Ventilation asymmetry, diaphragmatic mobility and exercise capacity in men with traumatic brachial plexus injury.

OBJECTIVE: To investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic mobility and exercise capacity, compartmental volume changes, as well as volume contribution of each hemithorax and ventilation asymmetry during different respiratory maneuvers, and compare with healthy individuals. The velocity of shortening of the diaphragm, inspiratory, and expiratory muscles were also assessed. PARTICIPANTS: The cross-sectional study was conducted with 40 male individuals (20 with TBPI who have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired by age and body mass index). Only patients with C8-T1 root avulsion were studied. MAIN OUTCOME: Compartmental and hemithoracic volumes, as well as asymmetry between the affected and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute walking test was performed to evaluate exercise capacity, while diaphragm mobility was assessed during quiet breathing (QB) using an ultrasound device. RESULTS: TBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all p < .001) compared with healthy. The pulmonary ribcage compartment of the affected side was the main contributor to the reduction in volume during inspiratory capacity, vital capacity, and inspiratory load imposition (all p < .05). This compartment also exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory ribcage muscles. CONCLUSION: Compared with healthy, TBPI patients who have not undergone nerve transfer surgery present low exercise capacity and diaphragmatic mobility, as well as reduced volume of the upper ribcage compartment on the affected side that leads to reduced shortening velocity and ventilation asymmetry.

Epidemiological Profile of Surgically-Treated Peripheral-Nerve Diseases

Objective To outline the epidemiological profile of surgical patients treated at the peripheral-nerve outpatient clinic of a public hospital in the state of Pernambuco, Brazil, from 2008 (the year this service was implemented in the hospital ) to 2016. Material and Methods A cross-sectional study with data collection from the medical records. A descriptive analysis was performed with the qualitative variables presented as relative and absolute frequencies, and the quantitative variables, as means and standard deviations. The studied variables were gender, age, diagnosis, and surgical techniques. Results In total, 506 medical records were analyzed. Of these, 269 were of male patients (53%), and 238 were of female patients (46%). The age of the sample ranged from 5 to 84 years (41 14 years). The most prevalent diagnoses were: carpal tunnel syndrome (38.9%) followed by traumatic brachial plexus injury (33.2%). The first diagnosis was more frequent among women, while the second, among men. This collaborates with the predominant findings of upper-limb lesions (91%), in which men accounted for 52,75% (244) and women, for 47,25% (217). Conclusion The present study provided relevant information regarding the reality of peripheral-nerve surgeries performed at a public hospital in the state of Pernambuco, Brazil. Public health issues increasingly require the continuity of public policies and government incentive.

Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy.

BACKGROUND: Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors' results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. METHODS: Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. RESULTS: In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4-13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. CONCLUSION: Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.

Pulmonary capacity of patients with total traumatic injury of the brachial plexus submitted to neurotization with the phrenic nerve: a case series / Capacidade pulmonar de pacientes com lesão traumática total do plexo braquial submetidos à neurotização com o nervo frênico: uma série de casos

Total traumatic injury often requires surgical intervention such as neurotization using the phrenic nerve with the aim to recover the elbow function. However, its repercussions on the respiratory kinematics are unknown. Objective: To evaluate the ribcage volume in tricompartments division, kinematics of Duty Cycle, and shortening velocity of the respiratory muscles after nerve phrenic transfer. Methods: Five participants (4 male), aged 18 to 40 years old (32±2), diagnosed with total brachial plexus injury and with nerve phrenic transfer. The optoelectronic plethysmography (OEP) was the instrument to evaluate volume in quiet breathing (QB), inspiratory capacity (IC) and vital capacity (VC) of the rib cage in its tricompartments division (pulmonary rib cage, abdominal rib cage and abdomen rib cage) and in each hemithorax, as well as the shortening velocity of the respiratory muscles, and respiratory rate. Assessments occurred 30 days prior and 30 days after surgery. Results: There was a decrease in the total compartmental distribution in QB with statistical difference only in the abdominal compartment (p <0.05). Four patients showed a reduction in the shortening speed of the left diaphragm muscle. It was not possible to perform a group analysis of respiratory kinematics and volumes in CV, IC due to the variation found in each patient analyzed. Conclusion: There was a reduction in volume in the rib cage as well as a change in the speed of shortening of the respiratory muscles after the transfer of the phrenic nerve one month after surgery.

