Supercharged End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer for Hirayama Disease: A Case Report.

Hirayama disease is a rare condition of cervical myelopathy. Its early identification and correction can optimize functional outcomes. However, late presentation and some more severe cases may be associated with loss of hand function. Among the cases described, there are no reports of nerve transfers for this condition. We presented the first case report of a Hirayama disease of isolated ulnar nerve impairment managed with nerve transfer. Electroneuromyography showed isolated preganglionic involvement of C7, C8, and T1, with no sensory changes. The patient underwent nerve transfer with anterior interosseous nerve to ulnar nerve supercharge end-to-side, recovering hand function in 7 months.

A large Venous-Arterial PCO(2) Is Associated with Poor Outcomes in Surgical Patients.

Background. This study evaluated whether large venous-arterial CO(2) gap (PCO(2) gap) preoperatively is associated to poor outcome. Method. Prospective study which included adult high-risk surgical patients. The patients were pooled into two groups: wide [P(v-a)CO(2)] versus narrow [P(v-a)CO(2)]. In order to determine the best value to discriminate hospital mortality, it was applied a ROC (receiver operating characteristic) curve for the [P(v-a)CO(2)] values collected preoperatively, and the most accurate value was chosen as cut-off to define the groups. Results. The study included 66 patients. The [P(v-a)CO(2)] value preoperatively that best discriminated hospital mortality was 5.0 mmHg, area = 0.73. Preoperative patients with [P(v-a)CO(2)] more than 5.0 mmHg presented a higher hospital mortality (36.4% versus 4.5% P = 0.004), higher prevalence of circulatory shock (56.8% versus 22.7% P = 0.01) and acute renal failure postoperatively (27.3% versus 4.5% P = 0.02), and longer hospital length of stays 20.0 (14.0-30.0) versus 13.5 (9.0-25.0) days P = 0.01. Conclusions. The PCO(2) gap values more than 5.0 mmHg preoperatively were associated with worse postoperatively outcome.

Demência pré-senil precedida por depressão / Pré-senile insanity preceded by depression

Com o aumento da expectativa de vida, visto hoje em todo o mundo, um maior número de pessoas entra na faixa senil, em que a manifestação de doenças demenciais é mais comum. Entre essas, a doença de Alzheimer (DA) é a causa mais freqüente de demência. Relata-se caso de um paciente com Doença de Alzheimer na forma precoce (<65 anos), que apresentou alterações de memória e progressivo declínio funcional cognitivo e sintomas comportamentais (insônia e agitação psicomotora), quadro este precedido por depressão. O diagnóstico diferencial dessa condição se baseou na busca de perfil clínico característico por anamnese adequada, exame neurológico, além da investigação complementar pertinente, que consiste em exames laboratoriais e de neuroimagem. O paciente foi avaliado com o teste Mini-mental e segundo os critérios da Organização Mundial da Saúde (OMS) e da Associação Psiquiátrica Americana (APA). Os inibidores da colinesterase no tratamento da doença de Alzheimer representam uma abordagem terapêutica promissora.

With the increase of the life expectancy that is seen today in the world, a larger number of persons reaches an senil's age when the manifestation of dementia's disease illnesses is more common. Among these, the Alzheimer's disease (AD) is the most frequent cause of dementia. We report a case of a patient with a Alzheimer's disease, in the early-onset (<65 years), who presented memory problems and progressive functional, cognitive and behavioral (insomnia, psychomotor agitation). This case preceded by depression. The differential diagnosis of this condition is based on a specific clinical profile defined through an adequate medical history, neurological examination, related laboratory tests and neuroimaging studies. The patient was the evaluated with a Mini-mental State, the criterias of World Health Organization (WHO) and American Psychiatric Association (APA). Cholinesterase inhibitors for treating in Alzheimer's disease represent a promising therapeutical approach.

Oxygen consumption and thermoregulatory responses in three species of South American marsupials.

Oxygen consumption (VO(2)), body temperature (T(b)) and wet thermal conductance (C(wet)), under resting conditions, exposure to low ambient temperature (T(a)) and during sustained exercise (treadmill running) were measured in three phylogenetic related (same family; Didelphidae) South American marsupials possessing similar body masses: Caluromys philander (arboreal/fruit and insect eating), Philander opossum (terrestrial and arboreal/omnivore), and Metachirus nudicaudatus (terrestrial/omnivore). Our measurements of VO(2) and C(wet) under resting conditions agree with those previously reported for other marsupials. We expected that C. philander would show a lower maximal sustained VO(2), compared to the other two species, based on its more reduced skeletal muscle mass. However, the values obtained for C. philander were not statistically different (ANOVA) from those obtained for the other two species. When exposed to low ambient temperature (12 degrees C), differences among the three species were detected, i.e., M. nudicaudatus did not survive, while the other two species were able to reduce their T(b) under such conditions. C. philander gradually decreases its T(b) when cold exposed, and P. opossum shows a more pronounced T(b) drop only when exposure to low ambient temperatures occurs for a more prolonged period of time.