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no n&#237;vel do cotovelo e&#47;ou do punho&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> &#201; realizada principalmente nos casos de abscesso de nervo&#44; neurite n&#227;o responsiva ao tratamento cl&#237;nico por quatro semanas&#44; epis&#243;dios de neurites recorrentes ou subentrantes&#44; neurites deficit&#225;rias cr&#244;nicas com dor&#44; e neurites em pacientes com comorbidades que contraindicam o uso de corticoides nas doses adequadas&#44; e nos casos de contraindica&#231;&#227;o absoluta de corticoides&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Com o objetivo de descrever a evolu&#231;&#227;o cl&#237;nica da fun&#231;&#227;o neural e da recorr&#234;ncia da neurite em pacientes com neurite hans&#234;nica submetidos &#224; neur&#243;lise&#44; apresentamos uma s&#233;rie de 22 casos de cirurgia do nervo ulnar&#44; 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m&#237;n&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; m&#225;x&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>303&#41;&#59; em 11 &#40;50&#44;0&#37;&#41; pacientes o procedimento foi realizado em at&#233; seis meses&#44; o que &#233; relacionado com os melhores resultados por outros autores&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Para fins de compara&#231;&#227;o&#44; no presente estudo foi considerada a &#250;ltima avalia&#231;&#227;o neurol&#243;gica&#44; que variou de tr&#234;s a 168 meses&#44; tendo 12 &#40;54&#44;5&#37;&#41; pacientes com mais de um ano de seguimento&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">De 12 casos que j&#225; tinham sensibilidade alterada antes da cirurgia&#44; sete &#40;58&#44;3&#37;&#41; apresentaram melhora e&#44; de seis que tinham altera&#231;&#227;o da for&#231;a muscular&#44; 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necessariamente&#44; evolu&#237;rem com perda da fun&#231;&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Com esta s&#233;rie de casos&#44; ressalta&#8208;se a import&#226;ncia cl&#237;nica dos resultados em situa&#231;&#227;o de rotina&#44; em que a maior contribui&#231;&#227;o da neur&#243;lise associada ao tratamento cl&#237;nico da neurite hans&#234;nica foi a n&#227;o recorr&#234;ncia ou cronifica&#231;&#227;o do quadro&#44; evitando a corticoterapia prolongada e suas consequ&#234;ncias&#44; al&#233;m da poss&#237;vel evolu&#231;&#227;o para incapacidades f&#237;sicas&#44; inclusive com ganho da fun&#231;&#227;o sensitiva para a maioria dos casos apresentados&#46; Faz&#8208;se necess&#225;rio&#44; contudo&#44; a realiza&#231;&#227;o de estudos com metodologia apropriada para avaliar a efic&#225;cia da neur&#243;lise ou seus benef&#237;cios em compara&#231;&#227;o ao tratamento cl&#237;nico isolado&#44; mesmo diante das publica&#231;&#245;es existentes ao longo de d&#233;cadas&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0045" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado do Amazonas &#8211; bolsa de inicia&#231;&#227;o cient&#237;fica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0050" class="elsevierStylePara elsevierViewall">Juliana Barroso&#8208;Freitas&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Pedro Arthur da Rocha Ribas&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Paula Frassinetti Bessa Rebello&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Silmara Navarro&#8208;Pennini&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise dos dados&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">N&#176; ordem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Idade no diagn&#243;stico &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Forma cl&#237;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo em meses entre</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensibilidade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">For&#231;a muscular<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Tempo com recorr&#234;ncias &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neurite e neur&#243;lise&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neur&#243;lise e avalia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">BL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">BL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">LL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;05 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">M&#234;s da ocorr&#234;ncia do &#250;nico um epis&#243;dio de neurite&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas dos casos de hansen&#237;ase submetidos &#224; neur&#243;lise do nervo ulnar</p>"
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      "titulo" => "Refer&#234;ncias"
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              "identificador" => "bib0030"
              "etiqueta" => "1"
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                  "referenciaCompleta" => "World Health Organization &#8211; WHO &#91;Internet&#93;&#46; Weekly Epidemiological Record &#40;WER&#41; &#91;Acesso em 20 jan&#46; 2020&#93;&#46; Dispon&#237;vel em&#58; &#60;<span class="elsevierStyleHsp" style=""></span>https&#58;&#47;&#47;www&#46;who&#46;int&#47;wer&#47;2019&#47;wer9435&#95;36&#47;en&#47;&#62;&#46;"
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Carta ‐ Investigação
Evolução clínica da função neural em série de casos de neuropatia hansênica após neurólise ulnar
Juliana Barroso‐Freitasa,
Autor para correspondência
freitassjuliana@hotmail.com

Autor para correspondência.
