for the mitigation of the effects of this disabling disease.
Asunto(s)
Lepra/patología , Mycobacterium leprae/patogenicidad , Nervios Periféricos/patología , Células de Schwann/microbiología , Humanos , Neuroglía/patología , Receptores Notch/metabolismo , Transducción de SeñalRESUMEN
Axonal Charcot-Marie-Tooth disease (CMT) represents an expanding group of inherited motor and sensory neuropathies in clinical practice. SACS-gene related disorders have been associated with complex neurological phenotypes of early-onset cerebellar ataxia, spastic-ataxia, spastic paraplegia, demyelinating neuropathy and variable ophthalmological, cognitive and psychiatric disturbances, but never related to pure axonal neuropathy phenotypes. Two unrelated Brazilian men with early-onset axonal CMT-like presentations associated with SACS gene mutations are presented. Both patients presented with pure sensorimotor axonal neuropathy without cerebellar ataxia, spastic paraplegia or other systemic and neurological involvement. Classical neuroimaging findings observed in other sacsinopathies were observed in both cases. Homozygous pathogenic mutations were found in SACS gene in both patients. SACS gene mutations can be associated with pure axonal sensorimotor neuropathy without other neurological features, but with typical neuroimaging features of other sacsinopathies, disclosing the importance of performing neuroimaging studies in patients with suspected axonal CMT.
Asunto(s)
Enfermedad de Charcot-Marie-Tooth/genética , Proteínas de Choque Térmico/genética , Mutación , Adulto , Encéfalo/diagnóstico por imagen , Enfermedad de Charcot-Marie-Tooth/diagnóstico por imagen , Enfermedad de Charcot-Marie-Tooth/patología , Enfermedad de Charcot-Marie-Tooth/fisiopatología , Diagnóstico Diferencial , Humanos , Masculino , Nervios Periféricos/patología , Nervios Periféricos/fisiopatología , Fenotipo , Adulto JovenRESUMEN
BACKGROUND: Lymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). As minimally invasive treatments are considered appropriate for EGC, and lymphadenectomy may be restricted or even eliminated in some cases; it is imperative to identify the main risk factors for LNM to individualize the therapeutic approach. This study aims to evaluate the risk factors for LNM in EGC and to determine the adequacy of the endoscopic resection criteria in a western population. METHODS: EGC patients who underwent gastrectomy with lymphadenectomy were retrospectively analyzed utilizing a prospective database. The clinicopathological variables were assessed to determine which factors were associated to LNM. RESULTS: Among 474 enrolled patients, 105 had EGC (22.1%). LNM occurred in 13.3% of all EGC (10% T1a; 15.4% T1b). Tumor size, venous, lymphatic, and perineural invasions were confirmed as independent predictors of LNM by multivariate analysis. Expanded criteria were safely adopted only in selected cases, and 13.6% of patients who matched expanded indication had LNM. CONCLUSIONS: Tumor size, venous, lymphatic, and perineural invasions were associated with LNM and should be considered as surrogate markers for surgical treatment of EGC. Expanded criteria for endoscopic resection can be safely adopted only in selected cases.
Asunto(s)
Gastrectomía , Escisión del Ganglio Linfático , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Vasos Sanguíneos/patología , Resección Endoscópica de la Mucosa , Femenino , Humanos , Metástasis Linfática , Vasos Linfáticos/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Nervios Periféricos/patología , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Carga TumoralRESUMEN
O presente trabalho elucida o caso clínico de uma paciente em tratamento na Divisão de Reabilitação do Instituto Lauro de Souza Lima por consequência da dor neuropática hansênica em ambos os pés. Essa circunstância a remeteu a condições emocionais e psíquicas de difícil compreensão, a manifestação da dor no corpo passou a apresentar correspondências subjetivas e inconscientes, fazendo emergir com isso sofrimentos psíquicos frente á dor. Sendo assim, tivemos como objetivo geral investigar e compreender as manifestações emocionais presentes no seu discurso, e como específico analisar qual a relação estabelecida entre os processos subjetivos e a presença da dor neuropática. Nossa proposta foi embasada na metodologia de estudo de caso, apoiada no referencial teórico psicanalítico em que se evidenciou uma construção de elementos para uma investigação analítica. Concluímos nesse contexto que ocorreram rupturas nos investimentos narcísicos, no âmbito das relações afetivas, que intensificam a relação conflitiva entre o eu-corpo-dor. E quando esses conteúdos emergem à consciência, proporcionam elaboração psíquica e recursos para lidar com as dores do eu
