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1.
J Hand Surg Asian Pac Vol ; 26(1): 17-23, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559563

RESUMO

Background: Previous reports on schwannomas of the upper extremities have mainly focused on proximal involvement. This study aimed to evaluate pre- and peri-operative findings in schwannomas of the distal upper extremities and assess the accuracy of diagnosis and surgical outcome. Methods: We identified 24 patients with isolated tumors. Seven patients had schwannomas located in the forearm, eleven in the hand, and six in the digits. We collected the following data: preoperative clinical and magnetic resonance imaging findings, provisional diagnosis, surgical findings and procedures, tumor volume, and postoperative clinical findings. Data were compared between tumors of different locations. Results: The mean age of our cohort at the time of surgery was 48.0 years and the mean follow-up period was 10.6 months. All patients with forearm schwannomas were diagnosed preoperatively by the presence of the Tinel-like sign and suggestive magnetic resonance imaging findings. In contrast, schwannomas in the hands and digits often lacked these diagnostic features; only five patients with hand schwannomas and one with digit schwannoma were correctly diagnosed. Microsurgical enucleation was the most common treatment. Ten patients reported newly acquired paresthesia after operation, which resolved within the follow-up period in nine patients. Three of the four patients with preoperative paresthesia and one patient who underwent enucleation with surgical loupes still had paresthesia at the final follow-up. Conclusions: In schwannomas of the distal upper extremities, a more distal location is associated with a lower occurrence of the Tinel-like sign and fewer suggestive magnetic resonance imaging findings, resulting in lower diagnostic accuracy. However, intra-operative diagnosis is usually straightforward and microsurgical enucleation does not cause iatrogenic nerve deficit. When treating soft tissue tumors in the hand and digits that present without specific or suggestive findings, the possibility of schwannoma should be considered.


Assuntos
Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Dedos/cirurgia , Seguimentos , Antebraço/cirurgia , Mãos/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Adulto Jovem
2.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542025

RESUMO

Horner's syndrome results from interruption of the sympathetic innervation to the eye. This interruption may occur at three anatomical levels along the sympathetic trunk pathway. There are numerous causes of Horner's syndrome, including injury to the carotid artery, of which arterial dissection is the commonest pathology. Occlusive carotid disease secondary to atherosclerosis is a relatively rare cause of Horner's syndrome. We describe a patient with Horner's syndrome due to complete occlusion of the ipsilateral internal carotid artery.


Assuntos
Artéria Carótida Interna/patologia , Transtornos Cerebrovasculares , Síndrome de Horner/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem , Afasia/etiologia , Angiografia por Tomografia Computadorizada , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Parestesia/etiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico
3.
Medicine (Baltimore) ; 99(43): e22900, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120840

RESUMO

RATIONALE: Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS: A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES: On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS: The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES: Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS: Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico , Isquemia do Cordão Espinal/diagnóstico por imagem , Assistência ao Convalescente , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Exame Neurológico/métodos , Paraparesia/etiologia , Parestesia/diagnóstico , Parestesia/etiologia , Ácido Salicílico/administração & dosagem , Ácido Salicílico/uso terapêutico , Doenças da Medula Espinal/etiologia , Isquemia do Cordão Espinal/tratamento farmacológico , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/reabilitação
4.
Medicine (Baltimore) ; 99(31): e21474, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756170

RESUMO

RATIONALE: Tibial nerve injury is a sustainable but rare complication during total-ankle arthroplasty (TAA). We outlined 2 previously unreported cases of tibial nerve injury in TAA, including the prognoses and possible causes. PATIENT CONCERNS: First, a 63-year-old woman complained of a 5-month history of persistent tingling sensation and numbness on the medial and plantar aspects of her foot after TAA. Second, a 50-year-old woman complained of a 6-month history of tingling sensation and numbness on the plantar surface of her forefoot after TAA. DIAGNOSIS: Explorations were performed on suspicion of tarsal tunnel syndrome; however, both patients exhibited complete laceration of tibial nerve with neuroma formation. INTERVENTIONS: In both patients, we excised the neuroma and performed end-to-end nerve repair. OUTCOMES: The sensory disturbance of the sole considerably improved at long-term follow-up over 8 years after the neurorrhaphy procedures. LESSONS: Tibial nerve injury is rare following TAA, and is sometimes unrecognized or misdiagnosed. If tibial nerve injury is suspected, prompt surgical exploration should be performed; great precaution must also be taken to prevent injury of the tibial nerve during TAA.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Neuroma/cirurgia , Parestesia/etiologia , Nervo Tibial/lesões , Assistência ao Convalescente , Feminino , Pé/fisiopatologia , Humanos , Hipestesia/etiologia , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Síndrome do Túnel do Tarso/diagnóstico , Nervo Tibial/patologia , Resultado do Tratamento
5.
J Clin Neurosci ; 78: 387-388, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32741567

