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Sample records for brachial cutaneous nerve

  1. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

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    Ying Liu

    2015-01-01

    Full Text Available Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we performed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduction function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regenerated potentials first appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ?excellent? and ?good? muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The functional recovery of a transplanted nerve can be dynamically observed after the surgery.

  2. Neurotization from Two Medial Pectoral Nerves to Musculocutaneous Nerve in a Pediatric Brachial Plexus Injury

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    Yu, Dong-Woo; Kim, Min-Su; Jung, Young-Jin; Kim, Seong-Ho

    2012-01-01

    Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male s...

  3. Medial Antebrachial Cutaneous Nerve: Anatomical Relationship with the Medial Epicondyle, Basilic Vein and Brachial Artery / Nervio Cutáneo Antebraquial Medial: Relación Anatómica con el Epicóndilo Medial, Vena Basílica y Arteria Braquial

    Scientific Electronic Library Online (English)

    Aomjai, Damwan; Sithiporn, Agthong; Chavarin, Amarase; Pattarapol, Yotnuengnit; Thanasil, Huanmanop; Vilai, Chentanez.

    2014-06-01

    Full Text Available El recorrido del nervio cutáneo antebraquial medial (NCAM) proporciona la inervación sensorial medial del antebrazo. Su anatomía se ha descrito en parte, porque los datos relativos a su patrón de ramificación y distancias a puntos de referencia adyacentes son insuficientes. El propósito de este estu [...] dio fue proporcionar datos morfométricos sobre la anatomía del NCAM, comparando entre lados y sexos. Se disecaron 96 miembros superiores de 26 hombres y 22 mujeres. Se encontró que 5 ramos del NCAM traspasaron la fascia profunda y llegaron 4 hasta la línea interepicondilar (LIE). Presencia de 2 y 3 ramos se encontró en la mayoría de los casos (>80%). Las distancias de estos ramos a los puntos anatómicos variaron considerablemente. En caso de ausencia de ramos, la distancia medial al epicóndilo medial (EM) y arteria braquial (AB) fueron de aproximadamente 1,5 cm, mientras que a la vena basílica (VB) fueron 0,7 cm en ambos sexos. Independientemente del patrón de ramificación, el NCAM podría pasar sobre o cerca (a menos de 0,5 cm ) del EM, VB y AB. Asimetría en el patrón de ramificación se encontró en 50% de las muestras. Diferencias en algunos de los parámetros de medición se observaron según sexo, pero no por lado. Estos datos son relevantes para localizar el NCAM durante el bloqueo del nervio y la toma de injertos, sino también para evitar la lesión del nervio durante los procedimientos quirúrgicos. Abstract in english Medial antebrachial cutaneous nerve (MACN) courses in the medial arm to provide sensory innervation to the medial forearm. Its anatomy has been partly described since data regarding its branching pattern and distances to adjacent landmarks are still lacking. The purpose of this study was to provide [...] morphometric anatomy of the MACN with comparisons between sides and sexes. Ninety-six upper extremities from 26 males and 22 females were dissected. We found that up to 5 branches of MACN pierced the deep fascia with the maximum of 4 reaching the interepicondylar line (IEL). Presence of 2 and 3 branches was found in the majority of cases (> 80%). The distances from these branches to the landmarks varied considerably. In case of no branch, the mean distances to the medial epicondyle (ME) and brachial artery (BA) were approximately 1.5 cm while those to the basilic vein (BV) were 0.7 cm in both sexes. Regardless of the branching pattern, the MACN could pass over or close (within 0.5 cm) to the ME, BV and BA. Asymmetry in the branching pattern was found in 50% of specimens. Sex but not side differences were observed in some measurement parameters. These data are crucial for not only localizing the MACN during nerve block and graft harvest but also avoiding the nerve injury during surgical procedures.

  4. Neurotization from two medial pectoral nerves to musculocutaneous nerve in a pediatric brachial plexus injury.

    Science.gov (United States)

    Yu, Dong-Woo; Kim, Min-Su; Jung, Young-Jin; Kim, Seong-Ho

    2012-09-01

    Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries. PMID:23115676

  5. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

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    Hua Jin

    2015-01-01

    Full Text Available The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C 6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C 6 brachial plexus injury site (1 × 10 6 cells/mL, 3 ?L/injection, 25 injections immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C 6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals.

  6. Brachial Neuritis Presenting with Isolated Long Thoracic Nerve Involvement

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    Hatice Rana Erdem

    2009-06-01

    Full Text Available Brachial neuritis is a sudden onset disorder characterized by severe pain and weakness of the shoulder and upper extremities. Pain is followed by motor weakness, sensory and reflex impairments. Electroneuromyography is the most valuable method for the diagnosis of brachial neuritis. Early and definite diagnosis is important to prevent unnecessary procedures including surgical interventions. Here we report a patient admitted to our outpatient clinics with a 3-4 day history of sudden onset of severe pain and motor weakness of shoulder muscles. Due to his scapular winging and specific ENMG findings, he was diagnosed as brachial neuritis presenting with isolated nervus thoracicus longus neuropathy. Turk J Phys Med Rehab 2009;55:83-6.

  7. The technique comparison of brachial plexus blocks by ultrasound guided with blocks by nerve stimulator guided

    Science.gov (United States)

    Liu, Guo-Ying; Chen, Zhen-Qiang; Jia, Hai-Yan; Dai, Zhi-Gang; Zhang, Xue-Jun

    2015-01-01

    Objective: Brachial plexus perineural blocks provide specific analgesia for upper limb surgery. We present our experience with ultrasound-guided supraclavicular brachial plexus perineural blocks for distal upper limb surgery. Although single-injection ultrasound-guided supraclavicular blocks have been reported, little is known about the advantages using this approach compared with nerve stimulator guided. Methods: There were 60 patients who underwent upper limb surgery for orthopedic trauma and received a supraclavicular brachial plexus anesthesia. 30 patients (U-group) were injected by an ultrasound-guided technique with the needle tip remaining under direct vision. 30 patients (NS-group) were inserted by nerve stimulator guided. Recorded the onset time, puncture times, pains cases with tourniquet in each group. Compared the difference between two groups. Results: In U-group, all cases had successful perineural injection. Most of them, effect of anesthesia was fast onset and needed insert only once. No pains were reported under using tourniquet. There were no vessel punctures or other direct procedure-related complications. In NS-group, most injections were successful, but slow onset and needed multiply insert needle. 5 patients said pains under using tourniquet when surgery started and had to add opioid by vein. One patients’ lung were puncture and result in pneumothorax. One patient’s was intravascular injection. Conclusions: Supraclavicular brachial plexus perineural insertion using ultrasound guidance is feasible and almost have no complications, deserves further study with a randomized controlled trial comparing this relatively new technique with only using nerve stimulator. PMID:26629206

  8. Selective ultrasound guided pectoral nerve targeting in breast augmentation: How to spare the brachial plexus cords?

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    Desroches, Jean; Grabs, Ursula; Grabs, Detlev

    2013-01-01

    Subpectoral breast augmentation surgery under regional anesthesia requires the selective neural blockade of the medial and lateral pectoral nerves to diminish postoperative pain syndromes. The purpose of this cadaver study is to demonstrate a reliable ultrasound guided approach to selectively target the pectoral nerves and their branches while sparing the brachial plexus cords. After evaluating the position and appearance of the pectoral nerves in 25 cadavers (50 sides), a portable ultrasound machine was used to guide the injection of 10 ml of 0.2% aqueous methylene blue solution in the pectoral region on both sides of three Thiel's embalmed cadavers using a single entry point-triple injection technique. This technique uses a medial to lateral approach with the entry point just medial to the pectoral minor muscle and three subsequent infiltrations: (1) deep lateral part of the pectoralis minor muscle, (2) between the pectoralis minor and major muscles, and (3) between the pectoralis major muscle and its posterior fascia under ultrasound visualization. Dissection demonstrates that the medial and lateral pectoral nerves were well stained while leaving the brachial plexus cords unstained. We show that 10 ml of an injected solution is sufficient to stain all the medial and lateral pectoral nerve branches without a proximal extension to the cords of the brachial plexus. PMID:22730005

  9. Origin of medial and lateral pectoral nerves from the supraclavicular part of brachial plexus and its clinical importance - a case report.

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    Shetty, Prakashchandra; Nayak, Satheesha B; Kumar, Naveen; Thangarajan, Rajesh; D'Souza, Melanie Rose

    2014-02-01

    Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral nerve arose from the anterior division of the upper trunk of the brachial plexus. The lateral pectoral nerve supplied the pectoralis major and the medial pectoral nerve supplied pectoralis major and pectoralis minor muscles through two separate branches. PMID:24701504

  10. Origin of Medial and Lateral Pectoral Nerves from the Supraclavicular Part of Brachial Plexus and its Clinical Importance – A Case Report

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    Shetty, Prakashchandra; Nayak, Satheesha B; Kumar, Naveen; Thangarajan, Rajesh; D’Souza, Melanie Rose

    2014-01-01

    Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral nerve arose from the anterior division of the upper trunk of the brachial plexus. The lateral pectoral nerve supplied the pectoralis major and the medial pectoral nerve supplied pectoralis major and pectoralis minor muscles through two separate branches. PMID:24701504

  11. Brachial artery perforator-based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis.

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    Sekiguchi, Hirotake; Motomiya, Makoto; Sakurai, Keisuke; Matsumoto, Dai; Funakoshi, Tadanao; Iwasaki, Norimasa

    2015-02-01

    It is difficult for most plastic and orthopaedic surgeons to treat nerve dysfunction related to neural adhesion because the pathophysiology and suitable treatment have not been clarified. In the current report, we describe our experience of surgical treatment for adhesive ulnar neuropathy. A 58-year-old male complained of pain radiating to the ulnar nerve-innervated area during elbow and wrist motion caused by adhesive ulnar neuropathy after complex open trauma of the elbow joint. The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve. This flap may be a useful option for ulnar nerve coverage after neurolysis without microvascular anastomosis in specific cases. PMID:25088214

  12. Natural history of sensory nerve recovery after cutaneous nerve injury following foot and ankle surgery

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    Lu Bai

    2015-01-01

    Full Text Available Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Patients received oral vitamin B 12 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory function in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months

  13. Clinical and neuropathological study about the neurotization of the suprascapular nerve in obstetric brachial plexus lesions

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    Sellhaus Bernd

    2009-09-01

    Full Text Available Abstract Background The lack of recovery of active external rotation of the shoulder is an important problem in children suffering from brachial plexus lesions involving the suprascapular nerve. The accessory nerve neurotization to the suprascapular nerve is a standard procedure, performed to improve shoulder motion in patients with brachial plexus palsy. Methods We operated on 65 patients with obstetric brachial plexus palsy (OBPP, aged 5-35 months (average: 19 months. We assessed the recovery of passive and active external rotation with the arm in abduction and in adduction. We also looked at the influence of the restoration of the muscular balance between the internal and the external rotators on the development of a gleno-humeral joint dysplasia. Intraoperatively, suprascapular nerve samples were taken from 13 patients and were analyzed histologically. Results Most patients (71.5% showed good recovery of the active external rotation in abduction (60°-90°. Better results were obtained for the external rotation with the arm in abduction compared to adduction, and for patients having only undergone the neurotization procedure compared to patients having had complete plexus reconstruction. The neurotization operation has a positive influence on the glenohumeral joint: 7 patients with clinical signs of dysplasia before the reconstructive operation did not show any sign of dysplasia in the postoperative follow-up. Conclusion The neurotization procedure helps to recover the active external rotation in the shoulder joint and has a good prevention influence on the dysplasia in our sample. The nerve quality measured using histopathology also seems to have a positive impact on the clinical results.

  14. End-to-side nerve suture in traumatic injuries of brachial plexus: review of the literature and personal case series.

    Science.gov (United States)

    Battiston, B; Artiaco, S; Conforti, L G; Vasario, G; Tos, P

    2009-10-01

    We used end-to-side nerve coaptation combined with standard end-to-end neurotisations to treat 11 patients who presented with complete (six cases) or incomplete (five cases) traumatic brachial plexus injuries. All patients were available for functional evaluation at a minimum of 2 years postoperatively. In three patients with shoulder abduction recovery, electromyographical studies (EMG) showed a contribution from the end-to-side neurotisation. In the remaining cases end-to-side neurotisations were unsuccessful. Our study did not demonstrate a reliable role for end-to-side nerve suture in brachial plexus surgery. We believe that at present end-to-side suture must not be a substitute for standard reconstructive techniques in brachial plexus surgery. Occasionally termino-lateral nerve sutures may represent a support to standard reconstructive procedures especially in case of severe injuries when few undamaged donor nerves are available. PMID:19587073

  15. Origin of Medial and Lateral Pectoral Nerves from the Supraclavicular Part of Brachial Plexus and its Clinical Importance – A Case Report

    OpenAIRE

    Shetty, Prakashchandra; Nayak, Satheesha B.; Kumar, Naveen; Thangarajan, Rajesh; D’Souza, Melanie Rose

    2014-01-01

    Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral ...

  16. Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications

    OpenAIRE

    Butz, James J; Shiwlochan, Devina G; Brown, Kevin C; Prasad, Alathady M; Murlimanju, Bukkambudhi V; Viswanath, Srikanteswara

    2014-01-01

    During the routine dissection of upper limbs of a Caucasian male cadaver, variations were observed in the brachial plexus. In the right extremity, the lateral cord was piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited the passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal inse...

  17. Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions.

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    Pondaag, W; Malessy, M J A

    2014-07-01

    In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ? Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group (n = 25) and the intercostal nerve transfer group (n = 17). PMID:23940103

  18. Cutaneous Benign Epithelioid Peripheral Nerve Sheath Tumour: A Rare Entity

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    Rao, Anuradha CK; Rao, Lakshmi; Rao, G Chennakeshav; Somayagi, Vasudeva R

    2013-01-01

    Benign epithelioid peripheral nerve sheath tumor, a rare entity is an umbrella term describing benign, neural origin tumors with epithelioid morphology. Clinically indistinguishable from other benign cutaneous lesions, histopathology offers the only source of accurate diagnosis. Morphologic mimics include many benign and malignant soft tissue lesions. Besides a predominant epithelioid component, the lesion can also show a fair share of spindle cells. A circumscribed nodular tumour of low mito...

  19. Nerve growth factor, neuropeptides and cutaneous nerves in atopic dermatitis

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    Hodeib Abeer

    2010-01-01

    Full Text Available Introduction: Neurogenic components, as neurotrophic factors and neuropeptides, are probably involved in the pathogenesis of atopic dermatitis (AD with the neuroimmunocutaneous system as they modify the functions of immunoactive cells in the skin. Nerve growth factor (NGF is the best-characterized member of the neurotrophin family. Both NGF and neuropeptides (NPs may be associated with the disease pathogenesis. Aim: This study aims to evaluate the plasma level of NGF and NPs in AD patients and correlate them with the disease activity and nerve changes in the skin by electron microscopy. Materials and Methods: Plasma levels of NGF and vasoactive intestinal peptide (+VIP were measured by an immunoenzymatic assay while plasma levels of calcitonine gene related peptide (CGRP and neuropeptide Y (NPY were measured by radioimmunoassay in 30 AD patients in comparison to 10 normal non-atopic controls. Electron microscopic study was done in 10 AD patients. Results: It has been found that there is significant increase of plasma levels of NGF and NPs in AD patients compared with controls. There is a positive correlation between the plasma levels of NGF and disease activity (correlation coefficient = 0.750, P< 0.005. There is a significant correlation between the number of Schwann axon complex, evidenced by electron microscopic examination and plasma level of NGF in AD patients. Conclusion: It has been concluded that these neurogenic factors; NGF and NPs modulate the allergic response in AD, probably through interactions with cells of the immune-inflammatory component. NGF might be considered as a marker of the disease activity.

  20. Vascular endothelial growth factor gene therapy improves nerve regeneration in a model of obstetric brachial plexus palsy.

