Early detection of sensory nerve function impairment in leprosy under field conditions

Aim: To assess the fine sensation of palms and soles in field conditions, to enable early detection of nerve function impairment before the loss of protective sensation, thus preventing the development of disability. Methods: A cross-sectional descriptive study was conducted at seven tertiary referral hospitals located in different states in India. This study included all newly diagnosed patients affected by leprosy, who were registered during the period between March 2011 and April 2012. A detailed history was taken along with charting and voluntary muscle testing /sensory testing (VMT/ST) for the diagnosed patients. The sensation was measured using 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles first, followed by 2 gm Semmes-Weinstein filaments for palms and 10 gm for soles. Results: Among the 374 patients, 106 were identified with sensory nerve function impairment. Of the 106 patients, 84 were identified with absence of both fine and protective sensation and 22 patients had a loss of fine touch sensation with protective sensation intact. Limitation: This study was conducted only among patients who were newly diagnosed with leprosy. Hence, future longitudinal studies in a larger population will add more validity to the study. Conclusion: The patients who had loss of fine sensation would have been missed by the normal leprosy programme protocol which uses 2 gm and 10 gm filaments for testing sensory loss before initiating steroid therapy. Further research is needed to determine whether testing for fine sensation with 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles can be introduced at all specialized leprosy centres to detect nerve function impairment at an earlier stage followed by steroid therapy.

Reliability of diabetic neuropathy symptom and diabetic neuropathy examination scoring system for the diagnosis of diabetic peripheral neuropathy in type 2 diabetes mellitus patients

Background: This study aims to evaluate the reliability of the Diabetic Neuropathy Examination Score (DNE), 10-g Semmes-Weinstein Monofilament Examination and Quantitative Sensory Testing by Vibration Perception Threshold (VPT) in the diagnosis of diabetic polyneuropathy and seek a cost effective and reliable screening method in diabetic OPD and IPD against the gold standard of NCV.Methods: This study was carried out in 50 confirmed type 2 diabetic patients matched for age, sex, duration and ABI >0.9 irrespective of the presenting complaints. Patients with either limb amputation, other reasons for peripheral neuropathy, ABI <0.9, critical and comatose were excluded. A complete neurological assessment using a symptom questionnaire, Semmes Weinstein monofilament, vibration and thermal threshold perception analyzer was done and recorded. A score was given out of 20. The patients were retrograde subjected to NCV by a blinded technician and the readings were then compared to the scores.Results: The level of significance between the total neuropathy score and the presence of neuropathy (by NCV) was very significant (p<0.0001) with an association of 0.932. In patients with a mean total neuropathy score of 3.28,10.80 and 15.37, there was no, mild and severe levels of neuropathy in NCV respectively.Conclusions: There is correlation between the total neurological scores and NCV. Therefore, it can be used to screen all diabetic patients for earliest signs of diabetic neuropathy with sustainable results.

Correlação entre sensibilidade cutânea plantar e a idade: um estudo transversal / Correlation between plantar cutaneous sensitivity and age: a crosssectional study

