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Introduction The neurosurgical practice often involves situations that require rapid and immediate decisionmaking, and a very lowmargin for error may eventually lead to an unsatisfactory clinical outcome. Thus, neurosurgery is considered as a medical specialty with high risk for the occurrence of litigation for supposed malpractice. The main objective of the present study was to identify the most prevalent epidemiological profile of the authors of civil claims for alleged malpractice against neurosurgeons, as well as to identify the legal strategies most commonly employed in this type of lawsuit. Methods This is a descriptive, retrospective and quantitative study, with review of the initials/exordials of all civil actions motivated by alleged malpractice against neurosurgeons, defended by an office specialized in Medical Law, from 2008 to 2018. Data were collected relative to the author of the action; the disease that led to the outbreak of the action; and some legal information of interest for the outcome of the litigation. Results During the period studied, 16 compensation/eviction claims were identified as being motivated by supposed neurosurgical malpractice. The average age of the authors was 51 years old; with a high school or undergraduate level of education in 75% of the cases, and especially from the Class B social extract (43%). Degenerative affections of the lumbar spine (12 cases, 75%) were the most common diseases that motivated the litigation, followed by brain tumors (2 cases, 12.5%), 1 case of carpal tunnel syndrome, and 1 case of chronic pain due to inflammatory radiculitis. The average value of the sponsored claim was 649,000.00 reais. Justice gratuity was granted in 80% of the cases and the reversal of the burden of proof by 30%. The main documentary evidence was medical reports from third parties or the surgeon him/herself, and medical records.
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Brasil/epidemiologia , Erros Médicos/legislação & jurisprudência , Decisões Judiciais , Neurocirurgiões/ética , Epidemiologia Descritiva , Estudos Retrospectivos , Imperícia , Neurocirurgia/éticaRESUMO
RESUMEN Introducción: la educación médica en el siglo XXI plantea la necesidad de un nuevo proceso docente educativo, que se fundamente en los principios de la excelencia, calidad y pertinencia. Objetivo: elaborar una estrategia didáctica para el perfeccionamiento del proceso docente educativo de la enseñanza de la investigación cualitativa, que contribuya al desempeño de los estudiantes de la carrera Licenciatura en Enfermería en concordancia con la función investigativa del modelo del profesional. Métodos: se utilizó como método empírico la observación, y el análisis documental. Como método estadístico la estadística descriptiva. Resultados: Se evidencia la concordancia de los criterios de los expertos seleccionados con los autores revisados, en la que se le atribuye una gran importancia al papel de la investigación cualitativa como la herramienta para la construcción de la Enfermería como disciplina y profesión social. Conclusiones: dicha estrategia contribuye al perfeccionamiento desde lo instructivo, educativo y desarrollador del proceso docente educativo, a la vez que permite la incorporación de habilidades investigativas al desempeño profesional.
ABSTRACT Introduction: medical education in the 21st century poses the need for a new teaching-learning process, based on the principles of excellence, quality and relevance. Therefore, this research proposes how to improve the teaching-learning process of the qualitative research so that it contributes to the performance of students in the Nursing major in accordance with the research function of the professional model. Objective: to develop a didactic strategy for the improvement of the teaching-learning process of qualitative research in order to contribute to the performance of students in the Nursing major in accordance with the research function of the professional model. Methods: observation and documentary analysis as an empirical method. Descriptive statistics was applied as a statistical method. Results: the results of the evaluation of the experts, as indicators that define the strategic actions considered in order to be implemented in the strategy proposed, which demonstrates the agreement of the criteria of the chosen experts with the reviewed authors, where a great importance is attributed to the role of the qualitative research as the tool for the construction of nursing as a discipline and social profession. Conclusions: this strategy contributes to the improvement of the instructional, educational and developmental aspects of the teaching-learning process, and at the same time it allows the insertion of research skills into the professional performance.
