Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment / Espessura do músculo adutor do polegar para avaliação nutricional de portadores de doença renal crônica em tratamento conservador

Abstract Introduction: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. Results: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. Conclusion: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.

Resumo Introdução: Avaliar a associação da espessura do músculo adutor do polegar (EMAP) com o estado nutricional e propor pontos de corte para depleção de massa muscular em idosos portadores da doença renal crônica (DRC) em tratamento conservador. Metodologia: Estudo epidemiológico, delineamento transversal, incluindo portadores de DRC estágios 3 a 5, acima de 60 anos. Obteve-se dados socioeconômicos, clínicos, prática de atividade física e antropométricos. A EMAP foi descrita e comparada de acordo com o estágio da DRC, dados socioeconômicos, atividade física e estado nutricional e correlacionada com idade, taxa de filtração glomerular e variáveis antropométricas. Foram produzidas curvas Receiver Operating Characteristic (ROC), considerando como padrão de referência a classificação do índice de tecido magro. O ponto de corte foi definido pelo índice Youden. Resultados: Avaliou-se 137 indivíduos. A EMAP foi inferior nos desnutridos e/ou com depleção de massa muscular; no sexo masculino foi superior nos praticantes de atividade física (p<0,05). A medida se correlacionou moderadamente com IMC, circunferência da panturrilha e braquial, tecido de massa magra, índice de tecido magro e massa celular corporal (r<0,7), e negativamente com a idade (r=-0,34). A análise da curva ROC determinou pontos de corte de 15,33 mm para o sexo feminino e 20,33 mm para o masculino, com acurácia de 72,22% e 62,50%, respectivamente. Conclusão: A EMAP serve para estimar a massa muscular, e o ponto de corte sugerido é útil para afastar a probabilidade de depleção de massa muscular. Recomenda-se que seja utilizada de forma complementar na avaliação nutricional.

Síndrome de Davidenkow: Una neuropatía periférica rara / Davidenkow syndrome. A rare peripheral neuropathy

En 1939 Davidenkow describió un tipo de atrofia diferente y rara con un patrón predominante en distribución escápulo-peroneal. Algunos investigadores caracterizaron el síndrome como una variante de la enfermedad de Charcot-Marie-Tooth; sin embargo, Davidenkow percibió que las manifestaciones clínicas y de laboratorio no corroboraban exactamente esta hipótesis. Describimos el caso de una mujer de 39 años, con cuadro clínico semejante al síndrome descrito por Davidenkow, presentando atrofia escápulo-peroneal. Sus primeros síntomas comenzaron cuando tenía 24 años, inicialmente con debilidad motora proximal en los miembros superiores. No tenía historia familiar de miopatía o neuropatía y se excluyeron otros síndromes que se podrían incluir entre los diagnósticos diferenciales mediante la realización de pruebas de mutación genética, además del examen físico y electromiografía. El amplio espectro de enfermedades neuromusculares a veces dificulta su diagnóstico y debe ser siempre considerado en el diagnóstico diferencial.

A different and rare type of atrophy with a predominant pattern in scapulo-peroneal distribution was described by Davidenkow in 1939. The syndrome was characterized by some researchers as a variant of Charcot-Marie-Tooth disease, however Davidenkow noticed that clinical and laboratorial manifestations did not corroborate exactly with this hypothesis. We describe a case of a female patient, 39 years-old, clinical picture similar to the syndrome described by Davidenkow, presenting scapulo-peroneal atrophy. Her first symptoms had appeared when she was 24, initially with proximal motor weakness in the upper limbs. This patient did not have family history of myopathy or neuropathy. Several tests were performed to exclude other syndromes that could be included in the differential diagnosis, by testing gene mutation, in addition to the physical examination and electromyography. The large spectrum of neuromuscular diseases makes difficult the diagnosis of Davidenkow’s syndrome which always should be considered in the differential diagnosis.