A sensibilidade cutânea plantar se dá pela percepção de pressão de contato com o solo, importante para o sistema somatossensorial, nos membros inferiores, principalmente na região plantar dos pés a sensibilidade pode ser alterada por diversos fatores, entre um deles a idade. Portanto é clinicamente relevante e tem uma influência importante na funcionalidade e qualidade de vida. O objetivo do estudo foi analisar a progressão da perda de sensibilidade cutânea plantar em indivíduos com diferentes idades. O estudo foi do tipo transversal, realizado na ESEFFEGO-UEG. Cada participante da pesquisa foi avaliado individualmente através da aplicação dos monofilamentos de Semmes-Weinstein (Estesiometria), um método rápido para a avaliação da sensibilidade plantar, na região dos pés em 10 pontos divididos entre as regiões dorsal, de ante-pé, médio-pé e retro-pé. Foi realizada uma análise descritiva dos dados, para avaliar a normalidade utilizou-se o teste de Shapiro-Wilk. Para correlação o índice de correlação de Sperman. Intervalo de confiança de 95% e um nível de significância de 5% (p<0,05). Participaram da pesquisa 42 indivíduos, porém 11 foram excluídos por não participarem da avaliação da estesiometria, constituindo a amostra final por 31 participantes, sendo que na análise de correlação entre a idade e a estesiometria e suas respectivas regiões foi verificada correlação estatisticamente significante, moderada e negativa entre a idade e a sensibilidade cutânea plantar da região dorsal (-0,462), do ante-pé (-0,475), médio-pé (-0,561), estesiometria do MIE (-0,501), do MID (-0,545)e sensibilidade cutânea plantar total (-0,555) e ainda uma correlação forte entre a idade e a redução da sensibilidade da região do retro-pé (-0,613). Assim, quanto maior a idade menor a sensibilidade dos participantes. Portanto confirma-se uma correlação negativa entre sensibilidade cutânea plantar e idade. A correlação é mais forte ao se analisar redução da sensibilidade do retro-pé em indivíduos com maior idade....(AU)

Plantar skin sensibility is due to the perception of contact pressure with soil, important for the somatosensory system, in the lower limbs, especially in the plantar region of the feet. Sensitivity can be altered by several factors, including age. Therefore it is clinically relevant and has an important influence on functionality and quality of life. The aim of the study was to analyze the progression of loss of plantar skin sensibility in individuals of different ages. The cross-sectional study was carried out at ESEFFEGO-UEG. Each research participant was made through the application of Semmes- einstein monofilaments (nylon monofilament), a rapid method for the evaluation of plantar sensitivity in the region of the feet in 10 points divided between the dorsal, ante-foot, mid-foot and retro-foot. A descriptive data analysis was performed to evaluate the normality, using the Shapiro-Wilk test. For correlation, the Sperman correlation index.95% confidence interval and a significance level of 5% (p <0.05). 42 individuals participated in the study, but 11 were excluded because they did not participate in the evaluation of the stoichiometry, constituting the final sample by 31 participants. In the analysis of correlation between age and stasis and their respective regions, a statistically significant, moderate and negative correlation between age and plantar cutaneous sensibility of the dorsal region (-0,462), ante-foot (-0,475), midfoot (-0,561), the left lower limb (-0.501), right lower limb (-0.545) and total plantar cutaneous sensitivity (-0.555) and a strong correlation between age and reduced sensitivity of the retrofoot region (-0.613).Thus, the greater the age the lower the sensitivity of the participants. Therefore, a negative correlation between plantar cutaneous sensitivity and age was confirmed. The correlation is stronger when analyzing the reduction of backspeed sensitivity in older individuals....(AU)

Uso dos monofilamentos de Semmes Weinstein nos últimos cinco anos: revisão bibliográfica / Use of the Semmes Weinstein monofilament the past five years: Literature Review

O presente estudo teve por intuito revisar e analisar a bibliografia sobre a utilização dos Monofilamentos de Semmes Weinstein nos anos de 2010 à 2015, disponibilizada gratuitamente nas bases de dados Biblioteca Virtual da Saúde - BVS e PubMed. A questão apresentada por esse trabalho indaga em quais patologias foi frequente o uso da referida técnica, além de apontar as considerações sugestivas para seu o uso. Na pesquisa de bancos de dados, após cumprir os critérios de inclusão estabelecidos, foram selecionados trinta e oito artigos. Após a revisão e análise dos mesmos, foi possível verificar em quais patologias há maior incidência no uso dos monofilamentos, bem como identificar aspectos sugestivos referentes ao uso do objeto de estudo. Para nós, terapeutas ocupacionais, faz-se necessário conhecer as diversas utilizações existentes sobre o uso dos monofilamentos para que possamos compreender e aprofundar técnicas e locais de aplicação em diversas patologias, ampliando assim, nossa atuação na detecção e tratamento das afecções sensitivas.

