ABSTRACT
A 25-year-old white man, right after bilateral rhytidoplasty, presented with agitation, necessiting use of haloperidol. Some hours after, he developed severe pain in his legs and a diagnosis of neuroleptic malignant syndrome (NMS) was considered. Even with treatment for NMS he still complained of pain. A diagnosis of lower limb compartment syndrome (CS) was done only 12 hours after the initial event, being submitted to fasciotomy in both legs, disclosing very pale muscles, due to previous ischemia. This syndrome was not explained only by facial surgery, his position and duration of the procedure. It can be explained by a sequence of events. He had a history of pain in his legs during physical exercises, usually seen in chronic compartment syndrome. He used to take anabolizant and venlafaxine, not previously related, and the agitation could be related to serotoninergic syndrome caused by interaction between venlafaxine and haloperidol. Rhabdomyolisis could lead to oedema and ischmemia in both anterior leg compartment. This report highlights the importance of early diagnosis of compartment syndrome, otherwise, even after fasciotomy, a permanent disability secondary to peripheral nerve compression could occur.
Logo após ritidoplastia bilateral, um jovem de 25 anos apresentou agitação, necessitando uso de haloperidol. Algumas horas após, desenvolveu dor intensa em membros inferiores, e o diagnóstico de síndrome neuroléptica maligna foi considerado. Mesmo com o tratamento para tal, persistiu com dor. Após 12 horas do início do quadro, foi realizado o diagnóstico de síndrome compartimental de membros inferiores e o jovem foi submetido a fasciotomia bilateral. Uma seqüência de eventos desencadeou esta síndrome, já que sua ocorrência dificilmente seria justificada pela cirurgia facial e/ou posição do paciente durante o procedimento. O jovem apresentava previamente dor em membros inferiores aos exercícios, sugerindo a ocorrência de uma síndrome compartimental crônica. Ele fazia uso de anabolizantes e venlafaxina, não relatado no início do quadro, e a agitação poderia ser explicada por uma síndrome serotoninérgia desencadeada pela interação deste último medicamento e haloperidol. A rabdomiólise secundária a estes eventos causou edema e isquemia nos compartimentos anteriores de ambos os membros inferiores, levando a uma compressão secundária do nervo fibular. O caso em questão ilustra a importância do diagnóstico precoce da síndrome compartimental pois, caso contrário, mesmo com fasciotomia, uma complicação permanente devido à compressão de nervos periféricos pode se estabelecer.
Subject(s)
Adult , Humans , Male , Compartment Syndromes/etiology , Peroneal Neuropathies/etiology , Rhytidoplasty/adverse effects , Compartment Syndromes/surgery , Paralysis/etiology , Paralysis/surgery , Peroneal Neuropathies/surgeryABSTRACT
O autor apresenta 20 casos de paralisia alta do plexo braquial, acometendo as raízes C5, C6 ± C7, tratadas pela neurotização dos fascículos do nervo musculocutâneo que inervam o músculo bíceps braquial por fascículos do nervo ulnar para recuperação da flexão do cotovelo (Técnica de Oberlin).A neurorrafia pode ser executada sem enxertos nervosos de interposição. Em todos os paciente aferiu-se resultado positivo, com início da recuperação funcional aos 5,5 ± 1,7 meses pós- operatórios e flexão do cotovelo contra resistência aos 14,7 ± 5,5 meses depois da cirurgia.A seqüela provocada pela secção dos fascículos doadores do nervo ulnar foram clinicamente desprezíveis quando comparadas ao beneficio proporcionado. O sucesso alcançado pelo procedimento cirúrgico se deu, principalmente, pelo curto espaço de tempo entre o acidente e a cirurgia. Os resultados descritos estão de acordo com os da literatura e reafirmam que a neurotização "Ulnar-Biceps" e o procedimento de escolha para o tratamento cirúrgico das paralisias altas do plexo braquial.
