[Sensitivity and specificity of three complementary methods in the diagnosis of carpal tunnel syndrome]. / Sensibilidad y especificidad de tres métodos complementarios para el diagnóstico de síndrome de túnel carpiano.

INTRODUCTION: Currently there is no universally accepted standard of reference for the diagnosis of carpal tunnel syndrome so it is considered a «latent class¼ pathology, that is, it lacks any diagnostic tests that absolutely certain the presence of disease. METHODS: Prospective, observational and analytical study evaluating the three diagnostic methods used for carpal tunnel syndrome (clinical examination, ultrasound and electromyography). Normality values were set for each diagnostic method. RESULTS: 50 people (14 men and 36 women) were evaluated. The clinical examination showed a positive and significant correlation with the diameter of the affected median nerve (ecography) (R = 0.694, p = 0.032). The values of the under the curve area (UCA) for median nerve conduction speed (MNCS), cubital nerve conduction speed (CNCS), and distal latency (DL) by electromyography were 0.60, 0.519 and less than 0.50 respectively. This states that the diagnostic value of electromyography characteristics is bad. CONCLUSION: Our work establishes clinical examination as a good quality tool being the most sensitive method for diagnosing carpal tunnel syndrome. If there was a need for diagnostic confirmation, the ultrasound proved to be a highly satisfactory study generating less stress, pain and invasion to the patient, decreasing health expenditure and speeding up the process.

INTRODUCCIÓN: Actualmente, no existe un estándar de referencia aceptado universalmente para el diagnóstico del síndrome de túnel carpiano, por lo que se le considera una patología de «clase latente¼, es decir, que carece de alguna prueba diagnóstica que dé certeza absoluta de la presencia de la enfermedad. MÉTODOS: Estudio prospectivo, observacional y analítico en el cual se evaluaron los tres métodos diagnósticos utilizados para el síndrome de túnel carpiano (examen clínico, ecografía y electromiografía). En él, se establecieron valores de normalidad para cada método diagnóstico. RESULTADOS: Se evaluó un total de 50 personas (14 hombres y 36 mujeres). El examen clínico presentó correlación positiva y significativa con el diámetro del nervio mediano afectado (ecografía) (R = 0.694 y p = 0.032). Los valores del área bajo la curva (AUC, por sus siglas en inglés) para la velocidad de conducción del nervio mediano (VCNM), velocidad de conducción de nervio cubital (VCNC) y latencia distal motora (LDM) por electromiografía fueron de 0.60, 0.519 y. CONCLUSIÓN: < 0.50, respectivamente, lo cual determinó que el valor diagnóstico de las características por electromiografía es malo. Nuestro trabajo establece al examen clínico como una herramienta de buena calidad, siendo el método más sensible para el diagnóstico de síndrome de túnel carpiano. Si existiera la necesidad de realizar una confirmación diagnóstica, la ecografía mostró ser un estudio altamente satisfactorio, el cual genera menos estrés, dolor e invasión al paciente, disminuyendo, a su vez, el gasto de salud y agilizando el proceso.

Sensibilidad y especificidad de tres métodos complementarios para el diagnóstico de síndrome de túnel carpiano / Sensitivity and specificity of three complementary methods in the diagnosis of carpal tunnel syndrome

Resumen: Introducción: Actualmente, no existe un estándar de referencia aceptado universalmente para el diagnóstico del síndrome de túnel carpiano, por lo que se le considera una patología de «clase latente¼, es decir, que carece de alguna prueba diagnóstica que dé certeza absoluta de la presencia de la enfermedad. Métodos: Estudio prospectivo, observacional y analítico en el cual se evaluaron los tres métodos diagnósticos utilizados para el síndrome de túnel carpiano (examen clínico, ecografía y electromiografía). En él, se establecieron valores de normalidad para cada método diagnóstico. Resultados: Se evaluó un total de 50 personas (14 hombres y 36 mujeres). El examen clínico presentó correlación positiva y significativa con el diámetro del nervio mediano afectado (ecografía) (R = 0.694 y p = 0.032). Los valores del área bajo la curva (AUC, por sus siglas en inglés) para la velocidad de conducción del nervio mediano (VCNM), velocidad de conducción de nervio cubital (VCNC) y latencia distal motora (LDM) por electromiografía fueron de 0.60, 0.519 y < 0.50, respectivamente, lo cual determinó que el valor diagnóstico de las características por electromiografía es malo. Conclusión: Nuestro trabajo establece al examen clínico como una herramienta de buena calidad, siendo el método más sensible para el diagnóstico de síndrome de túnel carpiano. Si existiera la necesidad de realizar una confirmación diagnóstica, la ecografía mostró ser un estudio altamente satisfactorio, el cual genera menos estrés, dolor e invasión al paciente, disminuyendo, a su vez, el gasto de salud y agilizando el proceso.