The present study elucidates the clinical case of a patient undergoing treatment in the Rehabilitation Division of the "Lauro de Souza Lima" Institute due to leprosy neuropathic pain in both feet. This circumstance referred to emotional and psychic conditions of difficult comprehension, the manifestation of pain in the body began to present subjective and unconscious correspondences, thus causing psychic sufferings in the face of pain. Thus, we had as general objective to investigate and understand the emotional manifestations present in his discourse, and how specific to analyze the relationship established between the subjective processes and the presence of neuropathic pain. Our proposal was based on the methodology of a case study, based on the theoretical psychoanalytical framework in which a construction of elements for an analytical investigation was evidenced. We conclude in this context that there are ruptures in narcissistic investments, in the ambit of affective relations that intensify the conflicting relationship between the body-pain-self. And when these contents are presented to the conscious light, they provide psychic elaboration and resources to deal with the pains of the self
Asunto(s)
Humanos , Femenino , Anciano , Lepra/complicaciones , Lepra/psicología , Neuralgia/psicología , Nervios Periféricos/patología , Teoría PsicoanalíticaRESUMEN
A hanseníase é uma das maiores causas de complicações neuropáticas no mundo. Dentre estas, estão as úlceras neuropáticas, consideradas uma das causas mais comuns de amputações, morbidade e mortalidade, consequência de uma assistência à saúde embasada em procedimentos fragmentados com baixa resolutividade. Estudo de delineamento metodológico, com abordagem quali-quantitativa dos dados, que objetivou desenvolver um vídeo para intervenção educativa sobre avaliação para manejo da úlcera neuropática associada à hanseníase, a ser disponibilizado a enfermeiros. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa e foi realizada em 4 etapas: 1: Produção do roteiro e storyboard; 2:Validação do roteiro e storyboard; 3: Edição do vídeo e 4: Estudo piloto. A produção do conteúdo do roteiro e storyboard seguiu as recomendações do Ministério da Saúde e da Wound, Ostomy and Continence Nurses. A validação de conteúdo e aparência foi realizada por um comitê de especialistas. O instrumento apresentou os seguintes quesitos: objetivo; conteúdo; relevância; ambiente; funcionalidade, usabilidade e eficiência, os quais foram considerados validados a partir da concordância de 78% entre os avaliadores, calculada por meio do Índice de Validade de Conteúdo. Entre os especialistas na temática, houve maior prevalência do sexo feminino (88,9%), com idade entre 29 e 62 anos (média de 42,3 anos e desvio padrão de 11,0 anos), sendo a maior titulação acadêmica o doutorado (55,6%), e tempo de atuação profissional entre seis e 30 anos (média de 14,9 anos e desvio padrão de 8,2 anos). Dos especialistas em vídeo, a maioria era do sexo feminino (62,5%), com idade entre 30 e 46 anos (média de 37,5 anos e desvio padrão de 6,4 anos), com maior número de mestres (50%) e tempo de atuação profissional entre 2 e 24 anos (média de 10,8 anos e desvio padrão de 7,3 anos). Para todos os quesitos avaliados, obteve-se um Índice de Validade de Conteúdo superior ao mínimo preconizado. Após a adequação do roteiro e storyboard em face da validação, o vídeo foi gravado e, a partir de uma préedição, um estudo piloto (validação semântica) foi realizado por meio da técnica de grupo focal, com a participação de nove enfermeiros que atuavam na assistência à pessoa com hanseníase. Houve prevalência do sexo feminino (88,9%), com idade entre 29 e 50 anos e maior titulação acadêmica em nível de mestrado (55,6%), sendo que a maioria (55,6%) atuava na Estratégia Saúde da Família. A partir da análise de conteúdo do grupo focal, emergiram as categorias: dialogar sobre os objetivos propostos; identificar a aplicabilidade do vídeo na prática clínica do enfermeiro e valorizar a consulta de enfermagem na avaliação de pessoas com úlcera neuropática associada à hanseníase. Acredita-se que o vídeo educativo validado poderá auxiliar na realização de uma avaliação de enfermagem eficaz, segura e com qualidade à pessoa com úlcera neuropática decorrente da hanseníase
