Denoising swallowing sound to improve the evaluator's qualitative analysis

Swallowing dynamics involves the coordination and interaction of several muscles and nerves which allow correct food transport from mouth to stomach without laryngotracheal penetration or aspiration. Clinical swallowing assessment depends on the evaluator's knowledge of anatomic structures and of neurophysiological processes involved in swallowing. Any alteration in those steps is denominated oropharyngeal dysphagia, which may have many causes, such as neurological or mechanical disorders. Videofluoroscopy of swallowing is presently considered to be the best exam to objectively assess the dynamics of swallowing, but the exam needs to be conducted under certain restrictions, due to patient's exposure to radiation, which limits periodical repetition for monitoring swallowing therapy. Another method, called cervical auscultation, is a promising new diagnostic tool for the assessment of swallowing disorders. The potential to diagnose dysphagia in a noninvasive manner by assessing the sounds of swallowing is a highly attractive option for the dysphagia clinician. Even so, the captured sound has an amount of noise, which can hamper the evaluator's decision. In that way, the present paper proposes the use of a filter to improve the quality of audible sound and facilitate the perception of examination. The wavelet denoising approach is used to decompose the noisy signal. The signal to noise ratio was evaluated to demonstrate the quantitative results of the proposed methodology. (C) 2007 Elsevier Ltd. All rights reserved.

Neurophysiological patterns of ulnar nerve neuropathy in leprosy reactions

Background: Leprosy neuropathy, despite being primarily demyelinating, frequently leads to axonal loss. Neurophysiological examination of the nerves during Type 1 (T1R) and Type 2 reactions (T2R) may give some insight into the pathophysiological mechanisms.Methods: Neurophysiological examinations were performed in 28 ulnar nerves during a clinical trial of steroid treatment effectiveness, 19 patients with T1R and nine with T2R. The nerves were monitored during a period of 6 months; there were eight assessments per nerve, for a total of 224 assessments. Nine neurophysiological parameters were assessed at three sites of the ulnar nerve. The compound motor action potential amplitudes elicited at wrist, elbow and above, as well as the conduction velocity and temporal dispersion across the elbow, were chosen to focus on the changes occurring in the parameters at the elbow tunnel.Results and Conclusion: Neurophysiological changes indicating axonal and demyelinating processes during both T1R and T2R were detected across the elbow. Changes in demyelination, i.e. a Conduction Block, as a primary event present during T2R, occurring as an acute phenomenon, were observed regularly; in T1R Temporal Dispersion, a subacute phenomenon, was seen. During treatment remyelination occurred after both types of reactions.

Rat model of depending prostaglandin renal state: Effect of ketoprofen

Introduction .The renal prostaglandins (PGs), vasodilators, preserve kidney function during increased activity of the renin-angiotensin system or renal sympathetic nerves (renal PG-dependent state [RPGD]). Ketoprofen (Ket) inhibits cyclooxygenase and, therefore, the synthesis of PGs. The aim of this study was to determine, in the rat, the action of Ket in the renal histology and function in a RPGD state (stress of anesthesia and hemorrhage). Material and Methods . Twenty male Wistar rats, anesthetized with sodium pentobarbital, were randomly divided into two groups: G1-control ( n = 10) and G2-Ket ( n = 10) submitted to arterial hemorrhage of 30% of volemia (estimated as 6% of body weight) three times (10% each 10 min), 65 min after anesthesia. G2 animals received Ket, 1.5 mg. kg -1 , venously, 5 min after anesthesia and 60 min before the first hemorrhage moment (first moment of the study [M1]). Medium arterial pressure (MAP), rectal temperature (T), and heart rate were monitored. G1 and G2 received para-aminohippurate sodium (PAH) and iothalamate sodium (IOT) solutions during the entire experimental time in order to determine clearance of PAH (effective renal plasma flow [ERPF]) and clearance of IOT (glomerular filtration rate [GFR]) without urine collection (determination of blood concentrations of PAH and IOT through the high-performance liquid chromatography), filtration fraction (FF), and renal vascular resistance (RVR). The animals were sacrificed in M3, 30 min after the third hemorrhage (M2) moment, and the kidneys and blood collected during the hemorrhage periods were utilized for histological study and determinations of hematocrit (Ht), serum creatinine (S Cr ), ERPF, GFR, FF, and RVR, respectively. Results . There were significant reductions of MAP, T, and Ht and a significant increase of S Cr . During the experiment, ERPF and GFR did not change, but ERPF was always higher in G1 than in G2. Ket did not alter FF, which increased in G1 over the duration of experiment. The Ket group had significantly higher RVR than the control group. The histology verified that both G1 and G2 were similar for tubular dilation and necrosis, but they were significantly different for tubular degeneration: G1 > G2. Conclusion . The changes observed in kidney histology probably were determined by hemorrhage and hypotension. Ket inhibited the synthesis of PGs and diminished tubular degeneration.