Abstract: Introduction: Currently there is no universally accepted standard of reference for the diagnosis of carpal tunnel syndrome so it is considered a «latent class¼ pathology, that is, it lacks any diagnostic tests that absolutely certain the presence of disease. Methods: Prospective, observational and analytical study evaluating the three diagnostic methods used for carpal tunnel syndrome (clinical examination, ultrasound and electromyography). Normality values were set for each diagnostic method. Results: 50 people (14 men and 36 women) were evaluated. The clinical examination showed a positive and significant correlation with the diameter of the affected median nerve (ecography) (R = 0.694, p = 0.032). The values of the under the curve area (UCA) for median nerve conduction speed (MNCS), cubital nerve conduction speed (CNCS), and distal latency (DL) by electromyography were 0.60, 0.519 and less than 0.50 respectively. This states that the diagnostic value of electromyography characteristics is bad. Conclusion: Our work establishes clinical examination as a good quality tool being the most sensitive method for diagnosing carpal tunnel syndrome. If there was a need for diagnostic confirmation, the ultrasound proved to be a highly satisfactory study generating less stress, pain and invasion to the patient, decreasing health expenditure and speeding up the process.

Efficacy of PHENODRAL® product (sodium methylarsinate +ammonium ferric citrate +epinephrine) in bovines / Eficácia da formulação PHENODRAL® (metilarsinato de sódio + citrato de ferro amoniacal + adrenalina) em bovinos

We evaluated the efficacy of PHENODRAL® product on debilitated cattle, body condition (BC=2) and the influence of this product in clinical and laboratory parameters and weight gain. The experiment was performed using 20 young cattle aged 8 to 12 months, divided into two groups of 10 animals each, five males and five females/group (untreated Control Group - GI and Drug-treated group - Group - GII). The animals of GII received three doses of 15 mL of d PHENODRAL® product administered every six days (D0, D + 6 and D + 12), via IV, and the GI group received 0.9% IV saline administration. The experimental animals were monitored until D+35 The results showed that the weight gain in the GII group was higher in comparison to the control group GI, mainly at the moments before and after the product application, and a significant difference were observed at D + 28 in comparison to GI group. The results for the weekly parameters evaluated: feed intake, weekly weight gain and weekly feed conversion, were statistically different in moments D0 to D + 7, D + 7 to D + 14, D + 14 to D + 21 and D +21 to D + 28 between GI and GII emphasizing that the treated animals ingested greater amount of feed resulting in a higher weight gain due to better feed conversion compared to the control group animals. There were no statistical differences between GI and GII for the clinical, hematological and biochemical parameters evaluated throughout the trial period, however, the serum cortisol levels assessed in the GI group were above the reference values for the bovine species. On the other hand, the cortisol values found in GII decreased after the PHENODRAL® product administration, as well as the glucose concentrations when compared to the GI, thus demonstrating the efficacy of PHENODRAL® product in improving the treated animals performance.

Avaliou-se a eficácia do produto PHENODRAL® em bovinos debilitados com escore corporal 2 e a influencia deste produto nos parâmetros clínicos, laboratoriais e ganho de peso. O experimento foi realizado no município de Abadia dos Dourados/MG, com 20 bovinos jovens com idade entre 8 a 12 meses, divididos em dois grupos de 10 animais cada, sendo cinco machos e cinco fêmeas/grupo (Grupo Controle GI e Grupo Tratado GII). Os animais do grupo GII receberam três doses de 15 mL do produto PHENODRAL® administrado, a cada seis dias (D0, D+6 e D+12), via I.V., e o grupo GI recebeu administração de solução fisiológica 0,9%, via I.V. Os animais experimentais foram observados até o período D+35 Os resultados mostraram que o ganho de peso no grupo GII foi superior ao grupo controle GI, principalmente, nos momentos antes e após aplicação do produto, e uma diferença estatística mais evidente no momento D+28 em comparação ao GI. Os resultados encontrados para os parâmetros avaliados semanalmente: consumo de ração, ganho de peso semanal e conversão alimentar semanal, foram estatisticamente diferentes nos momentos D0 ao D+7, D+7 ao D+14, D+14 a D+21 e D+21 a D+28 entre os grupos GI e GII ressaltando-se que, os animais tratados ingeriram maior quantidade de ração resultando em um ganho de peso maior em função de melhor conversão alimentar em comparação aos animais do grupo controle. Não foram encontradas diferenças estatísticas entre os grupos GI E GII para os parâmetros clínicos, hematológicos e bioquímicos avaliados durante todo o período experimental, porém, os valores de cortisol sérico avaliados no grupo GI estavam acima dos valores de referencia para a espécie bovina. Por outro lado, os valores de cortisol no grupo GII diminuíram após a aplicação do produto PHENODRAL®assim como as concentrações de glicose em comparação ao GI, demonstrando assim a eficiência do produto PHENODRAL® na melhoria do desempenho dos animais tratados.

