Florianopolis, Brazil

University of South Santa Catarina

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Bertelli J.A.,Governador Celso Ramos Hospital | Ghizoni M.F.,University of South Santa Catarina
Journal of Hand Surgery | Year: 2013

A 39-year-old tetraplegic patient had paralysis of elbow, thumb, and finger extension and thumb and finger flexion. We transferred axillary nerve branches to the triceps long and upper medial head motor branches, supinator motor branches to the posterior interosseous nerve, and brachioradialis tendon to the flexor pollicis longus and flexor superficialis of the index finger. Surgery was performed bilaterally 18 months after spinal cord injury. At 12 months after surgery, we performed bilateral distal radioulnar arthrodesis percutaneously. By 22 months postoperatively, we observed triceps strength scoring M3 bilaterally and full metacarpophalangeal joint extension scoring M4 bilaterally. The thumb span was 53 and 66 mm from the proximal index phalanx on the right and left sides, respectively. Pinch strength measured 1.5 kg on the left side and 2.0 kg on the right. Before surgery, the patient was incapable of grasping; after surgery, a useful grasp had been restored bilaterally. © 2013 American Society for Surgery of the Hand. All rights reserved.


Bertelli J.A.,University of South Santa Catarina | Bertelli J.A.,Governador Celso Ramos Hospital
Journal of Hand Surgery | Year: 2015

Purpose To report our experiences reconstructing thumb and finger flexion in patients with extensive palsy of the upper limb by transferring the radial nerve branch to the extensor carpi radialis brevis (ECRB) to the anterior interosseous nerve (AIN). Methods Within 8 months after injury, 4 patients with either a combined high median/ulnar nerve palsy or C7-T1 brachial plexus root avulsion underwent surgical reconstruction for thumb and finger flexion. As part of the reconstructive procedure, the branch of the radial nerve to the ECRB was transferred to the AIN. Results At final evaluation, which averaged 13 months postoperatively, all patients had recovered full finger and thumb flexion, scoring M4 per Medical Research Council guidelines. Average grasp strength was 5 kg, and pinch strength was 2 kg. Even in anesthetic fingers and with their eyes closed, patients could correctly identify passive extension of their distal interphalangeal joints. Wrist extension was preserved in all patients. Conclusions In 4 patients, transfer of the branch of the radial nerve to the ECRB to the AIN predictably reconstructed thumb and finger flexion. Finger flexion also recovered in those fingers in which the flexor digitorum profundus was primarily innervated by the ulnar nerve. Despite extended sensory deficits, patients ultimately were able to use their hands regularly in daily life. Type of study/level of evidence Therapeutic III. © 2015 American Society for Surgery of the Hand.


Bertelli J.A.,University of South Santa Catarina | Ghizoni M.F.,University of South Santa Catarina
Journal of neurosurgery | Year: 2015

OBJECT: The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries.METHODS: Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs. Both the posterior division and the branch to the middle deltoid were used in 2 upper limbs, and the anterior division of the axillary nerve in the final 2 limbs. For thumb and finger extension reconstruction, the nerve to the supinator was transferred to the posterior interosseous nerve.RESULTS: In 22 of the 27 recipient nerves, a peripheral type of palsy with muscle denervation was identified. At an average of 19 months follow-up, elbow strength scored M4 in 11 upper limbs and M3 in 2, according to the British Medical Research Council scale. Thumb extension scored M4 in 8 upper limbs and scored M3 in 4. Finger extension scored M4 in 12 hands. No donor-site deficits were reported or observed.CONCLUSIONS: Nerve transfers are effective at restoring elbow, thumb, and finger extension in patients with a midcervical spinal cord injury, which occurs in the majority of patients with a peripheral type of palsy with muscle denervation in their upper limbs. Efforts should be made to perform operations in these patients within 12 months of injury.


Petronilho F.,University of South Santa Catarina
Inflammation & allergy drug targets | Year: 2013

Gastrin-releasing peptide (GRP) is a neuropeptide that acts through G protein coupled receptors and is involved in signal transmission in both the central and peripheral nervous systems. Its receptor, gastrin-releasing peptide receptor (GRPR), is expressed by various cell types, and it is overexpressed in cancer cells. In recent years, studies have suggested the relationship of GRP and inflammatory diseases. RC-3095, a selective GRPR antagonist, was found to have antiinflammatory properties in models of arthritis, gastritis, uveitis and sepsis. Furthermore, GRP mediates air pollutioninduced airway hyperreactivity and airway inflammation in mice. In conclusion, GRP and its receptor are relevant to the inflammatory response, being a potential therapeutic target several diseases are related to inflammation.


Bertelli J.A.,University of South Santa Catarina | Ghizoni M.F.,University of South Santa Catarina
Journal of Hand Surgery | Year: 2012

We undertook a brachialis to triceps nerve transfer to restore elbow extension in a 53-year-old man 5 months after he sustained a spine injury that resulted in a central cord syndrome. Within 3 months of surgery, the patient had recovered active elbow extension and had M3 level strength, which increased to M4 and 5 kg of strength by 12 months postoperatively. Despite transferring an antagonist nerve for triceps reinnervation, the patient had no problems controlling active elbow flexion-extension. Harvesting the brachialis nerve caused no permanent decrease in elbow flexion strength. © 2012 American Society for Surgery of the Hand.