Visual MRI Grading System to Evaluate Atrophy of the Supraspinatus Muscle

OBJECTIVE: To investigate the interobserver reproducibility and diagnostic feasibility of a visual grading system for assessing atrophy of the supraspinatus muscle on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Three independent radiologists retrospectively evaluated the occupying ratio of the supraspinatus muscle in the supraspinatus fossa on 192 shoulder MRI examinations in 188 patients using a 3-point visual grading system (1, > or = 60%; 2, 30-59%; 3, < 30%) on oblique sagittal T1-weighted images. The inter-reader agreement and the agreement with the reference standard (3-point grades according to absolute occupying ratio values quantitatively measured by directly contouring the muscles on MRI) were analyzed using weighted kappa. The visual grading was applied by a single reader to a group of 100 consecutive patients who had undergone rotator cuff repair to retrospectively determine the association between the visual grades at preoperative state and postsurgical occurrences of retear. RESULTS: The inter-reader weighted kappa value for the visual grading was 0.74 when averaged across three reader pairs (0.70-0.77 for individual reader pairs). The weighted kappa value between the visual grading and the reference standard ranged from 0.75 to 0.83. There was a significant difference in retear rates of the rotator cuff between the 3 visual grades of supraspinatus muscle atrophy on MRI in univariable analysis (p < 0.001), but not in multivariable analysis (p = 0.026). CONCLUSION: The 3-point visual grading system may be a feasible method to assess the severity of supraspinatus muscle atrophy on MRI and assist in the clinical management of patients with rotator cuff tear.

Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?

BACKGROUND: Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. METHODS: We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. RESULTS: The mean occupation ratio was significantly increased postoperatively from 0.44 +/- 0.17 to 0.52 +/- 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). CONCLUSIONS: The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair.

Suprascapular neuropathy in collegiate baseball player

Suprascapular neuropathy [SSN] is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release. A 20 year-old male baseball pitcher with right shoulder pain reported for athletic training evaluation, was treated conservatively, and due to lack of resolution was referred for further imaging and evaluation by an orthopedist. Following inconclusive magnetic resonance imaging findings the patient underwent electrodiagnostic testing which showed decreased nerve conduction velocity of the right suprascapular nerve. The patient elected for surgical intervention. Post-operative rehabilitation followed and the patient was able to pitch in 22 weeks. The patient provided positive subjective feedback and was able to return to unrestricted pitching without pain, loss of velocity, or loss in pitch control. This study demonstrates a need for further investigation into the most appropriate treatment and rehabilitation of suprascapular nerve injury

Obesidade sarcopênica: diagnóstico, prevalência e associações com aptidão física, resistência insulínica, estresse inflamatório e oxidativo / Sarcopenic obesity: diagnosis, prevalence and associations with physical aptitude, insulin resistance, inflammatory and oxidative stress

As elevadas prevalências de obesidade e sarcopenia vêm se tornando relevante nos últimos anos diante de que as condições decorrentes da co-existência destes dois quadros potencializa os danos à saúde do indivíduo. O presente estudo tem como objetivo diagnosticar, avaliar a prevalência e o comportamento das variáveis funcionais da massa muscular e metabólicas da obesidade sarcopênica em adultos. Foram avaliados 523 indivíduos, de ambos os sexos, com maior prevalência do sexo feminino (72,7%), com idade média de 54,74±10,18 anos, ingressantes em programa para Mudança do Estilo de Vida (MEV) “Mexa-se Pró Saúde”. Os indivíduos foram submetidos a avaliações clínicas, da pressão arterial, aptidão cardiorrespiratória, de antropometria e composição corporal, aptidão física e análises bioquímicas, incluindo resistência insulínica (HOMA-IR), estresse oxidativo (Malondialdeido – MDA) e estresse inflamatório (Proteína C-Reativa – PCR). As análises estatísticas foram realizadas pelo software SAS 9.2, adotando p<0,05. Adotou-se como critério de obesidade a circunferência abdominal elevada. Verificou-se que a indivíduos portadores de obesidade abdominal comparados aos não portadores, apresentam maiores valores de IMC, %GC, IMM, HOMA-IR, PCR, ácido úrico, triglicerídios e glicemia e valores reduzidos de HDL-c, flexibilidade e VO2max. Quando avaliada isoladamente a obesidade abdominal, foi verificado que sua presença reduz as chances de boa aptidão aeróbia e força muscular com aumento da chance de resistência insulínica. Já a sarcopenia reduz as chances de alteração na flexibilidade, redução do HDL-c e aumenta as chances de resistência insulínica. Quando combinadas, a obesidade sarcopênica se diferencia principalmente na aptidão física, onde a aptidão cardiorrespiratória se mostrou como condicionante da discriminação de obesidade sarcopência....