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RESUMEN Introducción: las nuevas tecnologías favorecen el desarrollo científico técnico de la sociedad, por lo cual se deben asimilar en el proceso enseñanza aprendizaje por los estudiantes de la carrera. Objetivo: caracterizar el uso de las tecnologías de la información y las comunicaciones por los estudiantes de la carrera Licenciatura en Enfermería de la Universidad de Ciencias Médicas de Pinar del Río entre enero y marzo de 2018. Métodos: estudio observacional, descriptivo, y transversal en los estudiantes de segundo año de licenciatura en Enfermería. Se emplearon métodos teóricos y empíricos. Se aplicaron medidas estadísticas como frecuencia absoluta y relativa porcentual. Resultados: se encontró que el 23,5 % no poseía acceso a ningún medio informático. La mitad del universo de estudio expresó poseer un teléfono móvil con sistema operativo Android o iOS. El 59,3 % de los estudiantes no empleaban la conexión institucional a Internet, el 23,5 % la emplea para fines docentes. El 76,5 % refirió utilizar las conferencias y materiales complementarios digitalizados para el estudio; el 46,9 % empleó tanto los medios digitales, como los convencionales. El 12 % de los estudiantes expresó que no encuentran útiles los medios informáticos para el aprendizaje. Conclusiones: Se encontró utilidad en el uso de las Tecnologías de la Información y la Comunicación en el proceso docente, los cuales poseen con elevado acceso; donde los teléfonos inteligentes, son las más empleadas, existiendo una pobre utilización del Internet para el proceso docente e investigativo. Los materiales en soporte digital son ampliamente empleados para el estudio.
ABSTRACT Introduction: new technologies favor the scientific and technical development of society, which is why they must be assimilated in the teaching-learning process by the students of the career. Objective: to characterize the use of information and communication technologies by students of the Degree in Nursing at the University of Medical Sciences of Pinar del Río between January and March 2018. Methods: observational, descriptive, and cross-sectional study in second-year undergraduate students in Nursing. Theoretical and empirical methods were used. Statistical measures were applied as absolute frequency and relative percentage. Results: it was found that 23,5 % did not have access to any computer medium. Half of the study universe said they own a mobile phone with an Android or iOS operating system. 59,3 % of the students did not use the institutional Internet connection, 23,5 % used it for teaching purposes. 76,5 % reported using conferences and complementary materials digitized for the study; 46,9 % used both digital and conventional media. 12 % of the students expressed that they do not find the computer media useful for learning. Conclusions: It was found useful in the use of Information and Communication Technologies in the teaching process, which have high access; where smartphones are the most used, there is a poor use of the Internet for the teaching and research process. The materials in digital support are widely used for the study.
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Humanos , Educação em Enfermagem , Tecnologia da Informação , Desenvolvimento Tecnológico , Educação em Saúde , Tecnologia Biomédica , CubaRESUMO
Introdução: a incidência de doenças neurodegenerativas tem aumentado nos últimos anos, passando a constituir um problema de saúde pública. Frente a isso se faz necessário o desenvolvimento de novas modalidades terapêuticas visando evitar, recuperar ou impedir as alterações celulares que possam levar à morte neuronal. Objetivo: realizar uma revisão bibliográfica acerca do potencial neuroprotetor, antioxidante e anti-inflamatório do Canabidiol (CBD) investigando sua ação sobre processos neurodegenerativos associados à doença de Alzheimer, Parkinson e Huntington. Metodologia: foi realizado um estudo descritivo e qualitativo desenvolvido na forma de revisão bibliográfica onde foram utilizados artigos disponíveis nos bancos de dados PubMed, Scielo e Scopus com o período de referência compreendido entre os anos de 1998 e 2016. Resultados: foram selecionados 10 artigos que tratavam do tema e todos eles mostraram que o CBD induziu neuroproteção e possuiu propriedades antioxidantes e anti-inflamatórios em diferentes modelos de citotoxicidade, estresse oxidativo e neurodegeneração. Conclusão: o CBD pode ser um importante agente terapêutico no tratamento, na prevenção e na reversão de lesões oriundas de doenças neurodegenerativas. Entretanto, há necessidade de reforçar estudos e ensaios em modelos animais antes de transpor o uso do CBD para humanos.
Introduction: the incidence of neurodegenerative diseases has increased in recent years, becoming a public health problem. In view of this, it is necessary to develop new therapeutic modalities in order to avoid, recover or prevent cell changes that may lead to neuronal death. Objective: to perform a literature review on the neuroprotective, antioxidant and anti-inflammatory potential effects of Canabidiol (CBD), investigating its action on neurodegenerative processes associated with Alzheimer's disease, Parkinson's and Huntington´s disease. Methodology: a descriptive and qualitative study was developed in the form of a bibliographic review where articles available on PubMed, Scielo e Scopus database with the reference period from 1998 to 2016 were used. Results: ten articles were selected that addressed the theme and they all showed that CBD induced neuroprotection and possessed antioxidant and anti-inflammatory properties in different models of cytotoxicity, oxidative stress and neurodegeneration. Conclusion:CBD may be an important therapeutic agent in the treatment, prevention and reversal of lesions from neurodegenerative diseases. However, there is a need to reinforce studies and trials in animal models prior to transposing CBD to humans.