Electromyographical, ultrasonographical and morphological modifications in semitendinous muscle after transposition as ventral perineal muscle flap

The aim of this study was to evaluate modifications occurring in semitendinous muscle after transposition as a ventral perineal muscle flap using electromyography, ultrasonography, and morphological studies. Ten male crossbreed dogs of 3-4 year old were used. The left semitendinous muscle was cut close to the popliteus lymph node, rotated and sutured at the perineal region. The contralateral muscle was considered as control. Motor nerve conduction studies of both sciatic-tibial nerves, and electromyographic and ultrasonographic examinations of both semitendinous muscles were performed before surgery and 15, 30, 60, and 90 days postoperatively. Semitendinous muscle samples were collected for morphological analysis 90 days after surgery. No alterations were observed in clinical gait examinations, or in goniometrical and electroneuromyographical studies in pelvic limbs after surgery. Electromyography demonstrated that the transposed muscle was able to contract, but atrophy was detected by ultrasonography and morphological analysis.

Estudo comparativo do bloqueio combinado femoral-isquiático, por punção em sítio único, com anestesia subaracnóidea para cirurgia unilateral do membro inferior

JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar vantagens em pacientes ambulatoriais. O objetivo deste trabalho foi comparar a raquianestesia unilateral com o bloqueio combinado femoral-isquiático em cirurgias ortopédicas unilaterais e ambulatoriais. MÉTODO: Sessenta pacientes foram aleatoriamente separados em dois grupos para receber 6 mg de bupivacaína hiperbárica ou hipobárica (grupo RQ) em decúbito lateral esquerdo ou 800 mg de lidocaína 1,6% com epinefrina nos nervos femoral e isquiático (grupo CFI) em decúbito dorsal. O bloqueio dos nervos foi realizado com agulha de 150 mm conectada a um neuroestimulador e inserida no ponto médio entre as duas abordagens clássicas, sendo injetados 15 mL no nervo femoral e 35 mL no nervo isquiático. Avaliados o tempo para realização dos bloqueios e sua duração. Vinte minutos após, os pacientes foram avaliados em relação aos bloqueios sensitivo e motor. RESULTADOS: O tempo para a realização da raquianestesia foi significativamente menor do que o bloqueio combinado femoral-isquiático. O bloqueio unilateral foi obtido em 90% dos pacientes no grupo RQ e 100% no grupo CFI. O tempo para recuperação do bloqueio sensitivo e motor foi significativamente maior no grupo CFI. Não houve bradicardia ou hipotensão. CONCLUSÕES: Este estudo conclui que é tecnicamente fácil realizar bloqueio anterior combinado femoral-isquiático e pode ser uma alternativa para o bloqueio unilateral do membro inferior. A raquianestesia unilateral com baixas doses de bupivacaína resultou em menor tempo para realização, menor número de tentativas e recuperação mais precoce do bloqueio combinado femoral-isquiático, porém com mesma efetividade.

Double muscle innervation using end-to-side neurorrhaphy in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Muscle graft as a substitute for peripheral nerve graft in rats

OBJETIVO: Avaliar a aplicabilidade do uso de músculo autógeno, tratado de diversas maneiras, em substituição aos enxertos de nervo. MÉTODOS: Os ratos foram separados em sete grupos que receberam, como tratamento a uma lesão nervosa padronizada, os seguintes tipos de enxertos: músculo fresco, músculo fixado com formol 10%, músculo congelado em freezer, músculo congelado em refrigerador, músculo denervado, nervo periférico e um grupo ficou sem qualquer tratamento. Foi avaliado o aspecto histológico das fibras nervosas no segmento reparado. RESULTADOS: A avaliação do segmento nervoso reparado mostrou que existiam axônios em quase todos os grupos, mas a metodologia empregada não possibilitou caracterizar adequadamente as diferenças entre os grupos. CONCLUSÃO: Este estudo mostrou a migração de axônios por meio de todos os enxertos utilizados.