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    Hillenbrand, Matthias; Holzbach, Thomas; Matiasek, Kaspar; Schlegel, Jürgen; Giunta, Riccardo E

    2015-03-01

    The treatment of obstetric brachial plexus palsy has been limited to conservative therapies and surgical reconstruction of peripheral nerves. In addition to the damage of the brachial plexus itself, it also leads to a loss of the corresponding motoneurons in the spinal cord, which raises the need for supportive strategies that take the participation of the central nervous system into account. Based on the protective and regenerative effects of VEGF on neural tissue, our aim was to analyse the effect on nerve regeneration by adenoviral gene transfer of vascular endothelial growth factor (VEGF) in postpartum nerve injury of the brachial plexus in rats. In the present study, we induced a selective crush injury to the left spinal roots C5 and C6 in 18 rats within 24 hours after birth and examined the effect of VEGF-gene therapy on nerve regeneration. For gene transduction an adenoviral vector encoding for VEGF165 (AdCMV.VEGF165) was used. In a period of 11 weeks, starting 3 weeks post-operatively, functional regeneration was assessed weekly by behavioural analysis and force measurement of the upper limb. Morphometric evaluation was carried out 8 months post-operatively and consisted of a histological examination of the deltoid muscle and the brachial plexus according to defined criteria of degeneration. In addition, atrophy of the deltoid muscle was evaluated by weight determination comparing the left with the right side. VEGF expression in the brachial plexus was quantified by an enzyme-linked immunosorbent assay (ELISA). Furthermore the motoneurons of the spinal cord segment C5 were counted comparing the left with the right side. On the functional level, VEGF-treated animals showed faster nerve regeneration. It was found less degeneration and smaller mass reduction of the deltoid muscle in VEGF-treated animals. We observed significantly less degeneration of the brachial plexus and a greater number of surviving motoneurons (P < 0·05) in the VEGF group. The results of this study confirmed the positive effect of VEGF-gene therapy on regeneration and survival of nerve cells. We could demonstrate a significant improvement on the motor-functional as well as on the histomorphological level. However, increased vascularization of the nerve tissue caused by VEGF does not seem to be the major reason for these effects. The clinical use of adenoviral VEGF-gene therapy in the newborn cannot be justified so far. PMID:25213596

  1. Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm

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    Sirasanagandla, Srinivasa Rao; Padavinangady, Abhinitha; Nayak, Satheesha B.; Jetti, Raghu

    2015-01-01

    Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have n...

  2. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

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    Radi Shahien

    2011-02-01

    Full Text Available Radi Shahien, Abdalla BowirratDepartment of Neurology, Ziv Medical Center, Zfat, IsraelAbstract: We report a complication related to epidural analgesia for delivery in a 24-year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy.Keywords: facial nerve paralysis, partial brachial plexopathy, epidural blood patch

  3. Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm.

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    Sirasanagandla, Srinivasa Rao; Padavinangady, Abhinitha; Nayak, Satheesha B; Jetti, Raghu

    2015-03-01

    Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have noticed that the dorsal cutaneous branch of ulnar nerve divided into three branches, the lateral two branches supplied the skin of the medial one and half fingers of the dorsum of hand. The medial branch established communications with the superficial branches of ulnar nerve and distributed to the skin of the one and half fingers of the volar aspect of hand. The possible outcome of this communications is discussed. Course and distribution of ulnar nerve on the contralateral side was found to be normal. PMID:25954612

  4. Cutaneous benign epithelioid peripheral nerve sheath tumour: A rare entity

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    Anuradha CK Rao

    2013-01-01

    Full Text Available Benign epithelioid peripheral nerve sheath tumor, a rare entity is an umbrella term describing benign, neural origin tumors with epithelioid morphology. Clinically indistinguishable from other benign cutaneous lesions, histopathology offers the only source of accurate diagnosis. Morphologic mimics include many benign and malignant soft tissue lesions. Besides a predominant epithelioid component, the lesion can also show a fair share of spindle cells. A circumscribed nodular tumour of low mitotic activity, it often exhibits areas resembling schwannoma or neurofibroma. An awareness of this entity and its varied morphological aspects helps to arrive at the correct diagnosis and hence avoid unnecessary extensive surgical procedures. This case presents features of this benign tumor which occurred in a 47 years old man.

  5. [A pediatric case of rupture of the brachial artery and radial nerve palsy secondary to proximal humeral exostosis].

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    Parratte, S; Launay, F; Jouve, J-L; Malikov, S; Petit, P; Bollini, G

    2007-04-01

    Rupture of the brachial artery associated with radial nerve palsy in a context of exostosis of the proximal humerus has not been described to date in the literature. Our patient was a fourteen-year-old girl with a history of violent pain occurring suddenly with no prodrome or triggering factor. The pain was localized at the level of the proximal left humerus. Physical examination revealed the presence of a hematoma and complete motor radial nerve palsy. The diagnosis was not confirmed by computed tomography with contrast injection but was confirmed by magnetic resonance imaging which eliminated malignant transformation of the exostosis. After checking the neurovascular bundles and evacuating the hematoma, treatment consisted in resection of the exostosis and arterial repair with an autologous venous graft. We discuss the diagnostic and therapeutic challenges which present vascular complications due to exostosis. PMID:17401293

  6. The Lateral Thoracic Nerve and The Cutaneous Maximus Muscle – A Novel In Vivo Model System For Nerve Degeneration And Regeneration Studies

    OpenAIRE

    Pan, Baohan; Grünewald, Benedikt; Nguyen, Thien; Farah, Mohamed; Polydefkis, Michael; McDonald, John; Schramm, Lawrence P.; Toyka, Klaus V.; Höke, Ahmet; Griffin, John W.

    2012-01-01

    We report a novel in vivo mouse model system to study regeneration of injured motor nerve and spatiotemporal pattern of denervation in experimental nerve diseases. The lateral thoracic nerve (LTN), as a pure motor nerve, innervates the cutaneous maximus muscle (CMM) by some of the shortest and the longest motor nerve fibers in the mouse body. Its branches and nerve terminals can be imaged in whole mount preparations. Here we describe the branching pattern of the LTN and its innervation of the...

  7. Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 1): Transferencias nerviosas extraplexuales / Nerve reconstruction techniques in traumatic brachial plexus surgery (Part 1): Extraplexal nerve transfers

    Scientific Electronic Library Online (English)

    J., Robla-Costales; M., Socolovsky; G., Di Masi; L., Domitrovic; A., Campero; J., Fernández-Fernández; J., Ibáñez-Plágaro; J., García-Cosamalón.

    2011-12-01

    Full Text Available Tras el gran entusiasmo generado en las décadas de los años '70 y '80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia n [...] erviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el espinal accesorio, el frénico, los intercostales, etc, para incrementar la cantidad de axones transferidos al plexo lesionado. En los casos de avulsiones de todas las raíces, las neurotizaciones extraplexuales son el único método de reinervación disponible para limitar los efectos a largo plazo de una lesión tan devastadora. Dada la avalancha de trabajos que se han publicado en los últimos años sobre las lesiones traumáticas del plexo braquial, se ha escrito el presente trabajo de revisión con el objetivo de clarificar al interesado las indicaciones, resultados y técnicas quirúrgicas disponibles en el arsenal terapéutico quirúrgico de esta patología. Dado que la elección de una u otra se toma generalmente durante el transcurso del mismo procedimiento, todos estos conocimientos deben ser perfectamente incorporados por el equipo quirúrgico antes de realizar el procedimiento. En esta primera parte se analizan las transferencias nerviosas extraplexuales, para luego hacer lo propio con las intraplexuales, en una segunda entrega. Abstract in english After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This [...] technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerne

  8. The cutaneous branches of the superior gluteal nerve with special reference to the nerve to tensor fascia lata.

    OpenAIRE

    Akita, K.; Sakamoto, H.(International Center for Elementary Particle Physics, Department of Physics, The University of Tokyo, Tokyo, Japan); Sato, T

    1992-01-01

    Cutaneous branches from the superior gluteal nerve were studied in 39 half pelves (18 right, 21 left) of 23 adult Japanese cadavers. A detailed description of the branches is not currently available in the literature. Most of these branches perforated tensor fascia lata and were distributed to the centre of the lateral gluteal region.

  9. Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizado (Parte 2): Transferencias nerviosas intraplexuales / Nerve Reconstruction Techniques in Traumatic Brachial Plexus Surgery (Part 2): Intraplexal nerve transfers

    Scientific Electronic Library Online (English)

    J., Robla-Costales; M., Socolovsky; G., Di Masi; D., Robla-Costales; L., Domitrovic; A., Campero; J., Fernández-Fernández; J., Ibáñez-Plágaro; J., García-Cosamalón.

    2011-12-01

    Full Text Available Tras el gran entusiasmo generado en las décadas de los '70 y '80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nervio [...] sa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el espinal accesorio, el frénico, los intercostales, etc., para incrementar la cantidad de axones transferidos al plexo lesionado. En los casos de avulsiones de todas las raíces, las neurotizaciones extraplexuales son el único método de reinervación disponible para limitar los efectos a largo plazo de una lesión tan devastadora. Dada la avalancha de trabajos que se han publicado en los últimos años sobre las lesiones traumáticas del plexo braquial, se ha escrito el presente trabajo de revisión con el objetivo de clarificar al interesado las indicaciones, resultados y técnicas quirúrgicas disponibles en el arsenal terapéutico quirúrgico de esta patología. Dado que la elección de una u otra se toma generalmente durante el transcurso del mismo procedimiento, todos estos conocimientos deben ser perfectamente incorporados por el equipo quirúrgico antes de realizar el procedimiento. En una primera entrega se analizaron las transferencias nerviosas extraplexuales; este trabajo viene a complementar al anterior revisando las transferencias intraplexuales, y así completando el análisis de las transferencias nerviosas disponibles en la cirugía del plexo braquial. Abstract in english After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This [...] technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in rec

  10. A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

    Scientific Electronic Library Online (English)

    Rodrigo, Mencalha; Neide, Fernandes; Carlos Augusto dos Santos, Sousa; Marcelo, Abidu-Figueiredo.

    2014-06-01

    Full Text Available PURPOSE: To determine the minimum volume of methylene blue (MB) to completely color the brachial plexus (BP) nerves, simulating an effective anesthetic block in cats. METHODS: Fifteen adult male cat cadavers were injected through subscapular approach with volumes of 2, 3, 4, 5 and 6 ml in both f [...] orelimbs, for a total of 30 brachial plexus blocks (BPB). After infusions, the specimens were carefully dissected preserving each nervous branch. The measurement of the effective area was indicated by the impregnation of MB. Nerves were divided into four segments from the origin at the spinal level until the insertion into the thoracic limb muscles. The blocks were considered effective only when all the nerves were strongly or totally colored. RESULTS: Volumes of 2, 3 and 4 ml were considered insufficient suggesting a failed block, however, volumes of 5 and 6 ml were associated with a successful block. CONCLUSIONS: The injection of methylene blue, in a volume of 6 ml, completely colored the brachial plexus. At volumes of 5 and 6 ml the brachial plexus blocks were considered a successful regional block, however, volumes of 2, 3 and 4 ml were considered a failed regional block.

  11. Surgical trainees neuropraxia? An unusual case of compression of the lateral cutaneous nerve of the forearm.

    LENUS (Irish Health Repository)

    Seoighe, D M

    2010-09-01

    Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow extension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficient for sensory recovery to be clinically detectable after 12 weeks.

  12. Electrical nerve stimulation as an aid to the placement of a brachial plexus block : clinical communication

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2002-07-01

    Full Text Available Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned within 2-5mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur. The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.

  13. Increased density of cutaneous nerve fibres in the affected dermatomes after herpes zoster therapy.

    Science.gov (United States)

    Zografakis, Charalampos; Tiniakos, Dina G; Palaiologou, Marina; Kouloukoussa, Mirsini; Kittas, Christos; Staurianeas, Nikos

    2014-03-01

    Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77?±?4.88/mm vs. 13.29?±?5.74/mm, p?=?0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43?±?2.35/mm and 2.8?±?2.86/mm, p?=?0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7?±?2.05/mm vs. 14.72?±?6.13/mm, p?=?0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection. PMID:23995395

  14. The brain plasticity in patients with brachial plexus root avulsion after contralateral C7 nerve-root transfer: a FDG-PET study

    International Nuclear Information System (INIS)

    Objectives: To study FDG-PET for imaging the brain plasticity in patients with brachial plexus root avulsion after contralateral C7 nerve-root transfer. Methods: One male patient with left brachial plexus root avulsion underwent a two-stage procedure (first phase: C7 root ? ulnar nerve; second phase: ulnar nerve ? recipient nerve) 4 years ago; Another with right brachial plexus root avulsion also underwent a two-stage procedure 3 years ago. First two patients underwent basic FDG-PET imaging, the next day FDG-PET scans were performed after initiative or passive limb movement. Using ROI and MPI tools to evaluate the images. The ratios of sensorimotor frontal cingulated Thalami to white matter were used as the semiquantitive index. Results: Whether brain plasticity had occurred was determined by whether the affected limb can perform initiative movement. The increases in glucose metabolism of left sensorimotor frontal cingulated Thalami in patient with left brachial plexus root avulsion were 40.1%, 37.9%, 48.3%, 31.9% after initiative movement, the right corresponding brain regions were 39.4%, 34.3%, 48.5%,35.4% respectively. However, the increases in glucose metabolism of left sensorimotor frontal cingulated Thalami in patient with right brachial plexus root avulsion were increased by 12.6%, 9.6%, 10.7%, 5.3% after passive movement, the right corresponding brain regions were respectively 17.9%, 12.9%, 15.4%, 10.1%. It was founded that the metabolism of bilateral sensorimotor frontal cingulated Thalami increased after initiative movement, while the metabolism of right sensorimotor frontal cingulated Thalami increased more obviously than that of the left brain regions when using MPI tool to substract the images before and after the affected limb movement. Conclusions: Sensorimotor frontal cingulated Thalami were necessary to the initiative movement. After being activated by movement, the metabolisms of plasticised brain regions increased obviously. However, the metabolisms of non-plasticised brain regions increased little. Therefore, FDG-PET can be used to evaluate the brain plasticity in brachial plexus root avulsion after contralateral C7 nerve-root transfer

  15. Rehabilitation Considerations of a Brachial Plexus Injury with Complete Avulsion of C5 and C6 Nerve Roots in a College Football Player: A Case Study

    OpenAIRE

    Saliba, Susan; Saliba, Ethan N; Pugh, Kelli F.; Chhabra, Abhinav; Diduch, David

    2009-01-01

    Severe brachial plexus injuries are rare in sports, but they have catastrophic results with a significant loss of function in the involved upper extremity. Nerve root avulsions must be timely managed with prompt evaluation, accurate diagnosis, and surgical treatment to optimize the potential for a functional outcome. This case report describes the mechanism of injury, diagnostic evolution, surgical management, and rehabilitation of a college football player who sustained a traumatic complete ...

  16. Combinación de transferencias nerviosas en el tratamiento de lesiones altas del plexo braquial / Combinaison des transferts nerveux dans le traitement des lésions du plexus brachial / Combined nerve transfers in the treatment of upper brachial plexus injuries

    Scientific Electronic Library Online (English)

    Enrique, Vergara Amador.

    2012-12-01

    Full Text Available Introducción: en las lesiones altas del plexo braquial se dirige la recuperación de la abducción y flexión del hombro con transferencia del nervio espinal accesorio al nervio supraescapular. El nervio axilar se reconstruye con injertos nerviosos si hubiera disponibilidad de C5 o C6, o con transferen [...] cias nerviosas de ramas del tríceps o de intercostales. La flexión del codo se logra con fascículos nerviosos del cubital al nervio del bíceps. Objetivo: mostrar los resultados en una serie de pacientes con lesión alta del plexo braquial tratados con transferencias nerviosas. Métodos: se estudiaron 34 pacientes con lesión de C5-C6 operados entre 2003 y 2010. Se realizó neurotización del espinal al nervio supraescapular, transferencia de fascículos del cubital al nervio del bíceps y en algunos casos de rama del tríceps al nervio axilar. Las cirugías se hicieron entre los 4 y 12 meses de la lesión. Resultados: en los pacientes con neurotización del axilar con rama del tríceps se obtuvo 110 grados de abducción. La transferencia con fascículos del cubital al bíceps resultó buena, con 118 grados de flexión y fuerza M4; también fueron mejores y más rápidos que los reconstruidos con injertos de nervios. Con la transferencia del espinal accesorio se logró 35 grados de abducción del hombro a los 14 meses. Con el tiempo se recupera un poco más la abducción y aparece la rotación externa, esta última fue de 47 grados en 10 pacientes después de los 18 meses. Usar un nervio del tríceps al nervio axilar mejora la abducción del hombro, en 3 pacientes se logró 110 grados de abducción. Conclusión: hoy día se logran mejores resultados con técnicas de transferencias nerviosas en las lesiones altas del plexo braquial y es el estándar de tratamiento de las avulsiones de C5 y C6. Abstract in english Introduction: in upper brachial plexus injuries, recovery of shoulder abduction and flexion is based on spinal accessory to suprascapular nerve transfer. The axillary nerve is reconstructed with nerve grafts if there is availability of C5 or C6, or with nerve transfers of triceps or intercostal bran [...] ches. Elbow flexion is achieved with nerve fascicles from the cubital to the biceps nerve. Objective: present the results obtained in a series of patients with upper brachial plexus injuries treated with nerve transfers. Methods: a study was conducted of 34 patients with C5-C6 injuries operated on between 2003 and 2010. Spinal to suprascapular nerve neurotization was performed, as well as transfer of fascicles from the cubital to the biceps nerve, and in some cases of triceps branch to the axillary nerve. Surgery was performed within 4 to 12 months from the injury. Results: 110 degrees abduction was obtained in patients with axillary neurotization with triceps branch. Transfer with cubital to biceps fascicles was good, with 118 degrees flexion and M4 strength. They were also better and faster than those reconstructed with nerve grafts. 35 degrees shoulder abduction was achieved with spinal accessory transfer at 14 months. Over time, abduction is further restored, and external rotation appears. In 10 patients external rotation was 47 degrees after 18 months. Triceps to axillary nerve transfer improves shoulder abduction. 110 degrees abduction was achieved in 3 patients. Conclusion: better results are currently obtained with nerve transfer techniques in upper brachial plexus injuries. This is the standard treatment for C5 and C6 avulsions.