A lesão traumática total freqüentemente requer intervenção cirúrgica, como neurotização usando o nervo frênico, com o objetivo de recuperar a função do cotovelo. No entanto, suas repercussões na cinemática respiratória são desconhecidas. Objetivo: Avaliar o volume da caixa torácica na divisão dos tricompartimentos, a cinemática do Duty Cycle e a velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico. Métodos: Cinco participantes (4 do sexo masculino), com idade entre 18 e 40 anos (32 ± 2), com diagnóstico de lesão total do plexo braquial e transferência do nervo frênico. A pletismografia optoeletrônica (OEP) foi o instrumento para avaliar o volume na respiração silenciosa (QB), a capacidade inspiratória (IC) e a capacidade vital (VC) da caixa torácica em sua divisão tricompartimental (caixa torácica pulmonar, caixa torácica abdominal e caixa torácica do abdômen ) e em cada hemitórax, bem como a velocidade de encurtamento dos músculos respiratórios e a frequência respiratória. As avaliações ocorreram 30 dias antes e 30 dias após a cirurgia. Resultados: Houve diminuição da distribuição compartimental total no QB com diferença estatística apenas no compartimento abdominal (p <0,05). Quatro pacientes apresentaram redução da velocidade de encurtamento do músculo diafragma esquerdo. Não foi possível realizar uma análise de grupo da cinemática respiratória e dos volumes em CV, IC devido à variação encontrada em cada paciente analisado. Conclusão: Houve redução do volume da caixa torácica e também alteração da velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico um mês após a cirurgia.

Chikungunya and Myositis: A Case Report in Brazil.

Chikungunya Virus (CHIKV) is a well-described alpha virus that causes infection in humans. The main symptoms are fever, rash and arthralgia and recently neurological disorders have been reported, in particular encephalitis. It is uncertain whether neurological symptoms are due to persistence of the virus or an ineffective immune response. One rarely described neurologic syndrome is myositis. In this paper, we report the case of a 19-year-old woman with mental confusion and aggressiveness two days after complaints of fever and arthralgia. On clinical evaluation, the patient had power 5/5 in the upper limbs and 3/5 in the lower limbs. Electromyography revealed the presence of myogenic potentials with reduced amplitudes and early recruitment predominantly in the proximal muscle. Two weeks later, she complained of muscle weakness of the lower limbs that started 15 days after acute Chikungunya infection. The patient improved within two months with only supportive care.

Life quality, depression and anxietysymptoms in chronic post-traumaticheadache after mild brain injury / Qualidade de vida, sintomas de depressão e ansiedade em cefaléia pós-traumática crônica após lesão cerebral leve

ABSTRACT. Post-traumatic headache (PTH) is the most common symptom found in the post-traumatic syndrome, whose onset occurs within seven days of the trauma. The condition is characterized as acute when it persists for up to 3 months. PTH beyond this period is considered chronic. Objectives: The objective of this study was to determine the clinical features of chronic post-traumatic headache (cPTH) and its association with depression, anxiety and quality of life. Methods: A total of 73 female subjects were evaluated. Patients were divided into three groups: (a) group without headache, CONTROL, n=25; (b) cPTH group, n=19; and (c) MIGRAINE, n=29, with all subjects in the 11-84 year age group. Symptoms of anxiety and depression were evaluated by the Beck inventories of anxiety and depression, and quality of life assessed by the Lipp and Rocha quality of life inventory. Qualitative variables were analyzed using the Chi-square or Fisher's exact tests and expressed as percentages whereas quantitative variables were analyzed by ANOVA, Mann-Whitney or Kruskal-Wallis tests with data expressed as mean±standard deviation, p<0.05. Results: Subjects with cPTH presented with headache manifesting similar features to those found in migraine. The cPTH group was associated with similar levels of anxiety and depression to the migraine group and higher than the CONTROL (p<0.001). Quality of life of individuals with cPTH was similar to that of subjects with migraine and lower than CONTROL subjects (p<0.05). Conclusions: cPTH presents similar clinical characteristics to migraine. Subjects with cPTH had high levels of anxiety and depression symptoms and reduced quality of life.