The author presents 20 cases of upper brachial plexus palsies, concerning C5, C6 ± C7 roots, treated by neurotization of the musculocutaneus nerve fascicles innervating the biceps brachial muscle with ulnar nerve fascicles to recover elbow flexion (Oberlin's Technique). The neurorraphy could be executed without interposition of nerve grafts. All the patients had positive result, with beginning of the functional recovery at 5.5 ± 1.7 of postoperative month sandel bow flexi on again stresistance at 14.7 ± 5.5 months after the surgery. The sequel provoked by the sectioned donor fascicles of the ulnar nerve is clinically worthless when compared with the benefit produced. The success reached by the surgical procedure can be mainly given by short gap of time between accident and surgery. The described results are in accordance with the literature and reaffirm that the Ulnar-Biceps neurotization is the first choice procedure for the surgical treatment of the upper brachial plexus palsies.
Subject(s)
Humans , Brachial Plexus , Paralysis , Ulnar Nerve , Ulnar Nerve/abnormalities , Ulnar Nerve/surgery , Ulnar Nerve/pathology , Paralysis/surgery , Brachial Plexus/anatomy & histology , Brachial Plexus/abnormalities , Brachial Plexus/surgery , Brachial Plexus/physiopathology , Brachial Plexus/injuriesABSTRACT
Después las lesiones severas del plexo braquial que provocan parálisis del hombro, algunas veces se requieren operaciones reconstructivas para restaurar la función; por lo que es preciso utilizar varios músculos para realizar la transferencia. Se trataron 15 pacientes con lesiones del hombro que se les aplicó la técnica de Mayer, para realizar la transferencia del trapecio hacia el húmero. En los resultados obtenidos se constató 10 casos con pronóstico bueno, 4 casos regular y 1 caso de malo. En 14 pacientes se logró un hombro estable. La transferencia del trapecio brindó una mejor función con respecto a la artrodesis en la parálisis del hombro.
After severe injures in the brachial plexus causing shoulder paralysis, reconstructive surgery is sometimes required to restore the previous function, so it is necessary to use several muscles to make the transfer. Fifteen patients with shoulder injures were treated with Mayer´s technique to transfer the trapezius to the humerus. The results showed 10 cases with good prognosis, 4 cases with regular prognosis and 1 with bad outcome. Stabilized shoulder was possible in 14 patients. The transfer of the trapezius provided a better function than arthrodesis in the shoulder paralysis.
Après les lésions sévères du plexus brachial provoquant la paralysie de l'épaule, il faut parfois des chirurgies réparatrices afin de restaurer la fonction, il est donc nécessaire d'utiliser plusieurs muscles pour faire une translocation. Quinze patients atteints de lésions scapulaires ont été traités par la technique de Mayer pour faire la transposition du trapèze vers l'humérus. On a pu constater que 10 cas ont eu un bon pronostic, 4 un pronostic passable, et 1 un pronostic mauvais. On a réussi la consolidation de l'épaule chez 14 patients. La transposition du trapèze a permis d'obtenir une meilleure récupération qu'avec une arthrodèse dans les cas de paralysie de l'épaule.
Subject(s)
Humans , Arthrodesis/methods , Shoulder/injuries , Paralysis/surgery , Paralysis/therapy , Brachial Plexus/injuriesABSTRACT
Se presenta un caso de un paciente blanco, masculino, con antecedentes de salud, que trabaja como fregador en una base de ómnibus, acude a consulta, ya que hace 3 meses presenta impotencia funcional a la flexión de la articulación interfalángica del pulgar y de la interfalángica distal del segundo dedo de la mano izquierda, sin otra sintomatología, lo que le imposibilitaba realizar trabajos manuales que antes realizaba. Se efectúa examen físico y complementarios y se diagnostica una parálisis del nervio interóseo anterior (Síndrome de Nevin-Kiloh). Después de tres meses de tratamiento conservador se decide someter al paciente a tratamiento quirúrgico, realizándose una transposición tendinosa. Después de 2 meses de operado ya se han recuperado las funciones perdidas. La evolución fue satisfactoria. Se revisa la literatura...
