The role of membranous urethral afferent autonomic innervation in the continence mechanism after nerve sparing radical prostatectomy: a clinical and prospective study

Purpose: We evaluated the somatic and autonomic innervation of the pelvic floor and rhabdosphincter before and after nerve sparing radical retropubic prostatectomy using neurophysiological tests and correlated findings with clinical parameters and urinary continence. Materials and Methods: From February 2003 to October 2005, 46 patients with prostate cancer were enrolled in a controlled, prospective study. Patients were evaluated before and 6 months after nerve sparing radical retropubic prostatectomy using the UCLA-PCI urinary function domain and neurophysiological tests, including somatosensory evoked potential, and the pudendo-urethral, pudendo-anal and urethro-anal reflexes. Clinical parameters and urinary continence were correlated with afferent and efferent innervation of the membranous urethra and pelvic floor. We used strict criteria to define urinary continence as complete dryness with no leakage at all, not requiring any pads or diapers and with a UCLA-PCI score of 500. Patients with a sporadic drop of leakage, requiring up to 1 pad daily, were defined as having occasional urinary leakage. Results: Two patients were excluded from study due to urethral stricture postoperatively. We evaluated 44 patients within 6 months after surgery. The pudendo-anal and pudendo-urethral reflexes were unchanged postoperatively (p = 0.93 and 0.09, respectively), demonstrating that afferent and efferent pudendal innervation to this pelvic region was not affected by the surgery. Autonomic afferent denervation of the membranous urethral mucosa was found in 34 patients (77.3%), as demonstrated by a postoperative increase in the urethro-anal reflex sensory threshold and urethro-anal reflex latency (p <0.001 and 0.0007, respectively). Six of the 44 patients used pads. One patient with more severe leakage required 3 pads daily and 23 showed urinary leakage, including 5 who needed 1 pad per day and 18 who did not wear pads. Afferent autonomic denervation at the membranous urethral mucosa was found in 91.7% of patients with urinary leakage. Of 10 patients with preserved urethro-anal reflex latency 80% were continent. Conclusions: Sensory and motor pudendal innervation to this specific pelvic region did not change after nerve sparing radical retropubic prostatectomy. Significant autonomic afferent denervation of the membranous urethral mucosa was present in most patients postoperatively. Impaired membranous urethral sensitivity seemed to be associated with urinary incontinence, particularly in patients with occasional urinary leakage. Damage to the afferent autonomic innervation may have a role in the continence mechanism after nerve sparing radical retropubic prostatectomy.

Orbitoethmoidal impacted injury by kitchen knife causing abducens nerve palsy

Introduction: Impacted knife injuries in the maxillofacial region are rare and infrequently reported. In cases of injury involving orbit or eye, these reports are even rarer. Discussion: Damage to the orbital contents may result in a rupture of the globe, extraocular muscle injury, lacrimal gland damage, and others. Orbital foreign bodies are not only difficult to detect, and clinical features vary according to its size, characteristics, shape, penetrating method, and site. In this report, a case of abducens nerve palsy after orbitoethmoidal knife injury is presented. © 2010 Springer-Verlag.

Optimal trajectory and solution of the inverse kinematics of a robotic manipulator by genetic algorithms

This paper presents the generation of optimal trajectories by genetic algorithms (GA) for a planar robotic manipulator. The implemented GA considers a multi-objective function that minimizes the end-effector positioning error together with the joints angular displacement and it solves the inverse kinematics problem for the trajectory. Computer simulations results are presented to illustrate this implementation and show the efficiency of the used methodology producing soft trajectories with low computing cost. © 2011 Springer-Verlag Berlin Heidelberg.

Trochlear nerve palsy associated with claude bernard-horner syndrome after brainstem stroke

The association of unilateral trochlear nerve palsy with Claude Bernard-Horner syndrome represents a rare clinical condition. We present the case of a patient with this unusual presentation. The investigation performed implicated cerebrovascular disease as the underlying cause of the condition in this patient. © 2011 S. Karger AG, Basel.