The present study was aimed to review and analyze the literature on the use of Monofilament of Semmes Weinstein in the years 2010 to 2015, available for free on Biblioteca Virtual em Saúde - BVS and PubMed. The question presented by this work to inquire under what conditions was the frequent use of that technique, while pointing out the suggestive considerations for its use. The database search, after meeting the inclusion criteria were selected thirty-eight articles. After review and analysis of the data, we found conditions in which there is greater emphasis on the use of monofilament and to identify aspects suggestive for the use of the subject matter. For us, occupational therapists, it is necessary to know the various existing uses on the use of monofilament so we can understand and deepen technical and application sites in various diseases, thus expanding our operations in the detection and treatment of sensory disorders.

Avaliação da eficácia do uso dos monofilamentos de Semmes-Weinstein para avaliação da sensibilidade abdominal / Evaluation of the effectiveness of Semmes­Weinstein monofilaments in assessing abdominal sensitivity

OBJETIVO: O objetivo deste estudo é avaliar se o método de Semmes-Weinstein tem resultados consistentes e verificar se existem diferenças de sensibilidade entre as regiões da parede abdominal. MÉTODOS: Os monofilamentos de Semmes-Weinstein foram utilizados para avaliar a sensibilidade da pele à pressão abdominal em 20 voluntárias. A pele abdominal foi dividida em nove regiões. A avaliação da sensibilidade cutânea à pressão foi realizada três vezes em cada área, com um intervalo de uma semana entre as medidas. RESULTADOS: Analisando-se as três medidas em cada área, isoladamente, não houve diferenças significativas no limiar pressórico. No entanto, o método de Semmes-Weinstein mostrou diferença estatisticamente significativa entre os valores pressóricos obtidos de cada região abdominal. CONCLUSÕES: Os monofilamentos de Semmes-Weinstein são consistentes para avaliar a sensibilidade da pele abdominal à pressão. Notou-se que o método de Semmes-Weinstein mostrou diferença estatisticamente significativa entre as diferentes áreas da região abdominal. Utilizando-se a metodologia do presente estudo, foi possível estabelecer um protocolo para reduzir o aspecto subjetivo, medindo a sensibilidade à pressão.

OBJECTIVE: The aim of this study is to evaluate whether Semmes-Weinstein monofilaments could be used to reliably assess the sensitivities of different abdominal wall regions. METHODS: Semmes-Weinstein monofilaments were used to evaluate skin sensitivity to abdominal pressure in 20 volunteers. The abdominal skin was divided into nine regions. The assessment of skin sensitivity to pressure was carried out three times in each area, with 1 week intervals between measurements. RESULTS: No significant differences in the pressure threshold were observed when the three measurements in each region were analyzed separately. However, with the Semmes-Weinstein monofilament technique, a statistically significant difference was observed between the values of pressure obtained in each abdominal region. CONCLUSIONS: Semmes-Weinstein monofilaments are a reliable tool in evaluating abdominal skin sensitivity to pressure. A statistically significant difference was observed between the different areas of the abdominal region with this technique. With the method reported in this study, it was possible to establish a protocol to reduce subjectivity and measure the skin sensitivity to pressure.

Avaliação convencional e estesiômetro: resultados controversos na avaliação sensitiva no câncer de mama / Evaluation Conventional & Esthesiometer: controversial results in sensory evaluation in breast cancer