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Humanos , Masculino , Feminino , Canabinoides , Fármacos Neuroprotetores , Doenças Neurodegenerativas , Anti-Inflamatórios , Antioxidantes , Epidemiologia Descritiva , Estudos de Avaliação como AssuntoRESUMO
Background: Triceps reinnervation is an important objective to pursue when repairing the brachial plexus for cases with upper roots injuries, and a number of different techniques have been developed in order to restore elbow extension in such cases. Objective: To demonstrate the surgical outcomes associated with the technique of transferring a single healthy motor fascicle from the radial nerve of the affected arm to a branch innervating 1 of the 3 heads of the triceps. Methods: A retrospective study of 13 adult patients sustaining an upper trunk syndrome associated with total elbow extension palsy who underwent the proposed technique as part of the surgical planning for reconstruction of the brachial plexus. Results: Outcomes scored as M4 for elbow extension were noted in 9 cases (70%), M3 in 3 (23%), and M1 in 1 subject (7%). No patient considered the postoperative strength for carpal or finger extension as impaired. There were no differences in outcomes by using a fascicle activating carpal or finger extension as donor, as well as regarding the use of the branch to the medial or lateral head of the triceps as the recipient. Conclusion: The technique of transferring a healthy motor fascicle from the radial nerve of the affected side to one of its nonfunctional motor branches to the triceps is an effective and safe procedure for recovering elbow extension function in patients sustaining partial injuries of the brachial plexus.
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Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Cotovelo/cirurgia , Transferência de Nervo/métodos , Nervo Radial/transplante , Adolescente , Adulto , Braço/inervação , Articulação do Cotovelo/inervação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.
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Plexo Braquial/lesões , Plexo Braquial/cirurgia , Mapeamento Encefálico/métodos , Rede Nervosa/fisiologia , Transferência de Nervo/métodos , Plasticidade Neuronal/fisiologia , Mapeamento Encefálico/tendências , Humanos , Transferência de Nervo/tendências , Resultado do TratamentoRESUMO
Objective To evaluate the predictors of functional recovery associated with the transfer of intercostal nerves (ICNs) to the branch innervating the long head of the triceps (BLHT). Methods A retrospective analysis of 14 patients with global brachial plexus palsy for whom the surgical planning included the transfer of 2 or 3 ICNs to the BLHT. Results The effective rate of functional recovery for elbow extension was 28%. Surgical timing, severity of the injury, and number of ICNs did not show significance for functional recovery. Patients who underwent ICN transfer for reanimation of elbow extension in combination with phrenic nerve (PN) transfer for reinnervation of elbow flexion, or shoulder stability, obtained poorer results regarding triceps recovery (p < 0.01). Conclusions Intercostal nerves are reliable donors for reinnervation of the triceps in global brachial plexus injuries. However, this technique should be avoided in patients in whom the PN has been transferred for elbow flexion or shoulder abduction.
Objetivos Avaliar os fatores preditores para recuperação funcional associados à transferência de nervos intercostais (NICs) para o ramo do nervo radial que inerva da cabeça longa do tríceps (RCLT). Métodos Análise retrospectiva de 14 pacientes com paralisia completa do plexo braquial, para os quais o planejamento cirúrgico incluiu a transferência de 2 ou 3 NICs para o RCLT. Resultados A taxa de recuperação da extensão do cotovelo foi de 28%. O intervalo cirúrgico, a gravidade da lesão e o número de NICs usados não demonstraram significância para a recuperação funcional. Os pacientes nos quais a transferência de NIC foi usada para recuperação da extensão do cotovelo concomitantemente à transferência do nervo frênico para reanimação da flexão do cotovelo ou para estabilização do ombro obtiveram piores resultados quanto a reinervação do tríceps (p < 0.01). Conclusões Os NICs podem ser utilizados como doadores para reinervação do tríceps em lesões completas do plexo braquial. No entanto, essa técnica deve ser evitada em pacientes nos quais o nervo frênico foi transferido conjuntamente visando a recuperação da flexão do cotovelo ou a estabilização do ombro.