Trimetazidine and N-acetylcysteine in attenuating hind-limb ischemia and reperfusion injuries: experimental study in rats

Aim. Lower-limb traumatic injury associated with ischemia and followed by reperfusion (I/R) is a common severe situation in muscle lesions due to trauma and hypoxia followed by local and systemic injuries induced by oxygen-derived free radical release during reperfusion. The aim of this study was to evaluate the attenuating effects of trimetazidine (TMZ) and N-acetylcysteine (NAC) in such situation.Methods. The muscles at the root of the right hind limb of Wistar rats were cross-sectioned, preserving femoral vessels and nerves and clamping the femoral artery for four hours. The clamp was then released and the femoral artery has been reperfused for 2 hours. Rats were randomly divided in groups of ten as follows: Group 1: sham I/R, treated with saline; Group 2: I/R, treated with saline; Group 3: sham I/R, treated with TMZ (7.5 mg/kg/dose); Group 4: sham I/R, treated with NAC (375 mg/kg/dose); Group 5: I/R treated with TMZ (7.5 mg/kg/dose); Group 6: I/R treated with NAC (375 mg/kg/dose). All rats received two intravenous bolus injections of the drugs, one before ischemia and one before reperfusion. Oxidative stress in plasma (MDA, total, oxidized and reduced glutathione), creatinephosphokinase (CPK), optical and electron microscopy and pelvic extremity circumference and volume were studied.Results. No statistical differences were found between the groups for MDA or total and reduced glutathione. Oxidized glutathione increased significantly in groups 5 and 2. Limb circumference as well as limb volume increased in all groups over time, mainly in groups 5, 2 and 1. CPK increased in all groups, being highest in groups 5, 6 and 2. Histological lesions were present in all but sham groups, being less severe in group 6. Soleus muscle analyses at electron microscopy exhibit some degree of alteration in all groups.Conclusion. This experimental model simulated severe limb trauma associated with ischemia and reperfusion, and, as such, it was aggressive, causing severe injury and local inflammatory reaction. The model did not show antioxidant action from NAC, and possible antioxidant action from TMZ was insufficient to attenuate tissue injuries. [Int Angiol 2009;28:412-7]

Fibular Nerve Injury After Small Saphenous Vein Surgery

Superficial nerve injuries are very common during varicose vein surgery. In contrast, deep nerve injuries are rare and reported especially when surgery involves the small saphenous vein (SSV). The deep motor nerves most commonly injured are the tibial nerve and the peroneal nerve, which are directly or indirectly affected by extrinsic compression, stretching, or healing process involvement. In this report, two cases of common fibular nerve injury after SSV stripping are described, including treatment used and patient outcomes. Nerve damage mechanisms, anatomy, and prevention strategies are also discussed. In conclusion, fibular nerve damage may occur during SSV stripping. Preventive measures include careful preoperative ultrasonographic investigation of the anatomy of the vein, determining location of the saphenopopliteal joint, and careful dissection far from fibular nerve and restricted to the popliteal fossa.

Manejo da dor inguinal crônica pós-hernioplastia (inguinodinia)

A dor inguinal crônica pós-herniorrafia é uma situação preocupante, pois aproximadamente 10% dos pacientes submetidos à hernioplastia inguinal apresenta os sintomas, que com frequência limita a capacidade física. A etiopatogênese está relacionada a uma periostite do púbis (dor somática) e mais frequentemente à lesão nervosa (dor neuropática). É importante distinguir clinicamente entre os dois tipos de dor, pois o tratamento pode ser diferente. O médico deve estabelecer uma rotina diagnóstica e de tratamento, sendo que a maior parte dos pacientes necessitarão de terapêutica cirúrgica. A prevenção desta condição é de grande importância e pode levar a uma menor incidência da síndrome. Algumas medidas são fundamentais, como evitar pontos ou clipes no periósteo do púbis, usar criteriosamente as próteses e identificar os nervos da região inguinal. Esta última medida é certamente a mais importante na prevenção da dor crônica e implica em conhecimento profundo da anatomia e o uso de uma técnica aprimorada.

