RESUMEN
Compressive syndromes of peripheral nerves both in the upper and lower limbs are part of daily clinical practice; however, the etiological diagnosis can be challenging and impact on the outcome of the patient. We report five cases with rare etiologies of nerve entrapments: one in the lower limb and four in the upper limbs with the final diagnosis made only during the operation. The patients evolved without post-operative complications and had good outcomes. This series includes the first report of sciatic compression by a lipoma in the popliteal fossa, two lipomas one with compression of infraclavicular brachial plexus and another with compressing the posterior interosseous nerve, and two reports of vascular lesions due to blunt traumas, which are also uncommon. This series adds to the literature more hypotheses of differential diagnoses in nerve entrapments, which is fundamental to surgical decisions and pre-operative planning-and perhaps most importantly prevents wrong diagnosis of idiopathic compressions, which would lead to a completely wrong approach and unfavorable outcomes.
RESUMEN
Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.
RESUMEN
INTRODUCTION: Angola has about 28 million inhabitants and approximately 0.21 physicians/1,000 population. There is only one specialist in some medical fields in the whole country while there is not even one specialist in some other fields. The objective of this study is to investigate the significance of the Cooperation Program for Foreign Doctors (Brazil) and its impact on the provision of specialized medical care in Angola, showing the evolution of the different specialties as well as the emergence of some specialties in Angola. METHODS: A retrospective study was performed, identifying the Angolan doctors trained in Brazil by the Cooperation Program for Foreign Doctors. The number and specialty of the trained physicians were obtained from the database of the program, and the number of doctors in each specialty in Angola was obtained by consulting the registry of doctors of the various specialist colleges in Angola. RESULTS: From February 2011 to March 2019, 111 physicians were trained in 32 specialties; there was a greater increase of 50% or more in 6 specialties, with emphasis on geriatrics, haematology, nuclear medicine, surgical oncology and sleep medicine that had no specialists. CONCLUSION: The lack of specialist doctors is a very common problem in low-income countries; on the other hand, high-income countries are already beginning to limit training in some specialties due to lack of labour market. The Angolan cooperation model could be adopted by several countries to promote a qualitative overall growth in health care.