Síndrome de leiomiomatose cutânea e uterina múltipla: relato de três casos clínicos / Multiple cutaneous and uterine leiomyomatosis syndrome: report of three clinical cases

A síndrome de Reed ocorre em mulheres com múltiplos leiomiomas cutâneos e leiomiomatose uterina. Relatam-se três casos de pacientes do sexo feminino, acompanhadas em hospital universitário, com pápulas e nódulos eritêmato-acas- tanhados dolorosos em membros superiores e tórax, agravados por frio, pressão e estresse, e associados a miomatose uterina. Foram realizados diversos tratamentos prévios, sem sucesso, tais como: aplicação de corticoterapia e toxina botulínica intralesional, bloqueadores de canais de cálcio, neuromoduladores e analgésicos orais. Foi, então, realizado tratamento cirúrgico, com melhora dos sintomas. O co- nhecimento e o esclarecimento dessa síndrome é fundamental para estabelecer a relação com miomatose uterina e câncer de células renais, para que, então, a partir da lesão de pele, se faça o rastreio das demais neoplasias, diagnóstico precoce e a educação em saúde.

Reed syndrome occurs in women with multiple cutaneous leiomyomas and uterine leiomyomatosis. We report the case of three female patients followed at a university hospital with painful erythematous-brown papules and nodules on the upper limbs and chest, aggravated by cold, pressure, stress, and associated with uterine myoma- tosis. Several previous unsuccessful treatments were performed, such as the applica- tion of corticotherapy and intralesional botulinum toxin, calcium channel blockers, neuromodulators, and analgesics. Surgical treatment was performed with the im- provement of symptoms. Knowledge and clarification of this syndrome are essential to establish a relationship between uterine myomatosis and renal cell neoplasm, so that, after the skin lesion, screening for other neoplasms, early diagnosis, and health education can be carried out.

Is there a correlation between depressive symptoms and motor skills in post-stroke patients? / Existe correlação entre sintomas depressivos e habilidades motoras em pacientes pós-AVC?

ABSTRACT Deficits in motor skills and depressive symptoms are common effects observed after stroke, so it is necessary to understand how these variables interact with each other. Therefore, the aim of this study was to investigate the relationship between these two variables in post-ischemic stroke patients. We evaluated 135 patients with a mean age of 60 years (± 15). The Fugl-Meyer assessment of motor function was used to assess motor skills in the upper limbs, lower limbs, balance, and sensitivity and the Beck Depression Inventory was applied to evaluate depressive symptoms. To assess the relationship between both components, Spearman's correlation was performed. Depressive symptoms were negatively correlated with all variables of motor skills. This study suggests that higher motor skills in post-stroke patients may be associated with fewer depressive symptoms. Thus, a better understanding of how post-stroke symptoms are interrelated may improve patient treatment and care, contributing to a better quality of life.

RESUMO Déficits na habilidade motora e presença de sintomas depressivos são comuns em pacientes pós-AVC. Assim, é necessário compreender como estas variáveis interagem entre si. O objetivo deste trabalho foi verificar esta relação em pacientes pós-AVC isquêmico. Participaram 135 sujeitos, com idade média de 60 anos (± 15). Foi utilizado o protocolo de desempenho motor Fugl Meyer para verificar a habilidade motora dos membros superiores, inferiores, equilíbrio e sensibilidade e o Inventário de Depressão de Beck para verificar os sintomas depressivos. Foi realizada a análise de Spearman para verificar a relação entre os dois componentes. Os sintomas depressivos se correlacionaram negativamente com todas as variáveis da habilidade motora. Assim, a maior habilidade motora implicou em menores sintomas depressivos. Portanto, compreender como as sequelas pós-AVC se relacionam auxilia no melhor tratamento e atendimento ao paciente, contribuindo para melhorar sua qualidade de vida.

Neuroprotective effect of epidural hypothermia after spinal cord lesion in rats

OBJECTIVES : To evaluate the neuroprotective effect of epidural hypothermia in rats subjected to experimental spinal cord lesion. METHODS: Wistar rats (n = 30) weighing 320-360 g were randomized to two groups (hypothermia and control) of 15 rats per group. A spinal cord lesion was induced by the standardized drop of a 10-g weight from a height of 2.5 cm, using the New York University Impactor, after laminectomy at the T9-10 level. Rats in the hypothermia group underwent epidural hypothermia for 20 minutes immediately after spinal cord injury. Motor function was assessed for six weeks using the Basso, Beattie and Bresnahan motor scores and the inclined plane test. At the end of the final week, the rats' neurological status was monitored by the motor evoked potential test and the results for the two groups were compared. RESULTS: Analysis of the Basso, Beattie and Bresnahan scores obtained during the six-week period indicated that there were no significant differences between the two groups. There was no significant difference between the groups in the inclined plane test scores during the six-week period. Furthermore, at the end of the study, the latency and amplitude values of the motor evoked potential test were not significantly different between the two groups. CONCLUSION: Hypothermia did not produce a neuroprotective effect when applied at the injury level and in the epidural space immediately after induction of a spinal cord contusion in Wistar rats. .