RESUMO

Sarcoidosis is uncommon multiple organ granulomatous disease of unknown etiology. Neurosarcoidosis occurs in about 5% of cases and most frequently follows systemic disease. We present a case of 52 -years -old woman with a progressive hemifacial paresthesia and multiple enhancing dural based lesions. Resection of the right frontal mass allowed for the diagnosis to be made. The patient had no other features of sarcoidosis. Therefore, the diagnosis of neurosarcoidosis, especially when unaccompanied by systemic features can be challenging but should be considered in the differential diagnosis of multiple enhancing dural based tumours.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Face/patologia , Sarcoidose/diagnóstico , Diagnóstico Diferencial , Face/cirurgia , Feminino , Granuloma/diagnóstico , Humanos , Hipestesia/diagnóstico , Hipestesia/etiologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Parestesia/etiologia
6.
J Cardiothorac Surg ; 15(1): 133, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522214

RESUMO

PURPOSES: We compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients. METHODS: From January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor. RESULTS: We noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques. CONCLUSION: Modified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.


Assuntos
Hiperidrose/cirurgia , Qualidade de Vida , Simpatectomia/métodos , Adolescente , Adulto , Bradicardia/etiologia , Dor no Peito/etiologia , Feminino , Humanos , Masculino , Parestesia/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Simpatectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 99(26): e20893, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590797

RESUMO

RATIONALE: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Here, we present a rare example of successful surgical management of TTS with posterior facet talocalcaneal coalition. PATIENT CONCERNS: A 74-year-old woman presented with hypoesthesia, numbness, and an intermittent tingling sensation on the plantar area over the right forefoot to the middle foot area. The hypoesthesia and paresthesia of the right foot began 6 years previously and were severe along the lateral plantar aspect. The symptoms were mild at rest and increased during daily activities. Tinel sign was positive along the posteroinferior aspect of the medial malleolus. DIAGNOSIS: Lateral ankle radiography showed joint-space narrowing and sclerotic bony changes with a deformed C-sign and humpback sign. Oblique coronal and sagittal computed tomography revealed an irregular medial posterior facet, partial coalition, narrowing, and subcortical cyst formation of the posterior subtalar joint. Magnetic resonance imaging showed an abnormal posterior talocalcaneal coalition compressing the posterior tibia nerve. Electromyography and nerve conduction velocity studies were performed, and the findings indicated that there was an incomplete lesion of the right plantar nerve, especially of the lateral plantar nerve, around the ankle level. INTERVENTIONS: Surgical decompression was performed. Intraoperatively, the lateral plantar nerve exhibited fibrotic changes and tightening below the posterior facet talocalcaneal coalition. The coalition was excised, and the lateral plantar nerve was released with soft-tissue dissection. OUTCOMES: The patient's symptoms of tingling sensation and hypoesthesia were almost relieved at 4 months postoperatively, but she complained of paresthesia with an itching sensation when the skin of the plantar area was touched. The paresthesia had disappeared almost completely at 8 months after surgery. She had no recurrence of symptoms at the 1-year follow-up. LESSONS: The TTS with tarsal coalition is rare. Supportive history and physical examination are essential for diagnosis. Plain radiographs and computed tomography or magnetic resonance imaging are helpful to determine the cause of TTS and verify the tarsal coalition. After diagnosis, surgical excision of the coalition may be appropriate for management with a good outcome.


