Made available in DSpace on 2016-01-26T12:51:22Z (GMT). No. of bitstreams: 1 thiagoguimaraesnaves -dissert.pdf: 396666 bytes, checksum: 322f0d9f8506ec60598fc70d1e33cc6a (MD5) Previous issue date: 2009-10-20 / Objective: To establish electrophysiologic values for CTS diagnosis in the elderly. Casuistic and methods: thirty healthy volunteers with at least 65 years old were selected. Exclusion criteria were: any sensory symptom, peripheral neuropathy, sistemic diseases, alcohol abuse and wrist fracture. The following parameters were calculated: 1. Median sensory distal latency on the segment wrist - digit II, 14 cm (SDL); 2. Median/radial latency difference on the segment wrist - digit I, 10 cm (MRD); 3. Median/ulnar latency difference on the segment wrist - digit IV, 14 cm (MUD4); 4. Median/ulnar mixed latency difference on the segment palm - wrist, 8 cm (MUPD); 5. Combined sensory index (CSI), calculated as the adding of MRD, MUD4 and MUPD; 6. Mixed median palmar latency (PL), 8 cm; 7. Median/ulnar motor latency difference, lumbrical/interossei, 8 cm (LUMB); 8. Median motor distal latency, pulse-APB, 8 cm (DML). Results: Twenty-one volunteers were female and 9 were male. Mean age was 69.9 (range 65-86). The 97.5th upper normal limits suggested were: SDL 3.80 ms, MRD 0.95 ms, MUD4 0.95 ms, MUPD 0.50 ms, PL 2.45 ms, CSI 2.20 ms and DML 4.30 ms. Conclusions: The reference values for MRD, MUD4, MUDP and CSI in elderly are different from youngers. There are quite less differences for DSL and PL and none at all for DML. The use of these new values in elderly will reduce the number of false positives. / Objetivo: determinar parâmetros eletrofisiológicos para diagnóstico da STC em idosos. Casuística e Métodos: Trinta voluntários saudáveis com no mínimo 65 anos de idade foram selecionados. Os critérios de exclusão foram: quaisquer sintomas sensitivos, neuropatia periférica, doenças sistêmicas, abuso alcoólico e antecedente de fratura no pulso. Os seguintes parâmetros foram estudados: 1. Latência distal sensitiva do nervo mediano, segmento pulso-dedo II, 14 cm (LDS); 2. Diferença de latência sensitiva mediano/radial, pulso-dedo I, 10 cm (DMR); 3. Diferença de latência sensitiva mediano/ulnar, pulso-IV dedo, 14 cm (DMU4) ; 4. Diferença de latência mista mediano/ulnar, palma-pulso, 8 cm (DMUP); 5. Índice sensitivo combinado (ISC), calculado pela soma de DMR, DMU4 e DMUP; 6. Latência palmar mista do nervo mediano, 8cm (LP); 7. Diferença de latência motora mediano/ulnar lumbrical-interósseo, 8 cm (LUMB); 8. Latência distal motora do nervo mediano, pulso-APB, 8 cm (LDM). Resultados: Vinte e um voluntários eram mulheres e 9 homens com média de idade de 69,9 anos (variação 65-86). Os limites superiores de normalidade 97,5% sugeridos foram: LDS 3,80 ms, DMR 0,95 ms, DMU4 0,95 ms, DMUP 0,50 ms, LP 2,45 ms, ISC 2,20 ms e LDM 4,30 ms. Conclusões: Os valores de referência para DMR, DMU4, DMUP e ISC em idosos são diferentes em relação aos jovens. As diferenças foram menores para LDS e LP; não houve diferença para LDM. O uso destes novos valores reduzirá o número de exames falso-positivos em idosos.

Title: Electromyographic and clinical evaluation of vincristine-induced peripheral neuropathy in pediatric patients after treatment of acute lymphoblastic leukemia and correlation with the Bruinkins-Oseretsky Test of Motor Proficiency Second Edition Objectives: The aim of this work was to characterize the neurological consequences of vincristine-induced peripheral neuropathy (VIPN) clinically and electromyographically and to evaluate motor skills of pediatric patients after the end of treatment of acute lymphoblastic leukemia. We also determined the relationship between the results of the clinical and electromyographic evaluation of VIPN and the correlation with the results of motor skills tests. Methods: The study involved 35 probands (19 girls and 16 boys) with a mean age of 10.7 years (SD ± 4.3) and a mean time since the last dose of vincristine of 2.3 years (SD ± 1.2). VIPN was assessed using a clinical pediatric-modified Total Neuropathy Score (ped-mTNS) and nerve conduction studies (NCS). Motor skills were assessed using the Bruinkins-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Results: The clinical presence of VIPN, according to ped-mTNS, was found in 20 % of probands. Abnormalities in nerve conduction studies were reported by 60.9 % of probands. Of these, 92.9 % had motor...