Leprosy is one of the major causes of neuropathic complications in the world. Among the complications most commonly found are neuropathic ulcers, considered one of the most common causes of amputations, morbidity and mortality in the world, as a consequence of health care based on fragmented procedures with low resolution. This is a methodological design study with qualitative and quantitative data, aiming to develop a video for educational intervention on evaluation for the management of neuropathic ulcer associated with leprosy, to be made available to nurses. The research was approved by the Research Ethics Committee and was carried out in 4 stages: 1: Production of the script and storyboard; 2: Script and storyboard validation; 3: Video editing and 4: Pilot study. The production of script content and storyboard followed the recommendations of the Ministry of Health and Wound, Ostomy and Continence Nurses. Validation of content and appearance was performed by a committee of experts. The instrument presented the following requirements: objective; content; relevance; environment; functionality, usability and efficiency, which were considered validated from the agreement of 78% between the evaluators, calculated through the Content Validity Index Among the specialists in the subject, there was a higher prevalence of female (88.9%), aged between 29 and 62 years (mean of 42.3 years and standard deviation of 11.0 years), the highest academic qualification being the doctoral degree (55.6%), and professional performance time between six and 30 years (mean of 14.9 years and standard deviation of 8.2 years). Of the video specialists, the majority were female (62.5%), aged between 30 and 46 years (mean of 37.5 years and standard deviation of 6.4 years), with a greater number of masters (50%) and time of professional activity between 2 and 24 years (mean of 10.8 years and standard deviation of 7.3 years). For all evaluated items, a Content Validity Index higher than the recommended minimum was obtained. After the adaptation of the script and storyboard in the face of validation, the video was recorded and, from a pre-edition, a pilot study (semantic validation) was performed through the focal group technique, with the participation of nine nurses who assisted the person with leprosy. There was a prevalence of females (88.9%), aged between 29 and 50 years, and a higher academic degree at the master's level (55.6%), with the majority (55.6%) working in the Family Health Strategy. From the content analysis of the focus group, the following categories emerged: dialogue about the proposed objectives; to identify the applicability of the video in the clinical practice of the nurse and to value the nursing consultation in the evaluation of people with neuropathic ulcer associated with leprosy. It is believed that the validated educational video can help in the performance of an effective, safe and quality nursing assessment to the person with neuropathic ulcer due to leprosy
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Humanos , Nervios Periféricos/patología , Heridas y Lesiones/enfermería , Educación en Enfermería , Lepra/complicacionesRESUMEN
BACKGROUND: Leprosy neuropathy is considered the most common peripheral neuropathy of infectious etiology worldwide, representing a public health problem. Clinical diagnosis of primary neural leprosy (PNL) is challenging, since no skin lesions are found and the slit skin smear bacilloscopy is negative. However, there are still controversial concepts regarding the primary-neural versus pure-neural leprosy definition, which will be explored by using multiple clinical-laboratory analyses in this study. METHODOLOGY/PRINCIPAL FINDINGS: Seventy patients diagnosed with primary neural leprosy from 2014 to 2016 underwent clinical, laboratorial and neurophysiological evaluation. All patients presented an asymmetric neural impairment, with nerve thickening in 58.6%. Electroneuromyography showed a pattern of mononeuropathy in 51.4%. Positivity for ELISA anti-PGL1 was 52.9%, while the qPCR of slit skin smear was 78.6%. The qPCR of nerve biopsies was positive in 60.8%. Patients with multiple mononeuropathy patterns showed lower levels of anti-PGL-1 (p = 0.0006), and higher frequency of neural thickening (p = 0.0008) and sensory symptoms (p = 0.01) than those with mononeuropathy. CONCLUSIONS/SIGNIFICANCE: PNL is not a synonym of pure neural leprosy, as this condition may include a generalized immune response and also a skin involvement, documented by molecular findings. Immunological, molecular, and neurophysiological tools must be implemented for diagnosing primary neural leprosy to achieve effective treatment and reduction of its resultant disabilities that still represent a public health problem in several developing nations. Finally, we propose a algorithm and recommendations for the diagnosis of primary neural leprosy based on the combination of the three clinical-laboratorial tools.
