Circular saw misuse is related to upper limb injuries: a cross-sectional study

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking

Síndrome de Laugier-Hunziker

A síndrome de Laugier-Hunziker é uma desordem adquirida rara, benigna, de etiopatogenia desconhecida, inicialmente descrita em 1970, caracterizada por hiperpigmentação macular mucocutânea frequentemente associada à melanoníquia longitudinal. O diagnóstico é clínico, excluindo outras causas de hiperpigmentação mucocutânea, podendo a dermatoscopia correlacionar-se com os achados histológicos da síndrome. Relatamos um caso de Síndrome de Laugier-Hunziker, com base em seus achados clínicos e dermatoscópicos

Peripheral nerve regeneration with conduits: use of vein tubes

Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the complexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are not amenable to primary end-to-end tensionless neurorraphy. When facing a segmental nerve defect, great effort has been made. to develop an alternative to the autologous nerve graft in order to circumvent morbidity at donor site, such as neuroma formation, scarring and permanent loss of function. Tubolization techniques have been developed to bridge nerve gaps and have been extensively studied in numerous:experimental and clinical trials. the use of a conduit intends to act as a vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration. Among several conduits, vein tubes were validated for clinical application with improving outcomes over the Years. This article aims to address the investigation and treatment of segmental nerve injury and draw the current panorama on the use of vein tubes as an autogenous nerve conduit.Universidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, Div Hand Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, Div Hand Surg, São Paulo, BrazilWeb of Scienc

Anterior interosseous nerve: anatomical study and clinical implications

ABSTRACT Objective: The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected. Methods: This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non-white; 18 were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers. Results: The anterior interosseous nerve arose from the median nerve, an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it. Conclusion: The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles

Bone marrow-derived mesenchymal stem cells versus adipose-derived mesenchymal stem cells for peripheral nerve regeneration

Studies have confirmed that bone marrow-derived mesenchymal stem cells (MSCs) can be used for treatment of several nervous system diseases. However, isolation of bone marrow-derived MSCs (BMSCs) is an invasive and painful process and the yield is very low. Therefore, there is a need to search for other alterative stem cell sources. Adipose-derived MSCs (ADSCs) have phenotypic and gene expression profiles similar to those of BMSCs. The production of ADSCs is greater than that of BMSCs, and ADSCs proliferate faster than BMSCs. To compare the effects of venous grafts containing BMSCs or ADSCs on sciatic nerve injury, in this study, rats were randomly divided into four groups: sham (only sciatic nerve exposed), Matrigel (MGsciatic nerve injury + intravenous transplantation of MG vehicle), ADSCs (sciatic nerve injury + intravenous MG containing ADSCs), and BMSCs (sciatic nerve injury + intravenous MG containing BMSCs) groups. Sciatic functional index was calculated to evaluate the function of injured sciatic nerve. Morphologic characteristics of nerves distal to the lesion were observed by toluidine blue staining. Spinal motor neurons labeled with Fluoro-Gold were quantitatively assessed. Compared with sham-operated rats, sciatic functional index was lower, the density of small-diameter fibers was significantly increased, and the number of motor neurons significantly decreased in rats with sciatic nerve injury. Neither ADSCs nor BMSCs significantly improved the sciatic nerve function of rats with sciatic nerve injury, increased fiber density, fiber diameters, axonal diameters, myelin sheath thickness, and G ratios (axonal diameter/fiber diameter ratios) in the sciatic nerve distal to the lesion site. There was no significant difference in the number of spinal motor neurons among ADSCs, BMSCs and MG groups. These results suggest that neither BMSCs nor ADSCs provide satisfactory results for peripheral nerve repair when using MG as the conductor for engraftment.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)CAPESUniv Fed Sao Paulo, Dept Orthoped & Traumatol, Div Hand & Upper Limb Surg, Sao Paulo, BrazilUniv Sao Paulo, Inst Chem, Dept Biochem, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Neurosci, Dept Neurol & Neurosurg, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Orthoped & Traumatol, Div Hand & Upper Limb Surg, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Neurosci, Dept Neurol & Neurosurg, Sao Paulo, BrazilWeb of Scienc

Nerve Regeneration: Is There an Alternative to Nervous Graft?

Background in nerve injury with nervous gap, no restitution method was found better than the autograft, however, it has the disadvantage of damaging a normal nerve to be used as a graft. Platelet-rich plasma (PRP) is a possible filler material for vein grafts used as conduits for nerve regeneration, preventing its collapse, and providing growth factors and osteoconductive proteins.Methods Isogenic rats were randomly divided into three groups. They received nerve autografts (GRF), PRP-containing vein grafts or a sham operation. Outcomes were evaluated by the sciatic functional index (SFI), morphometric, and morphologic analyses of the nerve distal to the lesion, and the number of spinal cord motoneurons positive for retrograde Fluoro-Gold (Santa Cruz Biotechnology, Inc., Dallas, TX) tracer.Results the PRP and GRF groups had lower SFI values than the control animals throughout the postoperative period. the SFI was significantly higher in the PRP group than the GRF group at 90 days postoperatively (p = 0.011). Fiber diameter and number of motoneurons were significantly decreased in both the PRP and GRF groups, as compared with the control.Conclusion PRP within a vein conduit may be an effective alternative or adjuvant to GRF, the current preferred treatment for nerve injury with a nerve gap, and further investigations are required to fully define the role of PRP in nerve regeneration.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, Div Hand Surg, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Orthoped & Traumatol, Div Hand Surg, São Paulo, BrazilFAPESP: 2010/52624-0Web of Scienc