Assuntos
Coalizão Tarsal/cirurgia , Síndrome do Túnel do Tarso/complicações , Síndrome do Túnel do Tarso/cirurgia , Articulação Zigapofisária/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Eletromiografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Parestesia/etiologia , Coalizão Tarsal/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Articulação Zigapofisária/inervação
8.
AJNR Am J Neuroradiol ; 41(9): 1707-1711, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32586958

RESUMO

We report a case of bifacial weakness with paresthesia, a recognized Guillain-Barré syndrome subtype characterized by rapidly progressive facial weakness and paresthesia without ataxia or other cranial neuropathies, which was temporally associated with antecedent coronavirus 2019 (COVID-19). This case highlights a potentially novel but critically important neurologic association of the COVID-19 disease process. Herein, we detail the clinicoradiologic work-up and diagnosis, clinical course, and multidisciplinary medical management of this patient with COVID-19. This case is illustrative of the increasingly recognized but potentially underreported neurologic manifestations of COVID-19, which must be considered and further investigated in this pandemic disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Paralisia Facial/etiologia , Síndrome de Guillain-Barré/complicações , Parestesia/etiologia , Pneumonia Viral/complicações , Humanos , Masculino , Pandemias , Adulto Jovem
9.
J Oral Pathol Med ; 49(6): 499-504, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32531871

RESUMO

Oral dysaesthesia is a condition characterised by persistent alteration to oral sensation, perceived by the patient to be abnormal and unpleasant, in the absence of mucosal pathology. Its aetiology remains uncertain. The condition was attributed as a psychosomatic disease for much of the 20th century, but with newer technologies, recent literature has mostly focused on a possible peripheral or central neuropathic aetiology to oral dysaesthesia. Despite this, psychotropic medications and psychological treatments remain forefront in the armamentarium for the management of oral dysaesthesia. This article aims to review the literature surrounding the pathogenesis of oral dysaesthesia and explore whether oral dysaesthesia is a somatic symptom disorder.


Assuntos
Síndrome da Ardência Bucal , Sintomas Inexplicáveis , Transtornos Somatoformes , Humanos , Parestesia/etiologia
11.
PLoS One ; 15(5): e0233460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442237

RESUMO

BACKGROUD: Fabry disease (OMIM #301 500), the most prevalent lysosomal storage disease, is caused by enzymatic defects in alpha-galactosidase A (GLA gene; Xq22.1). Fabry disease has historically been characterized by progressive renal failure, early stroke and hypertrophic cardiomyopathy, with a diminished life expectancy. A nonclassical phenotype has been described with an almost exclusive cardiac involvement. Specific therapies with enzyme substitution or chaperone molecules are now available depending on the mutation carried. Numerous clinical and fundamental studies have been conducted without stratifying patients by phenotype or severity, despite different prognoses and possible different pathophysiologies. We aimed to identify a simple and clinically relevant way to classify and stratify patients according to their disease severity. METHODS: Based on data from the French Fabry Biobank and Registry (FFABRY; n = 104; 54 males), we applied unsupervised multivariate statistics to determine clusters of patients and identify clinical criteria that would allow an effective classification of adult patients. Thanks to these criteria and empirical clinical considerations we secondly elaborate a new score that allow the severity stratification of patients. RESULTS: We observed that the absence of acroparesthesia or cornea verticillata is sufficient to classify males as having the nonclassical phenotype. We did not identify criteria that significantly cluster female patients. The classical phenotype was associated with a higher risk of severe renal (HR = 35.1; p <10-3) and cardiac events (HR = 4.8; p = 0.008) and a trend toward a higher risk of severe neurological events (HR = 7.7; p = 0.08) compared to nonclassical males. Our simple, rapid and clinically-relevant FFABRY score gave concordant results with the validated MSSI. CONCLUSION: Acroparesthesia and cornea verticillata are simple clinical criteria that efficiently stratify Fabry patients, defining 3 different groups: females and males with nonclassical and classical phenotypes of significantly different severity. The FFABRY score allows severity stratification of Fabry patients.