  17. Primary Cutaneous Carcinosarcoma: The first reported case with peripheral nerve sheath differentiation

    Directory of Open Access Journals (Sweden)

    Pelin Y?ld?z

    2014-06-01

    Full Text Available Primary cutaneous carcinosarcomas (CS are extremely rare biphasic tumors mainly located on sun-exposed areas. Two hypotheses–multiclonal (convergence and monoclonal (divergence- have been suggested for the evolution of the tumor. According to multiclonal hypothesis two or more stem cells of epithelial and mesenchymal origin give rise to these tumors, while a single totipotential cell differentiatiate into epithelial and mesenchymal components, either synchronously or metachronously according to monoclonal hypothesis. Cutaneous CSs are subdivided into two distinct groups as epidermal and adnexal CSs, due to their epithelial content. We present an interesting cutaneous adnexal CS, showing peripheral nerve sheath differentiation and having the spiradenocarcinoma component derived from spiradenoma. As far as we know, it is the first case of the literature with this features.

  18. Resultado da neurotização do nervo ulnar para o músculo bíceps braquial na lesão do plexo braquial / Results of ulnar nerve neurotization to brachial biceps muscle in brachial plexus injury

    Scientific Electronic Library Online (English)

    Marcelo Rosa de, Rezende; Neylor Teofilo Araújo, Rabelo; Clóvis Castanho, Silveira Júnior; Pedro Araújo, Petersen; Emygdio José Leomil de, Paula; Rames, Mattar Júnior.

    2012-12-01

    Full Text Available OBJETIVO: Avaliar de forma crítica os fatores que influenciam os resultados da neurotização do nervo ulnar no ramo motor do músculo bíceps braquial, visando a restauração da flexão do cotovelo em pacientes com lesão do plexo braquial. MÉTODOS: 19 pacientes, 18 homens e uma mulher, com idade média de [...] 28,7 anos foram avaliados entre fevereiro de 2003 e maio de 2007. Oito pacientes apresentavam lesão das raízes C5-C6 e 11, das raízes C5-C6-C7. O intervalo de tempo médio entre a injúria e o tratamento cirúrgico foi 7,5 meses. Quatro pacientes apresentavam fraturas cervicais associadas à lesão do plexo braquial. O seguimento pós-operatório foi de 15,7 meses. RESULTADO: Oito pacientes recuperaram força de flexão do cotovelo MRC grau 4; dois, MRC grau 3 e nove, MRC Abstract in english OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachial biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight pat [...] ients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC

  19. Ultrasound Guided Transversus Abdominis Plane Block for Anterior Cutaneous Nerve Entrapment Syndrome.

    Science.gov (United States)

    Sahoo, Rajendra Kumar; Nair, Abhijit S

    2015-10-01

    Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time. PMID:26495084

  20. Lesiones altas del plexo braquial. Reconstrucción con técnicas combinadas de neurotización e injertos nerviosos / Upper brachial plexus injuries. Reconstruction with combined techniques of neurotization and nerve grafts

    Scientific Electronic Library Online (English)

    Enrique, Vergara-Amador.

    2015-01-01

    Full Text Available Antecedentes. Las lesiones altas del plexo braquial son reconstruidas con neurotización e injerto nervioso. El nervio espinal accesorio, la raíz C7, las ramas del tríceps y los nervios mediano y cubital son los más usados para transferencias. Objetivo. Mostrar la experiencia con neurotización de la [...] rama inferior del nervio espinal accesorio (NEA) al nervio supraescapular (NSE), transferencia nerviosa de fascículos del nervio cubital o del mediano y, en ocasiones, injertos nerviosos hacia el nervio musculocutáneo y al tronco posterior, y reconstrucción del nervio axilar en algunos casos. Materiales y métodos. Se revisan 42 pacientes con lesiones altas de plexo braquial, operados mediante combinación de neurotización e injertos nerviosos. Se hizo un seguimiento mínimo de 15 meses. Resultados. Las lesiones de 40 pacientes fueron producidas por accidente en moto. En 22 solo se transfirió el NSE con el NEA; con esto, se recuperó abducción de hombro de 33º. A 8 pacientes se les combinó con reparación del axilar; mejorando la abducción a 81º. En 30 pacientes con neurotización del nervio cubital o mediano para el bíceps, se obtuvo respuesta a los 3 o 4 meses. Al final, la flexión del codo era de 116º y M4. Conclusión. Los mejores resultados en hombro fueron con la combinación de NSE y del nervio axilar; con esta, se logró 81º de abducción. La rotación externa mejoró en 28,5% de los pacientes, con respuesta tardía. Mientras que la neurotización del bíceps con fascículos del cubital consiguió una flexión de 116º, muy comparable con otras series. Hoy esta técnica es el gold estandard para la reconstrucción de flexión del codo. Abstract in english Background. The upper brachial plexus injuries are reconstructed with neurotization and nerve grafting. The spinal accessory nerve, C7 root, branches of the triceps, and median and ulnar nerve are most commonly used for transfers. Objective. To show the experience with neurotization of the lower bra [...] nch of the spinal accessory nerve (NEA) to suprascapular nerve (NSE), nerve fascicles transfer of median or ulnar nerve, and sometimes nerve grafting to the musculocutaneous nerve and the posterior trunk, and axillary nerve reconstruction in some cases. Materials and methods. We reviewed 42 patients with upper brachial plexus injuries, operated by the combination transfer and nerve grafts. Minimum follow-up 15 months. Results. 40 patients were due to motorcycle accidents. In only 22 was transferred the NEA to NSE, recovering shoulder abduction of 33 °. In 8 patients to combine with axillary nerve repair, improved abduction to 81°. In 30 patients with ulnar or median nerve neurotization to the biceps, the response was obtained between 3 and 4 months. At follow- up elbow flexion was 116° and M4. Conclusion. The best results in shoulder were obtained with the combination of NSE and axillary nerve, achieving 81 ° of abduction. External rotation improved in 28.5% of patients, with a delayed response. Shoulder flexion of 116 was obtained with ulnar nerve neurotization, very comparable with other series. Today this technique is the gold standard for reconstruction of elbow flexion.

  1. Sensory nerves contribute to cutaneous vasodilator response to cathodal stimulation in healthy rats.

    Science.gov (United States)

    Gohin, Stéphanie; Decorps, Johanna; Sigaudo-Roussel, Dominique; Fromy, Bérengère

    2015-09-01

    Cutaneous current-induced vasodilation (CIV) in response to galvanic current application is an integrative model of neurovascular interaction that relies on capsaicin-sensitive fiber activation. The upstream and downstream mechanisms related to the activation of the capsaicin-sensitive fibers involved in CIV are not elucidated. In particular, the activation of cutaneous transient receptor potential vanilloid type-1 (TRPV1) channels and/or acid-sensing ion channels (ASIC) (activators mechanisms) and the release of calcitonin gene-related peptide (CGRP) and substance P (SP) (effector mechanisms) have been tested. To assess cathodal CIV, we measured cutaneous blood flow using laser Doppler flowmetry for 20min following cathodal current application (240s, 100?A) on the skin of the thigh in anesthetized healthy rats for 20min. CIV was studied in rats treated with capsazepine and amiloride to inhibit TRPV1 and ASIC channels, respectively; CGRP8-37 and SR140333 to antagonize CGRP and neurokinin-1 (NK1) receptors, respectively; compared to their respective controls. Cathodal CIV was attenuated by capsazepine (12±2% vs 54±6%, Preceptors suggests that cathodal CIV is the result of CGRP and SP released through activated capsaicin-sensitive fibers. Therefore cathodal CIV could be a valuable method to assess sensory neurovascular function in the skin, which would be particularly relevant to evaluate the presence of small nerve fiber disorders and the effectiveness of treatments. PMID:26205659

  2. The application of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the key technique and application value of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysms. Methods: Since Mach 1997 to October 2002, endovascular exclusion for abdominal aortic aneurysm had been preformed on 136 patients. The main body short limb graft was used in 118 cases. (Vanguard 6, Talent 86, AneuRx 2, Zenith 3, domestic 21). 12 of these patients were undergone brachial-femoral guidewire technique for the procedure. Results: All of the 12 cases with brachial-femoral stretch guidewire technique had the stent-grafts introduced, connected and released successfully. One case suffered brachial artery thrombosis postoperatively. One case had left medial antebrachial cutaneous nerve injured, but no other artery or incision complications occurred. 9 cases with the brachial-femoral stretch guidewire technique showed obviously, shortening of the time for this procedure. Conclusions: For the patients with poor general condition or specific anatomic conditions, such as aneurysm diameter >6 cm and the angle between aneurysm and common iliac artery >45 degree, aneurysm necktwist > 30 degree or iliac artery twist > 45 degree, age over 75 years old and combination with more than one important organ disfunction, the brachial-femoral guidewire technique is the valuable method of choice

  3. Brachial plexopathy

    OpenAIRE

    Khadilkar, Satish V.; Khade, Snehaldatta S.

    2013-01-01

    Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles....

  4. Cutaneous manipulation of vascular growth factors leads to alterations in immunocytes, blood vessels and nerves: evidence for a cutaneous neurovascular unit

    Science.gov (United States)

    Ward, Nicole L; Hatala, Denise A; Wolfram, Julie A; Knutsen, Dorothy A.; Loyd, Candace M

    2011-01-01

    Background Skin cells produce soluble factors which influence keratinocyte proliferation, angiogenesis, nerve innervation and immunocyte response. Objective To test the hypothesis that epidermal-dermal interactions influence neural outgrowth, vascular survival, immunocyte recruitment and keratinocyte proliferation. Methods We genetically manipulated the epidermis to express excess vascular endothelial growth factor (VEGF) and/or angiopoietin-1 (Ang1) and then examined the epidermal and dermal phenotypes. We compared these findings with those occurring following overexpression of the Ang1 receptor Tie2 in endothelial cells or keratinocytes. Results Keratinocyte-overexpression of Ang1 resulted in increased epidermal thickness compared to control littermates. Keratinocyte-specific overexpression of Ang1 or VEGF increased dermal angiogenesis compared to control animals and combined Ang1-VEGF lead to further increases. Cutaneous leukocyte examination revealed increases in CD4+ T cell infiltration in mice with keratinocyte-specific overexpression of Ang1, VEGF and Ang1-VEGF combined; in contrast only keratinocyte-specific Ang1 overexpression increased cutaneous F4/80+ macrophage numbers. Interestingly, combined keratinocyte-derived Ang1-VEGF overexpression reduced significantly the number of F4/80+ and Cd11c+ cells compared to mice overexpressing epidermal Ang1 alone. Endothelial cell-specific Tie2 overexpression increased dermal angiogenesis but failed to influence the epidermal and immune cell phenotypes. Keratinocyte-specific Tie2 expressing mice had the highest levels of CD4+, CD8+ and CD11c+ cell numbers and acanthosis compared to all animals. Finally, increases in the number of cutaneous nerves were found in all transgenic mice compared to littermate controls. Conclusion These findings demonstrate that change to one system (vascular or epidermal) results in change to other cutaneous systems and suggest that individual molecules can exert effects on multiple systems. PMID:21129919

  5. Local cutaneous nerve terminal and mast cell responses to manual acupuncture in acupoint LI4 area of the rats.

    Science.gov (United States)

    Wu, Mei-Ling; Xu, Dong-Sheng; Bai, Wan-Zhu; Cui, Jing-Jing; Shu, Hong-Ming; He, Wei; Wang, Xiao-Yu; Shi, Hong; Su, Yang-Shuai; Hu, Ling; Zhu, Bing; Jing, Xiang-Hong

    2015-10-01

    Previous studies have shown that the effects of manual acupuncture (MA) are contributed by collagen fibers and mast cells in local acupoints, at which acupuncture stimulation causes various afferent fiber groups to be excited. However what happens in local nerve fibers and mast cells after MA remains unclear. The aim of this study was to examine the response of cutaneous nerve fibers and mast cells to MA stimulation in acupoint Hegu (LI4). The contralateral LI4 of the same rat was used as a non-stimulated control. Immnohistochemistry analysis were carried out to observe the expression of histamine (HA), serotonin (5-HT) and nociceptive neuropeptides, calcitonin gene-related peptide (CGRP) and substance P (SP), in the LI4 area. Mast cells were labeled with anti-mast cell tryptase antibody and simultaneously with HA or 5-HT primary antibodies to observe their co-expression. Our results showed that SP and CGRP were expressed more highly on the cutaneous nerve fibers of LI4 after MA stimulation than that of the control. Mast cells aggregated in close proximity to the blood vessels in intra-epidermis and dermis and some of them with degranulation in the lower dermis and subcutaneous tissue of LI4. Both mast cells and their granules appeared with HA (+) and 5-HT (+) expression at stimulated L14 sites, while a few intact mast cells with a little expression of 5-HT and HA were distributed in areas of non-stimulated L14. The results indicated that local cutaneous nerve terminals and mast cells responded to MA with higher expression of SP and CGRP in nerve fibers, as well as with aggregation and degranulation of mast cells with HA and 5-HT granules at acupoint LI4. These neuroactive substances may convey signals to certain pathways that contribute to the effects of acupuncture. PMID:26148746

  6. Suplantación del ramo superficial del nervio radial por el nervio cutáneo antebraquial lateral / Supplantation of the superficial branch of the radial nerve by the lateral antebrachial cutaneous nerve

    Scientific Electronic Library Online (English)

    Gloria, Baena Caldas; Elizabeth, Peña Tovar; Janneth, Zúñiga.

    2013-12-01

    Full Text Available Introducción: la inervación sensorial del dorso de la mano proviene principalmente del ramo superficial del nervio radial, pero este territorio puede ser asumido por el nervio cutáneo antebraquial lateral. Objetivo: describir una rara variación anatómica del nervio cutáneo antebraquial lateral, hall [...] ada en el anfiteatro del Departamento de Morfología de la Universidad del Valle, en Cali, Colombia. Materiales y Métodos: cadáver masculino, colombiano, disecado por estudiantes de Medicina. Resultados: el ramo superficial del nervio radial estaba ausente y su territorio sensorial había sido asumido totalmente por el nervio cutáneo antebraquial lateral, el cual se prolongaba hasta el dorso de la mano y se dividía en nervios digitales dorsales que alcanzaban el dorso de los dedos pulgar, índice, medio y mitad lateral del anular. Discusión y Conclusiones: por las implicaciones clínico-quirúrgicas que puede tener la distribución de un nervio, es importante conocer con precisión su anatomía normal y sus posibles variaciones y orientarlas al conocimiento de las características morfológicas de cada población. (MÉD.UIS.2013; 26(3) :51-55) Abstract in english Introduction: the sensitive innervation of the dorsum of the hand comes mainly from the superficial branch of the radial nerve, but this territory can be assumed by the lateral antebrachial cutaneous nerve. Objective: to describe a rare variation of the lateral cutaneous nerve of the forearm found i [...] n the cadaver lab of the Department of Morphology, at the Universidad del Valle in Cali, Colombia. Materials and Methods: male colombian cadaver, dissected by medical students. Results: the superficial branch of the radial nerve was absent and its sensory territory was totally assumed by the lateral antebrachial cutaneous nerve, which in the dorsum of the hand divided in the digital dorsal nerves for the thumb, index and middle fingers and the lateral half of the fourth digit. Discussion and Conclusion: considering the clinical and surgical implications that the distribution of a nerve can have, it is important to know precisely its normal anatomy and its possible variations, and direct them to the knowledge about the morphological characteristics of each population. (MÉD. UIS.2013;26(3):51-55)

  7. Brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Satish V Khadilkar

    2013-01-01

    Full Text Available Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN, often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise.