Recently, obesity and sarcopenia have been showing high prevalence among population and when this conditions are combined may increases damage to the individual’s health. This study aimed to diagnose, assess prevalence, muscle mass function and metabolic variables related to sarcopenic obesity in adults. Were assessed 523 individuals, of both sexes, with higher prevalence in females (72.7%) with a mean age of 54.74 ± 10.18 years old, selected for Lifestyle Modification Program (MEV). The individuals were assessed for medical anamnese, blood pressure, cardiorespiratory fitness, body composition and anthropometry, physical fitness and biochemical analyzes, including analysis of insulin resistance (HOMA-IR), oxidative stress (malondialdehyde - MDA) and inflammatory stress (C-Reactive Protein - PCR). Statistical analyzes were performed by SAS software 9.2 (p <0.05). Obesity was defined by higher measures of waist circumference. It was verified that individuals with abdominal obesity compared to non-obese, presented higher BMI,% BF, MMI, HOMA-IR, CRP, uric acid, triglycerides and blood glucose and reduced levels of HDL-c, flexibility and VO2max. When evaluated separately was found that abdominal obesity reduces the chances of good aerobic fitness and muscle strength with increased chance of insulin resistance. On the other hand, sarcopenia reduces the chances of good flexibility, adequate levels of HDL-C and increases the chances of insulin resistance. When combined, sarcopenic obesity differs mainly in physical fitness, with cardiorespiratory fitness as determinant of sarcopenic obesity discrimination...

Sarcopenia e dependência para realização das atividades básicas da vida diária de idosos domiciliados no município de São Paulo: saúde, bem-estar e envelhecimento (2000 e 2006) / Sarcopenia and dependency to perform activities of daily living in elderly domiciled in the city of São Paulo SABE survey - health, well-being and aging (2000 e 2006)

Introdução: A sarcopenia é caracterizada pela redução da força e massa muscular (MM), e acompanhada pelo declínio da capacidade funcional, em idosos, e sua associação com dependência para realização das atividades básicas da vida diária (ABVD) tem sido relatada na literatura internacional, entretanto, há escassez de informações sobre o tema no Brasil. Objetivo: Estimar a associação entre sarcopenia e dependência para a realização das ABVD, em idosos domiciliados no município de São Paulo, segundo sexo. Casuística e métodos: Foram analisados idosos ( 60 anos), de ambos os sexos, do Estudo SABE, longitudinal, epidemiológico e de base domiciliar, realizado no município de São Paulo, em 2000 e 2006, e que, em 2000, não apresentaram dependência. A variável sarcopenia foi definida por meio de três componentes: desempenho no teste de sentar e levantar de uma cadeira (SeL), categorizado em baixo (tempo percentil 75, segundo sexo), e normal (< percentil 75); pela força de preensão manual (FPM), categorizada em baixa (força percentil 25, segundo índice de massa corporal e sexo) e normal (> percentil 25); e massa muscular (MM), categorizada em baixa ( percentil 20, segundo sexo) e normal (> percentil 20), sendo diagnosticados sarcopênicos, idosos que apresentaram, simultaneamente, baixo desempenho e baixa MM, ou, então, desempenho normal, mas, baixas FPM e MM. A dependência para a realização das ABVD foi referidas pelos idosos, em 2006, sendo considerando dependentes, aqueles que responderam positivamente, para, pelo menos uma questão referente à dependência. As variáveis de controle foram sexo, grupos etários (60-74 e 75 anos), etnia (caucasianos, asiáticos, outros), número de doenças referidas (1 ou > 1). Resultados: Dos idosos sobreviventes, 799 apresentaram todos os dados necessários ao estudo (60,3 por cento mulheres, 85,6 por cento < 75 anos). Foram identificados como sarcopênicos, em 2000, 8,9 por cento dos idosos (homens = 8,3 por cento ; mulheres = 9,3 por cento ), e dependentes para a realização das ABVD, em 2006, 7 por cento (homens = 6,5 por cento ; mulheres = 7,3 por cento ). Idosos sarcopênicos apresentaram chance 3,13 vezes maior, para dependência (IC 95 por cento 1,67-5,87), em 2006, ajustado pelas demais variáveis, em relação aos não sarcopênicos.