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Humanos , Transferência de Nervo , Neuropatias do Plexo Braquial , Neuropatias do Plexo Braquial/cirurgia , Transferência de Nervo/métodosRESUMO
Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries. Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus. Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively. Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer.
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Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Articulação do Cotovelo/inervação , Articulação do Cotovelo/cirurgia , Transferência de Nervo , Nervo Frênico/transplante , Adolescente , Adulto , Plexo Braquial/fisiopatologia , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Paravertebral abscesses are usually caused by Staphylococcus aureus, and often affect older people with diabetes mellitus or immunosuppression. We report a huge lumbar abscess caused by Escherichia coli in an 81-year-old woman with diabetes and melanoma metastasis. Lumbar vertebra and surrounding soft tissues were involved by the Gram-negative infection, and imaging features were indicative of malignant condition. Diagnosis was established by images of magnetic resonance, histopathology, and bacterial culture from abscess fluid. This condition poses diagnosis challenges and seems to be increasing in frequency. Reports of case studies might enhance the suspicion index of primary care physicians about this entity.
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Abscesso/microbiologia , Escherichia coli/isolamento & purificação , Melanoma/complicações , Músculo Esquelético/microbiologia , Neoplasias Cutâneas/complicações , Abscesso/complicações , Abscesso/tratamento farmacológico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Índice de Massa Corporal , Ciprofloxacina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipertensão/complicações , Região Lombossacral , Melanoma/secundário , Músculo Esquelético/patologia , Estadiamento de Neoplasias , Transferência de Pacientes , Fatores de Risco , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
BACKGROUND: The prognosis for motor recovery associated with ulnar nerve injuries at a level proximal to the elbow is usually considered poor. Nerve transfers techniques were introduced as an alternative for the management of nerve lesions of the upper limb, aiming to improve the surgical results of those nerves for which direct reconstruction has not historically yielded good outcomes. METHODS: A retrospective chart review was conducted to compare the outcomes obtained using nerve grafting (20 cases) with those of distal nerve transfer (15 patients) for the treatment of proximal injuries of the ulnar nerve. Nerve transfer combined the suture of the anterior interosseous nerve to the motor branch of the ulnar nerve and the cooptation of its sensory branch to the third common digital nerve via an end-to-side suture. RESULTS: The Medical Research Council M3/M4 outcomes were observed significantly more often in the nerve transfer group (80 vs. 22%), and the mean values for handgrip strength were higher (31.3 ± 5.8 vs. 14.5 ± 7.2 kg). The groups were similar in attaining good sensory recovery (40 vs. 30%) and mean two-point-discrimination (grafting: 11 ± 2 mm; nerve transfer: 9 ± 1 mm). The mean value of the disabilities of arm, shoulder, and hand for the nerve transfer group (23.6 ± 6.7) was significantly lower than for grafting (34.2 ± 8.3). CONCLUSIONS: Distal nerve transfer resulted in better motor and functional outcomes than nerve grafting. Both techniques resulted in similar sensory outcomes, and nerve grafting was demonstrated to be a better technique for managing the painful symptoms associated with the nerve injury.
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Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos/métodos , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Introducción: las habilidades comunicativas orales revisten gran importancia en la enseñanza de lenguas extrajeras, aunque la enseñanza del nivel fonológico, y por ende, de la pronunciación como sub-habilidad indispensable de las mismas deben recibir atención dado su impacto en el desempeño oral de los estudiantes de la carrera de medicina. Objetivo: caracterizar la enseñanza del nivel fonológico en el inglés médico en función del desarrollo de la inteligibilidad en la carrera de medicina. Material y método: estudio cualitativo sustentado en el método dialéctico materialista. En su elaboración se emplearon métodos del nivel teórico como el histórico-lógico y sistémico-estructural y del nivel empírico como la observación directa a clases así como al proceso evaluativo de las habilidades comunicativas orales en el inglés con fines médicos. Resultados: se obtuvo un resumen de las dificultades del proceso de enseñanza-aprendizaje del nivel fonológico por medio de la observación directa de la realidad educativa en que se enmarca dicho proceso, y del proceso evaluativo de las habilidades comunicativas orales en el ciclo de inglés con fines médicos a partir de los indicadores asumidos. Conclusiones: se evidenciaron dificultades en el proceso de enseñanza del nivel fonológico en el inglés con fines médicos que limitan la inteligibilidad de la mayoría de los estudiantes del ciclo de inglés médico en la carrera de medicina, debido a un ineficiente tratamiento de la pronunciación dentro de las clases de expresión oral, en elementos clave para la inteligibilidad como son los suprasegmentales y los segmentales, así como en otros procesos asociados a la producción oral.