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Lepra Tuberculoide/patología , Enfermedades del Sistema Nervioso Periférico/patología , Adulto , Algoritmos , Brasil , Femenino , Humanos , Lepra Tuberculoide/complicaciones , Lepra Tuberculoide/diagnóstico , Masculino , Persona de Mediana Edad , Mycobacterium leprae , Nervios Periféricos/patología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/etiología , Reacción en Cadena en Tiempo Real de la Polimerasa , Piel/patologíaRESUMEN
Angiotensin-(1-7) (Ang [1-7]) and its receptor Mas are involved in a number of physiological processes, including control of arterial pressure and modulation of nervous system actions. However, the involvement of the Ang-(1-7)/Mas axis in peripheral nerve injury has not been investigated. Using a model of sciatic nerve injury in mice, we demonstrated opposing changes in Mas receptor expression at days 2 and 14 post-injury. Mas receptor expression was more intense 2days after the nerve lesion, compared with the intensity of the intact nerve. At this time point, the sciatic nerve functional index was -20. At day 14 after the lesion, the intensity of the immunostaining labeling in longitudinal sections of the nerve was reduced (â¼30%) and the functional index increased +36 (gait improvement). In the axotomized group treated with A779 (a Mas receptor antagonist), the functional recovery index decreased in relation to the untreated axotomized group. The Mas receptor inhibitor also altered the intensity of labeling of S-100, GAP43, and IBA-1 (morphological features compatible with delayed axon growth). This study demonstrated that Ang-(1-7)/Mas axis activity was differentially modulated in the acute and post-acute stages of nerve injury.
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Nervios Periféricos/efectos de los fármacos , Nervios Periféricos/metabolismo , Proteínas Proto-Oncogénicas/metabolismo , Receptores Acoplados a Proteínas G/metabolismo , Neuropatía Ciática/metabolismo , Angiotensina II/análogos & derivados , Angiotensina II/farmacología , Animales , Proteína GAP-43/metabolismo , Masculino , Ratones , Fragmentos de Péptidos/farmacología , Nervios Periféricos/patología , Proto-Oncogenes Mas , Proteínas Proto-Oncogénicas/antagonistas & inhibidores , Receptores Acoplados a Proteínas G/antagonistas & inhibidores , Proteínas S100/metabolismoRESUMEN
Familial amyloid polyneuropathy was first described by Corino de Andrade in 1952 in Northern Portugal. It is a fatal autosomal dominant neurodegenerative disorder characterized by a progression of neurologic symptoms, beginning early in the reproductive life. The Transthyretin gene mutation originates a mutated protein that precipitates in the connective tissue as amyloid deposits. This disease is presently named Transthyretin-related hereditary amyloidosis. We performed an extensive review on this disease based on searches in Medical databases and in paper references. In this review, we briefly summarize the epidemiology and the mechanisms involved on amyloid deposition; we detailed how to evaluate the mechanisms implicated on the development of the major signs and symptoms associated with reproductive dysfunction; and we discuss the mechanisms involved in secondary sexual dysfunction after psychological treatments. Treatment of the disease is directed towards relieving specific symptoms in association with liver transplant, and molecular and genetic therapeutics. Although the current clinical trials indicate symptoms relief, no data on the reproductive function was reported. Thus, preimplantation genetic diagnosis is presently the only available technique that eradicates the disease as it avoids the birth of new patients.
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Neuropatías Amiloides Familiares , Diagnóstico Preimplantación , Adulto , Femenino , Humanos , Masculino , Mutación , Nervios Periféricos/patología , Prealbúmina/genéticaRESUMEN
Preventing damage caused by nerve degeneration is a great challenge. There is a growing body of evidence implicating extracellular nucleotides and their P2 receptors in many pathophysiological mechanisms. In this work we aimed to investigate the effects of the administration of Brilliant Blue G (BBG) and Pyridoxalphosphate-6-azophenyl-2', 4'- disulphonic acid (PPADS), P2X7 and P2 non-selective receptor antagonists, respectively, on sciatic nerve regeneration. Four groups of mice that underwent nerve crush lesion were used: two control groups treated with vehicle (saline), a group treated with BBG and a group treated with PPADS during 28days. Gastrocnemius muscle weight was evaluated. For functional evaluation we used the Sciatic Functional Index (SFI) and the horizontal ladder walking test. Nerves, dorsal root ganglia and spinal cords were processed for light and electron microscopy. Antinoceptive effects of BBG and PPADS were evaluated through von Frey E, and the levels of IL-1ß and TNF-α were analyzed by ELISA. BBG promoted an increase in the number of myelinated fibers and on axon, fiber and myelin areas. BBG and PPADS led to an increase of TNF-α and IL-1ß in the nerve on day 1 and PPADS caused a decrease of IL-1ß on day 7. Mechanical allodynia was reversed on day 7 in the groups treated with BBG and PPADS. We concluded that BBG promoted a better morphological regeneration after ischiatic crush injury, but this was not followed by anticipation of functional improvement. In addition, both PPADS and BBG presented anti-inflammatory as well as antinociceptive effects.