Peripheral neuropathies are a set of common diseases that affect the peripheral nervous system, causing damage to vital connections between various parts of the body and the brain and spinal cord. Different clinical conditions are known to selectively impact various size nerve fibers, which often makes it difficult to diagnose which peripheral neuropathy a patient might have. The nerve conduction velocity diagnostic test provides clinically useful information in the diagnosis of some peripheral neuropathies. This method is advantageous because it tends to be minimally invasive yet it provides valuable diagnostic information. However, this test does not determine characteristics of peripheral nerve fiber size distributions, and therefore does not show any detailed information regarding the nerve fibers within the nerve trunk. Being able to determine which nerve fibers are contributing to the evoked potential within a nerve trunk could provide additional information to clinicians for the diagnosis of specific pathologies of the peripheral nervous system, such as chronic inflammatory demyelinating polyneuropathy or early diabetic peripheral neuropathy. In this study, three rat sciatic nerves are sectioned and stained with hematoxylin and eosin in order to measure the nerve fiber diameters within the nerve trunk. Stained samples are viewed using brightfield microscopy and images are analyzed using ImageJ. Histograms were created to show the frequency of various nerve fiber diameters. The nerve fiber diameters measured during this research are consistent with the range of previously published diameter values and will be used to support continuing research for a novel method to characterize peripheral nerve fiber size distributions using group delay.

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Diabetiker entwickeln nach durchschnittlich 10 Jahren Folgeschäden. Die Polyneuropathie mit nachfolgender Osteoarthropathie des Fußes ist eine meist zu spät erkannte und suboptimal versorgte Komplikation. Nicht rechtzeitig erkannte Schäden führen zu Ulcera, sekundären Infektionen, Osteomyelitiden und Amputationen. Fragestellung: Ist eine Ganganalyse incl. Posturographie in der Lage, eine evtl. bestehende Polyneuropathie zu verifizieren, um eine frühzeitige orthopädische Schuhversorgung vornehmen zu können? Material und Methoden: Es wurden Diabetiker (n = 73) mit (mittels Messung der Nervenleitgeschwindigkeit NLG) nachgewiesener Neuropathie und eine gesunde Vergleichsgruppe (n = 38) ohne Neuropathie am Ganganalysesystem GANGAS untersucht. Ergebnisse: Die Allgemeinparameter relative Geschwindigkeit, Schrittlänge und Kadenz, sowie die Belastungsparameter Fersen-, Mittelfuß-, Vorfußbelastung und Belastung beim Auftritt und Abstoß zeigten keine wesentlich signifikanten Unterschiede im Gruppenvergleich. Dagegen zeigte die Posturographie (apparative Untersuchung der Schwankung des Druckschwerpunktes beim Romberg-Test, welche durch die Länge und Geschwindigkeit beschrieben wurde) signifikante Unterschiede zwischen beiden Patientengruppen. So lag z.B. der Median der Weglänge des Druckschwerpunktes beim Test mit geschlossenen Augen bei den Diabetikern bei 21,27 cm und in der Vergleichsgruppe bei 15,4 cm (p = 0,007). Die Bewegungsgeschwindigkeit des Druckschwerpunktes beim Test mit geschlossenen Augen betrug im Median 1,33 cm/sec bei den Diabetikern und 0,96 cm/sec in der gesunden Vergleichsgruppe (p = 0,006). Beim Test mit offenen Augen ergab sich kein signifikanter Unterschied im Gruppenvergleich. Klinische Relevanz: Eine Instabilität des Ganges der Patienten mit diabetischer Neuropathie und entsprechenden Folgeschäden des Fußes läßt sich durch die Ganganalyse mit Standardparametern nach vorliegendem Datenmaterial nicht nachweisen. Die Posturographie ist eine einfache, zeitlich mit geringem Aufwand verbundene Methode, die mit statistischer Signifikanz die subjektiven Kriterien der klinisch-orthopädischen Frühdiagnostik sinnvoll ergänzen und damit die Verdachtsdiagnose eine diabetischen Fußes objektiv nachweisen kann, bevor bleibende Schäden am Fuß entstanden sind. / Every diabetic patient after about ten years develops secondary changes in different tissues. Polyneuropathy with consecutive osteoarthropathy of the foot often is recognized too late and suboptimal treated. Diabetic disorders recognized too late may lead to ulcera, secondery infections and even amputations. Question: Is standard gait analysis including posturography able to verify diabetic neuropathy in order to supply the patient with adapted orthopadic shoeware in time? Materials and methods: A group of diabetics (n=73) with proved neuropathy by measuring nerve conduction velocity and a healthy control group (n=38) without neuropathy were examined by the gait-analysis-system GANGAS. Results: The general parameters: relative speed, length of step and cadence as well as the loading parameters of the heel, middle foot and forefoot during treading and repulsion show no significant differences between both groups. Posturography however (apparative examination of the elongation of focal point of pressure (FPP) according to the Romberg test, described by length and speed) shows significant differences between both groups. For diabetics making the test with closed eyes the mean value of walking length of the FPP was 21,27 cm, for the healthy control persons it was only 15,4 cm (p = 0,007). Asimulary results were found for the speed of movement of FPP during the test with closed eyes: mean value in diabetics 1,33 cm/s and for the healthy control persons 0,96 cm/s (p = 0,006). During this test with open eyes there was no significant difference between both groups. Clinical Relevance: Walking instability of patients with diabetic neuropathy and corresponding sequential damage of the foot could not be proved by the current data with standard parameters. Posturography however is able to give additional information with statistical significance to the subjective criteria of the clinical-orthopedic early diagnosis and verify the diagnosis of a beginning diabetic foot before severe disorders have occured.