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Authors
Advisor(s)
Abstract(s)
Introdução
O recurso à biopsia de nervo ou músculo, à electroneuromiografia e a exames analíticos é
importante no processo de diagnóstico das patologias do Sistema Nervoso Periférico, nomeadamente
miopatias e neuropatias. Tais exames possuem características diferentes e oferecem perspectivas
igualmente distintas, muitas vezes decisivas para o correcto diagnóstico destas patologias.
Objectivo
O objectivo deste trabalho consistiu em saber se os resultados da biopsia de nervo ou músculo
se correlacionavam com a hipótese clínica de diagnóstico e/ou com o resultado da
electroneuromiografia, num grupo de doentes com patologia do Sistema Nervoso Periférico.
Materiais e Métodos
Foi realizado um estudo de casos, do qual fizeram parte 18 indivíduos que realizaram biopsia
de nervo ou músculo entre os anos de 2003 e 2007, solicitada pelo Hospital Pêro da Covilhã. Os dados
foram recolhidos entre Abril e Julho de 2009, através dos processos clínicos em papel e do Sistema de
Apoio ao Médico e colocados em bases de dados. O tratamento desses dados foi realizado através dos
programas informáticos Microsoft Excel e SPSS Statistics 17.0.
Resultados
A amostra era maioritariamente do sexo masculino (67%), com idades compreendidas entre os
22 e os 72 anos.
Os sinais e sintomas mais evidentes consistiam na força diminuída (72%), nas alterações da
sensibilidade (67%) e dos reflexos (39%) e no cansaço (50%). A miopatia era a hipótese de diagnóstico
em 78% da amostra. As biopsias e electroneuromiografias mostraram diferentes percentagens de resultados
anormais (39% e 92%, respectivamente). A baixa percentagem de biopsias anormais resultou num
número baixo de casos (7 em 18) em que o resultado da biopsia coincidiu com a hipótese de
diagnóstico. Igualmente baixo foi o número de casos (6 em 13) em que o resultado da biopsia foi
coincidente com o resultado da electroneuromiografia.
O teste do qui-quadrado, confirmado pelo rácio de verosimilhança (likelihood ratio), para os
dados relativos à miopatia não revelou associação estatisticamente significativa entre o resultado da
biopsia e a hipótese de diagnóstico. O estudo revelou uma associação estatisticamente significativa
entre o resultado da biopsia e o resultado da electroneuromiografia, embora tal associação deva ser
interpretada com cuidado.
Conclusões
Neste grupo de doentes, o resultado da biopsia não mostrou associação estatisticamente
significativa com a hipótese de diagnóstico, tendo os resultados da biopsia coincidido com a hipótese
de diagnóstico em 7 de 18 doentes. O resultado da biopsia mostrou associação estatisticamente
significativa com o resultado da electroneuromiografia, embora os resultados de ambos os exames
tenham sido coincidentes em apenas 6 de 13 doentes (3 com miopatia; 3 com neuropatia). Este estudo
sugere que a biopsia de nervo ou músculo deve ser vista como meio complementar de diagnóstico da
patologia do Sistema Nervoso Periférico, não sendo suficiente por si só para o diagnóstico final.