, Pedro Arthur da Rocha Ribasb, Paula Frassinetti Bessa Rebelloc, Silmara Navarro‐Penninic
a Hospital Universitário Getúlio Vargas, Manaus, AM, Brasil
b Universidade Nilton Lins, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Fundação de Amparo à Pesquisa do Estado do Amazonas, Manaus, AM, Brasil
c Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brasil
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os nervos ulnar e tibial posterior s&#227;o os mais envolvidos&#46; Com frequ&#234;ncia&#44; o dano neural tamb&#233;m pode ocorrer durante epis&#243;dios agudos de rea&#231;&#245;es imunol&#243;gicas contra ant&#237;genos bacilares&#44; que podem surgir no decorrer da doen&#231;a ou mesmo ap&#243;s o tratamento poliquimioter&#225;pico&#44; na forma de neurite com edema&#44; obstru&#231;&#227;o vascular&#44; isquemia e estrangulamento na passagem pelos canais osteofibrosos dos membros&#44; levando &#224; dor e ao d&#233;ficit de fun&#231;&#227;o&#44; principal causa das incapacidades f&#237;sicas e estigma da doen&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A base do tratamento da neurite &#233; a prednisona&#44; utilizada para o controle do processo inflamat&#243;rio e da dor&#44; evitando o dano neural permanente&#46; A neur&#243;lise &#233; a cirurgia para descompress&#227;o do nervo por meio de uma incis&#227;o do epineuro e abertura do canal osteofibroso para libera&#231;&#227;o do mesmo&#44; no n&#237;vel do cotovelo e&#47;ou do punho&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> &#201; realizada principalmente nos casos de abscesso de nervo&#44; neurite n&#227;o responsiva ao tratamento cl&#237;nico por quatro semanas&#44; epis&#243;dios de neurites recorrentes ou subentrantes&#44; neurites deficit&#225;rias cr&#244;nicas com dor&#44; e neurites em pacientes com comorbidades que contraindicam o uso de corticoides nas doses adequadas&#44; e nos casos de contraindica&#231;&#227;o absoluta de corticoides&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Com o objetivo de descrever a evolu&#231;&#227;o cl&#237;nica da fun&#231;&#227;o neural e da recorr&#234;ncia da neurite em pacientes com neurite hans&#234;nica submetidos &#224; neur&#243;lise&#44; apresentamos uma s&#233;rie de 22 casos de cirurgia do nervo ulnar&#44; realizadas em 2015 e 2016 na Funda&#231;&#227;o de Dermatologia Tropical e Venereologia Alfredo da Matta&#44; na cidade de Manaus &#40;AM&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Imediatamente antes da neur&#243;lise e ap&#243;s a mesma &#40;30&#44; 90 dias e na data do retorno&#41;&#44; foi realizada a avalia&#231;&#227;o neurol&#243;gica simplificada segundo o Minist&#233;rio da Sa&#250;de do Brasil&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> A avalia&#231;&#227;o da sensibilidade foi realizada com estesi&#244;metro ou monofilamento de Semmes&#8208;Weinstein&#44; composto por um conjunto de seis fios de nylon de diferentes cores e espessuras que&#44; pressionados contra a pele&#44; correspondem a diferentes pesos &#40;de 0&#44;05<span class="elsevierStyleHsp" style=""></span>g a 300<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; Foram considerados os monofilamentos de 0&#44;05<span class="elsevierStyleHsp" style=""></span>g &#40;verde&#41; e 0&#44;2<span class="elsevierStyleHsp" style=""></span>g &#40;azul&#41; como sensibilidade normal&#44; e acima destes&#44; diminu&#237;da&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Para a avalia&#231;&#227;o da for&#231;a muscular foi examinado o m&#250;sculo abdutor do quinto dedo e utilizada a escala do Medical Research Council&#44; que gradua a for&#231;a de 0 &#40;aus&#234;ncia de movimento muscular&#41; a 5 &#40;movimento completo contra a gravidade com resist&#234;ncia m&#225;xima&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Os n&#237;veis 4 &#40;movimento completo contra a gravidade com resist&#234;ncia parcial&#41; e 5 foram considerados normais&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">O tempo entre o primeiro epis&#243;dio de neurite e a realiza&#231;&#227;o da neur&#243;lise foi em m&#233;dia 25&#44;3 meses &#40;Dp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#44;3&#59; m&#237;n&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; m&#225;x&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>303&#41;&#59; em 11 &#40;50&#44;0&#37;&#41; pacientes o procedimento foi realizado em at&#233; seis meses&#44; o