Upper limb proximal form of benign monomelic amyotrophy: on purpose of 2 cases / Amiotrofia monomélica benigna forma proximal de membro superior: a propósito de 2 casos

Benign monomelic amyotrophy (BMA) is a rare form of motor neuron disease of unknown cause and it?s characterized by weakness and muscular atrophy restricted to an upper or lower limb, usually in the distal part, absence of upper motor neuron signs and self limited course. In this report we describe the clinical and electromyographic features of two young men with BMA in the proximal portion of the right upper limb, a location of BMA rarely described in the literature.

Amiotrofia Monomélica Benigna (AMB) é uma entidade rara do neurônio motor, de causa desconhecida, caracterizada por fraqueza muscular e amiotrofia restritas a 1 membro superior ou inferior, frequentemente em terço distal, sem comprometimento da via piramidal e cursoautolimitado. Descrevemos os achados clínicos e eletroneuromiográficos de 2 pacientes jovens com AMB na porção proximal do membro superior, localização raramente descrita na literatura.

Study on the Changes in Limb Circumferences and Muscle Areas of Critically Ill Patients using Ventilators

PURPOSE: The purpose of this study was to identify muscle atrophy in critically ill patients on ventilators. A comparison was made between limb circumferences and muscle areas on the day of admission to an intensive care unit (ICU) and on the 8th day after admission. METHODS: The data were collected from 30 critically ill patients using ventilators at S hospital ICU in Seoul during the period from October 2005 to April 2006. Limb circumferences and skinfold thickness were measured on the day of admission and on the 8th day after admission to the ICU. Limb circumferences and skinfold thickness were measured on the right mid-arm, right mid-thigh, and right mid-calf using a measuring tape and a skinfold calipers. Limb muscle areas were calculated by an equation after measuring limb circumferences and skinfold thickness. The data were analyzed by paired t-test and independent t-test. RESULTS: 1) Mid-arm circumference, mid-thigh circumference and mid-calf circumference on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 2) Mid-arm muscle area, mid-thigh muscle area and mid-calf muscle area on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 3) Steroid and vecuronium medication didn't affect changes in limb circumferences (mid-arm, mid-thigh, mid-calf) and muscle areas (mid-arm, mid-thigh, mid-calf) on the 8th day after admission to the ICU compared to the day of admission. CONCLUSION: Limb muscle atrophy may occur on the 8th day after admission to the ICU in critically ill patients using ventilator.

Benign monomelic amyotrophy with proximal upper limb involvement: case report

Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call atention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

A amiotrofia monomélica é condição rara em que a amiotrofia neurogênica é restrita somente a um membro superior ou inferior. Usualmente esporádica, possui um início insidioso e evolução lenta de 2-4 anos após as primeiras manifestações, seguida por estabilização. Relatamos o caso de um homem que aos 20 anos apresentou lentamente amiotrofia e paresia proximal no membro superior direito, estabilizando-se em quatro anos. A eletroneuromiografia identificou a presença de desnervação e fasciculações em diversos músculos proximais do membro superior direito. Chamamos a atenção para esta rara localização desta entidade, assim como descrevemos algumas das hipóteses da fisiopatologia.