Bertelli J.A.,University of South Santa Catarina | Ghizoni M.F.,University of South Santa Catarina
Journal of Neurosurgery | Year: 2012

Object. Classically, C5-7 root injuries of the brachial plexus have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. However, current myotome maps generally indicate that C-8 participates in the innervation of thumb and finger extensors. Therefore, the authors have hypothesized that, for palsies of the thumb and finger extensors, the injury should affect the C-5 through C-8 roots. Methods. The authors tested their hypothesis in 30 patients with upper-type palsies of the brachial plexus. They traced a correlation between clinical findings and root injury, as documented by CT myelography, direct visualization during surgery, and electrophysiological studies. Results. In C5-8 root injuries, shoulder abduction and external rotation were paralyzed, and in all patients, wrist extensors were paralyzed. However, in 22 of the 30 patients, wrist extension was possible, because of contraction of the extensor digitorum communis and extensor pollicis longus. Wrist flexion and pronation also were preserved. The T-1 root contributed significantly to innervation of the thumb and finger flexors, ensuring 34% grasping and 40% pinch strength relative to the normal side. Hand sensation was largely preserved. Conclusions. Based on the authors' observations, they suspect that the clinical scenario previously attributed to a C5-7 root injury is, in fact, a C5-8 root injury. The authors propose referring to this partial palsy of the brachial plexus as a "T-1 hand.".


Maraschin J.F.,University of South Santa Catarina
Advances in experimental medicine and biology | Year: 2012

Diabetes mellitus (DM) represents a heterogeneous group of conditions that share certain characteristics with hyperglycemia as a common feature. The first worldwide accepted classification scheme for DM was published in 1979 by the National Diabetes Data Group (NDDG) and classified DM based on the pharmacologic therapy applied into two major groups: Insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The terms coined by the NDDG became popular during the 1980s and 1990s, but with time, the misclassification of patients became evident. Since the correct classification of DM allows a more adequate treatment, the new classification proposed by the American Diabetes Association in 1997 was based in the pathogenesis of the disease and comprises four categories: Type 1 DM, Type 2 DM, other types and gestational diabetes. Despite significant advances in diabetes understanding, some gray areas still remain and new studies are necessary to further improve diabetes classification.


Traebert J.,University of South Santa Catarina
Oral health & preventive dentistry | Year: 2011

To assess the prevalence and severity of dental caries among 12-year-old schoolchildren and to examine its possible association with maternal schooling. A cross-sectional study involving a representative sample (n = 253) of the 12-year-old schoolchildren enrolled in 14 schools of the municipality of Curitibanos, Brazil was carried out in 2006. Clinical information was obtained through the World Health Organization criteria. Non-clinical data were obtained through interviews with schoolchildren. Associations were analysed using chi-square test or Fisher exact test followed by non-conditional multiple logistic regression analysis to test the independence of associations between outcome and explanatory variables. P-values were set at < 0.05. The prevalence of caries was 81.7% and the mean decayed, missing or filled teeth score was 4.08. Prevalence was significantly higher among girls, with a prevalence ratio of 2.58 (95% CI 1.25, 5.32) (P = 0.010); among schoolchildren from mothers with lower education level, with a prevalence ratio of 3.26 (95% CI 1.32, 8.06) (P = 0.010); and among schoolchildren who had ever visited a dentist, with a prevalence ratio of 2.91 (95% CI 1.14, 7.62) (P = 0.030). The prevalence and severity of caries were higher than the Brazilian national average. The prevalence was statistically associated with maternal schooling, had visited a dentist, and gender.


Traebert J.,University of South Santa Catarina
International journal of paediatric dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children | Year: 2010

To assess whether an oral health-related quality of life (OHRQoL)measure showed differential item functioning (DIF) by ethnicity. A simple random sample of 12- and 13-year-old schoolchildren enrolled in the Taranaki District Health Board's school dental service, New Zealand. Each child (n = 430) completed the Child Perception Questionnaire (CPQ(11-14)) in the dental clinic waiting room, prior to a dental examination. The dataset included age, gender, ethnicity, and deprivation status. The general principle of the analytic plan was that equal scores from each CPQ(11-14) item were expected from both non-Mäori and Mäori groups regardless of their ethnic group. Ordinal logistic regression was performed. The dependent variables were the CPQ(11-14) items. The ethnicity group and each CPQ(11-14) domain score were the independent variables. Non-uniform DIF was assessed through adding an interaction term for each CPQ(11-14) sub-scale. Non-uniform DIF was found in two items, one in the Functional Limitations sub-scale and another in the Social Well-being sub-scale. Uniform DIF was found in one item of the Emotional Well-being sub-scale. Both non-uniform and uniform DIF by ethnicity was found in three of 37 items of the CPQ(11-14) questionnaire, showing it is important to perform DIF analysis when applying OHRQoL measures. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.


Bertelli J.A.,University of South Santa Catarina
The Journal of hand surgery, European volume | Year: 2013

Stretch injuries of the C5-C7 roots of the brachial plexus traditionally have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. Based on current myotome maps we hypothesized that, as far as motion is concerned, palsies involving C5-C6 and C5-C7 root injuries should be similar. In 38 patients with upper-type palsies of the brachial plexus, we examined for correlations between clinical findings and root injury level, as documented by CT tomomyeloscan. Contrary to commonly held beliefs, C5-C7 root injuries were not associated with loss of extension of the elbow, wrist, thumb, or fingers, but residual hand strength was much lower with C5-C7 vs C5-C6 lesions.

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