Laryngeal lesion in leprosy and the risk of aspiration

Leprosy affects the larynx, damaging its mucosa and sensory nerves and loss of sensation may result in aspiration of food and secretions. The laryngeal lesion may be insidious. Post-mortem studies showed bronchopneumonia that could have originated from aspiration. In patients with laryngeal symptoms, dysphagia or aspiration pneumonia loss of laryngeal sensation should be looked for.

MOTOR NERVE CONDUCTION and REPETITIVE NERVE STIMULATION IN CAPTIVE RING-TAILED COATI (NASUA NASUA)

There are few electrophysiologic studies in wild animals. The aim of this study was to determine normal data for motor nerve conduction studies and repetitive stimulation in sciatic-tibial and ulnar nerves in clinically normal captive coati. Eight adult ring-tailed coatis (Nasua nasua), two females and six males weighing 68 kg, were used. Average nerve conduction velocity was 70.81 m/sec (standard deviation [SD] = 3.98) and 56.93 m/sec (SD = 4.31) for the sciatic-tibial and ulnar nerves, respectively. Repetitive stimulation responses demonstrated minimal variations of the area of the compound muscle action potentials at low (3 Hz) and high (20 Hz) frequencies. The maximal obtained decremental area response was 8%. These normal data of conduction studies may be used in assessing abnormalities for clinical diagnosis. In addition, the obtained normal repetitive stimulation data were similar to dogs and humans and may be used for post- and presynaptic disturbances of the neuromuscular transmission in coatis.

Análise morfométrica e ultra-estrutural do nervo óptico de ratos induzidos a ingestão de álcool

OBJETIVO: Analisar os efeitos da ingestão crônica de álcool sobre o nervo óptico em um modelo murino adulto. MÉTODOS: Doze ratos machos da raça Wistar, de 30 dias de idade, foram divididos por sorteio em 2 grupos experimentais: tratado (TG), com 8 animais, alimentados com ração-padrão para roedores de laboratório e uma mistura de água de torneira e etanol ad libitum; controle (CG), com 4 animais, alimentados com a mesma ração e água de torneira pura ad libitum. Após 40 semanas todos os ratos foram sacrificados, sendo os nervos ópticos de ambos os olhos preparados para microscopia óptica e eletrônica. A área de secção transversal de cada nervo a aumento de 500´, assim como número de fibras axonais dentro de 5 campos aleatoriamente selecionados a aumento de 2000´ foram medidos com auxílio de digitalizador de imagens acoplado ao microscópio óptico. Foram realizadas fotomicrografias de 10 campos aleatoriamente selecionados de cada nervo (5 centrais e 5 periféricos) a aumento de 4200´ em microscópio eletrônico de transmissão. RESULTADOS: A análise morfométrica não mostrou diferenças estatisticamente significativas entre os 2 grupos estudados. em contraste com o CG, o exame ultra-estrutural dos nervos ópticos do TG mostrou um intenso desarranjo das bainhas de mielina, que se tornaram espessadas, com separação de suas lamelas, apresentando, por vezes, degenerações interlamelares elétron-densas, além da presença de muitas organelas degeneradas. CONCLUSÃO: Os achados desse estudo mostram alterações ultra-estruturais no nervo óptico de ratos adultos após ingestão crônica de álcool, sem modificações morfométricas significativas.

Surgical procedures used for post-traumatic neurogenic bladder in a cat: report case

Um gato de um ano de idade, macho, castrado, sem raça definida, foi encaminhado ao Hospital Veterinário Escola para avaliação de retenção urinária associada à subluxação nas vértebras T12-T13, que foi causada por um acidente automobilístico. Realizou-se a denervação do esfíncter uretral, por transecção dos nervos pudendo e hipogástrico, para permitir o esvaziamento da bexiga, porém três meses após a cirurgia inicial o animal apresentou recorrência da retenção urinária. Esfincterotomia endoscópica uretral foi então realizada, resultando em incontinência urinária por quatro meses.

Guttural Pouch Diseases Causing Neurologic Dysfunction in the Horse

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)