Este estudo clínico, prospectivo e randomizado, foi realizado no período de agosto de 2004 a fevereiro de 2008,na amostra de conveniência de 60 mulheres, submetidas à cirurgia de mama com esvaziamento axilar, divididasem dois grupos (n=30): o GI (Orientação com Kit de diferentes texturas, para realização em domicilio) e oGII (Controle). O objetivo foi analisar o efeito da orientação domiciliar, em pacientes após cirurgia de câncer de mama com queixa de hipoestesia, pela avaliação convencional e com o uso do estesiômetro. A sensibilidade superficial foi avaliada pelos monofilamentos de Semmes-Weinstein e pela avaliação convencional utilizando dois tubos de ensaios com água quente (38 a 43°C) e fria (16 a 27°C), pincel e agulha. O GI foi submetido a dez sessões e ambos a avaliações em três momentos. O M1 (Pré intervenção), o M2 (Pós-intervenção) após dez sessões de intervenção fisioterapêutica e o M3 (washout) após três meses do segundo momento avaliativo. A região alvo de avaliação e intervenção sensitiva foi o dermátomo do nervo intercostobraquial. No teste de Goodman (avaliação convencional) houve melhora em ambos os grupos no P1, durante a avaliação térmica. No teste "t" de student (estesiômetro) houve melhora no P2 apenas no GI (p=0,003) entre os momentos ume dois mantendo no momento três (p=0,121 e p=0,733 respectivamente). Foi concluído que houve divergênciae resultados opostos, após analisado o efeito da orientação domiciliar no dermátomo do nervo intercostobraquial, pelas avaliações convencional e com uso do estesiômetro.

This study, clinical, prospective, randomized study was conducted from August 2004 to February 2008 in a convenience sample of 60 women who underwent breast surgery with axillary dissection, divided into two groups (n = 30). The GI (Guidance Kit with different textures, to perform at home) and GII (control). The objective was to analyze the effect of home orientation in patients after surgery for breast cancer complaining of numbness, evaluation, and the conventional esthesiometer. The surface sensitivity was assessed by monofilament Semmes-Weinstein and evaluation using conventional two test tubes with hot water (38 to 43°C) and cold (16 to 27°C), paintbrush, needle. The GI was subjected to 10 sessions and assessments in both 3times. The M1 (pre intervention), the M2 (post-intervention) after 10 sessions of physical therapy intervention and M3 (washout) after 3 months the second time for assessment. The region targeted for evaluation and intervention was the sensory nerve dermatome intercostobrachial. In the test of Goodman (conventional assessment) there was improvement in both groups, the P1, during the thermal evaluation. The t-test ofstudent (esthesiometer) there was improvement in P2 only in GI (p = 0.003) between points 1 and 2 while the time 3 (p = 0.121 and p = 0.733 respectively). It was concluded that there were divergent and opposite results after examining the effect of home orientation in the nerve dermatome intercostobrachial, evaluation, and the conventional esthesiometer.

Risk Determinants of Peripheral Neuropathy in Patients with Type II Diabetes Mellitus Attending Follow-Up Clinics at Universiti Kebangsaan Malaysia Medical Center (UKMMC): A Cross-Sectional Study

Peripheral neuropathy is highly associated with foot complications among diabetics. This study aimed to identify risk factors associated with the development of peripheral neuropathy in diabetic patients and their association with degree of severity of peripheral neuropathy. A cross-sectional study was conducted in follow-up clinics at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia involving 72 diabetic patients and 19 controls. Exclusion criteria were those with amputated limbs, gross foot deformity and existing peripheral neuropathy. Controls were non diabetics who walked normally, had no history of foot problem and attended the clinic as subjects’ companion. Quantitative assessment of neuropathy was done using Semmes-Weinstein monofilament. Neuropathy Disability Score (NDS) were used to quantify severity of diabetic neuropathy. Spearman’s Rank test and Mann-Whitney test were used to determine correlation between variables and their differences. Logistic regression analysis was used to determine risk factors associated with peripheral neuropathy. The mean HbA1c among diabetics was 8.6% + 4.1, and mean NDS was 7.0 + 6.0. A total of 79.1% demonstrated various level of neuropathy with presence of callus was associated with higher NDS scores. Older age (P=0.02), body weight (P=0.03), HbA1c (P=0.005) and duration of diabetes (P <0.005) showed positive correlation with NDS. Proper foot care program for diabetics should include recognition of the callus, with special emphasis given to those with heavier weight and increasing age.

