Univariate analysis of peripheral neurotoxicity induced by oxaliplatin chemotherapy in patients with colorectal cancer and its prevention and treatment strategies / 中国基层医药

Objective:To analyze the related factors of neurotoxicity induced by oxaliplatin chemotherapy in patients with colorectal cancer and its prevention and treatment strategies.Methods:A total of 300 patients with colorectal cancer treated with oxaliplatin in Zhejiang Cancer Hospital from January 2018 to December 2020 were randomly selected for baseline collection using the convenience sampling method. The occurrence of oxaliplatin-induced peripheral neurotoxicity (OIPN) was statistically analyzed. The factors that affect the occurrence of OIPN were analyzed using univariate analysis.Results:There was a significant difference in OIPN score between patients of different genders, between patients who had different education levels, between patients who had different occupations, and between patients who lived in different long-term residence places ( t = 7.29, 3.39, 2.53, 18.11, all P < 0.05). There was no significant difference in OIPN score between patients adhering to different religion's beliefs, between patients married and not, between patients who lived with and without members, between patients who paid medical costs and not, and between patients who had a previous history of smoking and not ( t = 3.25, 0.37, 0.69, 2.39, 0.15, all P > 0.05). There was a significant difference in OIPN score between patients with different tumor-node-metastasis stages, between patients who received medication via different administration routes, and between patients who received different times of oxaliplatin administration ( t = 8.40, 3.34, 3.49, all P < 0.05). Conclusion:Medical staff should pay attention to the occurrence of OIPN in patients with colorectal cancer treated with oxaliplatin, focus on the patient's factors related to the disease, and take correct and effective coping strategies promptly to reduce the adverse reactions, improve the quality of life, and ensure the therapeutic effect.

Exodontia de pré-molar incluso em íntimo contato com o nervo mentoniano: relato de caso / Unerupted premolar extraction in close contact with the mental nerve: case report

Ocasionalmente, as unidades dentárias sofrem alterações em sua região de desenvolvimento natural, impossibilitando a erupção ou irrompimento em posições funcionais. Objetivo: O presente trabalho tem como objetivo relatar o procedimento ambulatorial de exodontia de pré-molar impactado em íntimo contato com o nervo mentual, observando os riscos presentes. Relato de Caso: Paciente do gênero feminino, faioderma, 30 anos de idade, procurou o serviço de Cirurgia e Traumatologia Bucomaxilofacial da OSID/UFBA para exodontia da unidade 35 inclusa, com finalidade ortodôntica, após insucesso de tracionamento prévio. O plano de tratamento incluiu exodontia do elemento 35 sob anestesia local. No pós-operatório de sete dias, foi referida presença de hipoestesiaemregião de mento e lábioesquerdo, sendo esta sintomatologia ausente após o vigésimo primeiro dia de acompanhamento. No momento, em acompanhamento de 04 meses de pós-operatório, a paciente encontra-se sem sinais e sintomas de hipoestesia em hemiface afetada, bem como retorno ao tratamento ortodôntico. Conclusão: A técnica cirúrgica minimamente invasiva é imprescindível para obtenção de bons resultados com o mínimo de repercussão para o paciente, ainda que o trauma cirúrgico devido ao afastamento do nervo mentoniano possa provocar alteração de sensibilidade pós-operatória temporária. Este caso pode contribuir para a literatura mínima disponível sobre os segundos pré-molares impactados, oferecendo uma opção de abordagem em seu plano de tratamento, de forma a evitar lesões ao nervo mentoniano e persistência de hipoestesia no pós-operatório(AU)

Occasionally, dental units undergo changes in their region of natural development, making it impossible to erupt in functional positions. Objective: The present study aims to report the outpatient procedure of impacted premolar extraction in close contact with the mental nerve, observing the present risks. Case Report: Female patient, faioderm, 30 years old, sought the Service of Oral and Maxillofacial Surgery of OSID/UFBA for extraction of included unit 35, with orthodontic purpose, after failure of previous orthodontic traction. Conclusion: The minimally invasive surgical technique is essential to obtain good results with minimal repercussion for the patient, although the surgical trauma due to the separation of mental nerve may cause a change in the temporary postoperative sensitivity. This case may contribute to the minimal literature available about impacted second premolars, offering an option of approach in its treatment plan, in order to avoid lesions to the mental nerve and persistence of postoperative hypoesthesia(AU)

Unusual complications caused by lipoma of the tongue

Lipoma is the most common, benign, soft tissue, mesenchymal tumour and is composed of mature adipose tissue. It is infrequent in the oral cavity (approximately 0.3% of all tongue neoplasias). We describe the case of a 68-year-old man with a swelling at the tongue edge and tongue dysesthesia. Medical history, clinical assessment, radiographic images, and cytological analysis enabled specialists to classify this neoplasia as a lipoma. The patient recovered fully after surgical excision of the affected area, and the neuralgic symptoms regressed. Surgical excision is an elective treatment; however, accurate differential diagnosis, histological examination, and follow-up are required.