We present the case of a white, male patient, with healthy antecedents, working as a car washer in a bus parking lot. He comes to our consult referring a flexional functional impotence of the thumb interphalanx joint and of the distal interphalanx of the left hand second finger already for three months, without any other symptom, making him impossible to do some works he did before. We made a physical and complementary examination, and diagnosed the paralysis of the anterior inter-bone nerve ( Nevin- Kiloh syndrome). After three months of conservative treatment, we decided the surgical intervention of the patient, performing a tendon transposition. Two months after surgery, the lost functions have been recovered. The evolution was satisfactory. We reviewed the literature.
Subject(s)
Humans , Male , Thumb , Paralysis/surgeryABSTRACT
Procurou-se avaliar o efeito da infusão de células progenitoras indiferenciadas autógenas no tratamento de pacientes com lesão medular crônica. Trinta e nove pacientes com diagnóstico de lesão medular completa há pelo menos dois anos foram submetidos à mobilização e coleta das células progenitoras em sangue periférico. O concentrado de células progenitoras foi reinfundido por arteriografia no paciente doador. Estes pacientes foram então submetidos a exames de potencial evocado somato-sensitivo para avaliar a recuperação neurológica. Após dois anos e meio de seguimento, o protocolo descrito mostrou-se seguro e levou a positivação do exame de potencial evocado em vinte e seis pacientes (66,7 por cento).
The objective of this study was to evaluate the effect of autogenous undifferentiated progenitor cell infusion in the treatment of patients with chronic spinal cord injury. Thirty-nine patients with complete spinal cord injury for at least two years underwent peripheral blood stem cell mobilization and collection. The progenitor cell concentrate was cryopreserved and reinfused through arteriography into the donor patient. These patients were submitted to examinations with somatosensitive evoked potential to evaluate neurological recovery after undifferentiated cell infusion. In two and a half year, this protocol was safe for the patients and cause positive answers for evoked potentials in twenty-six patients (66,7 per cent).
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Paralysis/surgery , Stem Cells , Spinal Cord Injuries/rehabilitation , Central Nervous System/surgeryABSTRACT
El pie paralítico fláccido tiene como deformidades más frecuentes el equino, varo y marcha en "steppage". Existen múltiples tratamientos quirúrgicos. Recientemente, Rodríguez describe una modificación del procedimiento de "Bridle", en el cual el tibial posterior es transferido al dorso del pie, con inserción ósea en la cuña media y tenodesado con el peroneo longus y el tibial anterior, a modo de "rienda" balanceada con tracción en tres puntos. Objetivos: Evaluar el resultado funcional de pacientes con pie paralítico fláccido flexible y semiflexible operados con procedimiento de "Bridle" modificado. Material y método: Evaluación retrospectiva de pacientes con pie paralítico fláccido tratados con técnica de "Bridle" modificado en el Hospital Clínico PUC entre agosto/2000 y abril/2004. Resultados:6 pacientes, 4 hombres y 2 mujeres, con 6 pies operados. Edad promedio de 27,6 (18-37) años. Seguimiento promedio de 26 meses. AOFAS pre/post cirugía: 32/76. Satisfacción completa en todos los pacientes (escala Kenneth-Johnson). Cinco pacientes regresaron a trabajar. Retorno parcial a actividad deportiva en 3 de 4 pacientes. Complicaciones locales en 1 caso; sin complicaciones sistémicas. Conclusión: existen pocas publicaciones sobre este procedimiento; nuestros resultados son comparables con la literatura. El procedimiento de "Bridle" modificado permite obtener un pie funcional, estable y plantígrado, con satisfacción completa en todos los pacientes.