Introduction: oral communication skills are very important in the teaching of foreign languages, although teaching phonological level, and hence the pronunciation as an essential sub-skill, should receive the same attention due to their impact on the oral performance of Medicine students. Objective: to characterize the teaching of the phonological level in medical English depending on the development of intelligibility in the Medicine major. Material and method: qualitative study supported by the dialectical materialist method. In its course, theoretical methods were used, such as the logical-historical and the systemic-structural, and empirical methods, such as direct observation to classes and the evaluation process of oral communication skills in English for medical purposes. Results: a summary was created of the difficulties of the teaching-learning process of the phonological level, through direct observation of the educational reality, in which this process is contained, and also of the evaluation process of oral communication skills in the English for medical purposes cycle, from the assumed indicators. Conclusions: difficulties were found in the process of teaching the phonological level in English with medical purposes, which limit the intelligibility by most of the students in the medical English cycle of the Medicine major, due to the inefficient management of pronunciation within speaking lessons and on key elements for intelligibility, such as the suprasegmental and segmental ones, as well as other processes associated with oral production.
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BACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop. METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system. RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference. CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.
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Transtornos Neurológicos da Marcha/cirurgia , Transferência de Nervo/métodos , Nervo Fibular/cirurgia , Nervo Tibial/transplante , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECT: Recent advancements in operative treatment of the brachial plexus authorized more extensive repairs and, currently, elbow extension can be included in the rank of desirable functions to be restored. This study aims to describe the author's experience in using the medial pectoral nerve for reinnervation of the triceps brachii in patients sustaining C5-7 palsies of the brachial plexus. METHODS: This is a retrospective study of the outcomes regarding recovery of elbow extension in 12 patients who underwent transfer of the medial pectoral nerve to the radial nerve or to the branch of the long head of the triceps. RESULTS: The radial nerve was targeted in 3 patients, and the branch to the long head of the triceps was targeted in 9. Grafts were used in 6 patients. Outcomes assessed as Medical Research Council Grades M4 and M3 for elbow extension were noted in 7 (58%) and 5 (42%) patients, respectively. CONCLUSIONS: The medial pectoral nerve is a reliable donor for elbow extension recovery in patients who have sustained C5-7 nerve root injuries.
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Plexo Braquial/lesões , Plexo Braquial/cirurgia , Articulação do Cotovelo/inervação , Transferência de Nervo , Nervos Torácicos/transplante , Adulto , Braquetes , Vértebras Cervicais , Cotovelo/inervação , Eletromiografia , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular , Transferência de Nervo/métodos , Condução Nervosa , Nervo Radial/lesões , Nervo Radial/fisiopatologia , Nervo Radial/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.
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Hiperidrose/cirurgia , Simpatectomia/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.
OBJETIVO: A cirurgia para hiperidrose palmar e axilar usualmente inclui a interrupção da cadeia simpático-torácica em múltiplos níveis. Este estudo objetivou apresentar os resultados tardios associados à simpatectomia torácica vídeo-assistida (STVA) dos gânglios T2,T3 e T4 nesses casos. MÉTODOS: Foram analisados os resultados cirúrgicos obtidos em 36 pacientes quanto à taxa de resolução dos sintomas e à ocorrência de hiperidrose compensatória (HC). Todos os sujeitos foram acompanhados por 36 meses. RESULTADOS: Bons resultados foram observados em 98,6% dos pacientes para a forma palmar e em 60% para a forma axilar (p=0,0423). Em 86% dos casos, havia relato de algum episódio de HC, mas apenas 45% ainda notavam sua ocorrência ao final do período de acompanhamento. CONCLUSÕES: A STVA é eficaz para o tratamento da hiperidrose palmar, mas mostrou-se plenamente satisfatória em apenas dois terços dos casos associados à forma axilar. A HC deve ser considerada ocorrência esperada no protocolo cirúrgico; no entanto, evolui de maneira autolimitada na maioria dos casos.