Efficacy of PHENODRAL® product (sodium methylarsinate +ammonium ferric citrate +epinephrine) in bovines / Eficácia da formulação PHENODRAL® (metilarsinato de sódio + citrato de ferro amoniacal + adrenalina) em bovinos

We evaluated the efficacy of PHENODRAL® product on debilitated cattle, body condition (BC=2) and the influence of this product in clinical and laboratory parameters and weight gain. The experiment was performed using 20 young cattle aged 8 to 12 months, divided into two groups of 10 animals each, five males and five females/group (untreated Control Group - GI and Drug-treated group - Group - GII). The animals of GII received three doses of 15 mL of d PHENODRAL® product administered every six days (D0, D + 6 and D + 12), via IV, and the GI group received 0.9% IV saline administration. The experimental animals were monitored until D+35 The results showed that the weight gain in the GII group was higher in comparison to the control group GI, mainly at the moments before and after the product application, and a significant difference were observed at D + 28 in comparison to GI group. The results for the weekly parameters evaluated: feed intake, weekly weight gain and weekly feed conversion, were statistically different in moments D0 to D + 7, D + 7 to D + 14, D + 14 to D + 21 and D +21 to D + 28 between GI and GII emphasizing that the treated animals ingested greater amount of feed resulting in a higher weight gain due to better feed conversion compared to the control group animals. There were no statistical differences between GI and GII for the clinical, hematological and biochemical parameters evaluated throughout the trial period, however, the serum cortisol levels assessed in the GI group were above the reference values for the bovine species. On the other hand, the cortisol values found in GII decreased after the PHENODRAL® product administration, as well as the glucose concentrations when compared to the GI, thus demonstrating the efficacy of PHENODRAL® product in improving the treated animals performance.(AU)

Avaliou-se a eficácia do produto PHENODRAL® em bovinos debilitados com escore corporal 2 e a influencia deste produto nos parâmetros clínicos, laboratoriais e ganho de peso. O experimento foi realizado no município de Abadia dos Dourados/MG, com 20 bovinos jovens com idade entre 8 a 12 meses, divididos em dois grupos de 10 animais cada, sendo cinco machos e cinco fêmeas/grupo (Grupo Controle GI e Grupo Tratado GII). Os animais do grupo GII receberam três doses de 15 mL do produto PHENODRAL® administrado, a cada seis dias (D0, D+6 e D+12), via I.V., e o grupo GI recebeu administração de solução fisiológica 0,9%, via I.V. Os animais experimentais foram observados até o período D+35 Os resultados mostraram que o ganho de peso no grupo GII foi superior ao grupo controle GI, principalmente, nos momentos antes e após aplicação do produto, e uma diferença estatística mais evidente no momento D+28 em comparação ao GI. Os resultados encontrados para os parâmetros avaliados semanalmente: consumo de ração, ganho de peso semanal e conversão alimentar semanal, foram estatisticamente diferentes nos momentos D0 ao D+7, D+7 ao D+14, D+14 a D+21 e D+21 a D+28 entre os grupos GI e GII ressaltando-se que, os animais tratados ingeriram maior quantidade de ração resultando em um ganho de peso maior em função de melhor conversão alimentar em comparação aos animais do grupo controle. Não foram encontradas diferenças estatísticas entre os grupos GI E GII para os parâmetros clínicos, hematológicos e bioquímicos avaliados durante todo o período experimental, porém, os valores de cortisol sérico avaliados no grupo GI estavam acima dos valores de referencia para a espécie bovina. Por outro lado, os valores de cortisol no grupo GII diminuíram após a aplicação do produto PHENODRAL®assim como as concentrações de glicose em comparação ao GI, demonstrando assim a eficiência do produto PHENODRAL® na melhoria do desempenho dos animais tratados. (AU)

[Thrombosis of great pulmonary vessels causing severe pulmonary hypertension in systemic lupus erythematosus]. / Trombosis de grandes vasos pulmonares como causa de hipertension pulmonar severa en el lupus eritematoso sistémico.