  8. Transcriptional Profiling of Cutaneous MRGPRD Free Nerve Endings and C-LTMRs

    Directory of Open Access Journals (Sweden)

    Ana Reynders

    2015-02-01

    Full Text Available Cutaneous C-unmyelinated MRGPRD+ free nerve endings and C-LTMRs innervating hair follicles convey two opposite aspects of touch sensation: a sensation of pain and a sensation of pleasant touch. The molecular mechanisms underlying these diametrically opposite functions are unknown. Here, we used a mouse model that genetically marks C-LTMRs and MRGPRD+ neurons in combination with fluorescent cell surface labeling, flow cytometry, and RNA deep-sequencing technology (RNA-seq. Cluster analysis of RNA-seq profiles of the purified neuronal subsets revealed 486 and 549 genes differentially expressed in MRGPRD-expressing neurons and C-LTMRs, respectively. We validated 48 MRGPD- and 68 C-LTMRs-enriched genes using a triple-staining approach, and the Cav3.3 channel, found to be exclusively expressed in C-LTMRs, was validated using electrophysiology. Our study greatly expands the molecular characterization of C-LTMRs and suggests that this particular population of neurons shares some molecular features with A? and A? low-threshold mechanoreceptors.

  9. Neurinomas of the brachial plexus: case report.

    Science.gov (United States)

    Forte, A; Gallinaro, L S; Bertagni, A; Montesano, G; Prece, V; Illuminati, G

    1999-01-01

    Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves, a low proportion of which arise from the brachial plexus. Authors report a case of an ancient schwannoma arising from the brachial plexus. The tumour, usually asymptomatic, may cause sensory radicular symptoms, or rarely motor deficits in the involved arm. Enucleation of the tumour from the nerve without damage to any of the fascicles is the correct treatment. PMID:10710825

  10. Obstetric brachial plexus injury

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

    Full Text Available Obstetric brachial plexus injury (OBPI, also known as birth brachial plexus injury (BBPI, is unfortunately a rather common injury in newborn children. Incidence varies between 0.15 and 3 per 1000 live births in various series and countries. Although spontaneous recovery is known, there is a large subset which does not recover and needs primary or secondary surgical intervention. An extensive review of peer-reviewed publications has been done in this study, including clinical papers, review articles and systematic review of the subject. In addition, the authors? experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Causes of OBPI, indications of primary nerve surgery and secondary reconstruction of shoulder, etc. are discussed in detail. Although all affected children do not require surgery in infancy, a substantial proportion of them, however, require it and are better off for it. Secondary surgery is needed for shoulder elbow and hand problems. Results of nerve surgery are very encouraging. Children with OBPI should be seen early by a hand surgeon dealing with brachial plexus injuries. Good results are possible with early and appropriate intervention even in severe cases.

  11. MR imaging of brachial plexus

    International Nuclear Information System (INIS)

    The brachial plexus is a difficult region to evaluate with radiological techniques. MR imaging has great potentials for the depiction of the various anatomical structures of the branchial plexus - i.e., spinal ganglion, ventral nerve rami root exit of the neural foramina, trunks an cordes. Moreover, MR imaging, thanks to its direct multiplanarity, to its excellent soft-tissue contrast, and to its lack of motion artifacts, allows good evaluation of pathologic conditions in the branchial plexus, especially traumas and cancers. On the contrary CT, in spite of its high spatial resolution and good contrast, cannot demonstrate the anatomical structures of the brachial plexus. US detects superficials structures, and conventional radiographs depict only indirect changes in the adjacent lung apex and skeletal structures. From November 1989 to May 1990, 20 normal volunteers (15 males and 5 females; average age: 35 years) were studied with MR imaging. Multisection technique was employed with a dedicated coil and a primary coil. The anatomical structures of the brachial plexus were clearly demonstrated by T1-weighted sequences on the sagittal and axial planes. T2-weighted pulse sequences on the coronal plane were useful for the anatomical definition of the brachial plexus and for eventual tissue characterization. The correct representation of the anatomical structures of the brachial plexus allowed by MR imaging with author's standard technique makes MR imaging the most appropriate exam for the diagnosis of pathologic conditions in the brachial plexus, although its use must be suggested by specific clinical questions

  12. The medial cord to musculocutaneous (MCMc) nerve transfer: a new method to reanimate elbow flexion after C5-C6-C7-(C8) avulsive injuries of the brachial plexus--technique and results.

    Science.gov (United States)

    Ferraresi, S; Garozzo, D; Basso, E; Maistrello, L; Lucchin, F; Di Pasquale, P

    2014-04-01

    The aim of this paper is to report on our ample experience with the medial cord to musculocutaneous (MCMc) nerve transfer. The MCMc technique is a new type of neurotization which is able to reanimate the elbow flexion in multilevel avulsive injuries of the brachial plexus provided that at least the T1 root is intact. A series of 180 consecutive patients, divided into four classes according to the quality of hand function, is available for a long-term follow-up after brachial plexus surgery. The patients enrolled for the study have in common a brachial plexus palsy showing multiple cervical root avulsive injuries at two (C5-C6), three (C5-C6-C7) and four (C5-C6-C7-C8) levels. The reinnervation of the musculocutaneous nerve is obtained via an end-to-end transfer from two donor fascicles located in the medial cord. The selected fascicles are those directed principally to the flexor carpi radialis, ulnaris and, to a lesser degree, the flexor digitorum profundus. Under normal anatomic conditions, they are located in the medial cord, and their site corresponds to the inverted V-shaped bifurcation between the internal contribution of the median nerve and the ulnar nerve. The technique has no failure and no complications when the hand shows a normal wrist and finger flexion and a normal intrinsic function. In case of suboptimal conditions of the hand, the technique has proved technically more challenging, but still with 67% satisfactory results. In the four-root avulsive injuries, however, this method shows its limitations and an alternative strategy should be preferred when possible. EMG analysis shows a reinnervation in both the biceps and the brachialis muscles, explaining the high quality of the observed results. Moreover, this technique theoretically offers the possibility of a "second attempt" at a more distal level in case of failure of the first surgery. This procedure is quick, safe, extremely effective and easily feasible by an experienced plexus surgeon. The ideal candidate is a patient harbouring a C5-C6 avulsive injury of the upper brachial plexus with a normally functioning hand. PMID:24526364

  13. Distribución de los Nervios Cutáneo Dorsal Medial y Cutáneo Dorsal Intermedio en el Hombre / Distribution of the Medial Dorsal Cutaneous and Intermediate Dorsal Cutaneous Nerves in Man

    Scientific Electronic Library Online (English)

    Karina, Hunter; Mariano, del Sol.

    2010-09-01

    Full Text Available Gran parte de la inervación sensitiva del dorso del pie está dada por los ramos cutáneos del nervio fibular superficial, los nervios cutáneo dorsal medial (NCDM) y cutáneo dorsal intermedio (NCDI). El objetivo de esta investigación fue estudiar las divisiones de los NCDM y NCDI a nivel del tercio di [...] stal de la pierna y el dorso del pie, para contribuir con conocimientos específicos al abordaje quirúrgico de la región. Disecamos 19 piernas y pies en cadáveres de individuos adultos, masculinos, correspondientes al Departamento de Morfología de la Universidad de La Frontera de Temuco. Se dividió el dorso del pie, en tercios anterior, medio, posterior y luego, las divisiones observadas se padronizaron. La división de los NCDM y NCDI, en ramos medial y lateral, se observó en el tercio distal de la pierna, en un 47,4% y 52,6% respectivamente. La división del ramo medial de los NCDM y NCDI en ramos terminales, se observó en el tercio posterior del dorso del pie (42,2%) y en el tercio distal de la pierna (21,1%), respectivamente. La división del ramo lateral de los NCDM y NCDI en ramos terminales, se observó en el tercio posterior del dorso del pie (21,1%) y en el tercio anterior del dorso del pie (15,8%) respectivamente. La división de los ramos terminales del ramo medial de los NCDM y NCDI en nervios digitales dorsales, se observó en el tercio medio del dorso del pie en un 21,1% y 15,6% respectivamente. La división de los ramos terminales del ramo lateral de los NCDM y NCDI en nervios digitales dorsales, se observó en el tercio anterior del dorso del pie en un 15,8%, para ambos. Estos datos, pueden servir de referencia durante los procedimientos quirúrgicos realizados en la región, evitando lesiones iatrogénicas del área. Abstract in english The sensory innervation of the dorsum of the foot is given by the cutaneous branches of the superficial fibular nerve, the medial dorsal cutaneous (MDCn) and intermediate dorsal cutaneous (IDCn) nerves. The aim of this research was to study the divisions of the MDCn and IDCn at the distal third of t [...] he leg and dorsum of the foot, to contribute expertise for the surgical approach in the región. Nineteen legs and feet of adult male cadavers, of the Department of Morphology, Universidad de La Frontera in Temuco, were dissected. We divided the dorsum of the foot in anterior, middle and posterior third, then the divisions were observed and patterned. The division of the MDCn and IDCn in medial and lateral branches was observed in the distal third of the leg, 47.4% and 52.6% respectively. The division of the medial branch of the MDCn and IDCn in terminal branches, was observed in the posterior third of the dorsum of the foot (42.2%) and in the distal third of the leg (21.1%), respectively. The division of the lateral branch of the MDCn and IDCn in terminal branches, was observed in the posterior third of the dorsum of the foot (21.1%) and in the anterior third of the dorsum of the foot (15.8%) respectively. The division of the terminal branches of the medial branch of the MDCn and IDCn in dorsal digital nerves was observed in the middle third of the dorsum of the foot at 21.1% and 15.6% respectively. The division of the terminal branches of the lateral branch of the MDCn and IDCn in dorsal digital nerves was observed in the anterior third of the dorsum of the foot at 15.8% for both. These data may serve as a reference during surgical procedures performed in the region, avoiding iatrogenic injuries of the area.

  14. ASPECTOS BIOMÉTRICOS DE LOS RAMOS MOTORES DEL NERVIO MUSCULOCUTÁNEO PARA EL MÚSCULO BRAQUIAL / BIOMETRIC ASPECTS OF THE MOTOR BRANCHES OF THE MUSCULOCUTANEOUS NERVE TO THE BRACHIAL MUSCLE

    Scientific Electronic Library Online (English)

    E., Olave; C., Gabrielli; M. T. T., Braga; M., del Sol.

    Full Text Available RESUMEN: Los puntos motores son el lugar de penetración de las fibras motoras en el músculo a través del epimisio por lo que su conocimiento es de importancia, sobretodo cuando se quiere electroestimular un músculo atrofiado. En relación a este tema, estudiamos la inervación del músculo braquial, de [...] scribiendo con detalles los ramos que proceden del nervio musculocutáneo, considerando el nivel en que se originan, su distribución terminal y nivel de penetración en el tejido muscular. Para ello, estudiamos 46 miembros superiores de 23 cadáveres formolizados de individuos adultos, brasileños, de ambos sexos. Para determinar el punto de origen y el punto de penetración de los ramos musculares mencionados se consideró como referencia a la línea biepicondilar (LBE). El músculo braquial recibió ramos procedentes del nervio musculocutáneo en todos los casos (100%); un ramo fue encontrado en 15 casos (65,2%) en el lado derecho y en 18 casos (78,3%) en el izquierdo; con dos ramos se observaron 6 casos (26,1%) en el lado derecho y 2 casos (8,7%) en el izquierdo. También se presentaron 3 y 4 ramos. Cuando se presentó 1 ramo, su nivel de origen en el lado derecho fue en promedio de 130,1 ± 13,3 mm respecto de LBE y de 127,8 ± 12,0 mm en el izquierdo. Cuando se presentaron dos ramos, el nivel de origen de éstos, en el lado derecho fue en promedio de 126,2 ± 14,5 mm para el proximal y de100,2 ± 37,1 mm para el distal, siempre respecto de LBE. En el lado izquierdo, por tratarse de solo dos casos, no se calculó el promedio. Con respecto al punto de ingreso en el vientre muscular, la mayor parte de ellos lo hicieron por la parte medial del músculo, encontrando que cuando fue ramo único, 13 de ellos tuvieron esta característica en el lado derecho y 15 en el izquierdo. La casi totalidad de estos nervios se subdividieron en ramos menores (secundarios), encontrando 2, 3, 4 y 5 de ellos, los que penetraron en el tejido muscular a distintos niveles. Estos datos pueden servir de referencia a las cirugías de reinervación, bloqueo selectivo de puntos motores y tratamientos fisioterapéuticos en el brazo Abstract in english SUMMARY: The motor points are the penetration place of the motor fibers in the muscle through the epimisio, that is why its knowledge is of great importance, mainly when an atrophied muscle require to be electro-stimulated. In relation to this subject, we studied the innervation of the brachial musc [...] le, describing in detail the branches coming from the musculocutaneous nerve, taking into account the levels where they originate, their final distribution and the penetration level in the muscular tissue. For this purpose, we have studied 46 upper limbs of 23 formolized corpses of Brazilian adult individuals of both sexes.In order to determine the origin and the penetration points of the mentioned muscular branches the biepicondilar line (LBE) was considered as reference. The brachial muscle received branches coming from the musculocutaneous nerve in all cases (100%); 1 branch was found in 15 cases (65.2%) at the right side and in 18 cases (78.3%) at the left side. With 2 branches, 6 cases (26.1%) were observed at the right side and 2 cases (8.7%) at the left side. There were also 3 and 4 branches. When there was only 1 branch, its origin level at the right side was of 130.1 ± 13.3 mm on average in respect to LBE and of 127.88 ± 12.0 mm at the left side. When there were 2 branches, their origin level was 126.2 ± 14.5 mm on average for the proximal and of 100.2 ± 37.1 mm for the distal, always in respect to LBE. At the left side, as there were only 2 cases, the average was not calculated. In relation to the entrance point in the muscular vientre, most of then did it through the medial portion of the muscle, finding that, when there was a single branch, 13 of then had this characteristic at the right side and 15 at the left side. Almost all these nerves subdivided in smaller branches (secondary) finding 2, 3, 4 and 5 of them, which penetrated in the muscular tissue at

  15. Malignant brachial plexopathy: A pictorial essay of MRI findings

    Directory of Open Access Journals (Sweden)

    Iyer Veena

    2010-01-01

    Full Text Available For imaging, the brachial plexus is a technically and anatomically challenging region of the peripheral nervous system. MRI has a central role in the identification and accurate characterization of malignant lesions arising here, as also in defining their extent and the status of the adjacent structures. The purpose of this pictorial essay is to describe the MRI features of primary and secondary malignant brachial plexopathies and radiation-induced brachial nerve damage.

  16. MRI of the brachial plexus: A pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Es, Hendrik W. van [Department of Radiology, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein (Netherlands)], E-mail: h.es@antoniusziekenhuis.nl; Bollen, Thomas L.; Heesewijk, Hans P.M. van [Department of Radiology, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein (Netherlands)

    2010-05-15

    Magnetic resonance imaging (MRI) of the brachial plexus is the imaging modality of first choice for depicting anatomy and pathology of the brachial plexus. The anatomy of the roots, trunks, divisions and cords is very well depicted due to the inherent contrast differences between the nerves and the surrounding fat. In this pictorial review the technique and the anatomy will be discussed. The following pathology will be addressed: neurogenic tumors of the brachial plexus and sympathetic chain, superior sulcus tumors, other tumors in the vicinity of the brachial plexus, the differentiation between radiation and metastatic plexopathy, trauma, neurogenic thoracic outlet syndrome and immune-mediated neuropathies.

  17. MRI of the brachial plexus: A pictorial review

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) of the brachial plexus is the imaging modality of first choice for depicting anatomy and pathology of the brachial plexus. The anatomy of the roots, trunks, divisions and cords is very well depicted due to the inherent contrast differences between the nerves and the surrounding fat. In this pictorial review the technique and the anatomy will be discussed. The following pathology will be addressed: neurogenic tumors of the brachial plexus and sympathetic chain, superior sulcus tumors, other tumors in the vicinity of the brachial plexus, the differentiation between radiation and metastatic plexopathy, trauma, neurogenic thoracic outlet syndrome and immune-mediated neuropathies.

