Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia.

OBJECTIVE: To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. MATERIAL AND METHODS: This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. RESULTS: The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01). In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. CONCLUSION: Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result.

OBJETIVO: Avaliar os resultados e as complicações do tratamento cirúrgico da síndrome do túnel do carpo (STC) por via aberta, com o emprego da técnica anestésica local com uma solução composta por lidocaína, epinefrina e bicarbonato de sódio. MATERIAIS E MÉTODOS: Estudo de coorte, por meio da avaliação dos prontuários de 16 pacientes submetidos a cirurgia aberta para STC com emprego de anestesia local com 20 mL de lidocaína 1%, adrenalina 1:100.000 e 2 mL de bicarbonato de sódio. Avaliação do escore DASH no pré e pós-operatório de seis meses e comparação da intensidade da dor durante o ato anestésico, durante a cirurgia e em relação a outros tipos de procedimentos. RESULTADOS: O escore DASH melhorou de 65,17 para 16,53 no pós-operatório de seis meses (p < 0,01). Em relação à anestesia, 75% dos pacientes relataram que essa técnica é melhor ou igual a uma punção venosa e 81% relataram que é melhor do que um procedimento dentário. Em dois casos ocorreu dor no intraoperatório. Não ocorreram isquemias. CONCLUSÃO: O emprego de anestesia local para o tratamento cirúrgico da síndrome do túnel do carpo é eficaz para o procedimento e para o resultado final.

Orofacial apraxia in motor neuron disease.

INTRODUCTION: Cognitive and behavioral impairments are considered to occur frequently in amyotrophic lateral sclerosis/motor neuron disease (MND). Rarely, apraxia has been reported in MND. Orofacial, or buccofacial, apraxia is characterized by a loss of voluntary control of facial, lingual, pharyngeal and masticatory muscles in the presence of preserved reflexive and automatic functions of the same muscles. METHODS: We report a patient with MND who presented with spastic dysarthria and asymmetric orofacial apraxia. She progressed to frontotemporal dementia (FTD). RESULTS: Clinical and neurophysiological examinations were suggestive of bulbar-onset MND-FTD. Tractography showed a reduction of fractional anisotropy in the centrum semiovale, corona radiata, corticomedullary pathway and inferior aspect of the medulla; the changes were more severe on the left side. To our knowledge, this is the first report of an asymmetric presentation of an apraxic syndrome in MND-FTD.

What is the relevance of percutaneous endoscopic gastrostomy on the survival of patients with amyotrophic lateral sclerosis?

Percutaneous endoscopic gastrostomy (PEG) is a standard procedure for feeding dysphagic amyotrophic lateral sclerosis (ALS) patients. Nevertheless, the effect of prognostic factors influencing survival after PEG remains unclear. We aimed to evaluate the prognostic value of several clinical features on survival after PEG placement. This study investigated 151 patients with ALS, in whom a PEG was inserted over the last 16 years in our centre. Survival curves were determined by Kaplan-Meier and the analysis of potential prognostic factors was performed by a Cox regression model. The overall median survival was 32 months, longer in spinal-onset disease patients - 42 vs. 29 months in bulbar-onset patients (p < 0.001). Median survival after PEG placement was 7.5 months, similar in both bulbar- and spinal-onset patients, 7.9 vs. 7.1 months, respectively. Thirteen percent of patients died within one month after PEG placement; this short-term survival was influenced by low forced vital capacity (FVC < 50%). In a multivariate analysis, only older age at disease onset was independently associated with poor outcome after PEG placement. In conclusion, survival after PEG placement was similar in bulbar- and spinal-onset patients, suggesting that the latter were in a more advanced stage at the time of PEG placement. Low FVC was associated with higher risk of short-term mortality. Older age at disease onset was associated with poorer outcome in bulbar-onset patients. Younger bulbar-onset patients are those who benefited most from PEG.