We describe a 34 year old male patient with systemic lupus erythematosus (SLE) who developed pulmonary hypertension (PHT) associated with anticardiolipin antibodies. Ten years after diagnosis, an helical CT scan revealed thrombosis of the major pulmonary arteries, which was confirmed by digital pulmonary angiography. An inferior caval vein filter was placed and oral anticoagulation was begun. The patient refused pulmonary thromboendarterectomy and died soon thereafter. Even though PHT is widely described associated with SLE, proximal thrombosis of pulmonary arteries is exceptional. We describe such a patient review the different etiologies, incidence and diagnostic approach of PHT in SLE, focusing on those patients with an effective treatment.

Trombosis de grandes vasos pulmonares como causa de hipertension pulmonar severa en el lupus eritematoso sistémico. / [Thrombosis of great pulmonary vessels causing severe pulmonary hypertension in systemic lupus erythematosus]

We describe a 34 year old male patient with systemic lupus erythematosus (SLE) who developed pulmonary hypertension (PHT) associated with anticardiolipin antibodies. Ten years after diagnosis, an helical CT scan revealed thrombosis of the major pulmonary arteries, which was confirmed by digital pulmonary angiography. An inferior caval vein filter was placed and oral anticoagulation was begun. The patient refused pulmonary thromboendarterectomy and died soon thereafter. Even though PHT is widely described associated with SLE, proximal thrombosis of pulmonary arteries is exceptional. We describe such a patient review the different etiologies, incidence and diagnostic approach of PHT in SLE, focusing on those patients with an effective treatment.

Hematoma mediastinal causante de severa compresión de la vía aérea / Mediastinal hematoma causing severe airway compression

Presentamos el caso de una paciente de 43 años que ingresó al Centro Respiratorio por presentar un cuadro de asma grave, anemia severa y acidosis metabólica. Durante la ARM se detectó una masa mediastinal que comprimía la tráquea y que en la tomografía computada tenía densidad de tejidos sólidos. Previamente se había colocado un catéter central por punción de la vena yugular interna. La paciente falleció y en la autopsia se evidenció un hematoma mediastinal compresivo que se atribuyó a la punción. Se destacan el error diagnóstico cometido, por las características tomográficas del hematoma, y la génesis de una causa infrecuente de obstrucción de la vía aérea como complicación de un procedimiento cuya peligrosidad no fue adecuadamente valorada en relación a los trastornos de coagulación pre-existentes

Hematoma mediastinal causante de severa compresión de la vía aérea / Mediastinal hematoma causing severe airway compression

Presentamos el caso de una paciente de 43 años que ingresó al Centro Respiratorio por presentar un cuadro de asma grave, anemia severa y acidosis metabólica. Durante la ARM se detectó una masa mediastinal que comprimía la tráquea y que en la tomografía computada tenía densidad de tejidos sólidos. Previamente se había colocado un catéter central por punción de la vena yugular interna. La paciente falleció y en la autopsia se evidenció un hematoma mediastinal compresivo que se atribuyó a la punción. Se destacan el error diagnóstico cometido, por las características tomográficas del hematoma, y la génesis de una causa infrecuente de obstrucción de la vía aérea como complicación de un procedimiento cuya peligrosidad no fue adecuadamente valorada en relación a los trastornos de coagulación pre-existentes (AU)

[Long-term prognosis in acute myocardial infarction]. / El pronóstico a largo plazo en el infarto agudo del miocardio.

The purpose of this communication is to identify the variables contributing to long-term morbidity and mortality in survivors of an acute myocardial infarction (AMI). The study comprises 5 years of follow up in 364 patients who were admitted to the coronary care unit during the acute episode. At the end of the study, 34.5% of the patients had some degree of incapacity due to angina, cardiac failure or both. There was a precise correlation between these and the degree of myocardial dysfunction or the size of the cardiac silhouette during the AMI. Sixty-seven patients suffered a cardiac death. The 5 year cumulative survival rate by life table analysis was 78.6% at the end of the study. The death rate was clearly greater during the initial six months (7%) and reached 10.5% at the end of the first year. In subsequent years the average annual death rate was 2.2%. Two-fifths of the patients died during a recurrent AMI, one-fifth in chronic cardiac failure and the remaining two-fifths experienced a sudden death. Age, a previous infarction, ventricular dysfunction during the acute episode and a recurrent AMI resulted in a reduced possibility of post-hospital survival. Sex of the patients and ECG location of the AMI had no influence in mortality. The analysis of late deaths due to AMI suggests that mechanical dysfunction, residual ischemia and electrical instability are important factors in its determination. The data indicate that there may be considerable potential to reduce the cardiac death rate in the post-hospital phase of AMI.