Avaliação sensitiva de hansenianos pelos monofilamentos Semmes-Weinstein em serviço terciário de fisioterapia / Effectiveness of Semmes-Weinstein monofilaments in leprosy neuropathy in physiotherapy tertiary sevice

OBJETIVOS: Identificar a frequência das alterações da sensibilidade de mãos e pés de hansenianos através dos monofilamentos Semmes-Weinstein no hospital terciário.MÉTODO: Trinta pacientes do setor de fisioterapia do Hospital da Clínicas da FMRP-USP foram avaliados clinico-epidemiologicamente e submetidos ao teste por monofilamentos de agosto a dezembro de 2004.RESULTADOS: A média de idade dos pacientes foi de 48,4 anos, sendo 80% do sexo masculino e 70% oriundos da região de Ribeirão Preto. Classificavam-se como multibacilares 70% dos pacientes e 80% apresentavam-se com Grau I de incapacidade. Quanto ao teste nos membros superiores, o nervo ulnar foi o mais acometido nos paucibacilares (78%) e nos multibacilares (83%). Nos membros inferiores, o ramo plantar medial do nervo tibial posterior encontrou-se acometido em todos os pacientes do grupo multibacilar. A sensação protetora estava ausente nas mãos em 26% no grupo pauci e 46% no multibacilar, e nos pés 44% no paucibacilar e 56% no multibacilar. O diagnóstico foi tardio em 37% dos pacientes, apresentando no mínimo dois nervos com perda da sensação protetora.CONCLUSÃO: Os resultados evidenciaram que o acompanhamento da neuropatia da hanseníase pelos monofilamentos S-W, mostrou-se capaz de identificar alterações da sensibilidade em múltiplos nervos das extremidades, tanto nos pacientes paucibacilares quanto multibacilares, tornando-se evidente a gravidade dos pacientes atendidos nos serviço de atenção terciária à saúde.

OBJECTIVES: To identify the frequency of changes in the sensibility of hands and feet from leprosy patients through the Semmes-Weinstein monofilament in tertiary hospital.METHOD: Thirty patients of the Physiotherapy Service of Hospital das Clínicas FMRP-USP were evaluated from August to December 2004. The patients were clinically and epidemiologically evaluated. Afterwards, monofilaments were tested.RESULTS: The mean age was 48.4 years, 80% male and 70% came from the Ribeirão Preto region. Seventy percent of the patients were classified as multibacilary and 80% presented grade 1 of incapacity. Concerning to Semmes-Weinstein test on the upper limbs, the ulnar was the most impaired nerve on the paucibacillary patients (78%) and on the multibacillary (83%). On the lower limbs, the plantar medial branch from the tibial posterior nerve had been impaired in all patients. The protective sensation was absent on the hands in 26% on the paucibacillary group and 46% on the multibacillary, and on the feet in 44% on the paucibacillary and 56% on the multibacillary. Thirty seven percent of the patients have received late diagnosis, showing at least two nerves without protective sensation.CONCLUSIONS: The results showed the reliable use of Semmes-Weinstein monofilaments during the follow up of leprosy patients. This tool was able to identify sensitive changes in multiple nerves of the extremities, for paucibacilary and multibacilary patients, what clearly shows the severity of incoming patients in health tertiary care service.

Umbral de sensibilidad de los nervios periféricos de la mano en pacientes con diabetes tipo II / Sensitivity theshold of peripheral nerves of hand in patients with diabetes type II

Las neuropatías periféricas en mano de los pacientes con diabetes tipo II son poco estudiadas por lo que esta investigación de tipo descriptivo se buscó establecer su manifestación mediante una prueba de sensibilidad con monofilamentos de Semmes-Weinstein (SWME) realizada a 66 pacientes que asisten a la Clínica de Diabetes del Hospital Militar Central de Bogotá (HOSMIC), en un período de 4 meses. Se tuvo en cuenta la edad, el género y la dominancia, las que se relacionaron con el umbral sensitivo en los territorios autónomos de los nervios radial, mediano y cubital. Las 132 manos evaluadas el mayor porcentaje presentó disminución del tacto ligero, así: 43% nervio radial, 36% nervio mediano y 42% nervio cubital. La disminución de la sensación protectiva mostró que el nervio radial se comprometió en el 29%, el nervio mediano en el 21% y el cubital en el 14%. Las mujeres tienen el mayor porcentaje de normalidad en el tacto con 42%, mientras que los hombres lo presentaron en la disminución del tacto ligero en un 43%. En cuanto a edad, el mayor compromiso se presentó en usuarios mayores de 70 años en un 26% y no hubo notoria diferencia entre la sensibilidad de la mano dominante y la no dominante.