que &#233; relacionado com os melhores resultados por outros autores&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Para fins de compara&#231;&#227;o&#44; no presente estudo foi considerada a &#250;ltima avalia&#231;&#227;o neurol&#243;gica&#44; que variou de tr&#234;s a 168 meses&#44; tendo 12 &#40;54&#44;5&#37;&#41; pacientes com mais de um ano de seguimento&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">De 12 casos que j&#225; tinham sensibilidade alterada antes da cirurgia&#44; sete &#40;58&#44;3&#37;&#41; apresentaram melhora e&#44; de seis que tinham altera&#231;&#227;o da for&#231;a muscular&#44; cinco &#40;83&#44;3&#37;&#41; mantiveram o mesmo n&#237;vel e apenas um &#40;16&#44;7&#37;&#41; piorou&#46; Quinze &#40;68&#44;2&#37;&#41; pacientes n&#227;o tiveram mais neurite no nervo operado&#44; por&#233;m tr&#234;s destes ainda tiveram que usar prednisona por apresentarem rea&#231;&#227;o hans&#234;nica e&#47;ou neurite de outros nervos&#46; Dois pacientes tiveram apenas um &#250;nico epis&#243;dio de neurite&#44; que ocorreu tr&#234;s e quatro meses ap&#243;s a cirurgia&#46; Outros cinco &#40;18&#44;2&#37;&#41; tiveram neurites subentrantes do nervo operado&#44; com m&#233;dia de 52&#44;6 meses &#40;Dp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#59; m&#237;n&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#59; m&#225;x&#46;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172&#41; ap&#243;s a cirurgia&#44; sem&#44; necessariamente&#44; evolu&#237;rem com perda da fun&#231;&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Com esta s&#233;rie de casos&#44; ressalta&#8208;se a import&#226;ncia cl&#237;nica dos resultados em situa&#231;&#227;o de rotina&#44; em que a maior contribui&#231;&#227;o da neur&#243;lise associada ao tratamento cl&#237;nico da neurite hans&#234;nica foi a n&#227;o recorr&#234;ncia ou cronifica&#231;&#227;o do quadro&#44; evitando a corticoterapia prolongada e suas consequ&#234;ncias&#44; al&#233;m da poss&#237;vel evolu&#231;&#227;o para incapacidades f&#237;sicas&#44; inclusive com ganho da fun&#231;&#227;o sensitiva para a maioria dos casos apresentados&#46; Faz&#8208;se necess&#225;rio&#44; contudo&#44; a realiza&#231;&#227;o de estudos com metodologia apropriada para avaliar a efic&#225;cia da neur&#243;lise ou seus benef&#237;cios em compara&#231;&#227;o ao tratamento cl&#237;nico isolado&#44; mesmo diante das publica&#231;&#245;es existentes ao longo de d&#233;cadas&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0045" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado do Amazonas &#8211; bolsa de inicia&#231;&#227;o cient&#237;fica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0050" class="elsevierStylePara elsevierViewall">Juliana Barroso&#8208;Freitas&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Pedro Arthur da Rocha Ribas&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Paula Frassinetti Bessa Rebello&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Silmara Navarro&#8208;Pennini&#58; Concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise dos dados&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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    "fechaAceptado" => "2020-07-17"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Barroso&#8208;Freitas J&#44; Ribas PAR&#44; Rebello PFB&#44; Navarro&#8208;Pennini S&#46; Clinical evolution of neural function in a series of leprosy neuropathy cases after ulnar neurolysis&#46; An Bras Dermatol&#46; 2021&#59;96&#58;500&#8211;2&#46;</p>"
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        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Trabalho realizado na Funda&#231;&#227;o de Dermatologia Tropical e Venereologia Alfredo da Matta Manaus&#44; AM&#44; Brasil&#46;</p>"
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      2 => array:2 [
        "etiqueta" => "&#9734;&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Projeto aprovado pelo Comit&#234; de &#201;tica em Pesquisa da Institui&#231;&#227;o &#40;CEP&#8208;FUAM&#41; sob o n&#250;mero CAE 03242218&#46;5&#46;0000&#46;0002&#46;</p>"
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">03<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">BL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 g&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">300 g&nbsp;\t\t\t\t\t\t\n
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