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Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Hiperidrose/cirurgia , Simpatectomia/métodos , Seguimentos , Cirurgia Torácica Vídeoassistida , Resultado do TratamentoRESUMO
Some patients who sustain C5 to C7 nerve root injuries may demonstrate a natural recovery of elbow extension via the lower trunk; however the surgical effect of the reinnervation of the triceps brachii in such cases is still unknown. This study aims to determine the incidence of spontaneous recovery of the tricipital function and to identify the clinical and/or radiological predictors of poor spontaneous functional rehabilitation of elbow extension resulting from injuries of the upper roots of the brachial plexus. We conducted a review of the charts of 24 subjects sustaining an upper trunk syndrome with complete elbow extension palsy and who did not undergone any intervention for reinnervation of the triceps brachii in the primary brachial plexus surgery. Two years posttrauma, the muscle was scored as M0 in 12 patients (50%), M1 in 3 (12.5%), M2 in 1 (4.1%), M3 in 4 (16.6%), and M4 in 4 subjects (16.6%). The number of avulsed roots and the preoperative power of the latissimus dorsi did not demonstrate any significance in predicting the outcome of spontaneous elbow extension recovery; whereas the preoperative paralysis of the muscles for wrist extension was determined to be reliable predictive parameter for poor natural recovery of tricipital function.
Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Vértebras Cervicais/lesões , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Paralisia/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adulto , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/etiologia , Articulação do Cotovelo/inervação , Articulação do Cotovelo/fisiopatologia , Eletromiografia/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Condução Nervosa , Paralisia/etiologia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Remissão Espontânea , Estudos Retrospectivos , Medição de Risco , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Resultado do Tratamento , Extremidade Superior , Adulto JovemRESUMO
BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.
Assuntos
Neuropatias do Plexo Braquial/cirurgia , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Nervo Ulnar/transplante , Acidentes de Trânsito , Adulto , Braço/inervação , Cotovelo/fisiologia , Humanos , Masculino , Músculo Esquelético/cirurgia , Adulto JovemRESUMO
Extension of the elbow is required to oppose gravity; however, activation of the triceps brachii is frequently underestimated during the surgical planning for brachial plexus injuries. This report aims to describe a novel technique of distal nerve transfer designed for elbow extension reconstruction in patients sustaining a C5-C7 nerve root injury. We report a patient sustaining a brachial plexus injury with triceps palsy and preserved finger extension motion; after careful intraneural dissection of the radial nerve, a fascicle innervating the extensor digitorum communis muscle was sectioned, derouted and connected to a motor branch to the lateral head of the triceps. Eleven months after surgery, elbow extension strength scored MRC M4. No deficits on finger extension were observed.
Assuntos
Neuropatias do Plexo Braquial/cirurgia , Articulação do Cotovelo/fisiopatologia , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Nervo Radial/transplante , Acidentes de Trânsito , Adulto , Atrofia , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/fisiopatologia , Humanos , Masculino , Músculo Esquelético/patologia , Tendões/inervaçãoRESUMO
OBJECTIVE: The study aims to demonstrate the impact of some preoperative clinical parameters on the functional outcome of patients sustaining brachial plexus injuries, and to trace some commentaries about the use of intraoperative monitoring techniques. METHOD: A retrospective study one hundred cases of brachial plexus surgery. The analysis regarding postoperative outcomes was performed by comparing the average of the final result of the surgery for each studied cohort. RESULTS: Direct electrical stimulation was used in all patients, EMG in 59%, SEPs in 37% and evoked NAPs in 19% of the cases. Patients in whom the motor function of the hand was totally or partially preserved before surgery, and those in whom surgery was delayed less than 6 months demonstrated significant (p<0.05) better outcomes. CONCLUSION: The preoperative parameters associated to favorable outcomes in reconstruction of the brachial plexus are a good post-traumatic status of the hand and a short interval between injury and surgery.
Assuntos
Plexo Braquial/lesões , Plexo Braquial/cirurgia , Monitorização Intraoperatória/métodos , Adolescente , Adulto , Eletrofisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.