Subject(s)
Humans , Male , Female , Adult , Foot Diseases/surgery , Paralysis/surgery , Paralysis/etiology , Tendon Transfer , Tendon Transfer/methodsABSTRACT
Propósito. Demostrar la utilidad de la resonancia magnética (RM) en la evaluación de las lesiones obstétricas del plexo braquial. Material y métodos. Fueron evaluados mediante RM de campo alto (1,5 Tesla) 23 pacientes con semiología correspondiente a parálisis del plexo braquial. Se estudió con bobina de cerebro en los planos axial, coronal oblicuo y sagital en secuencias ponderadas para T1, T2 y STIR. Resultados. En cuatro pacientes (17 por ciento) el examen fue considerado como normal. En 19 pacientes (83 por ciento) se obtuvieron hallazgos patológicos (pseudomeningoceles, neuromas, tumor y quiste aracnoideo). Conclusión. La RM es un método no invasivo que logra determinar el sitio y grado de compromiso del plexo braquial, permitiendo de esta manera programar en forma precisa la terapéutica a instituir
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Birth Injuries , Brachial Plexus , Brachial Plexus Neuropathies/diagnosis , Paralysis/diagnosis , Magnetic Resonance Spectroscopy , Magnetic Resonance Imaging , Brachial Plexus Neuropathies/etiology , Paralysis/surgery , Paralysis/etiology , PrognosisABSTRACT
Con el objeto de evaluar las principales complicaciones tras la tiroidectomía total se realizó un estudio prospectivo histórico sobre 256 pacientes operados en nuestro servicio entre los años 1985 y 1997. La mayoría de ellos fueron intervenidos por enfermedades tiroideas benignas. Encontramos hipocalcemia permanente en el 1,5 por ciento de los casos y parálisis recurrenciales unilaterales definitivas en el 0,9 por ciento. Nuestro índice de mortalidad fue del 0,4 por ciento. Otras complicaciones evaluadas incluyeron: serohematoma, hemorragia postoperatoria, infección de la herida y embolismo pulmonar
Subject(s)
Humans , Male , Female , Thyroid Gland/pathology , Hypocalcemia/prevention & control , Hypoparathyroidism/complications , Paralysis/surgery , Postoperative Care , Postoperative Complications/prevention & control , Thyroidectomy/statistics & numerical dataSubject(s)
Humans , Vocal Cord Paralysis/surgery , Paralysis/surgery , Thyroidectomy/adverse effectsABSTRACT
Forty-four hands of 42 leprosy patients with paralysis of intrinsic muscles of the hand were treated by opponensplasty using ring finger superficialis (FDS4) or extensor indicis proprius (EIP). Superficialis tendon of middle finger was also used in these hands for lumbrical replacement by "direct lasso" operation. Low ulnar paralysis with Froment's sign was corrected by transfer of radial half of flexor pollicis longus (FPL) to extensor pollicis longus (EPL). Results of thumb correction were assessed and analysed in 37 hands of 35 patients. The mean follow-up period was 19 months. Best results were found with transfer of half FPL to EPL. Results of FDS transfer was good in 12 out of 16 manual workers. EIP transfer worked well, but the power of the thumb and patients' satisfaction was less.
Subject(s)
Adolescent , Adult , Humans , Leprosy/physiopathology , Median Nerve , Middle Aged , Paralysis/surgery , Patient Satisfaction , Postoperative Period , Thumb/surgery , Treatment Outcome , Ulnar NerveABSTRACT
Os autores apresentam um caso de paralisia do nervo fibular comum provocado por cisto sinovial e fazem uma breve revisäo da literatura.
Subject(s)
Humans , Male , Adult , Peripheral Nervous System Diseases/etiology , Paralysis/etiology , Peroneal Nerve , Synovial Cyst/complications , Peripheral Nervous System Diseases/surgery , Peripheral Nervous System Diseases/diagnosis , Paralysis/diagnosis , Paralysis/surgery , Peroneal Nerve/surgery , Synovial Cyst/diagnosis , Synovial Cyst/surgeryABSTRACT
A procedure of simultaneous flexor carpi ulnaris [FCU] transfer and selected flexor pronation origin [FPO] release was presented for the treatment of 35 hemiplegic cerebral palsy patients with pronation flexion deformity of the forearm, h and and wrist. The patients were divided into four groups as regards the severity of deformity, surgical recommendation, potential h and function and prognosis. Pattern A included six patients with very mild deformity treated by FCU transfer and selected release of pronator teres origin with a very good functional result. Pattern B included 15 patients with mild deformity treated by FCU transfer and selected release of FPO from the medial epicondyle only with a good functional result. Pattern C included nine patients with moderate