Sensory and Motor Median Nerve Neuropathy Due to a Deep Giant Hand Lipoma: A Case Report / Neuropatia sensorial e motora do nervo mediano por um lipoma gigante na mão: Relato de caso

Abstract Lipomas are the most common soft-tissue tumors in the human body, but their location in the hand is rare. Symptomatic hand lipomas, due to nerve compression, are even rarer. We present a case of median nerve neuropathy as a result of a giant palm lipoma, located on the thenar and hypothenar areas of the hand. The patient had typical symptoms of carpal tunnel syndrome, along with compromised thumb motion. Intraoperatively, the recurrent motor branch of the median nerve was sitting on the lipoma under a great tension. This particular location of the motor branch of the median nerve in relation to the lipoma makes this case unique. The tumor was excised protecting the neurovascular structures, and a few weeks later the patient regained full thumb motion, grip strength, and resolution of dysesthesia.

Resumo Os lipomas são os tumores de partes moles mais comuns no corpo humano, mas sua localização na mão é rara. Os lipomas de mão que causam sintomas por compressão do nervo são ainda mais raros. Apresentamos um caso de neuropatia do nervo mediano decorrente de um lipoma palmar gigante, localizado nas regiões tenar e hipotenar da mão. A paciente apresentava sintomas típicos de síndrome do túnel do carpo, além de comprometimento dos movimentos do polegar. Durante a cirurgia, o ramo motor recorrente do nervo mediano repousava sobre o lipoma sob grande tensão. Esta localização particular do ramo motor do nervo mediano em relação ao lipoma torna este caso único. O tumor foi extirpado, protegendo as estruturas neurovasculares e, poucas semanas depois, a paciente havia recuperado totalmente os movimentos do polegar e força de preensão, além de apresentar resolução da disestesia.

Effect of uncontrolled type-II diabetes mellitus and Its duration on nerve conduction parameters in adult Sudanese patients in Khartoum State

Background: Peripheral neuropathy is a serious complication of diabetes, which has socioeconomic consequences as well as a reduced quality of life. Early neuropathic process recognition and management could alter its course and considerably reduce the associated morbidity and mortality. This study determines the effect of long-term glycemic control on diabetic peripheral neuropathy in people with type 2 diabetes (T2DM). Methods: A hospital-based study was carried out at the National Centre of Neurosciences and Ibrahim Malik Hospital in Khartoum. All individuals who were older than 18 years and have had T2DM for less than 10 years were recruited. Using accepted techniques, the BMI, HbA1c level, and nerve conduction studies (NCS) were measured. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25.0 software. P-value ≤ 0.05 was considered significant. Results: Of the 95 patients with T2DM, 52 were male patients. Our findings showed that as the duration of diabetes increased, the sensory velocity reduced from 64.07 ± 3.22 to 54.00 ± 5.34 and the motor nerve from 63.39 ± 2.38 to 53.87 ± 2.08 (P = 0.05, P = 0.003, respectively). Additionally, with increased duration of diabetes, a significant decrease was seen in both motor nerve amplitude from 8.79 ± 3.11 to 6.94 ± 1.84 (P = 0.05) and sensory nerve amplitude from 25.71 ± 5.70 to 19.51 ± 6.51 (P = 0.003). Also, all parameters of NCS (velocity and amplitude) decreased when Hb A1c was >6 ­ sensory velocity from 63.96 ± 2.36 to 55.49 ± 2.43 (P = 0.03) and motor velocity from 63.00 ± 2.59 to 51.44 ± 1.66 (P = 0.02). And sensory amplitude decreased from 26.91 ± 1.26 to 20.85 ± 2.1 (P = 0.05), while motor amplitude decreased from 6.88 ± 3.55 to 6.61 ± 3.29 (P = 0.05). Additionally, there is a substantial (P = 0.05) correlation between sensory and motor amplitudes and the BMI. Conclusion: High BMI and poorly controlled (high HbA1c) long-term diabetes had a negative impact on all nerve conduction study parameters

Most Frequent Compressive Limb Neuropathies: A Literature Review / Neuropatias compressivas mais frequentes que acometem os membros: Revisão da literatura

Peripheral nerve injuries vary in length and severity, and they can occur secondary to trauma, compression and ischemia, leading to both motor and sensory neurological deficits. Nerve compression can occur in both the upper and lower limbs. These injuries can affect the quality of life, including the total or partial loss of the individual's productive capacity. The diagnostic methods are based on clinical criteria, but they may also include imaging and electroneurophysiological studies. A clinical examination using the Tinel and Phalen tests, for example, may suggest carpal tunnel syndrome. Complementary exams are used to confirm the diagnosis and rule out other possibilities, and the most used are electroneuromyography (ENMG), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Depending on the type of injury, recovery may be spontaneous or may require conservative or surgical treatment.