  18. Role of dexamethasone in brachial plexus block

    International Nuclear Information System (INIS)

    To evaluate the effect of dexamethasone added to (lignocaine) on the onset and duration of axillary brachial plexus block. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from September 2009 to March 2010. Patients and Methods: A total of 100 patients, who were scheduled for elective hand and forearm surgery under axillary brachial plexus block, were randomly allocated to group A in which patients received 40 ml 1.5% lidocaine with 2 ml of isotonic saline (0.9%) and group B in which patients received 40 ml 1.5% lidocaine with 2 ml of dexamethasone (8 mg). Nerve stimulator with insulated needle for multiple stimulations technique was used to locate the brachial plexus nerves. After the injection onset of action and duration of sensory blockade of brachial plexus were recorded at 5 minutes and 15 minutes interval. Results: Group A showed the onset of action of 21.64 ± 2.30 min and in group B it was 15.42 ± 1.44 min (p< 0.001). Duration of nerve block was 115.08 ± 10.92 min in group A and 265.42 ± 16.56 min in group B (p < 0.001). Conclusion: The addition of dexamethasone to 1.5% lignocaine solution in axillary brachial plexus block prolongs the duration of sensory blockade significantly. (author)

  19. División Alta del Nervio Fibular Superficial: Origen Precoz de los Nervios Cutáneos Dorsales del Pie / High Division of Superficial Fibular Nerve: Early Origin of the Dorsal Cutaneous Nerves of the Foot

    Scientific Electronic Library Online (English)

    E, Olave; C, Galaz; P, Retamal; C, Cruzat.

    2011-06-01

    Full Text Available Los nervios cutáneos dorsales del pie se originan a partir del nervio fibular superficial (NFS), después que éste pasa desde el compartimiento lateral de la pierna a través de la fascia profunda, para luego distribuirse superficialmente en el dorso del pie. A veces, el nervio fibular superficial se [...] divide precozmente, por lo que estos nervios se originan profundamente y con una disposición diferente. Con el propósito de dar a conocer en estos casos, los niveles de origen de los nervios cutáneos dorsales del pie y el punto de penetración en la fascia profunda de la pierna, se estudiaron 16 muestras de individuos, chilenos, adultos, fijadas en formaldehido al 10%. En 2 de ellas, su origen se observó a un nivel alto, cerca de la parte proximal de la fíbula. En el primer caso, el nervio cutáneo dorsal intermedio se originó directamente de la división posterior del NFS; la división anterior del NFS se subdividió en dos ramos, los que después de un corto trayecto se unieron y formaron el nervio cutáneo dorsal medial. En el segundo caso, los nervios cutáneos dorsales intermedio y medial se originaron directamente del NFS, que después de un corto trayecto se dividió en estos dos nervios. El origen de los nervios cutáneos dorsales del pie se registró en relación al epicóndilo lateral del fémur y el paso de éstos a través de la fascia profunda de la pierna hacia su distribución cutánea fue relacionado al maléolo lateral. Aunque el origen de los nervios cutáneos dorsales del pie ocurra a un nivel próximo a la cabeza de la fíbula, perforan la fascia mencionada, en su tercio distal. Un conocimiento detallado del NFS y de sus ramos y variaciones anatómicas puede reducir lesiones iatrogénicas en éstos durante los procedimientos quirúrgicos realizados en el compartimiento lateral de la pierna. Abstract in english The dorsal cutaneous nerves of the foot originate from the superficial fibular nerve (SFN), then pass from the lateral compartment of the leg piercing the deep fascia, thus distributed superficially in the dorsum of the foot. Sometimes SFN splits early, so these nerves originate deeply and with a di [...] fferent arrangement. The objective of this research was to study in these cases, the origin of the dorsal cutaneous nerves of the foot and pierce point level in the deep fascia of the leg. We studied 16 formolized samples of Chilean adult individuals. In two of them its origin was observed at a high level, near the proximal epiphysis of the fibula. In the first case the intermediate dorsal cutaneous nerve arose directly from the posterior division of SFN, of short course; the anterior division of SFN was subdivided into two branches, which after a short course, both branches joined to form the medial dorsal cutaneous nerve. In the second case the medial and intermediate dorsal cutaneous nerves originated directly from the SFN, which after a short course, it divided in these two nerves. The origin level was recorded in relation to the lateral epicondyle of the femur and the passage of these nerves through the deep fascia of the leg for its skin distribution was located in relation to the lateral malleolus. Although the origin of the dorsal cutaneous nerves of the foot occur very close to the proximal epiphysis of the fibula, passing through the mentioned fascia in its distal third. A detailed knowledge of the branches of the SFN and variations can reduce injuries in these nerves during surgical procedures in the lateral compartment of the leg.

  20. División Alta del Nervio Fibular Superficial: Origen Precoz de los Nervios Cutáneos Dorsales del Pie High Division of Superficial Fibular Nerve: Early Origin of the Dorsal Cutaneous Nerves of the Foot

    Directory of Open Access Journals (Sweden)

    E Olave

    2011-06-01

    Full Text Available Los nervios cutáneos dorsales del pie se originan a partir del nervio fibular superficial (NFS, después que éste pasa desde el compartimiento lateral de la pierna a través de la fascia profunda, para luego distribuirse superficialmente en el dorso del pie. A veces, el nervio fibular superficial se divide precozmente, por lo que estos nervios se originan profundamente y con una disposición diferente. Con el propósito de dar a conocer en estos casos, los niveles de origen de los nervios cutáneos dorsales del pie y el punto de penetración en la fascia profunda de la pierna, se estudiaron 16 muestras de individuos, chilenos, adultos, fijadas en formaldehido al 10%. En 2 de ellas, su origen se observó a un nivel alto, cerca de la parte proximal de la fíbula. En el primer caso, el nervio cutáneo dorsal intermedio se originó directamente de la división posterior del NFS; la división anterior del NFS se subdividió en dos ramos, los que después de un corto trayecto se unieron y formaron el nervio cutáneo dorsal medial. En el segundo caso, los nervios cutáneos dorsales intermedio y medial se originaron directamente del NFS, que después de un corto trayecto se dividió en estos dos nervios. El origen de los nervios cutáneos dorsales del pie se registró en relación al epicóndilo lateral del fémur y el paso de éstos a través de la fascia profunda de la pierna hacia su distribución cutánea fue relacionado al maléolo lateral. Aunque el origen de los nervios cutáneos dorsales del pie ocurra a un nivel próximo a la cabeza de la fíbula, perforan la fascia mencionada, en su tercio distal. Un conocimiento detallado del NFS y de sus ramos y variaciones anatómicas puede reducir lesiones iatrogénicas en éstos durante los procedimientos quirúrgicos realizados en el compartimiento lateral de la pierna.The dorsal cutaneous nerves of the foot originate from the superficial fibular nerve (SFN, then pass from the lateral compartment of the leg piercing the deep fascia, thus distributed superficially in the dorsum of the foot. Sometimes SFN splits early, so these nerves originate deeply and with a different arrangement. The objective of this research was to study in these cases, the origin of the dorsal cutaneous nerves of the foot and pierce point level in the deep fascia of the leg. We studied 16 formolized samples of Chilean adult individuals. In two of them its origin was observed at a high level, near the proximal epiphysis of the fibula. In the first case the intermediate dorsal cutaneous nerve arose directly from the posterior division of SFN, of short course; the anterior division of SFN was subdivided into two branches, which after a short course, both branches joined to form the medial dorsal cutaneous nerve. In the second case the medial and intermediate dorsal cutaneous nerves originated directly from the SFN, which after a short course, it divided in these two nerves. The origin level was recorded in relation to the lateral epicondyle of the femur and the passage of these nerves through the deep fascia of the leg for its skin distribution was located in relation to the lateral malleolus. Although the origin of the dorsal cutaneous nerves of the foot occur very close to the proximal epiphysis of the fibula, passing through the mentioned fascia in its distal third. A detailed knowledge of the branches of the SFN and variations can reduce injuries in these nerves during surgical procedures in the lateral compartment of the leg.

  1. A misdiagnosed melanoma: a case of cutaneous epithelioid malignant peripheral nerve sheath tumor.

    Science.gov (United States)

    Linos, Konstantinos; Warren, Simon

    2015-04-01

    Malignant Peripheral Nerve Sheath Tumor (MPNST) is a rare soft tissue sarcoma that can occur in superficial locations. Histologically it is categorized into two variants: a conventional/spindled and an epithelioid variant. The latter one is very rare and can be confused histologically with malignant melanoma as it is diffusely positive for S100-protein. Herein we present a case that was initially misdiagnosed as malignant melanoma and discuss morphological and immunohistochemical clues to reach a correct diagnosis. PMID:25933073

  2. Avaliação clínica da dor e sensibilidade cutânea de pacientes submetidas à dissecção axilar com preservação do nervo intercostobraquial para tratamento cirúrgico do câncer de mama / Clinical evaluation of pain and cutaneous sensitivity in patients with preservation of intercostobrachial nerve during the axillary dissection for breast cancer treatment

    Scientific Electronic Library Online (English)

    Mônica Duarte, Pimentel; Luiz Cláudio dos, Santos; Helenice, Gobbi.

    2007-06-01

    Full Text Available OBJETIVO: avaliar a dor e a sensibilidade cutânea superficial no dermátomo do nervo intercostobraquial (NICB) em pacientes submetidas à dissecção axilar com preservação do NICB para tratamento cirúrgico do câncer de mama. MÉTODOS: realizamos estudo tipo coorte prospectivo de 77 pacientes divididas e [...] m Grupo NP (n=34), sem preservação do NICB, e Grupo ICB (n=43), com preservação do NICB. A sensibilidade cutânea foi avaliada um ano após a cirurgia, empregando-se: 1) questionário modificado de McGill; 2) exame clínico incluindo perimetria braquial, pesquisa de sensibilidade táctil e dolorosa; 3) aplicação dos monofilamentos de Semmes-Weinsten que permitem avaliar de forma objetiva, qualitativa e quantitativamente, lesões de nervo periférico. Para análise estatística, foram usados os testes do chi2, Kruskal-Wallis e exato de Fisher. RESULTADOS: a dor foi relatada com maior freqüência pelas pacientes do Grupo NP (23/33) do que pelas pacientes do Grupo ICB (17/42); p=0,012. A sensibilidade dolorosa estava preservada na maioria das pacientes do Grupo ICB (38/42) e em apenas 11/33 do Grupo NP (p Abstract in english PURPOSE: loss of cutaneous sensitivity has been related to lesions of the intercostobrachial nerve (ICBN) during the axillary lymph node dissection for breast cancer treatment. We evaluated pain and cutaneous sensitivity in the ICBN dermatome of patients in which the nerve was preserved during the a [...] xillary dissection. METHODS: we carried out a prospective cohort study of 77 patients divided into: NP group (n=34), patients without ICBN preservation, and ICB group (n=43), patients in which the nerve was preserved. Cutaneous sensitivity was evaluated one year after surgery using 1) a modified McGill Pain Questionnaire; 2) clinical examination including brachial perimetry and evaluation of pain and tactile sensitivity; 3) Semmes-Weinstein monofilaments which allow an objective, qualitative, and quantitative evaluation of peripheral nerve lesions. RESULTS: pain was more frequently reported in the NP group (23/33) than in patients from the ICB group (17/42); p=0,012. Painful sensitivity was preserved in the majority of patients from the ICB group (38/42) but in only 11/33 patients from the NP group (p

  3. Origem e distribuição do plexo braquial de Saimiri sciureus Origin and distribution of the brachial plexus of Saimiri sciureus

    Directory of Open Access Journals (Sweden)

    Elenara B. Araújo

    2012-12-01

    Full Text Available Os autores descreveram a origem e composição do plexo braquial de quatro Saimiri sciureus, pertencentes ao Centro Nacional de Primatas (Cenp, Ananindeua/PA, os quais foram fixados com formaldeído e dissecados. Os achados revelaram que o plexo braquial desta espécie é constituído por fibras neurais provenientes da união das raízes dorsais e ventrais das vértebras cervicais C4 a C8 e torácica T1, e organizado em quatro troncos. Cada tronco formou um nervo ou um grupo de nervos, cuja origem variou entre os animais; na maioria, foi encontrado o tronco cranial originando o nervo subclávio, o tronco médio-cranial dando origem aos nervos supraescapular, subescapular, parte do radial, e em alguns casos ao nervo axilar, nervo musculocutâneo e ao nervo mediano; o tronco médio-caudal formou parte do nervo radial, e em alguns casos os nervos axilar, nervo musculocutâneo, nervo mediano, nervo toracodorsal, nervo ulnar e nervo cutâneo medial do antebraço, sendo os dois últimos também originados no tronco caudal.The authors described the origin and composition of the brachial plexus of four Saimiri sciureus, from the National Primate Center (Cenp, Ananindeua/PA, which were fixed with formaldehyde and dissected. Findings revealed that the brachial plexus of this species is composed by nervous fibers from the roots of cervical vertebrae C4 to C8 and thoracic vertebrae T1, and organized into four branchs. Each branch has formed a nerve or a group of nerves, the origin was varied between animals, mostly were found the cranial trunk originate the subclavian nerve; the medium-cranial originate the suprascapular, subscapular, part of radial and in some cases the axillary, musculocutaneous and median nerves; the medium-caudal trunk originate part of radial nerve and in some cases the axillary, musculocutaneous, median, thoracodorsal, ulnar and medial cutaneous of forearm nerves, the last two nerves also originate from the caudal trunk.

  4. Origem e distribuição do plexo braquial de Saimiri sciureus / Origin and distribution of the brachial plexus of Saimiri sciureus

    Scientific Electronic Library Online (English)

    Elenara B., Araújo; Ana R., Lima; Luane L., Pinheiro; José A.P.C., Muniz; Aline, Imbeloni; Érika, Branco.

    2012-12-01

    Full Text Available Os autores descreveram a origem e composição do plexo braquial de quatro Saimiri sciureus, pertencentes ao Centro Nacional de Primatas (Cenp), Ananindeua/PA, os quais foram fixados com formaldeído e dissecados. Os achados revelaram que o plexo braquial desta espécie é constituído por fibras neurais [...] provenientes da união das raízes dorsais e ventrais das vértebras cervicais C4 a C8 e torácica T1, e organizado em quatro troncos. Cada tronco formou um nervo ou um grupo de nervos, cuja origem variou entre os animais; na maioria, foi encontrado o tronco cranial originando o nervo subclávio, o tronco médio-cranial dando origem aos nervos supraescapular, subescapular, parte do radial, e em alguns casos ao nervo axilar, nervo musculocutâneo e ao nervo mediano; o tronco médio-caudal formou parte do nervo radial, e em alguns casos os nervos axilar, nervo musculocutâneo, nervo mediano, nervo toracodorsal, nervo ulnar e nervo cutâneo medial do antebraço, sendo os dois últimos também originados no tronco caudal. Abstract in english The authors described the origin and composition of the brachial plexus of four Saimiri sciureus, from the National Primate Center (Cenp), Ananindeua/PA, which were fixed with formaldehyde and dissected. Findings revealed that the brachial plexus of this species is composed by nervous fibers from th [...] e roots of cervical vertebrae C4 to C8 and thoracic vertebrae T1, and organized into four branchs. Each branch has formed a nerve or a group of nerves, the origin was varied between animals, mostly were found the cranial trunk originate the subclavian nerve; the medium-cranial originate the suprascapular, subscapular, part of radial and in some cases the axillary, musculocutaneous and median nerves; the medium-caudal trunk originate part of radial nerve and in some cases the axillary, musculocutaneous, median, thoracodorsal, ulnar and medial cutaneous of forearm nerves, the last two nerves also originate from the caudal trunk.