Peripheral neuropathies in hand of patients with diabetes are poorly studied so this research is a descriptive cross, find their expression through a sensitivity test to Semmes-Weinstein monofilament (SWME) performed to 66 patients attending to the Diabetes Clinic of the Central Military Hospital in Bogotá (HOSMIC), over a period of 4 months. The variables that were considered were age, gender and dominance which were related to sensory findings in the autonomous territories of the radial nerve, median and ulnar. It was established that 132 of the hands evaluated provided the highest percentage decrease in light touch, and 43% radial nerve, median nerve 36% and 42% ulnar nerve. The decrease of the protective sensation showed that the radial nerve was committed at 29%, the median nerve in 21% and the ulnar in 14%. It was concluded that women have the highest percentage of normalcy in touch with 42% while men showed a decrease in light touch by 43%. Regarding age, the greater was present in users over 70 years by 26% and there was no noticeable difference between the sensitivity of the dominant hand and non-dominant.

Sensibilidade da mama antes e após a mamoplastia com cicatriz curta em L / Breast tenderness before and after L-short scar mammoplasty

A preservação da sensibilidade da mama é uma das metas a seremalcançadas na moderna cirurgia de mama, mas a literatura sobre o assunto é escassa e contraditória. O objetivo desta pesquisa foi estudar prospectivamente a sensibilidade das mamas de 64 pacientes submetidas à técnica de mamoplastia com cicatriz curta em L. As mamas (n=125) foram testadas um dia antes da operação, seis meses e 12 meses depois, com os monofilamentos de Semmes- Weinstein. Foram testados nove pontos em cada mama: o mamilo, quatro pontoscardeais na aréola e quatro pontos cardeais na pele. As mamas foramclassificadas em três grupos, de acordo com o peso do tecido mamário excisado: grupo A, até 200 gramas; grupo B, de 201 a 400 gramas; grupo C, mais de 400 gramas. O teste de Kruskal-Wallis foi utilizado para comparar a sensibilidade das regiões da mama nos diferentes grupos, em períodos distintos. O teste de Friedman foi empregado para comparar a evolução da sensibilidade das regiões da mesma mama em diferentes períodos operatórios, separadamente em cada um dos grupos. Valores de p<0,05 foram considerados estatisticamentesignificativos. Descreveu-se a técnica de mamoplastia com cicatriz curta em L e manobras cirúrgicas para preservarem-se as divisões anteriores dos ramos cutâneos laterais dos nervos intercostais. Antes da operação, observou-se que a sensibilidade na pele das mamas foi menos intensa significativamente com o aumento da ptose mamária (graus I, II e III; p=0,021) e verificou-se, também, relação entre volumes mamários maiores e menos sensibilidade nas regiões daaréola (grupos B e C; p<0,001) e da pele (grupo C; p<0,001). Não se observou, 12 meses depois, relação entre maiores volumes excisados e menos sensibilidade mamária. Nos complexos aréolo-mamilares, todos os grupos alcançaram níveis de sensibilidade sem diferença significativa em relação aos níveis pré-operatórios, entre seis e 12 meses após a operação. Depois de seis e 12 meses, verificaram-se níveis de sensibilidade mais intensa significativamente na pele das mamas com excisões de mais de 200 gramas (grupo B; p=0,002 egrupo C; p<0,001). As pacientes também foram avaliadas subjetivamente, respondendo a questionário 12 meses após a operação. Do total, 89,1% informaram que a sensibilidade do complexo aréolo-mamilar não desapareceu nem mesmo nos primeiros dias de pós-operatório. Depois de 12 meses, nenhuma relatou áreas de insensibilidade na aréola ou no mamilo; 66,4% do total daspacientes e 94,4% das componentes do grupo C (média de excisão de tecido mamário de 499 gramas) descreveram sensibilidade da aréola e do mamilo melhor ou igual à sensibilidade pré-operatória. Concluiu-se que, após a mamoplastia com cicatriz curta em L, a sensibilidade mamária à pressão retorna aos níveis pré-operatórios ou melhora e que a maioria das pacientes fica satisfeita com a qualidade e a intensidade da sensibilidade na aréola e no mamilo, principalmente aquelas com mamas maiores.