As lesões nervosas periféricas variam em extensão e gravidade, as quais podem ocorrer secundárias a trauma, compressão e isquemia, e acarretam déficits neurológicos tanto motores quanto sensoriais. A compressão nervosa pode ocorrer nos membros superiores e inferiores. Estas lesões podem afetar a qualidade de vida, incluindo a perda total ou parcial da capacidade produtiva do indivíduo. Os métodos diagnósticos são baseados em critérios clínicos, mas também podem incluir métodos de imagem e estudos eletroneurofisiológicos. O exame clínico por meio dos testes de Tinel e de Phalen, por exemplo, pode sugerir síndrome do túnel do carpo. Os exames complementares servem para confirmar o diagnóstico e descartar outras possibilidades, sendo os mais utilizados a eletroneuromiografia (ENMG), a tomografia computadorizada (TC), a ressonância magnética (RM) e a ultrassonografia (US). De acordo com o tipo da lesão, a recuperação pode ser espontânea ou necessitar de tratamento conservador ou cirúrgico.

Prevalence of carpal tunnel syndrome in workers dealing with bovine manual milking / Prevalência da síndrome do túnel do carpo em trabalhadores que lidam com a ordenha manual de bovinos

ABSTRACT BACKGROUND AND OBJECTIVES: This study aimed at evaluating the prevalence of carpal tunnel syndrome among bovine manual milking workers in a city of the countryside of the State of Paraná. METHODS: Sample (n=92) was selected as from medical physiotherapy prescriptions for patients diagnosed with such syndrome, in the period from 2008 to 2010. RESULTS: Participated in the study 80 females with mean age of 47.7±11.3 years, and 12 males with mean age of 43.9±12.6 years. Among patients, 41 participants (44.6%) had performed manual milking in some period of life, being 36 females (39.1%) and 5 males (5.4%). Only females with carpal tunnel syndrome remained with manual milking as their primary occupation. CONCLUSION: This study has shown high frequency of carpal tunnel syndrome among workers dealing with manual milking, and suggests the expansion of bovine milk production mechanization to prevent carpal tunnel aggressions.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi verificar a prevalência da síndrome do túnel do carpo na ordenha manual de bovinos em uma localidade do interior do Estado do Paraná. MÉTODOS: A amostra (n=92) foi selecionada a partir de prescrições médicas de fisioterapia para pacientes com diagnóstico desta síndrome, ocorridas no período de 2008 a 2010. RESULTADOS: Foram incluídas 80 mulheres com média de idade de 47,7±11,3 anos e 12 homens com média de idade de 43,9±12,6 anos. Entre os acometidos, 41 participantes (44,6%) realizaram a ordenha manual em algum momento da vida, sendo 36 mulheres (39,1%) e 5 homens (5,4%). Somente as mulheres com síndrome do túnel do carpo permaneciam com a ordenha manual na sua ocupação principal. CONCLUSÃO: Este estudo mostrou elevada frequência de síndrome do túnel do carpo em trabalhadores que lidam com a ordenha manual e sugere a expansão da mecanização da produção do leite de gado bovino como medida preventiva às agressões no túnel do carpo.

Isolated Infraspinatus Tear and Suprascapular Nerve Neuropathy after Barbotage and Steroid Injection of Calcific Tendinitis / 대한스포츠의학회지

Isolated rupture of infraspinatus after barbotage for calcific tendinitis has not been reported in the literature. We report on a case of isolated infraspinatus rupture and suprascapular nerve neuropathy after steroid injection and barbotage of calcific tendinitis in rotator cuff. At 6-month follow-up after surgery, satisfactory clinical and radiological outcomes were observed with daily activity level. The author reports this case and review the literature.

Numb chin syndrome: A case report and review of the literature.

Numbness of the lower lip, the skin of the chin, or the gingiva of the lower anterior teeth secondary to various dental diseases is a common manifestation that is largely underappreciated. The association of numb chin syndrome (NCS) with serious disease like metastatic malignancy and systemic conditions is frequent enough to warrant a search for these possible etiologies. In this paper we report a case of NCS that occurred secondary to malignant disease; we discuss our findings with special emphasis on metastatic malignancies leading to NCS, when the survival is only for a few months.

Sural Nerve Morphometrics of Motor Neuron Disease / 中国康复理论与实践

@#Objective To investigate the pathological features of sural nerve biopsy in patients with motor neuron disease （MND）. Methods 22 patients with amyotrophic lateral sclerosis (ALS) underwent sural nerve biopsy and routine electrophysiological examination. The transected images were captured and morphometrically analyzed.Results The myelinated fiber density decreased in ALS patients' sural nerves, and larger fibers were involved mostly. The thinly myelinated fibers increased. Conclusion The sural nerves of ALS patients shows mild but definite pathological changes.

Neuropatía del nervio pudendo post parto vaginal / Pudend Nerv neuropaty postparto vaginal

Se presenta un caso de neuropatía del nervio pudendo, pos parto vaginal en una paciente segundigesta de 30 años, por­tadora de un síndrome muy raro (NPV). La sintomatología mas importante es el dolor perineal que puede asociarse a disfuncion urinaria, anal e incluso sexual; para el diagnostico es importante utilizar dos criteros mayores, o un criterio mayor y dos criterios menores y el tratamiento debe ser siempre secuencial e incluir tres etapas.

