Peripheral nerve injuries: A retrospective survey of 1124 cases.

BACKGROUND: Peripheral nerve injuries (PNIs) remain an important health problem often leading to severe motor disabilities predominantly in the younger population. OBJECTIVE: To analyze our experience of clinical and electrodiagnostic evaluation (EDX) of PNIs over a 26-year period. MATERIALS AND METHODS: Between 1989 and 2014, 1124 consecutive patients with 1418 PNIs were referred for clinical as well as EDX evaluation. These PNIs involved upper and lower limbs as well as the facial nerves. Patients with iatrogenic lesions and spinal cord/spinal root lesions were excluded from this analysis. Brachial plexus (BP) injuries with associated or not with root avulsions were considered as one particular nerve and was include in the study as BP. The etiological categories of the sustained trauma included vehicular accidents, penetrating injuries, falls, gunshot wounds, car accidents involving pedestrians, sports injuries, and miscellaneous injuries. RESULTS: The mean age of our patients was 34.2 years and most were males (76.7%). Majority (80.9%) of the PNIs were isolated injuries. Combined lesions most commonly involved the ulnar and median nerves. Upper-limb PNIs accounted for 72.6% of our patients. The ulnar nerve was injured most often, either singly or in combination. Vehicular accidents were the most common causes of injury (46.4%), affecting the brachial BP or the radial, fibular, or sciatic nerves. Penetrating trauma (23.9%) commonly affected the ulnar and the median nerves. Falls and gunshot wounds frequently affected the ulnar, radial, and median nerves. Sports injuries, mostly soccer related, affected predominantly the fibular nerves. BP injuries were considerably more common in accidents involving motorcycles than those involving cars (46.1% vs. 17.1%), and root avulsions was more frequently associated in these cases. CONCLUSIONS: Most PNIs were caused by vehicular accidents and penetrating trauma, and affected young men. Overall, ulnar nerve, primary BP, and median nerve PNIs were the most prevalent lesions.

NINJURIN1 single nucleotide polymorphism and nerve damage in leprosy.

UNLABELLED: Leprosy, a chronic infectious disease caused by Mycobacterium leprae, can damage the peripheral nervous system and represents one of the leading causes of nontraumatic neuropathy in some developing countries. The NINJURIN1 is a cell adhesion molecule that provides suitable substrates for repair of Schwann cells after peripheral nerve injury. The single nucleotide polymorphism NINJ1, is the result of a transversion of an adenine to a nucleotide polymorphic cytokine (A→C), responsible for an amino acid exchange of asparagine to alanine at position 110 of the protein (asp110ala). OBJECTIVES: The aim of this study was to investigate the importance of the polymorphism in the NINJ1 gene for neural impairment during leprosy course. METHODS: A single nucleotide polymorphism (asp110ala) was searched in 218 leprosy patients and 244 non-leprosy subjects using a polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: No statistical differences were observed in the frequency of the asp110ala SNP between leprosy patients versus non-leprosy and multibacillary versus paucibacillary clinical forms. The C allele (ala110) is increased among patients exhibiting nerve impairment (p=0.0379). Also, leprosy patients with the CC genotype (ala/ala) had a higher risk (OR=4.21) of developing nerve disability when compared those carrying the AA genotype (asp/asp) (OR=0.69). CONCLUSION: Our results show an association between the studied C allele (ala110) and damage nerve in leprosy patients. SIGNIFICANCE: Ninjurin analysis showed that asp110ala could be a valuable prognostic marker, since C allele (ala110) have increased susceptibility to nerve damage.

Biópsia muscular com estudo histoquímico: experiência inicial da Faculdade de Medicina de São José do Rio Preto / Muscle histochemistry: a study of the first 55 biopsies in São José do Rio Preto

São apresentados os primeiros 55 casos de biópsia muscular com estudo histoquímico da Faculdade de Medicina de São José do Rio Preto. A histoquímica muscular permite: 1. Revelar a natureza não uniforme dotecido muscular demonstrando as propriedades bioquímicas de diferentes tipos de fibra e sua participação seletiva em determinadas doenças; 2. Detectar ausência de enzimas específicas; 3. Detectar excesso ou acúmulo de substratos específicos; 4. Detectar anormalidades estruturais musculares que não aparecem nas reações histológicas rotineiras. A média de idade foi de 28,6 anos, variando de 25 dias a 76 anos, 56,4% eram do sexo masculino e 43,6% feminino. Foram rotineiramente utilizadas as seguintes técnicas: Hematoxilina &Eosina, Tricrômio de Gomori modificado, Citocromo-C-Oxidase, Dinucleotídeo Adenina Nicotinamida Desidrogenase reduzida pelo tetrazólio, Succinato-Desidrogenase, Fosfatase Alcalina, Fosfatase Ácida, Adenosina Trifosfato miofibrilar pré-incubadas a pH 9,4, 4,6 e 4,3, Ácido Periódico de Schiff e Oil-Red-O. Anormalidades foram encontradas em 72,8% das biópsias, sendo de padrão distrófico em 17 casos, inflamatório em 7 casos, mitocondrial em 6 casos, reinervação crônica em 4 casos, glicogenose em 2 casos e outros diagnósticos em 4 casos. Anormalidades mínimas ou inespecíficas foram encontradas em 5 casos (9%) e em10 casos (18,2%) foram normais. Nossos achados foram semelhantes aos de outros descritos na literatura nacional. A biópsia muscular como estudo histoquímico, ainda inexistente na região Noroeste do estado deSão Paulo, é uma das armas diagnósticas mais importantes para as doenças neuromusculares.

We present the muscle histochemistry from the first 55 biopsies at the State Medical School of São José doRio Preto, São Paulo, Brazil. Muscle histochemistry first, demonstrate the non-uniform nature of muscular tissue showing biochemical properties from different fiber types and their selective involvement in particular diseases; second, demonstrate the absence of specific enzymes; third, demonstrate abnormal storage of specific substrates, and fourth, demonstrate structural abnormalities that are not seen on ordinary histological stainings. The mean age was 28.6 years, ranging from 25 days to 76 years, 56.4% male and 43.6% female. Ourroutine techniques, done in all biopsies, included: Hematoxylin and Eosin, Gomori Trichrome, CytochromeOxidase, NADH dehydrogenase, Succinic Dehydrogenase, Alkaline Phosphatase, Acid Phosphatase, ATPase pH 9.4, 4.6 and 4.3, Periodic-acid Schiff and Oil-Red-O. Abnormalities were found in 72.8%, being dystrophicin 17 cases, inflammatory in 7 cases, mitochondrial in 6 cases, chronic reinnervation in 4 cases, glycogen storage disorder in 2 cases and other diagnostics in 4 cases. Minimal or unspecific abnormalities were found in 5 cases (9%) and were normal in 10 cases (18.2%). Our findings were similar to others described in Brazil. Muscle histochemistry is one of the most significant diagnostic tools for neuromuscular disorders and was not done before in this region of Brazil.