The carpal tunnel syndrome in chronic dialysis patients, it is a late complication of the arterio-venous fistula?
Arteriovenous Shunt, Surgical/*adverse effects Axilla/innervation
Calcium/metabolism Carpal Tunnel Syndrome/diagnosis/*etiology/surgery
Catheters, Indwelling Electromyography
Female Hemodialysis Solutions/therapeutic use
Kidney Failure, Chronic/therapy Male
Median Nerve/physiopathology/surgery Middle Aged
Nerve Block Paresthesia/surgery
Patient Satisfaction Phosphorus/metabolism
Polyneuropathies/complications Radial Artery/surgery
Renal Dialysis/*adverse effects Time Factors
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AbstractOut of 100 patients undergoing chronic hemodialysis in Lausanne (Switzerland), 12 developed a carpal tunnel syndrome (i.e. 8 men and 4 women, from 34 to 76 years old). Out of 66 patients with an arteriovenous fistula for less than 4 years, it is interesting to note that only 3 carpal tunnel syndrome were observed; whereas, out of 34 hemodialysis patients being dialyzed more than 4 years, 9 of them showed that syndrome. The symptomatology of the carpal tunnel syndrome is described by the authors. It has always been confirmed by EMG. On 10 patients, the symptoms were so acute that they needed a decompression of the median nerve. Five cases were bilateral. The operation is performed under axillary block, without tourniquet. The results were very satisfactory. Paresthesias disappeared after a few hours or a few days following the operation. No relationship could be established between CTS and the type of nephropathy, severity of polyneuropathy, Ca and P metabolism, vascular access complications, efficacity of dialysis, fluid overload or medical treatment. The authors are investigating the etiology of the carpal tunnel syndrome, ship hypothesize particularly concerning the direct or remote relation between the carpal tunnel syndrome and the arteriovenous fistula.
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Estudo comparativo do uso isolado de plasma rico em plaquetas e combinado com cimento de alfa-fosfato tricálcico no reparo ósseo em ratos Comparative study on use of platelet-rich plasma alone and in combination with alpha-tricalcium phosphate cement for bone repair in ratsAlessandra Deise Sebben; Gabriela Hoff; Caroline Peres Klein; Thiago Alexi de Freitas; Camilla Assad; Luís Alberto dos Santos; Jefferson Braga Silva (Sociedade Brasileira de Ortopedia e Traumatologia, 2012-01-01)OBJETIVOS: Avaliar o efeito do cimento &#945;-TCP combinado com PRP sobre a osteogênese, comparando os resultados com PRP utilizado isoladamente. MÉTODOS: Foi confeccionado defeito bilateral no fêmur de ratos e preenchido com um dos dois tipos de tratamentos (PRP ou &#945;-TCP+PRP), sendo avaliado em quatro e oito semanas. As imagens radiográficas forneceram valores da área da lesão, e a histologia (coloração Picrosirius) indicou a área de neoformação óssea. RESULTADOS: As médias referentes à área de lesão do grupo &#945;-TCP+PRP (2,64mm² ± 2,07 e 1,91mm² ± 0,93; quatro e oito semanas, respectivamente) demonstraram numericamente melhores resultados, porém não significativos (p > 0,05), em comparação com aqueles observados no grupo PRP (5,59mm² ± 2,69 e 3,23mm² ± 1,46; quatro e oito semanas, respectivamente). As médias de neoformação óssea foram de 62,7% ± 12,1% e 79,01% ± 6,25 no grupo PRP, e 73,3% ± 12,7 e 85,86% ± 10,45 no grupo &#945;-TCP+PRP, em quatro e oito semanas, respectivamente (p > 0,05). CONCLUSÃO: Os dados deste estudo sugerem que o tratamento com cimento &#945;-TCP combinado com PRP não demonstra diferença significativa quando comparado ao PRP isolado. Entretanto, há um possível efeito precoce sobre a regeneração óssea quando os dois biomateriais são aplicados em conjunto.<br>OBJECTIVES: To evaluate the effect of alpha-tricalcium phosphate (&#945;-TCP) cement combined with platelet-rich plasma (PRP) on osteogenesis, and to compare the results with use of PRP alone. METHODS: A bilateral defect was produced in rat femurs and was filled with one of two types of treatments (PRP or &#945;-TCP + PRP). The outcomes were evaluated after four and eight weeks. Radiographic images provided values for the lesion area, and histology (picrosirius staining) indicated the area of &#8203;&#8203;new bone formation. RESULTS: The means relating to the lesion area of the &#945;-TCP + PRP group (2.64 ± 2.07 and 1.91 ± 0.93 mm², after four and eight weeks, respectively) showed numerically better but non-significant results (p > 0.05) than those seen in the PRP group (5.59 mm ² ± 2.69 and 3.23 ± 1.46 mm ², after four and eight weeks, respectively). The mean new bone formation rates were 62.7% ± 12.1 and 79.01% ± 6.25 in the PRP group, and 73.3% ± 12.7 and 85.86% ± 10.45 in &#945;-TCP + PRP group, after four and eight weeks, respectively (p > 0.05). CONCLUSION: The data from this study suggest that treatment with &#945;-TCP cement combined with PRP does not show any significant difference in comparison with PRP alone. However, there is a possible early effect on bone regeneration when the two biomaterials are applied together.