We present a pudend nerve neuropathy, pos parto vaginal case in a 30 year old secondgest, carried of a very strange sindrome (NPV). The most important synthomwas perineal pain which can be asociated qith urinary disfunction or even sexual diosfunction; for the diagnosis is important to use two major criterias or una major criteria and two lesser criterias, and the tratment must always be secuencial and must include three stages.

A Case of Incomplete Femoral Nerve Neuropathy after Total Abdominal Hystrectomy / 대한산부인과학회잡지

Total abdominal hystrectomy is the most common surgery of Gynecology. It's complication are taken very important. Although neuropathy, especially femoral nerve injury, is rare, recently we have experienced a case of femoral neuropathy after total abdominal hystrectomy. We present this case with a brief review of literature.

Application of Pulsed Radiofrequency to Intractable Neuropathic Pain / 대한마취과학회지

For several decades, Radiofrequency lesioning has been used for intractable pain that originates from the spinal area. Heating of the tissue has been assumed to be the only mechanism that can cause this effect. There has never been the suggestion that the RF fields themselves can modify the neuro-cellular function independently of the thermal effect. Additionally, Radiofrequency machines can not be used in neuropathic pain because of their thermal effect. Recently, a modified type of Radiofrequency machine was developed, using a non-thermal pulse, and applying a relatively high voltage. Some authors have reported remarkable results using this technique recently. There are several possible mechanisms and several attempts have been tried to explain this therapeutic effect respectively, but none of them explain it fully. One possible mechanism is through an Electro-Magnetic Field (EMF) that doesn't produce high temperature in the tip area. This is done in a pulsed fashion to avoid the high temperature made during the active cycle. However there is no apparent mechanism that explains this therapeutic effect clearly. The patient whom we report now was a 23 year-old male who suffered from repetitive low back pain and radiculopathy. He failed to respond to other oral and invasive conventional therapies. We experienced a successful result in the treatment of his intractable neuropathic pain using this pulsed RF machine.

Cardiovascular Changes during General Anesthesia in Patients of Diabetic Autonomic Neuropathy / 대한마취과학회지

BACKGROUND: Autonomic reflex dysfunction in patients with diabetes is associated with unstable cardiovascular response in perioperative period. In this study we wanted to investigate the extent to which the intraoperative cardiovascular responses depend on the degree of autonomic dysfunction. METHODS: The influence of diabetic autonomic neuropathy upon the behavior of the circulatory system was investigated in 35 patients who had undergone ophthalmological surgery. A standardized test combination was used to study the patient's cardiovascular refractory reactions. The patients were then divided into a control group, non-diabetics without autonomic neuropathy (n = 18), and an experimental group, diabetics with autonomic neuropathy (n = 17). The anesthetic and surgical procedures (vitrectomy) were standardized and always identical. RESULTS: During the induction of anesthesia, patients in the experimental group didn't experience changes in mean arterial blood pressure and heart rate as compared to patients in control group. During the maintenance of anesthesia, there were significant decreases in mean arterial blood pressure and heart rate in the experimental group, but in the state of emergence of anesthesia, there were no significant differences in either group. CONCLUSION: Autonomic neuropathy represents a perioperative risk factor, especially during induction and maintenance of anesthesia. I therefore recommend an autonomic nervous function test for evaluation of diabetic autonomic neuropathy in preoperative anesthesiological examination.

Severe Bradycardia and Hypotension during Spinal Anesthesia in a Patient with Agent Orange Sequela: A case report / 대한마취과학회지

Various defoliant herbicides were sprayed to kill vegetation and thereby denied cover to enemy forces in Vietnam war, and the defoliant was later alleged to have caused long-lasting health problems such as cancers, birth defects, skin disorders, hepatic dysfunction, porphyria, peripheral neuropathy, and impaired immune function. We experienced a case of severe bradycardia and hypotension during spinal anesthesia for diagnostic arthroscopy in a 53-year-old Vietnam veteran with peripheral neuropathy. We concluded that it should require constant monitoring and vigilance to prevent severe cardiovascular complications during spinal anesthesia in Agent Orange sequela patients with peripheral neuropathy.

Preoperative Evaluation of Diabetic Autonomic Neuropathy by Power Spectral Analysis / 대한마취과학회지

Background: The aim of this study is to investigate the changes in the patterns of power spectra of R-R interval variability of diabetic patients who are subject to autonomic neuropathy. Methods: The changes in power spectra of eight diabetic patients were compared with those of eight normal persons while changing positions from supine to Trendelenburg and from supine to standing each. Results: Low, high and total frequency power densities of diabetic patient group were significantly lower than those of control group in resting supine position. Low frequency power density and ratio of low frequency power to high frequency power of control group increased significantly while changing position from supine to standing compared with those of diabetic patient group. And low frequency power density of control group decreased significantly compared with that of diabetic patient group while changing position from supine to Trendelenburg. Conclusions: The decrease in power densities of low, high and total frequency suggest depressed overall autonomic activities in diabetic patient group and significantly decreased changes in low frequency power and ratio of low frequency power to high frequency power while changing positions from supine to standing suggest attenuated sympathetic activity in diabetic patient group, reflecting autonomic changes in diabetic group rapidly.