Avaliação da neurólise ulnar na neuropatia hansênica / Assessment of ulnar neurolysis in leprous neuropathy

Os autores avaliam os resultados de 35 procedimentos de descompressão cirúrgica do nervo ulnar realizados em 28 pacientes hansênicos. Os parâmetros utilizados incluíram a escala analógica visual, a escala comportamental, a avaliação da força muscular, a estesiometria e a avaliação do efeito do procedimento no que tange à diminuição da corticoterapia no pós-operatório. Observou-se resolução imediata da dor após a realização da cirurgia, melhora da força muscular em metade dos pacientes, melhora da sensibilidade em metade dos pacientes. A diminuição da dosagem da prednisona após a cirurgia foi constante e significativa após a operação.

In this study, the authors assess the results of 35 surgical ulnar nerve decompression procedures performed on 28 leprous patients. The parameters employed included the visual analogue scale, the behavioral scale, the muscle strength evaluation, the esthesiometry and the evaluation of the effect of the procedure on decreasing postoperative corticoid therapy doses. Early resolution of pain was seen after surgery, muscle strength increased in half of the patients, sensitivity increased in half of the patients, with ongoing and significant decrease of prednisone doses after surgery.

A 12-year experience using the Brown two-portal endoscopic procedure of transverse carpal ligament release in 14,722 patients: defining a new paradigm in the treatment of carpal tunnel syndrome.

BACKGROUND: Compared with the open technique, endoscopic carpal tunnel release has a shorter postoperative recovery period but has been associated with an increased risk of iatrogenic injury. Because of morbidity of the open method, including painful scars, pillar pain, tendon adhesions, scar entrapment of the median nerve, chronic regional pain syndrome, and a longer postoperative recovery period, many patients have been treated nonoperatively to circumvent or forestall surgery, resulting in unrelieved median nerve compression and an increased risk of permanent nerve injury. METHODS: Inclusion criteria included a diagnosis of carpal tunnel syndrome based on history and physical examination and electrodiagnostic studies; failure of a short trial of conservative therapy; and advanced disease as evidenced by sensory, motor, or atrophic changes in the median nerve distribution. Exclusion criteria included prior surgery, wrist extension of less [corrected] than 40 degrees, mass within the carpal tunnel, Guyon's syndrome, and bony carpal tunnel abnormalities. Patients meeting these criteria were treated by the Brown two-portal endoscopic technique. RESULTS: A total of 14,722 patients were treated with the Brown endoscopic procedure. Eleven patients (0.07 percent) required conversion to an open procedure. There was one iatrogenic injury. Postoperative results were inversely related to the severity of the preoperative electrodiagnostic studies and the duration of symptoms regardless of the method of nonoperative treatment given. CONCLUSIONS: Operative decompression should be carried out promptly if symptoms have been present for 2 months or longer, as the occurrence of permanent nerve damage has been noted within this time frame. The authors advocate use of the two-portal endoscopic technique as previously described by Brown et al. for this purpose.

Comparative trial of steroids and surgical intervention in the management of ulnar neuritis.

Fifty-seven ulnar nerves in 39 patients with early neuritis were studied to assess the benefits offered by medial epicondylectomy and external decompression in addition to steroid therapy. The patients were randomly allocated to the surgical or medical group. In those cases where there was bilateral involvement, surgery was carried out on only one side. All cases were assessed prior to treatment and after the first and second years following treatment. The improvement in motor and sensory functions attained at the end of the first year was sustained into the second year. The improvement sustained in both groups was similar even in the second year, and medial epicondylectomy with external decompression seems to have no added benefit as compared to steroid therapy alone in the early treatment of ulnar neuritis. Early diagnosis and treatment, especially in borderline lepromatous cases, seem to offer some hope of nerve function recovery.

Kaposi's sarcoma with visceral involvement after intraarticular and epidural injections of corticosteroids.

Kaposi's sarcoma has been reported in patients receiving immunosuppressive therapy, most of whom are organ transplant recipients. The development of Kaposi's sarcoma after treatment with corticosteroids has been reported in only 38 patients who have not had acquired immunodeficiency syndrome or undergone organ transplantation. Cutaneous Kaposi's sarcoma developed 2 months after intraarticular steroid injections in a man with ulnar nerve entrapment. The lesions regressed spontaneously after 3 months but reappeared with visceral involvement 18 months later, shortly after initiation of a course of epidural steroid injections for treatment of low back pain. The cutaneous lesions and some visceral lesions rapidly regressed after cessation of treatment.