Neuromuscular weakness in critically ill.

Neuromuscular weakness in critically ill has been increasingly reported in the recent years. Occasionally it may lead to difficulty in weaning the patients from mechanical ventilation, which is difficult to diagnose clinically. Though in well-planned studies the incidence has been reported to be high, the diagnosis is often missed due to the presence of various confounding factors in the form of drug effects, underlying disorder and coexisting abnormalities of the central nervous system. A high index of suspicion with detailed neurological and electrophysiological examination is required for an early and accurate diagnosis. A wide spectrum of disorders and drugs can be responsible for the critical illness neuromuscular abnormality. The most frequent and defined disorders include; critical illness polyneuropathy (CIP) which is characterized by a sensorimotor reversible polyneuropathy presenting as distal symmetrical weakness with loss of deep tendon reflexes. Acute myopathy is another important disorder in this group which usually presents with quadriplegia often related to steroid use. Persistent blockade of neuromuscular junction is also defined in critically ill patients. It is, therefore, important to understand these disorders and their implications in the management of these patients. Some of the conditions require prolonged neuro-rehabilitation. The various acquired disorders leading to neuromuscular abnormalities in critical care, and their diagnosis and management are discussed.

Benign monomelic amyotrophy: a study of twenty-one cases

A consecutive series of 21 patients with single limb atrophy (monomelic amyotrophy) is reported. Sixteen had lower limb atrophy and five had upper limb involvement. The median age of the onset was 20 years. Characteristic features were sporadic occurrence, wasting confined to one limb, insidious onset with slow progression, stabilizing in 1 to 4 years, and absence of pyramidal signs. All the patients with upper limb involvement were male, however in our cases with lower limb amyotrophy there were no male preponderance. We observed wasting of the entire length of the lower limbs in six patients. There were nine cases with amyotrophy restricted to the leg and one with amyotrophy only in the thigh. In the upper limb in four cases the involvement was distal and in one patient the atrophy was proximal. The electromyographic features were suggestive of anterior horn disease not only in the affected limb but also, in some cases, in clinically uninvolved limb. Cervical or lumbar MRI was normal. MRI of the lower limb disclosed increased signal intensity in the gastrocnemius and soleus muscles in one patient suggesting denervation

Sinovitis por aluminio: a propósito de un caso / Synovitis by aluminium: a purpose of a case

Se trata de paciente masculino de 21 años quien sufre herida por arma de fuego en rodilla izquierda, se ingresa con la impresión diagnóstica de Sinovitis Plúmbica, se práctica sinovectomía, y al realizar Microscopia Electrónica de Barrido, se demuestra la existencia de Aluminio y no de plomo, por lo que concluimos que se trata de una Sinovitis por Aluminio

Enfermedad de Charcot Marie Tooth (Neuropatía hereditaria sensitivo motora, NHSM). Manifestaciones clínicas y su tratamiento ortopédico en 21 pacientes / Charcot-Marie-Tooth disease (hereditary senso-motor neupathy). Clinical manifestations and their orthopaedic treatment in 21 patients

