Asunto(s)
Artrogriposis/diagnóstico , COVID-19/prevención & control , Electrodiagnóstico/métodos , Neuropatía Hereditaria Motora y Sensorial/diagnóstico , Neuritis/diagnóstico , Traumatismos de los Nervios Periféricos/diagnóstico , Artrogriposis/rehabilitación , Artrogriposis/cirugía , Neuritis del Plexo Braquial/diagnóstico , Neuritis del Plexo Braquial/rehabilitación , Neuritis del Plexo Braquial/cirugía , Manejo de la Enfermedad , Cirugía General , Neuropatía Hereditaria Motora y Sensorial/rehabilitación , Neuropatía Hereditaria Motora y Sensorial/cirugía , Humanos , Control de Infecciones/métodos , Neuritis/rehabilitación , Neuritis/cirugía , Neurología , Terapia Ocupacional , Traumatismos de los Nervios Periféricos/rehabilitación , Traumatismos de los Nervios Periféricos/cirugía , Modalidades de Fisioterapia , Medicina Física y Rehabilitación , Guías de Práctica Clínica como Asunto , Derivación y Consulta , SARS-CoV-2 , Telemedicina/métodosRESUMEN
BACKGROUND: Reverse end-to-side anterior interosseous nerve transfer has been reported to enhance treatment of severe, proximal ulnar neuropathy. The authors report on patients with severe neuropathy treated with ulnar nerve transposition and distal reverse end-to-side anterior interosseous nerve transfer. METHODS: Thirty patients with severe ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative Medical Research Council muscle strength, clawing, and degree of wasting. Electrodiagnostic data included compound motor action potential and sensory nerve action potential amplitudes. Summary statistics were used for demographic and clinical data. The t test and Wilcoxon signed rank test were used where appropriate. RESULTS: Average follow-up was 18.6 months. Preoperatively, 20 patients had Medical Research Council less than or equal to grade 1 in hand intrinsics, small finger sensory nerve action potentials were absent in all patients except for three, and average compound motor action potentials were severely reduced (absent in nearly 40 percent) confirming severity. All groups had a statistically significant increase in strength. More than three-quarters of patients noted partial or complete resolution of clawing and intrinsic muscle wasting. Seventy-three percent of patients regained Medical Research Council greater than or equal to grade 3 and 47 percent achieved Medical Research Council greater than or equal to grade 4. Mean time to observation of nascent units was 8.5 months, and 77 percent of patients demonstrated an augmentation of motor unit numbers with forearm pronation on needle electromyography CONCLUSION:: Proximal subcutaneous ulnar nerve transposition when combined with reverse end-to-side anterior interosseous nerve-to-ulnar nerve transfer demonstrates significant clinical and electrodiagnostic improvement of intrinsic muscle function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Asunto(s)
Nervio Mediano/cirugía , Transferencia de Nervios/métodos , Nervio Cubital/cirugía , Neuropatías Cubitales/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
CASE: We present the unique case of deltoid and hand compartment syndrome in a young man after prolonged syncope because of polysubstance use. The patient was subsequently treated with urgent deltoid and hand compartment fasciotomies which resulted in full recovery of his shoulder function. CONCLUSIONS: Patients suspected of deltoid compartment syndrome should have a thorough physical examination, followed by repeat examinations. Invasive compartment monitoring should be used in equivocal cases, in patients with decreased level of consciousness, and in patients with distracting injury. Once diagnosed, deltoid compartment syndrome (± other compartments) should be taken for emergent fasciotomy, ensuring adequate decompression of all 3 deltoid compartments.
Asunto(s)
Síndromes Compartimentales/cirugía , Músculo Deltoides/cirugía , Fasciotomía/métodos , Mano/cirugía , Síncope/complicaciones , Adulto , Síndromes Compartimentales/etiología , Humanos , Masculino , Trastornos Relacionados con Sustancias/complicaciones , Síncope/inducido químicamenteRESUMEN
BACKGROUND: Several phase II studies have assessed intra-lesional interleukin-2 (IL-2) for the treatment of in-transit melanoma. This systematic review addresses the efficacy and side effect profile of IL-2. METHODS: MEDLINE, EMBASE, Cochrane Library, and Google Scholar databases were searched from 1980 to 2012 for studies evaluating the clinical response to IL-2 for in-transit melanoma. Titles and abstracts were screened by two independent researchers for suitability using predetermined inclusion and exclusion criteria. A modified quality assessment tool for observational studies was used. Data were pooled and analyzed to determine lesion and patient response rates. RESULTS: Forty-nine studies were identified. Forty-three did not meet inclusion criteria, leaving six observational trials. Heterogeneity was seen in IL-2 dosage and treatment interval. Response rate was variable as well. Overall, 2,182 lesions and 140 patients were treated in these six studies. Pooling the lesions, complete response was seen in 78%. Pooling subjects, 50% achieved a complete response. Treatment was generally well tolerated, with localized pain and swelling, and mild flu-like symptoms. There were only three grade 3 adverse events reported, including rigors, headache, and fever with arthralgia. CONCLUSIONS: Intra-lesional IL-2 safely and effectively provides locoregional control of in-transit melanoma.
Asunto(s)
Antineoplásicos/uso terapéutico , Interleucina-2/uso terapéutico , Melanoma/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Humanos , Inyecciones Intralesiones , Melanoma/patología , Melanoma/secundario , Recurrencia Local de Neoplasia/patología , Neoplasias Cutáneas/patologíaRESUMEN
Intra-lesional interleukin-2 (IL-2) is effective in treating in transit melanoma metastases. Results from multiple studies were examined to evaluate the efficacy of IL-2 for in transit disease. In the published literature, complete response ranged from 0% to 69% per patient, and 41% to 96% per lesion, with excellent tolerability. Combining the results of six studies show complete response in 50% of patients and 78% of lesions. Intra-lesional IL-2 should be considered early in the course of treatment for in transit disease, ahead of other, more toxic therapies.