  5. Effect of superficial radial nerve stimulation on the activity of nigro-striatal dopaminergic neurons in the cat: role of cutaneous sensory input

    International Nuclear Information System (INIS)

    The release of 3H-dopamine (DA) continuously synthesized from 3H-thyrosine was measured in the caudate nucleus (CN) and in the substantia nigra (SN) in both sides of the brain during electrical stimulation of the superficial radial nerve in cats lightly anaesthetized with halothane. Use of appropriate electrophysiologically controlled stimulation led to selective activation of low threshold afferent fibers whereas high stimulation activated all cutaneous afferents. Results showed that low threshold fiber activation induced a decreased dopaminergic activity in CN contralateral to nerve stimulation and a concomitant increase in dopaminergic activity on the ipsilateral side. Stimulation of group I and threshold stimulation of group II afferent fibers induced changes in the release of 3H-DA mainly on the contralateral CN and SN and in the ipsilateral CN. High stimulation was followed by a general increase of the neurotransmitter release in the four structures. This shows that the nigro-striatal dopaminergic neurons are mainly-if not exclusively-controlled by cutaneous sensory inputs. This control, non-specific when high threshold cutaneous fibers are also activated. Such activations could contribute to restablish sufficient release of DA when the dopaminergic function is impaired as in Parkinson's disease. (Author)

  6. Cutaneous sensory spots and the "law of specific nerve energies": history and development of ideas.

    Science.gov (United States)

    Norrsell, U; Finger, S; Lajonchere, C

    1999-03-15

    By use of suitable methods, different spots on the skin surface can be shown to be selectively sensitive to one of four sensory qualities in decreasing order of density: pain, touch, cool and warm. The presence of such spots was observed virtually simultaneously in the early 1880s by three independent investigators. Two papers on punctuate sensitivity of the skin were published in 1882 and 1883 by Magnus Blix of Uppsala University in Sweden; three papers were published in 1884 by Alfred Goldscheider, a German army doctor; and one was published in 1885 by Henry Donaldson of Johns Hopkins University in Maryland. Donaldson's findings originated from a serendipitous observation. In contrast, Blix's and Goldscheider's experiments were based on Johannes Muller's concept of "specific sense energies" and the extension of this idea to sensory qualities (the law of "specific nerve energies") by others, including Hermann von Helmholtz. The discovery of different types of sensory spots had considerable influence on other researchers of the period, including Max von Frey, but has only recently been substantiated by electrophysiological experiments. PMID:10372506

  7. Potential genotoxic effects of GSM-1800 exposure on human cutaneous and nerve cells

    International Nuclear Information System (INIS)

    Introduction The GSM-1800 signal has been in use for several years in Europe and questions raised about its potential biological effects, in view of the fact that, with respect to GSM-900, the increase in the carrier frequency corresponds to a more superficial absorption in the tissues. Consequently, the skin becomes an even more important target for the absorption of the radiofrequency radiation (R.F.R.) emitted by mobile phones. Nevertheless, brain tissues remain a critical target. Cells In order to determine whether R.F.R. at 1800 MHz could behave as a genotoxic agent, skin and brain cells were exposed to a 217-Hz-modulated GSM-1800 signal and assayed using the comet assay: (1) normal human epidermal keratinocytes (N.H.E.K.) and dermal fibroblasts (N.H.D.F.) which are cutaneous cells from epidermis and dermis respectively, and (2) the S.H. -S.Y.5.Y. and C.H.M.E.-5 human cell lines, which are neuroblastoma and micro-glial cells, respectively. Exposure The R.F.R. exposure system that was used in these experiments was manufactured by I.T. I.S. (Zurich, Switzerland). It consists in two shorted waveguides allowing to run exposed and sham conditions at the same time in the same culture incubator, at 37 Celsius degrees, 5% CO2. It is controlled by a software, which provides blind conditions until completion of data analysis. The specific absorption rate (S.A.R.) used was 2 W/kg, corresponding to the public exposure limit recommended by I.C.N.I.R.P. and the exposure duration was 48 hours. Comet assay At the end of the exposure, cells were removed from their Petri dish by trypsin/EDTA treatment, counted and 5 x 104 cells were used to detect DNA damage including single DNA breaks. Positive controls were performed using hydrogen peroxidase (1%, 1 hour). The genotoxic effects were detected using the alkaline comet assay kit (Trevigen slides) following the supplier procedure. Under these conditions, 6 independent experiments were performed for each cell type (2 Petri dishes by run). The analysis was done on at least 100 images from two comet slides (one per Petri dish) for each cellular model and exposure condition. Results The analysis of the slides is ongoing. Once the data analysis is completed, I.T.I.S. will break the blinding codes, and the results will be presented at the meeting. Acknowledgement: This work was supported by France Telecom R and D, Bouygues Telecom, the Cnrs and the Aquitaine Council for Research. (authors)

  8. Entrapment of the Median Nerves and Brachial Arteries in the Lower Arms Bilaterally and Additional Origin of Biceps brachii Muscle: Case Report Compresión Bilateral del Nervio Mediano y de la Arteria Braquial en la Parte Distal del Brazo y Origen Adicional del Músculo Bíceps Braquial: Reporte de Caso

    OpenAIRE

    Niladri Kumar Mahato

    2010-01-01

    Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, especially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inte...

  9. Thoracic Outlet Syndrome Caused by Schwannoma of Brachial Plexus

    OpenAIRE

    Yun, Dong Hwan; Kim, Hee-Sang; Chon, Jinmann; Lee, Jongeon; Jung, Pil Kyo

    2013-01-01

    Schwannomas are benign, usually slow-growing tumors that originate from Schwann cells surrounding peripheral, cranial, or autonomic nerves. The most common form of these tumors is acoustic neuroma. Schwannomas of the brachial plexus are quite rare, and symptomatic schwannomas of the brachial plexus are even rarer. A 47-year-old woman presented with a 1-year history of dysesthesia, neuropathic pain, and mild weakness of the right upper limb. Results of physical examination and electrodiagnosti...

  10. Study of Sural Nerve Complex in Human Cadavers

    OpenAIRE

    Seema, S. R.

    2013-01-01

    Aim. The sural nerve complex (SNC) consists of four named components: medial sural cutaneous nerve (MSCN), lateral sural cutaneous nerve (LSCN), peroneal communicating nerve (PCN), and sural nerve (SN). The formation and distribution of the sural nerve vary in different individuals. SN is universally recognized by surgeons as a site for harvesting an autologous nerve graft. The nerve is widely used for electrophysiological studies. Hence the study of sural nerve complex was taken up. Method. ...

  11. The brachial plexus branches to the pectoral muscles in adult rats: morphological aspects and morphometric normative data

    OpenAIRE

    Riva, Nilo; Domi, Teuta; Lopez, Ignazio Diego; Triolo, Daniela; Fossaghi, Andrea; Dina, Giorgia; Podini, Paola; Comi, Giancarlo; Quattrini, Angelo

    2012-01-01

    Animal models provide an important tool to investigate the pathogenesis of neuromuscular disorders. In the present study, we analyze fiber composition of the brachial plexus branches to the pectoral muscles: the medial anterior thoracic nerve (MATN) and the lateral anterior thoracic nerve (LATN). The morphological and morphometric characteristics and the percentage of motor fibers within each nerve are here reported, adding information to microscopic anatomy knowledge of the rat brachial plex...

  12. The brachial plexus branches to the pectoral muscles in adult rats: morphological aspects and morphometric normative data

    OpenAIRE

    NiloRiva; GiancarloComi

    2012-01-01

    Animal models provide an important tool to investigate the pathogenesis of neuromuscular disorders. In the present study, we analyze fiber composition of the brachial plexus branches to the pectoral muscles: the medial anterior thoracic nerve and the lateral anterior thoracic nerve. The morphological and morphometric characteristics and the percentage of motor fibers within each nerve are here reported, adding information to microscopic anatomy knowledge of the rat brachial plexus. As control...

  13. Brachial plexopathy: recurrent cancer or radiation

    International Nuclear Information System (INIS)

    We reviewed clinical and electrodiagnostic features of 16 patients with neoplastic brachial plexopathy (NBP) and 17 patients with radiation-induced plexopathy (RBP). The groups were similar in symptom-free interval after cancer diagnosis and location of the plexus lesions. NBP patients had pain and Horner's syndrome; RBP patients had paresthesias, but rarely Horner's. NBP patients presented earlier after symptom onset and had a shorter course. RBP patients more frequently had abnormal sensory and normal motor nerve conduction studies and characteristically had fasciculations or myokymia on EMG

  14. Brachial plexopathy: recurrent cancer or radiation

    Energy Technology Data Exchange (ETDEWEB)

    Lederman, R.J.; Wilbourn, A.J.

    1984-10-01

    We reviewed clinical and electrodiagnostic features of 16 patients with neoplastic brachial plexopathy (NBP) and 17 patients with radiation-induced plexopathy (RBP). The groups were similar in symptom-free interval after cancer diagnosis and location of the plexus lesions. NBP patients had pain and Horner's syndrome; RBP patients had paresthesias, but rarely Horner's. NBP patients presented earlier after symptom onset and had a shorter course. RBP patients more frequently had abnormal sensory and normal motor nerve conduction studies and characteristically had fasciculations or myokymia on EMG.

  15. Nerve grafting in peripheral nerve injuries

    Directory of Open Access Journals (Sweden)

    Simi? Vesna D.

    2003-01-01

    Full Text Available Autologous nerve grafting is the most commnly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve.In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases. Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases. Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient’s age, location and the extent (total or partial of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.

  16. Fastklemt nerve som årsag til svære postoperative smerter fra arvæv

    DEFF Research Database (Denmark)

    Møller, Michael; Venzo, Alessandro

    2014-01-01

    Entrapment of a cutaneous nerve in a surgical scar may cause chronic post-operative pain. The condition presents with similar symptoms as a traumatic neuroma or as an anterior cutaneous nerve entrapment syndrome, which, however, is often idiopathic. We present a case, where entrapment of a cutaneous nerve in a laparotomy scar caused chronic pain. The symptoms were immediately relieved after selective neurectomy.

  17. Absence of Musculocutaneous Nerve Associated with Variations of Distribution Patterns of the Median Nerve / Ausencia del Nervio Musculocutáneo Asociada con Variaciones de los Patrones de Distribución del Nervio Mediano

    Scientific Electronic Library Online (English)

    Yong, Zhang; Shengbo, Yang; Fangjiu, Yang; Peng, Xie.

    2014-06-01

    Full Text Available Las variaciones en el plexo braquial y los patrones de distribución de sus ramos no son infrecuentes. Un ramo comunicante, que es la variante más frecuente, a menudo surge desde el nervio musculocutáneo al nervio mediano. Sin embargo, los ramos que surgen del fascículo lateral del plexo braquial y n [...] ervio mediano en vez de nervio musculocutáneo son muy raros. La descripción detallada de las anomalías es importante para procedimientos quirúrgicos. En nuestro caso el nervio musculocutáneo estaba ausente, un ramo del fascículo medial inervó el músculo coracobraquial y dos ramos del nervio mediano inervaron los músculos bíceps y braquial, respectivamente. Por otra parte, el nervio mediano originó al nervio cutáneo antebraquial lateral. Este informe proporciona evidencia de algunas variaciones anatómicas útiles para cirujanos, anestesistas y neurólogos durante la práctica clínica. Abstract in english Variations in the brachial plexus and the distribution patterns of its branches are not uncommon. A communicating branch, which is the most frequent variation, often arises from musculocutaneous nerve to median nerve. However, the branches arising from lateral cord of the brachial plexus and median [...] nerve instead of musculocutaneous nerve are very rare. Detailed description of the abnormalities is important for surgical procedures. Our case study reports the musculocutaneous nerve was absent, a branch from the medial cord innervated the coracobrachialis muscle and two branches from the median nerve innervated the biceps and brachialis muscles, respectively. Moreover, the median nerve gave off the lateral antebrachial cutaneous nerve. This report provides evidence of such possible anatomical variations to surgeons, anesthetists and neurologists during clinical practice.

  18. Brachial neuropathy 22 years after radiation therapy for fibrosarcoma: a case report

    OpenAIRE

    Al-Benna, Sammy; Schubert, Cornelius; Steinau, Hans Ulrich; Steinstraesser, Lars

    2009-01-01

    This case report presents a 56-year-old man with right upper limb weakness which arose 22 years after initial local radiation treatment for a grade III fibrosarcoma. Nerve conduction studies revealed impairment of all three major upper limb nerves compared with the left, with particular impairment of the median and ulnar nerves in the most fibrotic area that had been irradiated. In addition, the patient received multiple courses of chemotherapy. The occurrence of radiation-induced brachial pl...

  19. Padrões de condução de impulsos nervosos, determinados eletronicamente, para análise de comportamento de nervos "in vivo" Nerve conduction patterns determined electronically for analysing peripheral nerves behavior in vivo

    Directory of Open Access Journals (Sweden)

    Eros Abrantes Erhart

    1970-06-01

    Full Text Available Padrões de condução de impulsos nervosos foram determinados eletrônicamente, in vivo, nos nervos ulnar (13, hipoglosso (16 e cutâneo medial do braço (7 de cães anestesiados. Os traçados obtidos confirmaram, em linhas gerais, os descritos na literatura. Todavia, demonstraram um fato novo, adicional, isto é, que fibras motoras e sensitivas, integrantes de nervos periféricos, apresentam uma condução específica, unidirecional (centrífuga nas fibras motoras e centrípeta nas sensitivas, desde que mantidas praticamente intactas em seus respectivos leitos conectivos naturais. Embora este tipo de condução específica corresponda ao que se admite e aceita como comportamento normal, biológico, dessas fibras nervosas, e constitua ainda, base do exame neurológico, esta evidência nunca foi demonstrada anteriormente em experiências e preparações neurofisiológicas.Nerve conduction patterns of the ulnar, hypoglossal and medial brachial cutaneous nerves were determined and recorded electronically in vivo on anesthetized dogs. The recorded tracings obtained were generally found to be in accordance with those described in the literature. However, our tracings showed a new additional fact, i.e., that motor and sensory peripheral nerve fibers have a specific unidirectional conduction (centrifugally for motor and centripetally for sensory, as long as these nerves were maintained undisturbed in their natural connective tissue bed. Although these facts correspond to what is considered normal biological behavior of nerve fibers, when in their natural environment, as far as we know, this has not been demonstrated before in neurophysiological experiments.

  20. Padrões de condução de impulsos nervosos, determinados eletronicamente, para análise de comportamento de nervos "in vivo" / Nerve conduction patterns determined electronically for analysing peripheral nerves behavior in vivo

    Scientific Electronic Library Online (English)

    Eros Abrantes, Erhart; José, Furlani; Antonio Carlos, Berardi; Fausto, Bérzin; Walter, Biazotto.

    1970-06-01

    Full Text Available Padrões de condução de impulsos nervosos foram determinados eletrônicamente, in vivo, nos nervos ulnar (13), hipoglosso (16) e cutâneo medial do braço (7) de cães anestesiados. Os traçados obtidos confirmaram, em linhas gerais, os descritos na literatura. Todavia, demonstraram um fato novo, adiciona [...] l, isto é, que fibras motoras e sensitivas, integrantes de nervos periféricos, apresentam uma condução específica, unidirecional (centrífuga nas fibras motoras e centrípeta nas sensitivas), desde que mantidas praticamente intactas em seus respectivos leitos conectivos naturais. Embora este tipo de condução específica corresponda ao que se admite e aceita como comportamento normal, biológico, dessas fibras nervosas, e constitua ainda, base do exame neurológico, esta evidência nunca foi demonstrada anteriormente em experiências e preparações neurofisiológicas. Abstract in english Nerve conduction patterns of the ulnar, hypoglossal and medial brachial cutaneous nerves were determined and recorded electronically in vivo on anesthetized dogs. The recorded tracings obtained were generally found to be in accordance with those described in the literature. However, our tracings sho [...] wed a new additional fact, i.e., that motor and sensory peripheral nerve fibers have a specific unidirectional conduction (centrifugally for motor and centripetally for sensory), as long as these nerves were maintained undisturbed in their natural connective tissue bed. Although these facts correspond to what is considered normal biological behavior of nerve fibers, when in their natural environment, as far as we know, this has not been demonstrated before in neurophysiological experiments.

  1. Anatomical characteristics of the brachial plexus of the maned sloth (Bradypus torquatus Illiger, 1811

    Directory of Open Access Journals (Sweden)

    Gessica Ariane de Melo Cruz

    2013-09-01

    Full Text Available Eight male and female maned sloth (Bradypus torquatus cadavers, previously fixed in formalin, were used to identify the origin of the brachial plexus, nerves and innervation territory in order to determine an anatomical pattern for this species. The plexus of B. torquatus was derived from the C7 to C10 and T1 to T2 spinal nerves, but the participation of T2 was variable. The spinal nerves gave origin to the cranial and caudal trunks, which joined to form a common trunk, from which two fascicles were formed. All the nerves from the brachial plexus were originated from these two fascicles, except the thoracic, long pectoral and suprascapular nerves, which arose before the formation of the common trunk. The organization of the brachial plexus into trunks and fascicles, and subsequent origin of peripheral nerves, demonstrates that most of the spinal nerves contribute to the composition of the peripheral nerves and the possibility that lesions or traumatic injuries would damage most of the thoracic member.