Se revisaron 21 pacientes con diagnóstico de enfermedad de Charcot-Marie-Tooth o Neuropatía Hereditarias Sensitivo Motora (CMT o NHSM) con edad promedio de 13.4 años (rango de 6 a 23), fueron 11 pacientes femeninos y 10 masculinos. El inicio de la sintomatología ocurrió a la edad promedio de 4.5 años (rango de 1 a 10.1). El diagnóstico se realizó en forma clínica, por velocidad de conducción nerviosa y biopsia en todos los pacientes. Del total de pacientes, 18 se diagnosticaron como CMT clásico o NHSM tipo I; 2 pacientes con variante Roussy-levy (NHSM tipo II), y un sólo pacientes con la variante Dejerine-Sottas (NHSM tipo III). El seguimiento mínimo fue de 1 año y máximo de 10 años (promedio de 6.8 años). Dentro de las manifestaciones clínicas encontramos deformidad cavo-varo de ambos pies en todos los pacientes y asociado a esta deformidad 4 pacientes presentaron ortejos en garra bilateral, uno tuvo segundo ortejo en garra bilateral, y en un paciente ambos pies se observaron péndulos. En 4 pacientes se presentó afección motora de extremidades superiores y en uno de estos también fue sensitiva en forma leve. Escoliosis de la columna se diagnósticó en el paciente con la variante (NHSM tipo III) y subluxación de la cadera en un paciente con CMT clásico. Los pacientes fueron clasificados de acuerdo a las características de la deformidad en tres estadios y en base a estos se estableció el tipo de tratamiento, siendo este de tipo conservador (estadio I) fisioterapia y ortesis; y Quirúrgico (estadio II y III) transferencias tendinosas, fasciotomías, tenotomías, osteotomías, falangectomías, artrodesis, cotiloplastía, e instrumentación segmentaria de columna. Conocemos que estos pacientes tarde o temprano llegaran al tratamiento quirúrgico pero el manejo conservador les permite una mejor marcha o función y disminución de la sintomatología

Neuropatia idiopática do plexo lombossacro em criança: relato de caso / Idiopathic lumbosacral plexus neuropathy in child: case report

Os autores relatam um caso de plexopatia lombossacra em criança e em que a extensa investigaçao, incluindo ressonância nuclear magnética normal, biópsia muscular compatível com desinervaçao inicial e eletromiografia normal, afastou condiçoes associadas. O paciente apresentava dor intensa, fraqueza e atrofia do membro inferior esquerdo, reflexo aquileu ausente e reflexo patelar diminuído à esquerda. Parestesia no membro envolvido acompanhava o quadro. O tratamento realizado foi dexametasona por um mês e morfina intratecal durante três meses. A evoluçao foi favorável, apresentando, após um ano, atrofia discreta do membro acometido e leve paresia do músculo iliopsoas esquerdo.

Elastólise cutânea generalizada adquirida pós-inflamatória: relato de cinco casos / Generalized acquired post-inflammatory cultaneous elastolysis: report of five cases

Relato de cinco casos de elastólise cutânea generalizada adquirida pós-inflamatória, observados no período de 1981 a 1993: quatro, do sexo feminino e um do masculino, sendo dois negros e três pardos. O início da doença ocorreu entre os dois e oito anos de idade. Os pacientes apresentaram quadros dermatológicos diversos na fase aguda inflamatória que precedeu à cútis laxa e ao pseudo envelhecimento cutâneo definitivo: dois, prurido agudo infantil, o terceiro, urticária, o quarto, dermatite atópica, e o quinto, queimadura térmica. Uma revisäo da literatura é feita e se estabelece uma comparaçäo desses casos com os outros 16 já descritos, discutindo-se aspecto clínicos, etiopatogênicos e terapêuticos

A clinical study of benign focal amyotrophy

We reviewed the clinical, electrophysiological, radiological, and histopathological findings in 25 patients with benign focal amyotrophy. There were 14 patients with upper limb type and 11 with lower limb type. 18 patients had unilateral involvement and 7 had bilateral involvement asymmetrically. The characteristics clinical features were sporadic occurrence, predominance in young males, nonprogressive course or initial progression for 1 to 3 years followed by stationary state, segmental distribution of muscle weakness and atrophy localized to one limb or both homologous limbs markedly asymmetrically, and absence of any definite sensory loss or central nervous system involvement. The electrophysiological, radiological, and muscle histopathological findings suggested chronic focal anterior horn cell disease. Although the prevalence of this disease is still unknown, the importance of recognition is being emphasized because of its common occurrence in our country and the benign prognosis.