Assuntos
Doença de Fabry/classificação , Adulto , Estudos de Coortes , Córnea/diagnóstico por imagem , Doença de Fabry/complicações , Doença de Fabry/diagnóstico por imagem , Feminino , França , Humanos , Pessoa de Meia-Idade , Parestesia/etiologia , Fenótipo , Estudos Prospectivos , Sistema de Registros , Adulto Jovem
14.
Arch Phys Med Rehabil ; 101(8): 1296-1303, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32325164

RESUMO

OBJECTIVE: To assess the effects of perineural corticosteroid and 5% dextrose water (D5W) injections in patients with mild to moderate ulnar neuropathy at the elbow (UNE). DESIGN: Prospective, randomized, double-blind, controlled trial (6-month follow-up). SETTING: Outpatients of local medical center settings. PARTICIPANTS: Patients (N=36) with mild to moderate UNE were randomized, and 33 participants were included in the final data analysis. INTERVENTIONS: Patients were administered a single perineural injection with 5 mL D5W and 3 mL corticosteroid (triamcinolone acetonide, 10mg/mL) mixed with 2 mL normal saline under ultrasound guidance in the dextrose and steroid groups, respectively. MAIN OUTCOME MEASURES: The visual analog scale digital pain or paresthesia/dysesthesia score was the primary outcome. The secondary outcomes were the Disabilities of the Arm, Shoulder, and Hand questionnaire, motor nerve conduction velocity, and cross-sectional area (CSA) of the ulnar nerve. The measurement assessment was conducted before and 1, 3, 4, and 6 months after injection. RESULTS: Thirty-three patients completed the study. Both injections were found to be equally effective at most measurement points, although the dextrose group experienced larger reductions in symptom severity and CSA of the ulnar nerve from the third month onward. CONCLUSIONS: We suggest D5W as a more suitable injectate for perineural injection in patients with UNE.


Assuntos
Anti-Inflamatórios/uso terapêutico , Glucose/uso terapêutico , Triancinolona Acetonida/uso terapêutico , Neuropatias Ulnares/tratamento farmacológico , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Método Duplo-Cego , Cotovelo , Feminino , Seguimentos , Glucose/administração & dosagem , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Dor/etiologia , Medição da Dor , Parestesia/etiologia , Estudos Prospectivos , Inquéritos e Questionários , Triancinolona Acetonida/administração & dosagem , Nervo Ulnar/diagnóstico por imagem , Neuropatias Ulnares/complicações , Neuropatias Ulnares/fisiopatologia , Ultrassonografia , Extremidade Superior/fisiopatologia
15.
Endocrine ; 68(2): 253-254, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32346814
16.
World Neurosurg ; 136: 454-461.e1, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32204297

RESUMO

BACKGROUND: Chiari malformation (CM) is often comorbid with syringomyelia. The treatment of CM via posterior fossa decompression (PFD) may not improve syringomyelia in up to 40% of patients, based on historical cohorts. Management of these patients is problematic, as both reoperation and syrinx shunting have high failure rates in the long term. METHODS: We retrospectively reviewed our cases in which patients with CM type 1 or 1.5 and syringomyelia underwent PFD without postoperative improvement in syringomyelia. Symptomatology and radiographic measurements were collected at presentation and on the first and latest available postoperative scans and analyzed. We present 2 cases to illustrate the challenges in the management of these patients. RESULTS: Our cohort consisted of 48 consecutive patients with CM and syringomyelia who underwent PFD. Of these, 41 patients had postoperative improvement in or resolution of syringomyelia. We subsequently studied the cohort of 7 patients who underwent PFD with (n = 5) or without (n = 2) durotomy and demonstrated worsening of syringomyelia following surgery. This cohort had mean (±SEM) preoperative syrinx area of 23.9 ± 10.0 mm2. Postoperatively, the mean syrinx area increased to 40.5 ± 9.6 mm2 and 57.3 ± 12.5 mm2 on the first and latest postoperative scans available (P = 0.02), for an increase of 106.9% ± 94.4% and 186.0% ± 107.4% (P = 0.04). Presenting symptoms included occipital headache, paresthesias, visual deterioration, and paraspinal pain. On last follow-up (mean 13.9 ± 4.9 months), the majority of symptoms were resolved in this cohort, despite persistence of syringomyelia. CONCLUSIONS: In this small cohort of unique patients, syrinx resolution was not achieved via decompression surgery. Despite "radiographic failure," good symptom control was achieved, with most patients remaining or becoming asymptomatic postoperatively, thus supporting our rationale for what has largely been a conservative approach in this population.