Breast sensitivity preservation is one of the aims to be achieved bymodern breast surgery but the literature on the subject is scarce and contradictory. The purpose of this work was to prospectively study the breast sensitivity of 64 patients who underwent surgery with the L short scar mammaplasty technique. The breasts (n = 125) were tested one day before surgery, as well as six months and twelve months after it, with Semmes-Weinstein monofilaments. Nine points on each breast were tested: the nipple, four cardinal points on the areola and four cardinal points on the skin. Breasts were classified in three groups, according to the mammary tissue weight resected: group A up to 200 g, group B from 201 to 400 g and group C over 400 g. The ruskal-Wallis Test was used in order to compare breast region sensitivity in the different groups, in distinct periods. The Friedman Test was used to compare the evolution of sensitivity of the same breast in different operative periods in each group separately; p<0.05 values were considered to be statistically significant. The L short scar mammaplasty technique and surgical maneuvers carried out to preserve the anterior divisions of the lateral cutaneous branches of the intercostal nerves were described. Before surgery it was noticed that breast skin sensitivity was significantly less intense with the increase on breast ptosis (grades I, II and III; p=0.021). It was also noticed a relation between larger breasts volumes and less sensitivity in areola regions (groups B and C; p<0.001) and on skin (group C; p<0.001). Twelve months after surgery it wasnt observed a relation between larger resected volumes and less breast sensitivity. In nipple-areola complexes, all groups reached sensitivity levels without significant difference in relation to pre-operative levels, from six to twelvemonths after surgery. After six and twelve months, significantly more intense sensitivity levels on breast skin were verified in resections of more than 200 g (group B; p=0.002 and group C; p<0.001). Patients were also subjectively evaluated, answering a questionnaire 12 months after surgery. From the total, 89.1% reported that nipple-areola complex sensitivity didnt disappear even on the first days of the post-operative period. After 12 months, no patient reported areola or nipple insensitivity areas; 66.4% from the total of patients and 94.4% from group C patients (mammary tissue resection mean of 499 g) reported areola or nipplesensitivity equal to or better than pre-operative sensitivity. In conclusion, after the L short scar mammaplasty, breast sensitivity to pressure returns to pre-operative levels or improves and most patients get pleased with areola or nipple sensitivity intensity and quality, mainly those with larger breasts

Sensory Thresholds of Normal Human Feet Using Semmes-Weinstein Monofilament

OBJECTIVE: To obtain the sensory thresholds of the feet from healthy adult using Semmes-Weinstein monofilaments. METHOD: Twenty male and twenty female volunteers aging from 24 to 38 years old were selected. There were no known medical conditions associated with decreased foot sensation and history of previous injury to the foot. The subjects were blindfolded with the leg resting on a chair as 14 plantar and 5 dorsal locations were tested on each foot. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. RESULTS: The mean sensitivity for all sites was 3.41+/-0.17. Sensation in the plantar surface of greater toe, 5th toe, arch, and dorsal surface of 1st web space, 3rd toe at the metatarsophalangeal joint level, 5th metatarsal head were the most sensitive. The least sensitive regions were the heel pad, lateral plantar midfoot, and medial and lateral heel. CONCLUSION: Normal data of sensory threshold using Semmes-Weinstein monofilament could be used for the early detection of peripheral neuropathy or loss of protective sensation.