Tratamento radioterápico adjuvante nos sarcomas de extremidades de alto grau / Adjuvant radiotherapy in high-grade extremity sarcomas

OBJETIVO: Avaliar as terapias utilizadas em nossa instituição no tratamento dos sarcomas de extremidades de alto grau, mediante análise da sobrevida global do tratamento multidisciplinar. MATERIAIS E MÉTODOS: Estudo retrospectivo com 36 pacientes, no período de 1993 a 2007, em estádios IIb/III, submetidos a radioterapia externa após cirurgia com ou sem reforço de dose com braquiterapia. RESULTADOS: Trinta e seis pacientes foram submetidos a tratamento cirúrgico seguido de radioterapia externa, sendo que quatro pacientes (11 por cento) receberam reforço de dose com braquiterapia e sete pacientes (19 por cento) receberam quimioterapia. A dose mediana de radioterapia foi de 50 Gy (IC95 por cento: 47-53 Gy), sendo realizado reforço de dose em quatro pacientes com braquiterapia, com dose variando de 16,2-35 Gy. A quimioterapia foi indicada em sete pacientes (19 por cento) com margens positivas. Quinze pacientes apresentaram recidiva local e/ou a distância (42 por cento) e todos faleceram. Vinte e um pacientes (58 por cento) encontram-se sem evidência clínica e radiológica de recidiva local e/ou a distância. O seguimento mediano é de 88 meses (IC95 por cento: 74-102). A taxa de sobrevida global para sete anos foi de 80 por cento. CONCLUSÃO: Concluímos que a associação cirurgia + radioterapia apresenta-se como tratamento eficaz e com ótimas respostas e melhora da sobrevida global na possibilidade de associação da braquiterapia.

OBJECTIVE: To evaluate the therapies utilized in the authors' institution for management of high-grade extremity sarcomas, analyzing the overall survival rates following multidisciplinary treatment. MATERIALS AND METHODS: Retrospective study developed in the period from 1993 to 2007 with 36 patients diagnosed with stages IIb/III, submitted to postoperative external beam radiotherapy, with or without boost dose, utilizing high-dose brachytherapy. RESULTS: Thirty-six patients underwent surgery followed by adjuvant external beam radiation therapy. Four patients (11 percent) received boost dose with brachytherapy, and seven (19 percent) received chemotherapy. The average dose for radiotherapy was 50 Gy (CI 95 percent: 47-53 Gy), and the four patients with brachytherapy boost received doses ranging from 16.2 to 35 Gy. Chemotherapy was indicated for seven patients (19 percent) with positive margins. Fifteen patients (42 percent) presented local or distant recurrence, and all of them progressed to death. Twenty-one patients (58 percent) remain with no clinical/radiological evidence of local/distant recurrence. The mean follow-up time was 88 months (IC 95 percent: 74-102). The overall seven-year survival rate was 80 percent. CONCLUSION: Combined surgery and radiotherapy is an effective treatment with excellent outcomes in cases where brachytherapy is associated, with improved overall survival rates.

Reflex Movements in Patients with Brain Death: A Prospective Study in A Tertiary Medical Center

Reflex movements have been reported to occur in up to 75% of brain-dead patients, but this issue has not been addressed in Korea. The patients admitted to our hospital who met the criteria for brain death were enrolled between March 2003 and February 2005. The frequency and type of reflex movements in these patients were evaluated prospectively using a standardized protocol. Brain death was determined according to the guideline of Korean Medical Association. Of 26 patients who were included, five (19.2%) exhibited reflex movements such as the pronation-extension reflex, abdominal reflex, flexion reflex, the Lazarus sign, and periodic leg movements. This finding suggests that the frequency of spinal reflex movements is not rare and the awareness of these movements may prevent delays in brain-dead diagnosis and misinterpretations.

The lateralizing significance of version of head and dystonic limb posturing in epileptic seizures.

Several clinical signs have been described for lateralization and localization of seizure focus in complex partial seizures; however, the specificity of each of these has been widely debated upon. The present study was done to evaluate 'dystonic unilateral limb posturing' and 'versive head movements' for lateralization and localization of epileptic foci in patients with intractable partial complex seizures, being investigated with long term Video-EEG monitoring. Fifteen patients with 46 seizures, studied with long term Video EEG, had either one or both of these signs. The video recordings of the clinical behaviour were noted and later compared with the corresponding EEG. Unilateral dystonic limb posturing and versive head movements had good lateralising value in complex partial seizures, suggestive of temporal lobe origin, contralateral to the seizure focus, with a specificity of 87.5% and 86% respectively. In addition, turning of the whole body to one side was associated with a contralateral seizure focus in 100% cases. Appendicular automatisms were found to be of no lateralising significance, as they occurred on either side with equal frequency. These motor phenomena should, therefore, be enquired about in detail, during history taking for lateralization or localization of seizure focus.

Early detection of thoracic vessels involvement in patients with behcet's disease having one episode of lower extremity deep vein thrombosis

To determine the risk of thoracic vessels involvement in patients with Behcet's disease [BD] presenting with lower extremity deep vein thrombosis [DVT]. The study was performed from August 1997 to April 1998, on 10 patients with BD, who had at least one episode of DVT in the lower extremities in their past or present illness. The diagnosis of DVT was based on physical examination and sonography and/or Doppler sonography. Medical history taking regarding pulmonary symptoms such as: cough, with or without sputum production, dyspnea, chest pain, and hemoptysis as well as physical examination, including vascular examination, was performed in all the cases. A new chest x-ray was taken from all 10 cases and following an informed consent, 7 patients had a high resolution CT scan [HRCT] of the chest. All of the 10 studied cases underwent thoracic vessels angiography using the intra-venous digital subtraction angiography [IVDSA] method. The analysis of data was done using Fisher's exact test and student T-Test. Out of the 10 studied cases, seven were male and three were female. Three patients had only one episode, while the other 7 had more than one episode of DVT in the lower extremities. The time interval from diagnosis of BD to the emergence of vascular lesions was 7.8 years. Regarding respiratory manifestations, 5 out of 10 cases were symptomatic and the rest were asymptomatic. Chest x-rays of 9 out of 10 cases were normal, while in one case changes in favor of pulmonary artery aneurysm [PAA], were observed. HRCT scans from the thoracic cage were done in 7 out of 10 cases, with 3 positive findings, [2 with pulmonary artery thrombosis [PAT] and 1 with superior vena cava obstruction [SVCO]]. On thoracic vessel IVDSA 6 cases with positive findings were detected [3 with PAA, 3 with SVCO, and 2 with pulmonary artery thrombosis], in both symptomatic and asymptomatic cases. [Fisher exact =0.4850][p value=0.05%, t [9] = 1.97, risk = 30%]. Gender and pulmonary symptomatology had no significant effect with respect to the results. Patients with [BD] with at least one episode of DVT in the lower extremities have a 30% risk of thoracic vessels involvement by non-invasive angiography using the IVDSA method. Hemoptysis is a late heralding sign for thoracic vessels involvement in BD patients with thrombophelebitis of the lower extremities. Therefore, we recommend radiological screening of thoracic vessels by IVDSA method in this group of BD patients, especially in areas with an increased prevalence of BD. Chest x-ray is not a good screening method for detection of thoracic vessels involvement although HRCT scan can be a helpful procedure for detection of thrombosis in thoracic vessels

Digital pulse volume recording: an essential test for the assessment of arteritis in diabetic patients

The high incidence of medial calcification in the distal arteries of lower extremities in diabetic patients is responsible for most of the errors made in measuring ankle-pressure index. Because digital arteries are rarely calcified, digital pulse volume recording has been proposed as a specific and complementary test. Between march 1993 and march 1996, this test was performed in addition to ankle-pressure index in 66 diabetic patients. The ankle-arm index was overestimated and erroneous in 89.4% of cases. Digital arteries were calcified in 74% of cases and diabetic neuropathy present in 53% of cases. Assessment of the severity of arteritis by digital pulse volume recording [category 1 to 5] has led to better prevention and treatment. It is an essential test for the assessment of arteritis in diabetics, but also for the prediction of success of a surgical procedure: distal amputation, lumbar sympathectomy and arterial reconstruction

Reconstruction of foot defects using free flaps

Reconstruction of foot defects has remained one of the difficult areas in plastic surgery. Many surgical methods were used for different defects. Microvascular tissue transfer probably provided a solution to many problems. The outcome had not been satisfying in the beginning, marked improvement has occurred in the past decade. In this study, eleven patients with varying foot defects were managed by free flap transfer, the latissimus dorsi muscle flap was used in four patients, the rectus abdominus muscle flap in fur patients, the lateral arm flap in one patient, the lateral intercostals flap in another patient and the latissimus dorsi musclocutaneous flap in a single patients. All muscle flaps completely survived, two failures occurred: the lateral arm flap and the latissimus dorsi musculocutaneous. Flap. The results improved with the use of muscle flaps and with proper preoperative evaluation of the vascular status at the recipient area. The use of muscle flap covered by split thickness skin graft can withstand significant weight breading even without any sort of neurotization and absence of any cutaneous sensation