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia , Fossa Craniana Posterior/cirurgia , Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Siringomielia/etiologia , Siringomielia/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Parestesia/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
Jt Dis Relat Surg ; 31(1): 50-5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160494

RESUMO

OBJECTIVES: This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). PATIENTS AND METHODS: The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1: mini-open and group 2: extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure pre- and postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. RESULTS: Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. CONCLUSION: Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.


Assuntos
Síndrome do Túnel Carpal , Descompressão Cirúrgica/métodos , Dor , Parestesia , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor/diagnóstico , Dor/etiologia , Medição da Dor/métodos , Parestesia/diagnóstico , Parestesia/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Punho/fisiopatologia , Punho/cirurgia
18.
Ir J Med Sci ; 189(4): 1311-1316, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32086681

RESUMO

BACKGROUND: Notalgia paresthetica (NP) is a neuropathic itching condition unilaterally localized in the midscapular area. It is a common but an underdiagnosed disease, and only a few studies investigating NP etiology with a limited number of patients have been reported in the literature. OBJECTIVE: We aimed to evaluate the demographic, clinical, histopathological, neurological, and radiological findings of NP patients and investigate correlations between them and symptoms of NP to elucidate the etiology of NP. METHODS: One hundred and seventeen consecutive patients diagnosed with NP were included and assessed in a multidisciplinary and prospective manner. We recorded demographic and clinical data and obtained a skin biopsy from the pruritic or hyperpigmented region. Pruritus severity was assessed by visual analogue scale (VAS). All patients were evaluated neurologically with magnetic resonance imaging. RESULTS: The mean age of the patients was 47.08 ± 12.28 years. The disease was more common in females (87.2%). Statistical analysis revealed that VAS scores were independent of the age, gender, and skin type of the patient. We found no significant difference in VAS scores between NP patients with or without comorbidities. Vertebral pathologies detected by MRI and amyloid deposition revealed in histopathology were not among the main factors affecting VAS scores. STUDY LIMITATION: Since consecutive patients enrolled into the study, we could not include equal number of male and female patients. CONCLUSION: We found no correlation between symptom severity and findings from neurological and histopathological evaluations. Further microneurological studies should be carried out to elucidate the etiology of NP.


Assuntos
Parestesia/etiologia , Prurido/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parestesia/patologia , Estudos Prospectivos , Prurido/patologia
19.
Yakugaku Zasshi ; 140(1): 1-6, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-31902877

RESUMO

Dysesthesia is an unpleasant abnormal sensation, often accompanied by pain, paresthesia (abnormal sensation), and numbness (decrease or loss of sensation). Dysesthesia has been associated with various conditions, although its underlying mechanisms are largely unknown. This study assessed the roles of transient receptor potential ankyrin 1 (TRPA1) in dysesthesia by utilizing three animal models of dysesthesia characterized by reductions in blood flow to the skin: a transient hindlimb ischemia/reperfusion model, characterized by spontaneous licking and tactile hypoesthesia of the ischemic hindpaw; a streptozotocin-induced diabetic neuropathy model in mice, characterized by cold hypersensitivity, which is likely parallel to the reduced skin blood flow of the hindpaw; and a hindlimb ischemia model. TRPA1 inhibition or deficiency blocked spontaneous licking in the transient hindlimb ischemia/reperfusion model and cold hypersensitivity in the diabetic mouse model mice. Consistent with these results, the nocifensive behaviors induced by intraplantar injection of a TRPA1 agonist were enhanced in the diabetic neuropathy and hindlimb ischemia models. Hypoxia enhanced H2O2-induced TRPA1 responses in human TRPA1-expressing cells and cultured mouse dorsal root ganglion neurons, with this hypoxia-induced TRPA1 sensitization to H2O2 being associated with hypoxia-induced inhibition of the hydroxylation of prolyl hydroxylases. These results suggest that dysesthesia following blood flow reduction is caused by the activation of TRPA1 sensitized by hypoxia and that hypoxia-induced TRPA1 sensitization plays a pivotal role in painful dysesthesia induced by peripheral blood flow reduction.


Assuntos
Parestesia/genética , Canal de Cátion TRPA1/fisiologia , Animais , Neuropatias Diabéticas , Modelos Animais de Doenças , Humanos , Hipóxia , Parestesia/etiologia , Parestesia/fisiopatologia , Fluxo Sanguíneo Regional , Pele/irrigação sanguínea , Canal de Cátion TRPA1/metabolismo
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