deformity treated by FCU transfer and selected release of FPO from the medial epicondyle and upper third of the forearm with a fair functional result. Pattern D included five patients with severe deformity treated as pattern C but to improve the appearance and hygiene with a poor functional result. This procedure reduced the power of wrist and finger's flexion by the release of FPO and reinforced the power of wrist extension and supination by FCU transfer. After a mean of four years follow up, the appearance of the h and and forearm was improved in all patients. No patient lost any motion and all patients gained some forearm, wrist and h and motion and there was not overcorrection of the h and or wrist deformities
Subject(s)
Humans , Male , Female , Forearm/abnormalities , Cerebral Palsy/surgery , Prognosis , Paralysis/surgeryABSTRACT
Dentre as várias técnicas descritas para restaurar a flexao do cotovelo, os autores demonstram os resultados obtidos em dez pacientes submetidos a transferência do tríceps para o bíceps (quatro casos) e do epicôndilo medial com o grupo flexor-pronador para o 1/3 distal do úmero (Steindler, seis casos). Houve melhora cosmética e funcional em todos, porém a média de flexao ativa e a força de flexao do cotovelo foi ligeiramente superior na transferência do tríceps. Concluem que esta transferência deverá ser a preferida, exceto nos casos em que o tríceps for fraco. Nesses casos, a indicaçao deverá ser a cirurgia de Steindler se os músculos flexores e pronadores da mao estiverem fortes (M5). Como, na maioria dos casos, o ombro também está seriamente comprometido, a artrodese dessa articulaçao é complemento importante à restauraçao da flexao do cotovelo, na recuperaçao funcional global do membro superior.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Elbow Joint/surgery , Elbow Joint/innervation , Tendon Transfer , Paralysis/surgery , Range of Motion, ArticularSubject(s)
Humans , Male , Female , Humerus/surgery , Brachial Plexus/injuries , Shoulder/physiopathology , Shoulder Joint/physiopathology , Paralysis/surgerySubject(s)
Humans , Male , Female , Paralysis/surgery , Paralysis/diagnosis , Paralysis/therapy , RehabilitationABSTRACT
Parálisis residual, definida como un radio de tren de cuatro 0.7, ha sido descrita frecuentemente después de la Anestesia, ésta ha sido detectada más a menudo (21-42 por ciento) después del uso de drogas bloqueadoras neuromusculares de larga acción (tubocurarina- Pancuronio- Gallamina- Alcuronium) que después del uso de agentes intermedios Atracurium - Vecuronio (0.9 por ciento) la severidad de bloqueo es compatible con una función respiratoria deteriorada. La parálisis persiste representa una falla en la reversión de los relajantes musculares, las Anticolinesterasas, Edrofonio y Neostygmine, actúan por diferentes mecanismos en la unión neuromuscular, la actividad de ellos depende de los relajantes usados y del nivel de bloqueo cuando son adminitrados. Los bloqueos intensos se recuperan lentamente y son más efectivamente antagonizados con Neostigmine que con Edrofonio. El uso seguro de relajantes, depende de una titulación ciudadosa de ambos, las drogas bloqueadoras neuromusculares y sus agentes de reversión. Un Bloqueo persistente sólo puede ser prevenido o reconocido y tratado por el uso de monitoreo neuromuscular durante y al final de la anestesia.
Subject(s)
Humans , Paralysis/surgery , Paralysis/complications , Postoperative Complications/classification , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Recovery RoomABSTRACT
Os autores apresentam os resultados obtidos no tratamento cirúrgico das paralisias definitivas do nervo radial. Säo discutidos os princípios fundamentais para a realizaçäo das transferências tendinosas, a técnica operatória utilizada e o método de avaliaçäo utilizado, concluindo que os princípios e a técnica empregada apresentam resultados bastante confiáveis
Subject(s)
Humans , Child , Adolescent , Adult , Male , Female , Paralysis/surgery , Radial Nerve/surgery , Tendon Transfer/methodsABSTRACT
A modification of the commonest surgical procedure to restore Abduction-Rotation using the flexor superficialis transfer with Y-insertion is described. The modification consists of doing a triple insertion at the thumb instead of Y-insertion. After introducing the triple insertion the procedure shows 80-90% or more good results, whereas 50% or more failures are reported in the existing literature, when a Y-insertion only is used which cannot safely prevent 'Z' deformity. 60 cases were followed up.