  2. MRI of the brachial plexus and its region: anatomy and pathology

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) of the brachial plexus and its region has become the imaging modality of choice, due to its multiplanar capabilities and inherent contrast differences between the brachial plexus, related vessels, and surrounding fat. A total of 41 patients with clinically suspected brachial plexus pathology or tumors in its region were studied. A normal anatomy was found in 12 patients. Pathologic entities included: traumatic nerve-root avulsion (n = 2), hematoma (n = 1), postoperative changes after scalenotomy (n = 2), primary tumor of the brachial plexus (n = 2), primary (n = 8) and metastatic (n = 1) tumors in the superior sulcus, primary (n = 5) and metastatic (n = 4) tumors in the axillary, supra- or infraclavicular region, and changes after nodal dissection and radiation therapy for breast carcinoma (n = 5; 1 patient also had had a prior scalenotomy). There was a positive correlation with surgery in 11 patients, and a negative correlation in 1 patient. (orig.)

  3. MRI of the brachial plexus

    International Nuclear Information System (INIS)

    Magnetic resonance imaging is the imaging method of first choice for evaluating the anatomy and pathology of the brachial plexus. This review discusses the used imaging techniques, the normal anatomy, and a variety of pathologies that can involve the brachial plexus. The pathology includes primary and secondary tumors (the most frequent secondary tumors being superior sulcus tumor and metastatic breast carcinoma), radiation plexopathy, trauma, thoracic outlet syndrome, neuralgic amyotrophy, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). (orig.)

  4. MRI of the brachial plexus

    Energy Technology Data Exchange (ETDEWEB)

    Es, H.W. van [Dept. of Radiology, St. Antonius Ziekenhuis, Nieuwegein (Netherlands)

    2001-02-01

    Magnetic resonance imaging is the imaging method of first choice for evaluating the anatomy and pathology of the brachial plexus. This review discusses the used imaging techniques, the normal anatomy, and a variety of pathologies that can involve the brachial plexus. The pathology includes primary and secondary tumors (the most frequent secondary tumors being superior sulcus tumor and metastatic breast carcinoma), radiation plexopathy, trauma, thoracic outlet syndrome, neuralgic amyotrophy, chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). (orig.)

  5. Entrapment of the Median Nerves and Brachial Arteries in the Lower Arms Bilaterally and Additional Origin of Biceps brachii Muscle: Case Report / Compresión Bilateral del Nervio Mediano y de la Arteria Braquial en la Parte Distal del Brazo y Origen Adicional del Músculo Bíceps Braquial: Reporte de Caso

    Scientific Electronic Library Online (English)

    Niladri Kumar, Mahato.

    2010-12-01

    Full Text Available No es infrecuente observar atrapamientos neuro-vasculares asociados con variaciones en el origen de los músculos del brazo. A pesar de haberse observado cabezas adicionales del músculo bíceps braquial y fibras extra del músculo braquial raramente estas cabezas adicionales bilaterales han sido causan [...] tes de la compresión del nervio mediano y de la arteria braquial. En este trabajo presentamos las cabezas del músculo bíceps braquial originándose en gran parte en el tabique intermuscular medial compartiendo su origen con el músculo braquial. Los orígenes adicionales del músculo forman largos túneles músculo fasciales. Los túneles miden 8 cm de longitud, y se extienden desde la parte inferior del brazo hasta la fosa cubital. Tanto el nervio mediano como la arteria braquial pasan por el túnel. La parte inferior del túnel izquierdo dio origen a fibras pertenecientes al músculo flexor superficial del antebrazo. Las estructuras neurovasculares no otorgaron colaterales en el túnel. El conocimiento de estas variaciones puede ayudar a los clínicos en el diagnóstico y el tratamiento de neuropatías y compromiso vascular. Abstract in english Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, espe [...] cially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inter-muscular septum, sharing its origin with the brachialis muscle. The extra origins of the muscle formed long musculo-aponeurotic tunnels. The tunnels measured eight centimeters in length extending from the lower arm to the cubital-fossa. Both the median nerve and the brachial arteries passed through the tunnel. The lower aspect of the left tunnel exhibited origins of fibres belonging to the superficial flexors of the forearm. The neuro-vascular structures did not give any branches in the tunnel. Awareness of such variations can aid clinicians in diagnosing and treating such neuropathies and vascular compromise.

  6. Clinically significant variations of the cords of the brachial plexus in relation to axillary artery

    Directory of Open Access Journals (Sweden)

    Jamuna M

    2011-01-01

    Full Text Available Variations in the formation, course and distribution of brachial plexus are common and are well documented, but the variation of the cords of brachial plexus in relation to axillary artery is rarely documented. Here a rare variation of the cords of brachial plexus and the branches of the cords in relation to the axillary artery in the right upper limb of an adult male cadaver is reported. The lateral, medial and posterior cords were present lateral to the axillary artery and all the branches of the cords were also present lateral to the axillary artery. The musculocutaneous nerve was found not piercing the coracobrachialis muscle. The clinical significance and the embryological reasons are discussed. Clinicians and surgeons should be aware of such variations while performing surgical procedure in the axilla as the nerves are more prone for injury.

  7. The brachial plexus branches to the pectoral muscles in adult rats: morphological aspects and morphometric normative data

    Directory of Open Access Journals (Sweden)

    Nilo Riva

    2012-10-01

    Full Text Available Animal models provide an important tool to investigate the pathogenesis of neuromuscular disorders. In the present study, we analyze fiber composition of the brachial plexus branches to the pectoral muscles: the medial anterior thoracic nerve and the lateral anterior thoracic nerve. The morphological and morphometric characteristics and the percentage of motor fibers within each nerve are here reported, adding information to microscopic anatomy knowledge of the rat brachial plexus. As control, we employed the quadriceps nerve, commonly used for the evaluation of motor fibers at hindlimbs. We demonstrated that the medial anterior thoracic nerve and the lateral anterior thoracic nerve are predominantly composed of large motor fibers and therefore could be employed to evaluate the peripheral nervous system involvement at forelimbs in neurological diseases models, predominantly affecting the motor fiber compartment.

  8. Technical note: the humeral canal approach to the brachial plexus.

    LENUS (Irish Health Repository)

    Frizelle, H P

    2012-02-03

    Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral\\/brachial canal using selective stimulation of the major nerves. This report outlines initial experience with this block, describing the technique and results in 50 patients undergoing hand and forearm surgery. All patients were assessed for completeness of motor and sensory block. The overall success rate was 90 percent. Motor block was present in 80 percent of patients. Completion of the block was necessary in 5 patients. Two patients required general anaesthesia. The preponderance of ulnar deficiencies agrees with previously published data on this technique. No complications were described. Initial experience confirms the high success rate described using the Dupre technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.

  9. Comparison of three techniques for paravertebral brachial plexus blockade in dogs

    OpenAIRE

    Rioja-Garcia, Eva; Sinclair, Melissa; Chalmers, Heather; Foster, Robert A; Monteith, Gabrielle

    2012-01-01

    OBJECTIVE To compare success and complication rates, based on staining of nerves and other structures, among three techniques of paravertebral brachial plexus blockade (PBPB) in dogs. STUDY DESIGN Prospective randomized design. ANIMALS A total of 68 thoracic limbs from 34 dogs. METHODS Limbs were randomly assigned to blind (BL) (n=24), nerve stimulator-guided (NS) (n=21), or ultrasound-guided (US) (n=23) technique. Injections were made with 0.3 mL kg-1 of lidocaine mixed with new...

  10. Ankle Brachial Index

    Energy Technology Data Exchange (ETDEWEB)

    Wikstroem, J.; Hansen, T.; Johansson, L.; Lind, L.; Ahlstroem, H. (Dept. of Radiology and Dept. of Medical Sciences, Uppsala Univ. Hospital, Uppsala (SE))

    2008-03-15

    Background: Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies. Purpose: To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly. Material and Methods: WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side. Results: There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one >=50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a >= 50% stenosis in the pelvic or leg arteries. Conclusion: An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population

  11. Cutaneous mechanisms of isometric ankle force control

    DEFF Research Database (Denmark)

    Choi, Julia T; Jensen, Jesper Lundbye; Leukel, Christian; Nielsen, Jens Bo

    2013-01-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the...

  12. Cutaneous mechanisms of isometric ankle force control

    DEFF Research Database (Denmark)

    Choi, Julia T; Jensen, Jesper Lundbye

    2013-01-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.

  13. Significance of magnetic resonance imaging in differential diagnosis of nontraumatic brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Peri? Stojan

    2011-01-01

    Full Text Available Background/Aim. Nontraumatic brachial plexopathies may be caused by primary or secondary tumors, radiation or inflammation. The aim of this study was to present the significance of MRI in revealing the cause of nontraumatic brachial plexopathy. Methods. A two-year retrospective study included 22 patients with nontraumatic brachial plexopathy. In all the patients typical clinical findings were confirmed by upper limb neurophysiological studies. In all of them MRI of brachial plexus was performed by 1.5 T scanner in T1 and T1 FS sequence with and without contrast, as well as in T2 and T2 FS sequences. Results. Seven (32% patients had brachial plexopathy with signs of inflammatory process, 5 (23% patients had secondary tumors, in 4 (18% patients multifocal motor neuropathy was established and in the same number (18% of the patients postradiation fibrosis was found. Two patients (9% had primary neurogenic tumors. Conclusion. According to the results of this study MRI is a method which may determine localization and cause of brachial plexopathy. MRI can detect focal nerve lesions when other methods fail to find them. Thus, MRI has a direct impact on further diagnostic and therapeutical procedures.

  14. Cutaneous Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Rupali Bargotra , Jyotsna Suri, Yudhvir Gupta

    2010-07-01

    Full Text Available We present a case of exclusive cutaneous sarcoidosis with no clinical or radiological evidence of diseaseanywhere else in the body.Exclusive cutaneous involvement is rare and is reported in about 4.5%patientsof sarcoidosis.

  15. Cutaneous Sarcoidosis

    OpenAIRE

    Rupali Bargotra , Jyotsna Suri, Yudhvir Gupta

    2010-01-01

    We present a case of exclusive cutaneous sarcoidosis with no clinical or radiological evidence of diseaseanywhere else in the body.Exclusive cutaneous involvement is rare and is reported in about 4.5%patientsof sarcoidosis.

  16. Cutaneous leishmaniasis

    OpenAIRE

    Reithinger, R.; Dujardin, J. C.; Louzir, H.; C Pirmez; ALEXANDER B.; BROOKER, S

    2007-01-01

    Cutaneous leishmaniasis is endemic in the tropics and neotropics. It is often referred to as a group of diseases because of the varied spectrum of clinical manifestations, which range from small cutaneous nodules to gross mucosal tissue destruction. Cutaneous leishmaniasis can be caused by several Leishmania spp and is transmitted to human beings and animals by sandflies. Despite its increasing worldwide incidence, but because it is rarely fatal, cutaneous leishmaniasis has become one of the ...

  17. [Transplantation in peripheral nerve injuries].

    Science.gov (United States)

    Grujici?, D; Samardzi?, M; Rasuli?, L; Savi?, D; Cvrkota, I; Simi?, V

    2003-01-01

    Autologous nerve grafting is the most commocommnlynly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient's age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities. PMID:14619715

  18. Enhancement of Median Nerve Regeneration by Mesenchymal Stem Cells Engraftment in an Absorbable Conduit: Improvement of Peripheral Nerve Morphology with Enlargement of Somatosensory Cortical Representation.

    Directory of Open Access Journals (Sweden)

    Julia Teixeira Oliveira

    2014-10-01

    Full Text Available We studied the morphology and the cortical representation of the median nerve (MN, 10 weeks after a transection immediately followed by treatment with tubulization using a polycaprolactone (PCL conduit with or without bone marrow-derived mesenchymal stem cell (MSC transplant. In order to characterize the cutaneous representation of MN inputs in primary somatosensory cortex (S1, electrophysiological cortical mapping of the somatosensory representation of the forepaw and adjacent body parts was performed after acute lesion of all brachial plexus nerves, except for the MN. This was performed in ten adult male Wistar rats randomly assigned in 3 groups: MN Intact (n=4, PCL-Only (n=3 and PCL+MSC (n=3. Ten weeks before mapping procedures in animals from PCL-Only and PCL+MSC groups, animal were subjected to MN transection with removal of a 4-mm-long segment, immediately followed by suturing a PCL conduit to the nerve stumps with (PCL+MSC group or without (PCL-Only group injection of MSC into the conduit. After mapping the representation of the MN in S1, animals had a segment of the regenerated nerve processed for light and transmission electron microscopy. For histomorphometric analysis of the nerve segment, sample size was increased to 5 animals per experimental group. The PCL+MSC group presented a higher number of myelinated fibers and a larger cortical representation of MN inputs in S1 (3,383±390 fibers; 2.3 mm2, respectively than the PCL-Only group (2,226±575 fibers; 1.6 mm2. In conclusion, MSC-based therapy associated with PCL conduits can improve MN regeneration. This treatment seems to rescue the nerve representation in S1, thus minimizing the stabilization of new representations of adjacent body parts in regions previously responsive to the MN.

  19. The Effective Injection Zone at the Popliteal Crease for Tibial and Common Peroneal Nerve Blocks and its Relation with the Origin Point of the Medial and Lateral Sural Cutaneous Nerves / Zona de Inyección Eficaz en el Pliegue Poplíteo para el Bloqueo de los Nervios Tibial y Fibular Común y su Relación con el Punto de Origen de los Nervios Cutáneo Sural Medial y Lateral

    Scientific Electronic Library Online (English)

    Lei, Zhong; Jincheng, Wang; Hongjuan, Fang; Yanguo, Qin; Jianlin, Zuo; Zhongli, Gao.

    2014-03-01

    Full Text Available El bloqueo nervioso poplíteo puede ser utilizado para proporcionar anestesia y analgesia prolongada del miembro inferior y para aliviar el dolor postoperatorio severo y duradero. El objetivo fue determinar la localización anatómica de los nervios tibial (NT) y fibular común (NFC) en el pliegue poplí [...] teo para un bloqueo nervioso efectivo. Se utilizaron 50 miembros inferiores frescos pertenecientes a 27 cadáveres adultos chinos (16 hombres y 11 mujeres, rango de edad entre 35-87 años). Se utilizaron 22 cadáveres para identificar la localización de los nervios y los 5 restantes para determinar la profundidad de los nervios en una sección transversal. El NT se encontró en el 50% de los casos desde el punto más lateral del pliegue poplíteo a 1,4 cm de la superficie. En el 20% de 50 muestras, el nervio cutáneo sural medial se ramificó por debajo o en el pliegue poplíteo, mientras que el NFC se encontró en el 26% de los casos desde el punto más lateral del pliegue poplíteo a 0,7 cm de la superficie. Además, en el 6% de las muestras, el nervio cutáneo sural lateral se ramificó por debajo o en el pliegue poplíteo. Nuestros resultados sugieren que el NT y NFC emergen del nervio ciático a distancias variables del pliegue poplíteo. Creemos que los resultados sobre la ubicación de NT y NFC en el pliegue poplíteo ofrecen una buena guía para el adecuado bloqueo nervioso. Abstract in english A popliteal nerve block may be used to provide anesthesia and extended analgesia of the lower extremity, to ameliorate severe and long lasting postoperative pain. The aim of this study was to elucidate the anatomical location of tibial (TN) and common peroneal (CPN) nerves in the popliteal crease fo [...] r effective nerve block. Fifty fresh specimens from 27 adult Chinese cadavers (16 males and 11 females, age range from 35 to 87 years) were investigated. Twenty-two cadavers were used to identify nerve locations and 5 cadavers were used to determine the depths of nerves in cross section. TN was found to be located at 50% from the most lateral point of the popliteal crease at 1.4 cm deep to the surface. In 20% of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26.0% from the most lateral point of the popliteal crease and at 0.7 cm deep to the surface. Furthermore, in 6.0% of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease. This study suggests that the TN and CPN leave the sciatic nerve at variable distances from the popliteal crease. However, we believe that the results of the present study about the location of TN and CPN at the popliteal crease offer a good guide to optimal nerve block.

  20. Ultrasound-guided brachial plexus block: a study on 30 patients

    Directory of Open Access Journals (Sweden)

    Amiri HR

    2009-05-01

    Full Text Available "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction, unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics. "n"n Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control opioid consumption during surgery, patient satisfaction and block related complications were reported."n"n Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed.        "nConclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.