A proposed neural control for the trajectory tracking of a nonholonomic mobile robot with disturbances

In this paper, a trajectory tracking control problem for a nonholonomic mobile robot by the integration of a kinematic neural controller (KNC) and a torque neural controller (TNC) is proposed, where both the kinematic and dynamic models contains disturbances. The KNC is a variable structure controller (VSC) based on the sliding mode control theory (SMC), and applied to compensate the kinematic disturbances. The TNC is a inertia-based controller constituted of a dynamic neural controller (DNC) and a robust neural compensator (RNC), and applied to compensate the mobile robot dynamics, and bounded unknown disturbances. Stability analysis with basis on Lyapunov method and simulations results are provided to show the effectiveness of the proposed approach. © 2012 Springer-Verlag.

Bothropstoxin-I reduces evoked acetylcholine release from rat motor nerve terminals: Radiochemical and real-time video-microscopy studies

Understanding the biological activity profile of the snake venom components is fundamental for improving the treatment of snakebite envenomings and may also contribute for the development of new potential therapeutic agents. In this work, we tested the effects of BthTX-I, a Lys49 PLA2 homologue from the Bothrops jararacussu snake venom. While this toxin induces conspicuous myonecrosis by a catalytically independent mechanism, a series of in vitro studies support the hypothesis that BthTX-I might also exert a neuromuscular blocking activity due to its ability to alter the integrity of muscle cell membranes. To gain insight into the mechanisms of this inhibitory neuromuscular effect, for the first time, the influence of BthTX-I on nerve-evoked ACh release was directly quantified by radiochemical and real-time video-microscopy methods. Our results show that the neuromuscular blockade produced by in vitro exposure to BthTX-I (1 μM) results from the summation of both pre- and postsynaptic effects. Modifications affecting the presynaptic apparatus were revealed by the significant reduction of nerve-evoked [3H]-ACh release; real-time measurements of transmitter exocytosis using the FM4-64 fluorescent dye fully supported radiochemical data. The postsynaptic effect of BthTX-I was characterized by typical histological alterations in the architecture of skeletal muscle fibers, increase in the outflow of the intracellular lactate dehydrogenase enzyme and progressive depolarization of the muscle resting membrane potential. In conclusion, these findings suggest that the neuromuscular blockade produced by BthTX-I results from transient depolarization of skeletal muscle fibers, consequent to its general membrane-destabilizing effect, and subsequent decrease of evoked ACh release from motor nerve terminals. © 2012 Elsevier Ltd.

Incomplete mandibular fracture after lateralization of the inferior alveolar nerve for implant placement

PURPOSE: The present case describes an inferior alveolar nerve lateralization for implant placement that caused mandible fracture a few days after surgery. CLINICAL REPORT: In this case, a 56-year-old female patient who had a severely atrophied jaw and showing bone height less than 7 mm from the bone crest and the mandibular canal was submitted to surgery lateralization of the inferior alveolar conducted with piezzo. Even with all postoperative care, the patient suffered an incomplete fracture of the mandible a few days after lateralization of the inferior alveolar nerve for implant placement. The patient was treated with soft diet and medications for pain and antibiotics, besides removing the implant associated with the fracture. CONCLUSION: It is suggested that this procedure may be conducted in 2 operative periods: firstly, the lateralization of the inferior alveolar; and secondly, after a period of 3 months, the implant placement in a situation of more bone stability. Copyright © 2013 by Mutaz B. Habal, MD.