Improvement of diabetic peripheral neuropathy using monochromatic infrared energy / 中华物理医学与康复杂志

Objective To observe the effect of monochromatic infrared energy(MIRE)on diabetic periphe- ral neuropathy(DPN).Methods Seventy-four subjects with diabetic peripheral neuropathy who were tested by Semmes-Weinstein monofilaments(SWM)were randomized into 2 groups:a conventional management group and a conventional management plus MIRE group.Then the patients'sensory function and other DPN symptoms were evalu- ated by the SWME and the score of Michigan Neuropathy Screening Instrument.Results After treatments,there was a decrease(P＜0.01)in the number of the sites insensitive to SWME(grade 5.07),and MNSI scores were sig- nificantly decreased(P＜0.01).The MIRE management was more effective than conventional management.Con- clusion Monochromatic infrared energy is perhaps a safe,non-pharmaceutical and non-invasive method for the treat- ment of diabetic peripheral neuropathy.

Nerve Conduction Study Findings and Risk Category of Diabetic Foot Screening Test

OBJECTIVE: To assess the correlation between the risk categories of diabetic foot screening test by 5.07 Semmes- Weinstein monofilament and the findings of standard nerve conduction studies of upper and lower extremities. METHOD: We studied 74 patients who were consulted to our department to rule out the diabetic neuropathy. We classified the patients to 4 risk groups by foot screening test using 5.07 Sememes-Weinstein monofilament, and performed the standard nerve conduction studies of upper and lower extremities. The risk categories of foot screening tests were compared to the findings of the nerve conduction studies. RESULTS: When the risk category becomes higher, there were more delay in latencies (motor and sensory potentials of median and ulnar nerve, sensory potentials of sural and superficial peroneal nerve, median and peroneal F-wave), slower conduction velocities (median, ulnar, peroneal, posterior tibial nerve) and lower amplitudes (motor and sensory potentials of media and ulnar nerve, peroneal and posterior tibial nerve, sural nerve) (p<0.05). Except for the amplitude of ulnar nerve and the latencies of peroneal and ulnar nerve, there were significant differences in the nerve conduction study data between the risk group 3 and the risk group 0 (p<0.05). CONCLUSION: We confirmed that the risk category of diabetic foot screening test by Semmes-Weinstein monofilament can meaningfully reflect the severity of diabetic neuropathy. We also suggest that it is necessary to pay attention to the nerve conduction study in the patients with history of foot ulcer.

Foot Screening Tests with Semmes-Weinstein Monofilament in Diabetic Inpatients

OBJECTIVE: To determine the prevalence of each risk category for diabetic foot ulcer by foot screening test with Semmes-Weinstein monofilament and to evaluate the correlation of the risk category with clinical data in diabetic inpatients. METHOD: Foot screening tests with Semmes-Weinstein monofilament was performed in 90 diabetic inpatients to determined the risk category for diabetic foot ulcer. An average age of patients was 55 years, and an average duration of the disease was 11 years. The correlation of risk category was evaluated with age, duration of the disease, FBS (fasting blood glucose) level, HbA1c value, and complications of diabetes including retinopathy, peripheral polyneuropathy, and renal failure. RESULTS: Patients with risk category 0 had no loss of protective sensation in 34.4% of cases. Patients with risk category 1, 2, and 3 had loss of protective sensation in 16.7%, 28.9% and 20% of cases, respectively. The older a patient was and the longer the duration of the disease was, the higher the risk category was significantly (p<0.05). There was no significant correlation of risk category with FBS level and HbA1c value. Among the complications associated with diabetes, retinopathy and peripheral polyneuropathy significantly correlated with risk category (p<0.05), but renal failure was not significantly associated. CONCLUSION: The foot screening test with Semmes-Weinstein monofilament should be helpful for proper management of diabetic foot in inpatient.

The Value of the Medial Plantar Sensory Nerve Conduction Study in Diabetic Patient

OBJECTIVE: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy. METHOD: Thirty healthy controls(mean age, 48.7 years; range, 38~59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37~64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilament 5.07. RESULTS: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29+/-0.49 msec and 3.1+/-1.34 V, respectively. All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively. CONCLUSION: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilament (North Coast Medical Inc, USA).