Elevated adipogenesis of marrow mesenchymal stem cells during early steroid-associated osteonecrosis developmentLee Kwong; Wang Yi; Chan Chun; Cheung Wing; Zhang Ge; Sheng Hui; Wang Hong; Leung Kwok; Qin Ling (BioMed Central, 2007-10-01)<p>Abstract</p> <p>Background</p> <p>Increased bone marrow lipid deposition in steroid-associated osteonecrosis (ON) implies that abnormalities in fat metabolism play an important role in ON development. The increase in lipid deposition might be explained by elevated adipogenesis of marrow mesenchymal stem cells (MSCs). However, it remains unclear whether there is a close association between elevated adipogenesis and steroid-associated ON development.</p> <p>Objective</p> <p>The present study was designed to test the hypothesis that there might be a close association between elevated adipogenesis and steroid-associated ON development.</p> <p>Methods</p> <p>ON rabbit model was induced based on our established protocol. Dynamic-MRI was employed for local intra-osseous perfusion evaluation in bilateral femora. Two weeks after induction, bone marrow was harvested for evaluating the ability of adipogenic differentiation of marrow MSCs at both cellular and mRNA level involving adipogenesis-related gene peroxisome proliferator-activated receptor gamma2 (PPARγ2). The bilateral femora were dissected for examining marrow lipid deposition by quantifying fat cell number, fat cell size, lipid deposition area and ON lesions. For investigating association among adipogenesis, lipid deposition and perfusion function with regard to ON occurrence, the rabbits were divided into ON<sup>+ </sup>(with at least one ON lesion) group and ON<sup>- </sup>(without ON lesion) group. For investigating association among adipogenesis, lipid deposition and perfusion function with regard to ON extension, the ON<sup>+ </sup>rabbits were further divided into sub-single-lesion group (SON group: with one ON lesion) and sub-multiple-lesion group (MON group: with more than one ON lesion).</p> <p>Results</p> <p>Local intra-osseous perfusion index was found lower in either ON<sup>+ </sup>or MON group when compared to either ON<sup>- </sup>or SON group, whereas the marrow fat cells number and area were much larger in either ON<sup>+ </sup>or MON group as compared with ON<sup>- </sup>and SON group. The adipogenic differentiation ability of MSCs and PPARγ2 expression in either ON<sup>+ </sup>or MON group were elevated significantly as compared with either ON<sup>- </sup>or SON group.</p> <p>Conclusion</p> <p>These findings support our hypothesis that there is a close association between elevated adipogenesis and steroid-associated osteonecrosis development.</p>
Estudo anatômico comparativo entre os lados direito e esquerdo do nervo axilar em relação à via deltopeitoral e ao acrômio Comparative anatomical study between the right and left sides of the axillary nerve in relation to deltopectoral approach and acromionAntonio Carlos Tenor Junior; Fabiano Rebouças Ribeiro; Rômulo Brasil Filho; Cantídio Salvador Filardi Filho; Hilton Vargas Lutfi; Eduardo Angoti Magri (Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01)OBJETIVOS: Estabelecer parâmetros anatômicos para o nervo axilar pelas medidas das distâncias ao acrômio e à via de acesso deltopeitoral, e verificar se há diferenças nas medidas comparativas entre os lados direito e esquerdo. MÉTODO: Realizou-se o estudo anatômico do trajeto do nervo axilar pela dissecção de 30 ombros em 20 cadáveres adultos frescos. Em 10 cadáveres foi realizada dissecção bilateral para estudo comparativo. Utilizou-se paquímetro digital com precisão de 0,05cm, mediram-se as distâncias entre a extremidade lateral do acrômio e os ramos anterior e posterior do nervo axilar e a distância entre o espaço deltopeitoral e o ramo anterior do nervo axilar. RESULTADOS: A menor distância entre o acrômio e o nervo axilar foi de 5,47cm e a maior, de 7,06cm. A menor distância entre o sulco deltopeitoral e o nervo axilar foi de 3,94cm. Houve diferença com significância estatística pelo teste de Wilcoxon nas medidas comparativas entre os lados direito e esquerdo, para as distâncias entre o ramo posterior do nervo axilar e o ponto médio da borda lateral do acrômio (A-E) e entre o ramo anterior do nervo axilar e a extremidade anterior do acrômio (B-C), ambas maiores no lado direito. CONCLUSÕES: O nervo axilar está situado entre 5,47 e 7,06cm distal ao acrômio e 3,94cm lateral ao espaço deltopeitoral. Houve diferença com significância estatística no estudo comparativo entre os lados direito e esquerdo, ambas maiores no lado direito.<br>OBJECTIVE: To establish anatomical parameters for the axillary nerve by measuring the distances to the acromion and the deltopectoral access, and to ascertain whether there are any differences in comparative measurements between the left and right sides. METHOD: An anatomical study on the path of the axillary nerve was conducted by dissecting 30 shoulders of 20 fresh adult cadavers. For comparative study, bilateral dissection was performed on 10 cadavers. Digital caliper gauges, accurate to the nearest 0.05 cm, were used to measure the distances between the lateral extremity of the acromion and the anterior and posterior branches of the axillary nerve, and between the deltopectoral space and the anterior branch of the axillary nerve. RESULTS: The shortest distance between the acromion and the axillary nerve was 5.47 cm, and the greatest distance was 7.06 cm. The shortest distance between the deltopectoral groove and the axillary nerve was 3.94 cm. A statistically significant difference was found using Wilcoxon's test in comparative measurements between the left and right sides for the distances between the posterior branch of the axillary nerve and the midpoint of the lateral border of the acromion (A-E), and between the anterior branch of the axillary nerve and the anterior extremity of the acromion (B-C), both of which were larger on the right side. CONCLUSIONS: The axillary nerve was situated between 5.47 and 7.06 cm distally to the acromion, and 3.94 cm laterally to the deltopectoral space. There was a statistically significant difference in the comparison between the left and right sides, and both measurements were larger on the right side.