Changes in plant species composition and functional traits along the successional trajectory of a restored patch of Atlantic Forest

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

Inferior Alveolar Nerve Function After Sagittal Split Osteotomy by Reciprocating Saw or Piezosurgery Instrument: Prospective Double-Blinded Study

Purpose: The aim of this prospective study was to objectively evaluate inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) by comparing 1 side treated with a reciprocating saw with the other side treated with a piezosurgery device.Materials and Methods: Clinical evaluation of IAN sensory disturbance was undertaken preoperatively and at 1 week, 4 weeks, 2 months, and 6 months postoperatively in 20 patients who underwent SSROat the Division of Oral and Maxillofacial Surgery, Araraquara Dental School, Sao Paulo State University. The 20 patients were examined at all periods for IAN functionality by Semmes-Weinstein testing; neither the patients nor the examiner knew which side was treated using piezosurgery or a reciprocating saw.Results: The mean age of the patients was 28.4 years (range, 20 to 48 yr). Before surgery, no patient had impaired function of the IAN in any of the 8 zones in the mental and inferior lip areas. All patients reported feeling the first monofilament at the time of the preoperative test. Seven days postoperatively, all patients reported some kind of altered sensitivity in at least 1 zone evaluated.Conclusions: The results of this study suggest there was no statistically significant difference in the sensitivity of the labiomental area regarding the instrument used to perform the osteotomy. Future studies will focus on enlarging the sample and evaluating the results. (C) 2014 American Association of Oral and Maxillofacial Surgeons

Facial Reanimation Utilizing Combined Orthodromic Temporalis Muscle Flap and End-to-Side Cross-Face Nerve Grafts

Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.There was significant improvement in smile symmetry in 89.5 % of patients.Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.spinger.com/00266.

Mesenchymal stem cells engrafted in a fibrin scaffold stimulate Schwann cell reactivity and axonal regeneration following sciatic nerve tubulization

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

Effect of low-level laser therapy (LLLT) on peripheral nerve regeneration using fibrin glue derived from snake venom

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

The sailboat island and the New Horizons trajectory

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

Trajectory and outcomes of speech language therapy in the Prader-Willi syndrome (PWS): case report

The aim of this study was to describe the trajectory and the outcomes of speech-language therapy in Prader-Willi syndrome through a longitudinal study of the case of an 8 year-old boy, along four years of speech-language therapy follow-up. The therapy sessions were filmed and documental analysis of information from the child's records regarding anamnesis, evaluation and speech-language therapy reports and multidisciplinary evaluations were carried out. The child presented typical characteristics of Prader-Willi syndrome, such as obesity, hyperfagia, anxiety, behavioral problems and self aggression episodes. Speech-language pathology evaluation showed orofacial hypotony, sialorrhea, hypernasal voice, cognitive deficits, oral comprehension difficulties, communication using gestures and unintelligible isolated words. Initially, speech-language therapy had the aim to promote the language development emphasizing social interaction through recreational activities. With the evolution of the case, the main focus became the development of conversation and narrative abilities. It were observed improvements in attention, symbolic play, social contact and behavior. Moreover, there was an increase in vocabulary, and evolution in oral comprehension and the development of narrative abilities. Hence, speech-language pathology intervention in the case described was effective in different linguistic levels, regarding phonological, syntactic, lexical and pragmatic abilities.

Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block. Comparison with interscalene block

Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial plexus blockade. According to the technique used, sixty-eight patients were allocated into two groups: interscalene group (IG, n=34) and selective group (SG, n=34), with neurostimulation approach used for both techniques. After appropriate motor response, IG received 30 mL of 0.33% levobupivacaine in 50% enantiomeric excess with adrenalin 1:200,000. After motor response of suprascapular and axillary nerves, SG received 15 mL of the same substance on each nerve. General anesthesia was then administered. Variables assessed were time to perform the blocks, analgesia, opioid consumption, motor block, cardiovascular stability, patient satisfaction and acceptability. Time for interscalene blockade was significantly shorter than for selective blockade. Analgesia was significantly higher in the immediate postoperative period in IG and in the late postoperative period in SG. Morphine consumption was significantly higher in the first hour in SG. Motor block was significantly lower in SG. There was no difference between groups regarding cardiocirculatory stability and patient satisfaction and acceptability. Failure occurred in IG (1) and SG (2). Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder.