Síndrome del Desfiladero Torácico en una niña. Caso clínico / Thoracic outlet syndrome in a girl. Clinical case

Introducción: El Síndrome del Desfiladero Torácico lo conforma una serie de síntomas y signos causados por la compresión de las estructuras neurovasculares en su salida por el desfiladero torácico a nivel supraclavicular.2 Dependiendo de la estructura afectada se habla de Síndrome del Desfiladero Torácico Neurológico, cuando la compresión es neurológica, SDTA cuando es arterial y SDTV cuando la compresión es venosa.3La presentación en la infancia es excepcional y la aparición con déficits motores se presenta en uno entre un millón de casos.1-6Los síntomas de dolor, debilidad y parestesias en la mano son orientativos y obligan a descartar esta entidad, así como signos clínicos de atrofia de musculatura son indicativos de la cronicidad.Los estudios preoperatorios como la electromiografía, RMN y angiografía asociada a RMN y pruebas dinámicas contribuyen al diagnóstico de esta entidad.7 La resección de la primera costilla y la escalenotomía es el procedimiento quirúrgico habitual en estos casos.8Presentamos el caso de una niña de 8 años que inicia sintomatología coincidiendo con la toma de biopsia a nivel supraclavicular en estudio de tumoración.

Introduction: The Thoracic Outlet Syndrome (TOS) conforms series of symptoms and signs caused by a compression of the neurovascular structures in the output thoracic pass at supraclavicluar level2. Depending on the affected structure, the syndrome can be Nerve Thoracic Outlet Syndrome (NTOS), Arterial Thoracic Outlet Syndrome (ATOS) or Venous Thoracic Outlet Syndrome (VTOS).3 The presentation in childhood is exceptional and the appearance with motor deficits occurs in one in a million cases.1The main clinical signs of TOS in adults include ip-silateral upper limb pain and discomfort, weakness, cold intolerance, and numbness of the hand. During physical examination, the muscles of the ipsilateral limb are relatively weak, and anesthesia, or pinprick sensation without pain is present on the inner sur- face of the hand and forearm. Thenar and hypothenar muscle atrophy may also be seen.In contrast, in children and teenagers, TOS usually presents as neck discomfort, upper limb numbness, weakness, and sensory loss.9We present the case of an 8-years-old girl started symptomatology coinciding with a biopsy taken for supraclavicular tumor at this level.

Dissection of intercostal nerves by means of assisted video thoracoscopy: experimental study.

In total brachial plexus preganglionic lesions (C5-C6-C7-C8 and T1) different extraplexual neurotizations are indicated for partial motor function restitution. Mostly for the flexion of the elbow. Neurotization with intercostal nerves (ICN) to musculocutaneous nerve has been known and accepted during many years with different results 2 - 5. The customary technique as described by various authors is carried out by means of a large submammary incision to harvest three or four intercostal nerves (Figure 1). Then are connected by direct suture or grafts to the musculocutaneous nerve or its motor branches 6 - 7. In this article the authors described the possibility of dissection intercostal nerves by means of assisted video thoracoscopy. (VATS-videdo assisted thoracic surgery).

Effect of temporal separation on synchronization in rhythmic performance.

A variety of short time delays inserted between pairs of subjects were found to affect their ability to synchronize a musical task. The subjects performed a clapping rhythm together from separate sound-isolated rooms via headphones and without visual contact. One-way time delays between pairs were manipulated electronically in the range of 3 to 78 ms. We are interested in quantifying the envelope of time delay within which two individuals produce synchronous performances. The results indicate that there are distinct regimes of mutually coupled behavior, and that 'natural time delay'--delay within the narrow range associated with travel times across spatial arrangements of groups and ensembles--supports the most stable performance. Conditions outside of this envelope, with time delays both below and above it, create characteristic interaction dynamics in the mutually coupled actions of the duo. Trials at extremely short delays (corresponding to unnaturally close proximity) had a tendency to accelerate from anticipation. Synchronization lagged at longer delays (larger than usual physical distances) and produced an increasingly severe deceleration and then deterioration of performed rhythms. The study has implications for music collaboration over the Internet and suggests that stable rhythmic performance can be achieved by 'wired ensembles' across distances of thousands of kilometers.

Neurotization with the brachialis muscle motor nerve.

Function of the wrist and hand in lower root avulsions is severely impaired. Based on anatomic and experimental studies which suggest that the motor nerve of the brachialis muscle could be used as a selective neurotizator in lower root avulsions with intact C5-C6 +/- C7 roots (Klumpke paralysis), we considered its use depending on the target. We describe two techniques for the median nerve (in C8-T1 avulsions) and one for the radial nerve (in C7-C8-T1 avulsions). In all cases, we added the lateral cutaneous nerve of the forearm in the neurotization to improve sensibility in the hand. The present report presents the results of its use in our first five patients.