Introduction The use of nerve or muscle biopsy, electroneuromyography and analytical exams is important for the diagnostic process of the pathology of the Peripheral Nervous System, namely in terms of myopathy and neuropathy. Such exams have different features and provide different perspectives as well, which are often critical to the correct diagnosis of these pathologies. Objective The goal of this thesis consisted of assessing whether nerve or muscle biopsy results correlated with the clinical diagnostic hypothesis and/or with the electroneuromyographical results, as far as the pathology of the Peripheral Nervous System is concerned. Methods A study of cases was conducted, of which 18 individuals took part and in whom a nerve or muscle biopsy was performed between 2003 e 2007, requested by Pêro da Covilhã Hospital. The data were collected between April and June 2009, retrieved from the clinical files and also from the software Sistema de Apoio ao Médico and placed in a specially elaborated database. Processing of data was performed using the Microsoft Excel and SPSS Statistics 17.0 software. Results The sample was mostly male (67%), aged between the 22 and 72 years old. The most obvious signs and symptoms consisted of decreased strength (72%), changes in sensitivity (67%) and reflexes (39%) and fatigue (50%). Myopathy was the diagnostic hypothesis for 78% of the sample patients Biopsies and electroneuromyography exams showed different percentages of anomalies (39% and 92%, respectively). The low percentage of abnormal biopsies resulted in a low number of cases (7 out of 18) in which the biopsy result coincided with the diagnostic hypothesis. The number of cases (6 out of 13) in which the biopsy result coincided with that from the electroneuromyography exam was also low. The chi-square, confirmed by likelihood ratio, as applied to data related to myopathy, did not show a statistically significant association between the biopsy result and the diagnostic hypothesis. The study showed a statistically significant association between the biopsy result and the electroneuromyographical result, although such association needs to be interpreted with caution. Conclusions In this patient group, the biopsy result did not show a statistically significant association with the diagnostic hypothesis, with biopsy results coinciding with the diagnostic hypothesis in 7 out of 18 patients. The biopsy result showed a statistically significant association with the electroneuromyographical result, although the results of both exams were coincident in only 6 out of 13 patients (3 with myopathy; 3 with neuropathy). This study suggests that nerve or muscle biopsy should be seen as a complementary method of diagnosis of the pathology of the Peripheral Nervous System, but is not enough, on its own, for the final diagnosis.
Introduction The use of nerve or muscle biopsy, electroneuromyography and analytical exams is important for the diagnostic process of the pathology of the Peripheral Nervous System, namely in terms of myopathy and neuropathy. Such exams have different features and provide different perspectives as well, which are often critical to the correct diagnosis of these pathologies. Objective The goal of this thesis consisted of assessing whether nerve or muscle biopsy results correlated with the clinical diagnostic hypothesis and/or with the electroneuromyographical results, as far as the pathology of the Peripheral Nervous System is concerned. Methods A study of cases was conducted, of which 18 individuals took part and in whom a nerve or muscle biopsy was performed between 2003 e 2007, requested by Pêro da Covilhã Hospital. The data were collected between April and June 2009, retrieved from the clinical files and also from the software Sistema de Apoio ao Médico and placed in a specially elaborated database. Processing of data was performed using the Microsoft Excel and SPSS Statistics 17.0 software. Results The sample was mostly male (67%), aged between the 22 and 72 years old. The most obvious signs and symptoms consisted of decreased strength (72%), changes in sensitivity (67%) and reflexes (39%) and fatigue (50%). Myopathy was the diagnostic hypothesis for 78% of the sample patients Biopsies and electroneuromyography exams showed different percentages of anomalies (39% and 92%, respectively). The low percentage of abnormal biopsies resulted in a low number of cases (7 out of 18) in which the biopsy result coincided with the diagnostic hypothesis. The number of cases (6 out of 13) in which the biopsy result coincided with that from the electroneuromyography exam was also low. The chi-square, confirmed by likelihood ratio, as applied to data related to myopathy, did not show a statistically significant association between the biopsy result and the diagnostic hypothesis. The study showed a statistically significant association between the biopsy result and the electroneuromyographical result, although such association needs to be interpreted with caution. Conclusions In this patient group, the biopsy result did not show a statistically significant association with the diagnostic hypothesis, with biopsy results coinciding with the diagnostic hypothesis in 7 out of 18 patients. The biopsy result showed a statistically significant association with the electroneuromyographical result, although the results of both exams were coincident in only 6 out of 13 patients (3 with myopathy; 3 with neuropathy). This study suggests that nerve or muscle biopsy should be seen as a complementary method of diagnosis of the pathology of the Peripheral Nervous System, but is not enough, on its own, for the final diagnosis.
Description
Keywords
Sistema nervoso periférico - Meios complementares de diagnóstico Sistema nervoso periférico Sistema nervoso periférico - Electroneuromiografia Miopatia Neuropatia
Citation
Publisher
Universidade da Beira Interior