Hypoesthesia of the Cutaneous Branch of Cervical Plexus after Shoulder Arthroscopy under General Anesthesia with Ultrasound Guided-Interscalene Block / 이화의대지

We present an uncommon case of hypoesthesia in the posterior and upper third of the superior area on the left ear auricle, after arthroscopic surgery of the shoulder in the lateral position under general anesthesia with ultrasound guided-interscalene brachial plexus block. A 65-year-old man underwent arthroscopic rotator cuff repair of the left shoulder in the right lateral decubitus position. Two days after operation, he complained of numbness around the left auricle; his symptoms persisted until 6 weeks after surgery. Audiometry and sensory examinations were normal. He recovered naturally by 6 months postoperatively. Postoperative neurological deficits that may not be block-related can be attributed to a combination of factors, such as patient-, anesthesia-, and surgery-related factors, including direct trauma, positioning, and retraction. Anesthesiologists should be aware that the injury may not be block-related and consider other possible causes.

Hypoesthesia after Open Reduction and Plate Fixation of Clavicular Midshaft Fractures: Correlation with Plate Location and Clinical Features of Hypoesthesia

PURPOSE: The aim of this study is to evaluate the correlation between the location of the plate and the incidence of clavicular hypoesthesia and the clinical features of patients with clavicular hypoesthesia after open reduction and internal fixation of clavicular midshaft fractures. MATERIALS AND METHODS: Seventy-eight patients who underwent open reduction and plate fixation for clavicle midshaft fractures between March 2013 and October 2014 were assessed for eligibility. The total clavicular length (A), the distance to the medial end of the plate from the sternoclavicular joint (B), and the distance to the lateral end of the plate from the sternoclavicular joint (C) were measured. Correlation between the location of the clavicular plate and the incidence of clavicular hypoesthesia was evaluated. In addition, the severity, and recovery of hypoesthesia were evaluated. Patient satisfaction, pain visual analogue scale were evaluated regarding hypoesthesia. RESULTS: The incidence of hypoesthesia was 32.1% (25/78 patients). No correlation was observed with respect to the location of the clavicular plate and the incidence of clavicular hypoesthesia (p=0.666 at the medial end, p=0.369 at the lateral end). Recovery from hypoesthesia was observed in 23 out of 25 patients (p=0.008). Patient satisfaction and pain showed negative correlation with the incidence of hypoesthesia (p=0.002 and p=0.022). CONCLUSION: There was no correlation between clavicular hypoesthesia and the plate location. Although most cases of hypoesthesia were recovered, we should try to avoid hypoesthesia due to the negative 'correlation' with patient satisfaction and pain.

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.

Reporte de 2 casos de mielopatía progresiva tardía posradiación / Report of two cases of late progressive myelopathy postradiation

Las complicaciones de la radioterapia se pueden presentar de manera aguda, subaguda o retardada y son diferentes en sus manifestaciones, según afecten al cerebro, la médula espinal o los nervios periféricos. Se presentaron 2 pacientes que recibieron tratamiento con radioterapia y después de un año del proceder terapéutico desarrollaron manifestaciones clínicas e imaginológicas compatibles con una mielopatía posradiación. Ninguno ha tenido progresión de la enfermedad con el uso de los esteroides aplicados...

Complications of radiation therapy can occur in acute, subacute or delayed manner and they are different in manifestations, as they affect the brain, spinal cord or peripheral nerves. Two patients who were treated with radiotherapy were presented and after a year of therapeutic procedure, they developed clinical manifestations and imaging features consistent with a post-radiation myelopathy. None had disease progression with the use of steroids...

Influência do tempo de aplicação da crioterapia na sensibilidade cutânea / Influence of cryotherapy application time on skin sensitivity

Justificativa e objetivos: A crioterapia é uma modalidade de tratamento com inúmeros efeitos terapêuticos, de baixo custo, de fácil aplicação e acesso. Os objetivos deste estudo foram verificar se existe alteração na sensibilidade de acordo com o tempo de aplicação da crioterapia além do comportamento da sensibilidade cutânea pós-aplicação. Métodos: Vinte e um sujeitos (14 mulheres e 7 homens, idade média 23,8±4 anos) foram divididos aleatoriamente em 3 grupos, com 7 sujeitos cada, tendo recebido aplicação da crioterapia por 10, 20 ou 30 minutos, denominados respectivamente grupos C10, C20 e C30. Todos foram previamente submetidos à avaliação da sensibilidade cutânea com monofilamento de Semmes-Weinstein, e avaliados imediatamente ao término da aplicação da crioterapia, 5, 10 e 15 minutos após a aplicação. Para análise dos dados foi utilizado o teste de Friedman complementado pelo pós-teste de comparação múltipla (post hoc de Dunn). Resultados: Na avaliação imediatamente após a aplicação da crioterapia todos os sujeitos apresentaram hipoestesia. Observou-se diferença significativa no retorno da sensibilidade do grupo C20 em relação aos demais, após 10 minutos da intervenção (p=0,0498). Para os grupos C10 e C30, o retorno da sensibilidade ocorreu após 15 minutos do término da aplicação. Conclusão: Cinco minutos depois do término da aplicação da crioterapia observou-se ausência de sensibilidade tátil, independentemente do tempo de intervenção. O retorno da sensibilidade normal foi observado depois de 10 minutos quando se aplicou o frio por 20 minutos, e depois de 15 minutos quando aplicado por 10 ou 30 minutos.

Background and objectives: Cryotherapy is a treatment modality with several therapeutic effects, of low cost and easy to apply and access. This study aimed to observing whether there are changes in sensitivity according to cryotherapy application time, in addition to skin sensitivity behavior after treatment. Methods: Participated in the study 21 individuals (14 females and 7 males, mean age 23.8±4 years) who were randomly distributed in three groups with 7 individuals each. Groups received cryotherapy application for 10, 20 or 30 minutes and were called groups C10, C20 and C30, respectively. All participants were previously submitted to skin sensitivity evaluation by Semmes-Weinstein monofilament and were evaluated immediately after cryotherapy application, 5, 10 and 15 minutes after application. Data were analyzed with Friedman's test complemented by multiple comparisons post-test (Dunn's post hoc). Results: All individuals had hypoesthesia in the evaluation immediately after cryotherapy application. There has been significant difference in sensitivity recovery of group C20 as compared to C10 and C30 10 minutes after the intervention (p=0.0498). For groups C10 and C30, sensitivity has returned 15 minutes after the end of application. Conclusion: There has been lack of tactile sensitivity five minutes after the end of application, regardless of intervention time. Normal sensitivity recovery was observed after 10 minutes when cold was applied for 20 minutes, and after 15 minutes when cold was applied for 10 or 30 minutes.

Hipoestesia, dor e incapacidade no membro superior após radioterapia adjuvante no tratamento para câncer de mama / Hypoesthesia, pain and disability of upper limb after adjuvant radiotherapy for breast cancer

JUSTIFICATIVA E OBJETIVOS: Tratamento cirúrgico e radioterapia (RT) podem provocar dor no membro superior (MS), distúrbio funcional e prejuízo nas atividades de vida diária. O objetivo deste estudo foi avaliar e comparar a sensibilidade superficial (SS) no dermátomo correspondente ao nervo sensitivo intercostobraquial (NICB), a dor e a incapacidade do MS homolateral à cirurgia antes e após RT adjuvante. MÉTODO: Vinte mulheres submetidas à cirurgia incluindo linfadenectomia axilar (LA) foram avaliadas antes e imediatamente após a RT adjuvante (25-30 sessões). Para avaliar a SS, dor e incapacidade foram utilizadas: a estesiometria, o Questionário de Dor McGill (MPQ) e o Índice de Dor e Incapacidade no ombro (SPADI). Duas medidas foram obtidas através do MPQ: número de palavras escolhidas (NWC) e índice de dor (PRI). Para comparação intragrupo, adotou-se teste de Wilcoxon Signed Rank Test para amostras pareadas, p < 0,05. RESULTADOS: Após a RT houve redução significativa da SS pelo aumento da pressão exercida pelo estesiômetro de 1,9 ± 0,2 para 2,8 ± 0,2 (p = 0,004) indicando hipoestesia. No MS contralateral não houve diferença. Escores do NWC e do PRI aumentaram significativamente (p = 0,005 e p = 0,006) após a RT. Observou-se aumento significativo do escore total do SPADI após a RT (p = 0,0001), com aumento da incapacidade de 24,6 ± 5,7 para 39,2 ± 5,7 (p = 0,001) e a dor de 26,3 ± 6,4 para 48,4 ± 7,1 (p = 0,001). CONCLUSÃO: Foi identificada hipoestesia no trajeto do NICB, dor e incapacidade no MS após a RT adjuvante.

BACKGROUND AND OBJECTIVES: Surgery and radiotherapy (RT) may induce upper limb (UP) pain, functional disorder and daily life activities impairment. This study aimed at evaluating and comparing superficial sensitivity (SS) on the dermatome corresponding to the intercostobrachial sensory nerve (ICBN), pain and disability of UL ipsilateral to surgery before and after adjuvant RT. METHOD: Twenty females submitted to surgery including axillary lymphadenectomy (AL) were evaluated before and immediately after adjuvant RT (25-30 sessions). The following tools were used to evaluate SS, pain and disability: esthesiometry, McGill Pain Questionnaire (MPQ), Pain Rating Index and shoulder disability (SPADI). Two measures were obtained from MPQ: number of words chosen (NWC) and pain rating index (PRI). Wilcoxon Signed Rank Test for paired samples was used for intragroup comparison, considering significant p < 0.05. RESULTS: There has been significant SS decrease after RT by increased esthesiometer pressure from 1.9 ± 0.2 to 2.8 ± 0.2 (p = 0.004) indicating hypoesthesia. There has been no difference in contralateral UL. NWC and PRI scores have significantly increased (p = 0.005 and p = 0.006) after RT. There has been significant total SPADI score increase after RT (p = 0.0001), with increased disability from 24.6 ± 5.7 to 39.2 ± 5.7 (p = 0.001) and pain from 26.3 ± 6.4 to 48.4 ± 7.1 (p = 0.001). CONCLUSION: Hypoesthesia was identified in the ICBN pathway, in addition to UL pain and disability after adjuvant RT.

Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury

Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got much better and after 4 mon, hypoesthesia completely disappeared. During this healing period, only early steroid medication was prescribed. In most cases, hypoesthesia is resolved within 6 mon, but being aware of etiology and the treatment options of hypoesthesia is important. Because the hypoesthesia caused by IAN block anesthesia is a mild to moderate nerve injury, early detection of symptom and prescription of steroids could be helpful for improvement of the hypoesthesia.

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression / Estudo prospectivo de 39 pacientes com neuralgia do trigêmeo tratados com compressão por balão percutâneo

OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54 percent), the right side of the face (84 percent) and V2V3 roots of trigeminal nerve (33 percent). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80 percent) were pain-free after 50 months with a 90 percent satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

OBJETIVO: A neuralgia do trigêmeo é a dor facial mais comum. Ela pode ser tratada através da compressão percutânea com balão, que é considerado procedimento seguro e eficaz. A proposta deste estudo foi avaliar nossos resultados e os fatores que influenciariam o seguimento. MÉTODO: Foi utilizada análise multivariada para estudar 39 pacientes submetidos ao procedimento, com seguimento de 50 meses. RESULTADOS: Houve predominância do sexo feminino (54 por cento), lado direito (84 por cento) e dos ramos V2V3 (33 por cento). A idade média foi de 62,3 anos. Não houve complicações maiores ou óbito. Dentre todas as variáveis, a única capaz de influenciar positivamente os resultados foi a hipoestesia pós-operatória (p=0,02). A maioria dos pacientes (80 por cento) estava livre da dor após 50 meses de seguimento, com 90 por cento de satisfação. CONCLUSÃO: Este procedimento foi considerado seguro, com baixa morbidade, sem mortalidade, com alta taxa de aprovação e representou melhora importante na qualidade de vida dos pacientes.

Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications / Ausência do nervo musculocutâneo: uma rara variação anatômica com possíveis implicações clínico-cirúrgicas

CONTEXT: The musculocutaneous nerve is one of the terminal branches of the lateral fasciculus of the brachial plexus, and is responsible for innervation of the flexor musculature of the elbow and for skin sensitivity on the lateral surface of the forearm. Its absence has been described previously, but its real prevalence is unknown. CASE REPORT: A case of absence of the musculocutaneous nerve that was observed during the dissection of the right arm of a male cadaver is described. The area of innervation was supplied by the median nerve. From this, three branches emerged: one to the coracobrachialis muscle, another to the biceps brachii muscle and the third to the brachialis muscle. This last branch continued as a lateral antebrachial cutaneous nerve. This is an anatomical variation that has clinical-surgical implications, considering that injury to the median nerve in this case would have caused unexpected paralysis of the flexor musculature of the elbow and hypoesthesia of the lateral surface of the forearm.

CONTEXTO: O nervo musculocutâneo é um dos ramos terminais do fascículo lateral do plexo braquial, sendo responsável pela inervação da musculatura flexora do cotovelo e pela sensibilidade cutânea da face lateral do antebraço. Sua ausência já foi descrita previamente, mas a sua real prevalência é desconhecida. RELATO DE CASO: Este é um relato de caso da ausência do nervo musculocutâneo observada durante a dissecção do membro superior direito de um cadáver do sexo masculino, sendo o seu território de inervação suprido pelo nervo mediano. Deste emergiam três ramos, um para o músculo coracobraquial, outro para o músculo bíceps braquial e o terceiro para o músculo braquial. Este último ramo continuava-se como nervo cutâneo lateral do antebraço. Trata-se de variação anatômica que tem implicações clínico-cirúrgicas, já que a lesão do nervo mediano, neste caso, acarretaria inesperada paralisia da musculatura flexora do cotovelo e hipoestesia da face lateral do antebraço.