Oxidative stress and S100B protein in cirrhotic children.

UNLABELLED: Cirrhosis represents the terminal stage of a number of chronic liver diseases. Consequences include accumulation of toxic metabolic wastes, reduced synthesis of key proteins, increased portal venous pressure, and portosystemic shunting. We conducted a case-control study to assess the serum levels of S100B protein and parameters of oxidative stress, superoxide dismutase (SOD), catalase (CAT) and oxidative stress measured by the thiobarbituric acid method (TBARS), in a group of 14 pediatric patients with cirrhosis. No differences were found between groups in S100B protein levels. SOD activity and TBARS levels were higher; and CAT activity was lower in the cirrhotic group. A negative correlation between S100B and TBARS in the case group was found (r = -0.815, p = 0.001). CONCLUSIONS: This study didn't indicate a possible role of S100B serum levels as marker of brain damage in cirrhotic children but suggest a possible relation between astrocyte function and oxidative damage in cirrhotic children.

Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region.

INTRODUCTION: Hepatitis virus C (HCV) infection is considered a health problem in the State of Acre localized in the Brazilian Amazon which has a prevalence rate of 5.9%. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. OBJECTIVE: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. METHOD: A cross sectional study was performed in patients assisted by a specialized center of infectious diseases in the State of Acre. All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). RESULTS: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51% had at least 8 years of formal education and 96% lived in the capital city of Acre State. Roughly 34% of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1%; IC95% 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1%) patients. CONCLUSION: Subclinical involvement of peripheral nerves seems common in patients with HCV, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.

Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region / Neuropatia periférica em pacientes com infecção pelo vírus C da hepatite na região amazônica

INTRODUCTION: Hepatitis virus C (HCV) infection is considered a health problem in the State of Acre localized in the Brazilian Amazon which has a prevalence rate of 5.9 percent. Peripheral neuropathy is a common extra-hepatic manifestation in patients with HCV. OBJECTIVE: To determine the prevalence of peripheral neuropathies using clinical and neurophysiological parameters. METHOD: A cross sectional study was performed in patients assisted by a specialized center of infectious diseases in the State of Acre. All patients completed a clinicoepidemiological questionnaire, physical examination and nerve conduction studies (NCS). RESULTS: We studied 78 patients with mean age 45.5 years (range from 10 to 76 years), two thirds were male, 51 percent had at least 8 years of formal education and 96 percent lived in the capital city of Acre State. Roughly 34 percent of patients complained about paresthesias mainly in upper limbs. The NCS diagnosed multiple mononeuropathy in 11 (14.1 percent; IC95 percent 7.6-23.2) patients and carpal tunnel syndrome in 4 (5.1 percent) patients. CONCLUSION: Subclinical involvement of peripheral nerves seems common in patients with HCV, with multiple mononeuropathy the main manifestation of nerve injury in this region as suggested by electrophysiological studies.

INTRODUÇÃO: A infecção pelo vírus da hepatite C (VHC) é considerada um problema de saúde pública no Estado do Acre com uma prevalência de 5,9 por cento. Neuropatia periférica é uma manifestação extra-hepática comum em pacientes com VHC. OBJETIVO: Determinar a prevalência de neuropatias periféricas através de parâmetros clínicos e neurofisiológicos. MÉTODO: Foi realizado estudo transversal em pacientes atendidos em uma clínica especializada de doenças infecciosas do Estado do Acre. Todos os pacientes foram submetidos a um questionário clínico-epidemiológico, exame físico e eletroneuromiografia (ENMG). RESULTADOS: Foram estudados 78 pacientes, com idade média de 45,5 anos (10 a 76), dois terços eram do sexo masculino, 51 por cento tinha pelo menos 8 anos de educação formal e 95 por cento moravam na capital do Estado. Aproximadamente 34 por cento dos pacientes se queixaram de parestesias, principalmente nos membros superiores. A ENMG diagnosticou mononeuropatia múltipla em 11 (14,1 por cento, IC95 por cento 7,6-23,2) pacientes e síndrome do túnel do carpo em 4 (5,1 por cento). CONCLUSÃO: Comprometimento dos nervos periféricos é comum em pacientes com VHC, sendo neuropatia múltipla a apresentação mais comumente diagnosticada pela ENMG.

[Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome]. / Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo.

The purpose of this study was to evaluate, through a series of cases, the relationship between the adverse neural tension of median nerve (ANTm) and the electrophysiological involvement in 38 patients with symptoms of the carpal tunnel syndrome (CTS), submitted to nerve conduction studies (NCS). The main measures had been ANTm (in degrees) obtained through the test of neural tension provocation (TNTP) and parameters of the NCS, divided into three groups: normal, without severe electrophysiological alteration and with severe electrophysiological alteration. Significant correlations were found between ANTm and parameters of the NCS (p<0.05), as well as between ANTm and the three groups defined by the electrophysiologic alteration (rs=+0.437, p=0.002). The TNAm values were significantly higher in the arms with electrophysiologic diagnoses (p=0.007). It is suggested that the ANTm does have a participation in the physiopathology of the CTS, and the use of therapeutical procedures that diminish the development of neural tension.

Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo / Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome

O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm) e o parâmetro eletrofisiológico em 38 pacientes com sintomas da síndrome do túnel do carpo (STC), submetidos a estudos de condução nervosa (ECN). As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN) e parâmetros dos ECN, dividindo-se os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e com alteração eletrofisiológica grave. Correlação significante entre TNAm e parâmetros dos ECN foram encontrados (p<0,05), bem como entre a TNAm e os três grupos definidos pela alteração eletrofisiológica (r s=+0.437, p=0,002). Valores de TNAm foram significantemente maiores nos braços com diagnóstico eletrofisiológico (p=0,007). Sugere-se que a TNAm tem participação na fisiopatologia da STC, indicando o uso de procedimentos terapêuticos que diminuam ou previnam a tensão neural.

Prediction of the neurophysiological diagnosis of carpal tunnel syndrome from the demographic and clinical data.

OBJECTIVE: To use demographic and clinical data to identify the clinical pattern that best predicts the diagnosis of carpal tunnel syndrome (CTS), as defined by neurophysiologic studies. METHODS: A diagnostic cross-sectional study in 2535 consecutive patients (3907 upper limbs) older than 12 years old who were referred for nerve conduction studies in the upper limbs between August 2001 and January 2003 in 3 university hospitals and 2 private neurophysiology services in the state of Rio Grande do Sul, Brazil. RESULTS: A neurophysiologic diagnosis of CTS was established in 39.1% of these upper limbs. The presence of paresthesias or pain at least 2 of the first 4 digits in association with one of the following: female gender, symptoms worsening at night or on awakening, an BMI > or =30, thenar atrophy, or other sign (Tinel's, Phalen's, or Reversed Phalen's signs); were the best pattern associated with the diagnosis. CONCLUSIONS: We have found that the clinical picture alone does not seem sufficient, in majority of the population, to correctly predict the diagnosis of CTS, as defined by median nerve neuropathy at the carpal tunnel. We believe that a compressive lesion of the median nerve at the carpal tunnel can be present both in patients with no typical symptoms of CTS (including asymptomatic individuals) and in patients in which neurophysiologic studies are negative. SIGNIFICANCE: Further studies separating patients into these groups will allow us to identify the long-term prognosis as well as the ideal therapeutic approach for each of these clinical situations.