Decapod crustaceans in fresh waters of southeastern Bahia, Brazil

A total of 117 species of freshwater decapod crustaceans are known from Brazil. Knowledge regarding the fauna of Decapoda from inland waters in the state of Bahia, northeast Brazil, is incipient. In spite of its wide territory and rich hydrographic net, only 13 species of limnetic decapods have been reported from that state. The objective of this contribution was to survey decapod crustaceans of some hydrographic basins in southeastern Bahia. The material described herein was obtained in samplings conducted between 1997 and 2005. voucher specimens were deposited in the carcinological collections of the Museu de Zoologia, Universidade Estadual de Santa Cruz, Ilhéus, Brazil, and Departamento de Oceanografia, Universidade Federal de Pernambuco, Recife, Brazil. A total of 13 species was collected. The carideans were represented by the atyids Atya scabra (Leach, 1815) and Potimirim potimirim (Müller, 1881) and the palaemonids Macrobrachium acanthurus (Wiegmann, 1836), M. amazonicum (Heller, 1862), M. carcinus (Linnaeus, 1758), M. heterochirus (Wiegmann, 1836), M. jelskii (Miers, 1877), M. olfersi (Wiegmann, 1836), and Palaemon (Palaemon) pandaliformis (Stimpson, 1871). The brachyurans were represented by the portunids Callinectes bocourti A. Milne-Edwards, 1879 and C. sapidus Rathbun, 1895, the trichodactylid Trichodactylus fluviatilis Latreille, 1828 and the panopeid Panopeus rugosus A. Milne-Edwards, 1881. Macrobrachium heterochirus represents a new record from Bahia, and M. amazonicum is reported for the first time in southeast Bahia. The occurrence of two extreme different forms of T. fluviatilis was observed. Form A is characterized by the frontal margin of carapace bordered by conspicuous granules, the anterolateral margin provided with developed teeth plus granules, and the posterolateral margin provided with granulation similar to that found on the front. In form B the frontal margin is smooth or has an inconspicuous granulation; the anterolateral margin is usually provided with 1-3 notches, and teeth (1-2), if present, are small; and the posterolateral margin is smooth or slightly granulated. Rev. Biol. Trop. 56 (3): 12251254. Epub 2008 September 30.

Se conoce un total de 117 especies de crustáceos decápodos de agua dulce en Brasil. El conocimiento de la fauna de decápodos de las aguas continentales en el estado de Bahia, noreste de Brasil, es incipiente. A pesar de su amplio territorio y una rica red hidrográfica, solo se conoce de 13 especies de decápodos limnéticos en ese estado. El objetivo de este proyecto fue estudiar los crustáceos decápodos de algunas cuencas hidrográficas en el sureste de Bahia. El material descrito aquí se obtuvo de muestreos llevados a cabo entre 1997 y 2005. Los especímenes testigo se depositaron en las colecciones carcinológicas del Museo de Zoología, Universidade Estadual de Santa Cruz, Ilhéus, Brasil, y en el departamento de Oceanografía, Universidade Estadual de Santa Cruz, Ilhéus, Brasil. Se recolectó un total de 13 especies. Los carideos estuvieron representados por los átidos Atya scabra (Leach, 1815) y Potimirim potimirim (Müller, 1881) y los palaemónidos Macrobrachium acanthurus (Wiegmann, 1836), M. amazonicum (Heller, 1862), M. carcinus (Linnaeus, 1758), M. heterochirus (Wiegmann, 1836), M. jelskii (Miers, 1877), M. olfersi (Wiegmann, 1836), y Palaemon (Palaemon) pandaliformis (Stimpson, 1871). Los braquiuros estuvieron representados por los portúnidos Callinectes bocourti A. Milne-Edwards, 1879 y C. sapidus Rathbun, 1895, los tricodáctilos Trichodactylus fluviatilis Latreille, 1828 y el panopeido Panopeus rugosus A. Milne-Edwards, 1881. Macrobrachium heterochirus representa un nuevo registro en Bahia, y M. amazonicum se halló por primera vez en el sureste de Bahia. Se observó la existencia de dos formas diferentes extremas de T. fluviatilis. La forma A se caracteriza por el margen frontal del caparazón bordeado por gránulos conspicuos, el margen anterolateral presenta dientes desarrollados además de gránulos, y el margen posterolateral presenta granulación similar a la encontrada en el frontal. En la forma B el margen frontal es liso o tiene granulación incospicua; el margen anterolateral presenta usualmente 1-3 muescas, y los dientes, si están presentes (1-2), son pequeños; y el margen posterolateral es liso o levemente granulado.