Revascularización de los miembros inferiores y efecto sobre el lecho capilar muscular / Lower limb revascularization and muscle capillary effect

El efecto que sobre el lecho capilar muscular ejerce un procedimiento de revascularización, ha sido estudiado en pacientes masculinos arteroescleróticos con oclusiones arteriales crónicas de miembros inferiores. Sus edades oscilan entre 59 y 79 años todos eran tabaquistas crónicos y ninguno era diabético.Una pequeña porción longitudinal del músculo gastronemiosse tomó para análisis histológico y recuento del número de capilares musculares permeables antes y tres meses después de practicar algún procedimiento quirúrgico de revascularización de miembros inferiores. Cada paciente se empleó como autocontrol. Una tendencia clara...

Ectrodactyly [lobster claw]: a rare deformity of the hands and feet

Two siblings having ectrodactyly of both hands and feet presented at the age of five and seven years with fairly good function and minimal disability. Both underwent surgery; approximation of cleft hand and bilateral osteotomies were performed to correct gross abduction of big toes in one sister while approximation of cleft in feet alone was sufficient in the other

role of profundaplasty in salvaging late chronic lower limb ischaemia

Twenty-three lower limbs were studied. Patients were examined and investigated according to a proposed protocol. All patients had more than a risk factor leading to the advanced lower limb ischemia and inadvocate a major prolonged surgical interference. Patients were classified into two groups according to the patency of the inflow aorto-iliac tracts. All had osteal stenosis of profunda femoris with complete superficial femoral artery occlusion. Profundaplasty was done for all limbs. A concomitant reconstruction of the inflow tract was done in cases with aorto-iliac occlusion either by end- arterectomy or pass-graft. Clinical and Doppler ultrasound studies for a follow-up period of three to ten months postoperatively showed the major role of the profunda femoris artery in salvaging the critically ischemic leg after its reconstruction. Also, it can lower the level of amputation by saving the knee in a lost foot. Profundaplasty is a rather short procedure that can be tolerated by critically in patients

Reconstruction of bone defects following tumour resection from the lower limb by vascularized fibular graft

Eight patients with malignant primary bone tumours affecting their lower limbs were treated with radical resection and reconstruction with a vascularised fibular graft. Patients were followed up for an average period of 30 months. All patients showed union of the graft at both ends within an average period of nine months. Six cases started to show hypertrophy of the graft within an average period of one year. One patient had a fracture of both the graft and the nail used for fixation three years postoperatively which united six months later after plating and grafting. Another patient with primary intramedullary osteosarcoma had recurrence of the tumour one year after the resection. Amputation was done but the patient died from distant spread

Effect of high voltage galvanic stimulation on blood flow in patients with arteriosclerotic disease of the lower limbs

The study was conducted to evaluate the effect of high voltage galvanic stimulation [HVGS] on arterial blood flow of the lower limbs in 20 male subjects with intermittent claudication of the lower limbs due to arteriosclerosis. The arterial blood flow was calculated using ultrasonic Doppler flow meter before and after stimulation by HVGS for 20 minutes and intensity of 60 voIts and frequency of 20 PP. A significant increment in arterial blood volume was observed following high voltage galvanic stimulation. It was concluded that HVGS could be a helpful tool in increasing blood volume to the exercising muscle reducing claudication pain and improving the claudication time

Effect of cryotherapy on voluntary control of lower extremities in diplegic cerebral palsied children

The purpose of this study was to assess the effect of cryotherapy on changing the excitability of motor neuron pool of the calf muscles and facilitation of active ankle excursion in diplegic cerebral palsied children. The study included eighteen patients from both sexes, with age ranged from four to six years. They were selected on a basic criteria to confirm the grade of spasticity and absence of structural deformities. Patients were randomly divided into two equal groups. H/M response of the soleus and active ankle excursion were measured pre and post the suggested period of treatment. The experimental group received a suggested program of ice application on the calf muscles followed by traditional treatment. while the control group received only a traditional program of remedial exercises. Treatment was conducted for tweleve weeks. Results collected at the end of treatment from the experimental group, revealed a valuable reduction in mean values of H/M response of the calf muscles which was concomitant with a significant increase of active ankle excursion. These results were statistically highly significant in relation to the results collected from the control group which can be attributed to the effect of ice application on inhibition of spasticity with consequent improvement of muscular tension of the antagonistic muscles. The benefits afforded from this study indicate that application of ice in cases of spasticity can reduce the excitability of motoneuron pool of the spastic muscles which is concomitant with improvement in range of motion