Geradores do P50: estudo com pacientes epilépticos, submetidos á amígdala-hipocampectomia / P50 generators: study with epileptic patients submitted on the amigadala-hippocampectomy

Estudar o envolvimento do hipocampo na gênese dopotencial evocado P50 e da supressão do mesmo em pacientes com epilepsia submetidos a tratamento cirúrgico. Foi realizado um estudo transversal com grupo de controle de comparação. Excluíram-se indivíduos com outra patologia neurológica ou psiquiátrica, hipoacusia auditiva, história familiar de transtornos psicóticos, uso de antipsicóticos atípicos ou de drogas ilícitas no último mês. Os indivíduos foram separados em dois grupos: grupo 1 (n=34) - amígdala-hipocampectomia; grupo 2 (n=40) - controles. Foi realizado, em todos os participantes, o potencial evocado auditivo de m,édia latência P50. Consideraram-se variáveis de comparação

What symptoms are truly caused by median nerve compression in carpal tunnel syndrome?

OBJECTIVE: This study aims to identify the symptoms, signs and distributions which are associated with neurophysiological carpal tunnel syndrome (N-CTS), defined by the finding of a median nerve lesion at the wrist through neurophysiologic studies, and to compare them with those of patients with sensory or motor complaints in the upper limbs whose electrophysiologic investigation did not show evidence of this syndrome. METHODS: A cross-sectional study was performed, with prospective gathering of data, following a predetermined protocol. We included all patients older than 12 years who were referred for nerve conduction studies and electromyography of at least one of the upper limbs between August 2001 and January 2003. The patients answered a clinicoepidemiologic questionnaire and painted the areas in which they felt pain and those in which they felt paresthesia, and were also examined to test for classical signs CTS. RESULTS: A neurophysiological diagnosis of CTS was reached in 1549 upper limbs (39%). Approximately 6% of the upper limbs with N-CTS and 16% of those without median nerve lesion do not have any hand or wrist symptoms (P<0.001). Paresthesia, pain, hand weakness and cramps were the symptoms statistically associated to N-CTS, with paresthesia being the one with the greatest power of association. This is usually felt in median innervation's territory, and is frequently extended to the whole hand, but without association with N-CTS when felt in proximal region. CONCLUSIONS: One concludes that the most characteristic manifestation of carpal tunnel syndrome (CTS) is paresthesia. Pain also occurs very frequently but it is less specific, and weakness, meanwhile, seems to have a low frequency. We believe that the variability in the clinical presentation of CTS is largely due to the presence of associated diseases and our results provide information which could help to better define the clinical criteria used in the diagnosis of this syndrome.

Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients

OBJETIVO: Descrever as características demográficas de gênero, idade e presença de movimentos repetitivos, uso de álcool e antiinflamatórios não-esteróides (AINE), especialidades médicas de encaminhamento para eletroneuromiografia (ENMG), nível de escolaridade, e distribuição sazonal em pacientes com síndrome do túnel do carpo (STC) diagnosticada neurofisiologicamente no Estado do Rio Grande do Sul, Brasil. MÉTODO: Foi estudada uma série de 1039 pacientes (1549 mãos), com STC definida neurofisiologicamente, que foram encaminhados para realização de ENMG, em 3 serviços universitários e 2 privados, entre agosto de 2001 a janeiro de 2003. Todos os pacientes responderam questionário com informações demográficas. O diagnóstico da STC foi realizado seguindo protocolo pré-estabelecido, com critérios diagnósticos definidos. RESULTADO: Cerca de um quarto dos pacientes já havia realizado ENMG prévia, sendo observada maior freqüência da STC em mulheres (5,6:1) e em pacientes acima de 40 anos. A maioria relatava esforços repetitivos na sua atividade diária (69,7%), 12,9% estava em uso de AINE e 14,9% relatavam ingesta regular de bebidas alcoólicas. Observamos maior freqüência da STC nos meses de julho e agosto em relação aos outros meses do ano. Cerca de 2/3 da nossa população apresentava pelo menos o primeiro grau completo. Na maior parte dos pedidos de ENMG não era descrita uma hipótese diagnóstica (69,9%), sendo a traumatologia/ortopedia a especialidade que mais solicitou exames neurofisiológicos (71,1%). CONCLUSAO: Concluímos que a STC, em nosso meio, apresenta características demográficas semelhantes às descritas na literatura. A maior parte de nossa amostra apresenta pelo menos o 1º. grau completo e foi encaminhada para realização de ENMG por traumatologistas. Salientamos a distribuição sazonal da STC que demonstra uma associação significativa com os meses de inverno.

Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients.

OBJECTIVE: To describe the demographic characteristics of gender, age, and presence of repetitive movements, intake of alcohol and non-steroid anti-inflammatories (NSAI), medical specialties that referred patients to nerve conduction studies and electromyography (NCS-EMG), school attainment, and seasonal distribution in patients with a neurophysiological diagnosis of carpal tunnel syndrome (CTS) in the State of Rio Grande do Sul, Brazil. METHOD: A series of 1039 patients (1549 hands) with neurophysiologically defined CTS was studied. Patients were referred for NCS-EMG in 3 universities and 2 private services, from August 2001 to January 2003. All patients completed a questionnaire containing demographic information. The diagnosis of CTS was established following a pre-established protocol, with defined diagnostic criteria. RESULTS: Around one fourth of patients had already performed NCS-EMG; the greatest frequency of CTS was observed in women (5.6:1) and in patients above the age of 40. Most patients reported performing repetitive movements in their daily routine (69.7%); 12.9% reported use of NSAI and 14.9% regular intake of alcoholic beverages. A greater frequency of CTS was observed in the months of July and August, when compared to the other months of the year. Around 2/3 of the study population had completed at least secondary school. Most requests of nerve conduction studies did not provide a diagnostic hypothesis (59.9%) and neurophysiologic studies were requested mostly by traumatology/orthopedics (71.1%). CONCLUSION: We have concluded that, in our environment, CTS shows some demographical characteristics that are similar to what the literature describes. Also, we have found that most of our sample concluded at least secondary school, and was referred to neurophysiologic studies by orthopedists. To be pointed out is the seasonal distribution of CTS, which demonstrates a significant association with winter months.

Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report.

UNLABELLED: Myopathy due to idiopathic hypoparathyroidism is very unusual. We report on a 30 years-old man referred with complaints of sporadic muscle pain and mild global weakness for 10 years. His physical examination showed normal strength in distal muscle and slightly weakness in the pelvic and scapular girdles with no atrophy. Deep muscle reflexes were slightly hypoactive. Trousseau's and Chvostek's signs were absent. He had bilateral cataract and complex partial seizures. His laboratory tests showed decreased ionised and total calcium and parathyroid hormone and increased muscle enzymes. EMG and muscle biopsy was compatible with metabolic myopathy. After treatment with calcium and vitamin D supplementation he showed clinical, neurophysiological and laboratorial improvement. IN CONCLUSION: patients with muscle symptoms, even when non-specific and with normal neurological examination, should have serum calcium checked, as myopathy due to idiopathic hypoparathyroidism, even being rare, is treatable and easy to diagnose.

Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report

Miopatia secundária a hipoparatireidismo idiopático é enfermidade raramente descrita. Relatamos o caso de homem de 30 anos que procurou atendimento médico com queixas de dores musculares e discreta fraqueza há cerca de 10 anos. Ao exame físico apresentava leve diminuição de força na musculatura pélvica e escapular, sem atrofia, ou fraqueza distal. Os reflexos miotáticos fásicos eram hipoativos e não havia sinais de Trousseau ou Chevostek. Havia história de catarata bilateral e crises parciais complexas. Os exames laboratoriais demonstraram hipocalcemia, com diminuição do paratormônio, hiperfosfatemia e enzimas musculares elevadas. A EMG e a biópsia de músculo foram compatíveis com miopatia metabólica. Após reposição de cálcio e vitamina D houve melhora clínica e neurofisiológica. Em conclusão: em pacientes com sintomas musculares, mesmo não específicos para miopatia ou com exame neurológico normal, deve-se dosar cálcio sérico, já que miopatia associada a hipoparatireoidismo é uma doença facilmente diagnosticada e tratável.