RESUMO. A cefaleia é o sintoma mais encontrado na síndrome pós-traumática, iniciando-se dentro de sete dias após o trauma. Sua a forma aguda dura até três meses e a crônica persiste após este período. Objetivos: O objetivo deste estudo foi determinar as características clínicas da cefaleia pós-traumática crônica (CPTc) e sua associação com a depressão, ansiedade e com nível de qualidade de vida. Métodos: Foram avaliados 73 sujeitos do gênero feminino, divididos em três grupos: (a) grupo sem cefaleia (CONTROLE, n=25), (b) grupo com CPTc (n=19) e (c) migrânea (MIGRÂNEA, n=29), com idades variando entre 11 e 84 anos. Os sintomas de ansiedade e depressão foram avaliados pelos inventários de ansiedade e depressão de Beck e a qualidade de vida pelo inventário de qualidade de vida de Lipp e Rocha. As variáveis qualitativas foram analisadas pelos testes qui-quadrado ou exato de Fisher e expressas em percentuais e as quantitativas por ANOVA, Mann-Whitney ou Kruskal-Wallis com os dados apresentados em média±desvio padrão, p<0,05. Resultados: Os sujeitos com CPTc apresentaram cefaleia com características semelhantes as encontradas na migrânea. A CPTc esteve associada aos níveis de sintomas de ansiedade e depressão similares ao grupo com migrânea e superior ao CONTROLE (p<0,001). Os níveis de qualidade de vida dos sujeitos com CPTc mostraram-se semelhantes aos dos sujeitos com migrânea e inferior ao CONTROLE (p<0,05). Conclusões: A CPTc apresenta características clínicas semelhantes a migrânea. Os sujeitos com CPTc apresentam elevado nível de sintomas de ansiedade e depressão e nível de qualidade de vida reduzida.

Life quality, depression and anxiety symptoms in chronic post-traumatic headache after mild brain injury.

Post-traumatic headache (PTH) is the most common symptom found in the post-traumatic syndrome, whose onset occurs within seven days of the trauma. The condition is characterized as acute when it persists for up to 3 months. PTH beyond this period is considered chronic. OBJECTIVES: The objective of this study was to determine the clinical features of chronic post-traumatic headache (cPTH) and its association with depression, anxiety and quality of life. METHODS: A total of 73 female subjects were evaluated. Patients were divided into three groups: (a) group without headache, CONTROL, n=25; (b) cPTH group, n=19; and (c) MIGRAINE, n=29, with all subjects in the 11-84 year age group. Symptoms of anxiety and depression were evaluated by the Beck inventories of anxiety and depression, and quality of life assessed by the Lipp and Rocha quality of life inventory. Qualitative variables were analyzed using the Chi-square or Fisher's exact tests and expressed as percentages whereas quantitative variables were analyzed by ANOVA, Mann-Whitney or Kruskal-Wallis tests with data expressed as mean±standard deviation, p<0.05. RESULTS: Subjects with cPTH presented with headache manifesting similar features to those found in migraine. The cPTH group was associated with similar levels of anxiety and depression to the migraine group and higher than the CONTROL (p<0.001). Quality of life of individuals with cPTH was similar to that of subjects with migraine and lower than CONTROL subjects (p<0.05). CONCLUSIONS: cPTH presents similar clinical characteristics to migraine. Subjects with cPTH had high levels of anxiety and depression symptoms and reduced quality of life.

A cefaleia é o sintoma mais encontrado na síndrome pós-traumática, iniciando-se dentro de sete dias após o trauma. Sua a forma aguda dura até três meses e a crônica persiste após este período. OBJETIVOS: O objetivo deste estudo foi determinar as características clínicas da cefaleia pós-traumática crônica (CPTc) e sua associação com a depressão, ansiedade e com nível de qualidade de vida. MÉTODOS: Foram avaliados 73 sujeitos do gênero feminino, divididos em três grupos: (a) grupo sem cefaleia (CONTROLE, n=25), (b) grupo com CPTc (n=19) e (c) migrânea (MIGRÂNEA, n=29), com idades variando entre 11 e 84 anos. Os sintomas de ansiedade e depressão foram avaliados pelos inventários de ansiedade e depressão de Beck e a qualidade de vida pelo inventário de qualidade de vida de Lipp e Rocha. As variáveis qualitativas foram analisadas pelos testes qui-quadrado ou exato de Fisher e expressas em percentuais e as quantitativas por ANOVA, Mann-Whitney ou Kruskal-Wallis com os dados apresentados em média±desvio padrão, p<0,05. RESULTADOS: Os sujeitos com CPTc apresentaram cefaleia com características semelhantes as encontradas na migrânea. A CPTc esteve associada aos níveis de sintomas de ansiedade e depressão similares ao grupo com migrânea e superior ao CONTROLE (p<0,001). Os níveis de qualidade de vida dos sujeitos com CPTc mostraram-se semelhantes aos dos sujeitos com migrânea e inferior ao CONTROLE (p<0,05). CONCLUSÕES: A CPTc apresenta características clínicas semelhantes a migrânea. Os sujeitos com CPTc apresentam elevado nível de sintomas de ansiedade e depressão e nível de qualidade de vida reduzida.