  1. Transfer of the rhomboid nerve to the suprascapular nerve: An anatomical feasibility study.

    Science.gov (United States)

    Goubier, J-N; Teboul, F

    2015-09-01

    Paralysis of the suprascapular nerve, in partial injuries of the brachial plexus, most often warrants a nerve transfer. Transfer of the spinal accessory nerve to the suprascapular nerve is performed most often. We propose to directly transfer the nerve of the rhomboid muscles (branch of the dorsal scapular nerve) to the suprascapular nerve in the supraspinatus fossa. This anatomical study included 10 shoulders. Dissection of the suprascapular nerve and the branch of dorsal scapular nerve to rhomboid muscles (rhomboid nerve) was performed through a posterior approach. Once the nerves were freed, the possibility of suturing the two nerves together was evaluated. Tensionless suture of the rhomboid nerve to the suprascapular nerve was possible in all shoulders in this study. In addition, the diameter of the two nerves was macroscopically compatible: the average diameter of the rhomboid and suprascapular nerve was 2.9 and 3mm, respectively. The diameter of the rhomboid nerve is more suitable than that of the spinal accessory nerve for a transfer to the suprascapular nerve. Moreover, the spinal accessory nerve is preserved in this technique, thereby preserving the function of the trapezius muscle, which could be used for muscle transfer if the nerve surgery fails. In addition, use of the rhomboid nerve allows the suture to be performed downstream to the suprascapular notch and avoids poor results linked to multilevel injuries of this nerve. Finally, if the posterior approach is extended laterally, associated transfer of the nerve to the long head of the triceps brachii to the axillary nerve is also possible. Rhomboid nerve transfer to the suprascapular nerve is anatomically possible. A clinical study will now be necessary to confirm this hypothesis and set out preliminary results. PMID:26159580

  2. Uso de concentrados autólogos de plaquetas como tratamiento de una fractura escapular y una lesión del plexo braquial producidas por un disparo en un caballo / Use of autologous platelet concentrates as treatment for a scapular fracture and brachial plexus nerve injury produced by a gunshot in a horse

    Scientific Electronic Library Online (English)

    C, López; JU, Carmona; I, Samudio.

    Full Text Available Las heridas de bala han sido escasamente descritas en caballos. Los disparos a corta distancia suelen producir daños en tejidos blandos y fracturas conminutas. Un caso de una fractura conminuta del cuello de la escápula con lesión aguda del plexo braquial producida por una bala de 9 mm en un sementa [...] l de seis años de edad es descrito. El paciente fue tratado con éxito mediante la combinación de desbridamiento quirúrgico de la región afectada e inyección local de varias dosis de concentrados autólogos de plaquetas (APC) y fisioterapia. A pesar de la fractura de la escápula y del daño en los nervios periféricos que toman al menos 18-24 meses para una recuperación completa, este paciente se recuperó satisfactoriamente en nueve meses. Estos resultados sugieren que las inyecciones de APC en combinación con fisioterapia pueden proporcionar un beneficio terapéutico en el tratamiento de lesiones agudas de tejidos blandos y fracturas óseas en caballos. Abstract in english Gunshot injuries have been scarcely reported in horses. Close-range gunshots usually produce extensive soft tissue damage and comminute fractures. A case of a comminute fracture of the neck of the scapula with acute injury of the brachial plexus produced by a 9 mm gunshot in a six year-old stallion [...] is described. The patient was successfully treated by combining surgical debridement of the affected region and local injection of several doses of autologous platelet concentrates (APCs) and physiotherapy. Although scapular fractures and peripheral nerve damage take at least 18-24 months for full recovery, this patient reached full recuperation of the affected limb in 9 months. These results suggest that injections of APCs in combination with physiotherapy could provide a therapeutic benefit in the treatment of soft tissue acute injuries and bone fractures in horses.

  3. Uso de concentrados autólogos de plaquetas como tratamiento de una fractura escapular y una lesión del plexo braquial producidas por un disparo en un caballo Use of autologous platelet concentrates as treatment for a scapular fracture and brachial plexus nerve injury produced by a gunshot in a horse

    Directory of Open Access Journals (Sweden)

    C López

    2010-01-01

    Full Text Available Las heridas de bala han sido escasamente descritas en caballos. Los disparos a corta distancia suelen producir daños en tejidos blandos y fracturas conminutas. Un caso de una fractura conminuta del cuello de la escápula con lesión aguda del plexo braquial producida por una bala de 9 mm en un semental de seis años de edad es descrito. El paciente fue tratado con éxito mediante la combinación de desbridamiento quirúrgico de la región afectada e inyección local de varias dosis de concentrados autólogos de plaquetas (APC y fisioterapia. A pesar de la fractura de la escápula y del daño en los nervios periféricos que toman al menos 18-24 meses para una recuperación completa, este paciente se recuperó satisfactoriamente en nueve meses. Estos resultados sugieren que las inyecciones de APC en combinación con fisioterapia pueden proporcionar un beneficio terapéutico en el tratamiento de lesiones agudas de tejidos blandos y fracturas óseas en caballos.Gunshot injuries have been scarcely reported in horses. Close-range gunshots usually produce extensive soft tissue damage and comminute fractures. A case of a comminute fracture of the neck of the scapula with acute injury of the brachial plexus produced by a 9 mm gunshot in a six year-old stallion is described. The patient was successfully treated by combining surgical debridement of the affected region and local injection of several doses of autologous platelet concentrates (APCs and physiotherapy. Although scapular fractures and peripheral nerve damage take at least 18-24 months for full recovery, this patient reached full recuperation of the affected limb in 9 months. These results suggest that injections of APCs in combination with physiotherapy could provide a therapeutic benefit in the treatment of soft tissue acute injuries and bone fractures in horses.

  4. Axillary Nerve Reconstruction: Anterior-Posterior Exposure With Sural Nerve Cable Graft Pull-Through Technique.

    Science.gov (United States)

    Baltzer, Heather L; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2015-12-01

    Deltoid paralysis after axillary nerve injury results in limitations in shoulder function and stability. In the setting of an isolated axillary nerve injury with no clinical or electromyographic evidence of recovery that is within 6 to 9 months postinjury, the authors' preferred technique to reinnervate the deltoid is to reconstruct the axillary nerve with sural nerve grafting. Intraoperative neuromuscular electrophysiology is critical to determine the continuity of the axillary nerve before proceeding with reconstruction. The majority of the time, both an anterior and posterior incision and dissection of the axillary nerve is required to adequately delineate the zone of injury. This also ensures that both proximally and distally, uninjured axillary nerve is present before graft inset and also facilitates the ability to perform a meticulous microsurgical inset of the nerve graft posteriorly. The nerve graft must be pulled through from posterior to anterior to span the zone of injury and reconstruct the axillary nerve. Careful infraclavicular brachial plexus dissection is necessary to prevent further injury to components of the brachial plexus in the setting of a scarred bed. Patients will require postoperative therapy to prevent limitations in shoulder range of motion secondary to postoperative stiffness. This paper presents a detailed surgical technique for axillary nerve reconstruction by an anterior-posterior approach with a pull-through technique of a sural nerve cable graft. PMID:26524659

  5. Radiation-induced malignant and atypical peripheral nerve sheath tumors

    International Nuclear Information System (INIS)

    The reported peripheral nerve complications of therapeutic irradiation in humans include brachial and lumbar plexus fibrosis and cranial and peripheral nerve atrophy. We have encountered 9 patients with malignant (7) and atypical (2) peripheral nerve tumors occurring in an irradiated site suggesting that such tumors represent another delayed effect of radiation treatment on peripheral nerve. In all instances the radio-theray was within an acceptable radiation dosage, yet 3 patients developed local radiation-induced skin and bony abnormalities. The malignant peripheral nerve sheath tumors developed only in the radiation port. Animal studies support the clinical observation that malignant peripheral nerve sheath tumors can occur as a delayed effect of irradiation

  6. The brachial plexus branches to the pectoral muscles in adult rats: morphological aspects and morphometric normative data

    Science.gov (United States)

    Riva, Nilo; Domi, Teuta; Lopez, Ignazio Diego; Triolo, Daniela; Fossaghi, Andrea; Dina, Giorgia; Podini, Paola; Comi, Giancarlo; Quattrini, Angelo

    2012-01-01

    Animal models provide an important tool to investigate the pathogenesis of neuromuscular disorders. In the present study, we analyze fiber composition of the brachial plexus branches to the pectoral muscles: the medial anterior thoracic nerve (MATN) and the lateral anterior thoracic nerve (LATN). The morphological and morphometric characteristics and the percentage of motor fibers within each nerve are here reported, adding information to microscopic anatomy knowledge of the rat brachial plexus. As control, we employed the quadriceps nerve, commonly used for the evaluation of motor fibers at hindlimbs. We demonstrated that the MATN and the LATN are predominantly composed of large motor fibers and therefore could be employed to evaluate the peripheral nervous system (PNS) involvement at forelimbs in neurological diseases models, predominantly affecting the motor fiber compartment. PMID:23087618

  7. Coexistent Malignant Peripheral Nerve Sheath Tumor and Lateral Spinal Meningoceles

    OpenAIRE

    Bhoir, Lata; Nichat, Pramod; Chug, Ashish; Verma, Harish

    2012-01-01

    Malignant peripheral nerve sheath tumor (MPNST) is a malignant spindle cell tumor of the soft tissue thought to be derived from the components of nerve sheath. MPNSTs are mainly located in the buttocks, thighs, brachial plexus, and paraspinal region. The objective of this article is to describe a case of neurofibromatosis type 1 who developed neurofibrosarcoma of the right lateral thoracic nerve with thoracic meningoceles, a rare coincidental finding which has not yet been reported in the Eng...

  8. Neuromuscular hamartoma arising in the brachial plexus

    International Nuclear Information System (INIS)

    We report a case brachial plexus neuromuscular hamartoma (choristoma) in a 28-year-old man who complained of numbness of the left hand and forearm for several years. MRI revealed a circumscribed, rounded mass in the left brachial plexus. The patient is well 2 years after surgery, with no neurological deficit. (orig.)

  9. Proactive error analysis of ultrasound-guided axillary brachial plexus block performance.

    LENUS (Irish Health Repository)

    O'Sullivan, Owen

    2012-07-13

    Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-guided axillary brachial plexus blockade, with the intention that the results may form a basis to enhance training and performance of the procedure.

  10. Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults

    Directory of Open Access Journals (Sweden)

    Duz Bulent

    2009-07-01

    Full Text Available Abstract Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.

  11. Non-Stimulation Needle with External Indwelling Cannula for Brachial Plexus Block and Pain Management in 62 Patients Undergoing Upper-Limb Surgery

    Directory of Open Access Journals (Sweden)

    Bin Yu, Xiaoqing Zhang, Peili Sun, Shuqi Xie, Qiying Pang

    2012-01-01

    Full Text Available Objective: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. Methods: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient's satisfaction. Results: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner's syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient's satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. Conclusions: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient's satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.

  12. Comunicación Masiva del Ramo Superficial del Nervio Radial con el Nervio Cutáneo Antebraquial Lateral, Implicancias Anatomo-Clínicas: Reporte de un Caso / Massive Communication Between the Superficial Branch of Radial Nerve and Lateral Cutaneous Nerve of the Forearm, Anatomical and Clinical Implications: A Case Report

    Scientific Electronic Library Online (English)

    Martín, Inzunza A; Guillermo, Salgado A; Andrea, González S; Juan Carlos, De la Cuadra F; Oscar, Inzunza H.

    2011-09-01

    Full Text Available La distribución de los ramos nerviosos sensitivos en el borde lateral y en el dorso de la mano han sido descritos con mayor exactitud en las últimas décadas, debido al avance de las técnicas de electrodiagnóstico que ofrecen un alto rendimiento, las cuales han permitido detectar que alrededor del 40 [...] % de la población examinada presenta algún grado de variación anatómica en el territorio de distribución de los nervios involucrados. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial (NRS) y al nervio cutáneo antebraquial lateral (CABL); donde NRS se conecta de forma íntegra con el ramo medial de CABL, formándose así un tronco común (TC) que se distribuye por la región dorsal de la mano. Por su parte, el ramo lateral de CABL se distribuye por el borde lateral de la mano, ocupando el territorio cutáneo de NRS; situación que aparece descrita en la literatura especializada sólo una vez. El hallazgo de estas variaciones anatómicas en los cadáveres disecados con fines docentes en nuestro Departamento de Anatomía, tienen un valor formativo indiscutible para nuestros alumnos de pregrado y especialmente para los de postgrado, quienes pueden comprobar de primera mano la enorme variabilidad del ser humano, valorando las implicancias en la clínica diaria de este conocimiento anatómico. Abstract in english The distribution of the sensory nerve branches in the lateral and the back of the hand have been described more accurately in the past decades due to advancement of high performance electro-diagnostic variation techniques, which indicate that approximately 40% of the population examined have some de [...] gree of anatomical variation in the distribution area of the nerves involved. In this case we present an extremely rare, bilaterally detected variation, involving the superficial branch of the radial nerve (SBRN) and lateral antebrachial cutaneous nerve of the forearm (LABCN), where the SBRN is connected integrally with the medial branch of LABCN, forming a common trunk (CT) distributed by the dorsal region of the hand. Furthermore, the lateral branch of the LABCN is distributed in the lateral border of the hand, occupying the area of the skin of the SBRN, an event that is described only once in the literature. The discovery of these anatomical variations in dissected cadavers for teaching purposes, in the Department of Anatomy, have an undeniable educational value for our undergraduate students and especially for the graduate who can observe the enormous variability of human beings first hand, and value implications of this anatomical knowledge in daily clinic.

  13. Cutaneous sarcoidosis.

    OpenAIRE

    Ghorpade A; Ramanan C

    1998-01-01

    Sarcoidosis is a multi-organ granulomatous disorder of unknown cause. Skin sarcoidosis occurs in about 25% of patients with systemic disease and may also arise in isolation. A wide range of clinical presentations of cutaneous sarcoidosis is recognised. The diagnosis rests on the presence of non-caseating granulomas on skin biopsy and the exclusion of other granulomatous skin disease. The treatment and overall prognosis of cutaneous sarcoidosis is primarily dependent on the degree of systemic ...

  14. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso Phrenic nerve block after interscalene brachial plexus block: case report

    Directory of Open Access Journals (Sweden)

    Luis Henrique Cangiani

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em paciente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2% com epinefrina a 1:200.000 e ropivacaína a 0,75% em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95%, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case with phrenic nerve block with respiratory repercus

  15. Inhibition of motoneurons during the cutaneous silent period in the spinal cord of the turtle

    DEFF Research Database (Denmark)

    Guzulaitis, Robertas; Hounsgaard, Jørn Dybkjær; Alaburda, Aidas

    2012-01-01

    The transient suppression of motor activity in the spinal cord after a cutaneous stimulus is termed the cutaneous silent period (CSP). It is not known if CSP is due to suppression of the premotor network or direct inhibition of motoneurons. This issue was examined by intracellular recordings from motoneurons in the isolated carapace-spinal cord preparation from adult turtles during rhythmic scratch-like reflex. Electrical stimulation of cutaneous nerves induced CSP-like suppression of motor nerv...

  16. Cutaneous zygomycosis.

    Science.gov (United States)

    Bonifaz, Alexandro; Vázquez-González, Denisse; Tirado-Sánchez, Andrés; Ponce-Olivera, Rosa María

    2012-01-01

    Cutaneous zygomycosis is a fungal infection caused by zygomycetes that affects the skin. It occurs in uncontrolled diabetic patients and immunosuppressed individuals. It has 2 clinical forms: primary cutaneous zygomycosis and secondary cutaneous zygomycosis. The first is characterized by necrotic lesions and the fungus is usually inoculated by trauma. If diagnosed early, it generally has a good prognosis. Secondary zygomycosis is usually a complication and extension of the rhinocerebral variety that starts as a palpebral fistula and progresses to a necrotic lesion with a poor prognosis. The diagnosis is made by identification of the fungus by direct KOH examination, culture, and biopsy. Treatment for the primary disease is surgical debridement plus amphotericin B. The secondary type is treated with amphotericin B and/or posaconazole. PMID:22682190

  17. Cutaneous Leishmaniasis

    Directory of Open Access Journals (Sweden)

    Mehmet Harman

    2015-12-01

    Full Text Available Leishmaniasis is used to describe a spectrum of diseases caused by the parasitic protozoa leishmania spp. and transmitted by infected female sandflies. There are three main forms of the disease; cutaneous, mucocutaneous, and visceral. According to the World Health Organization, almost 12 million people from 98 countries worldwide are currently infected with leishmaniasis, while 350 million people are at risk. It was reported that 2 million new cases are diagnosed every year, with three-fourth are cutaneous leishmaniasis (CL cases. The scientific and medical communities have learnt a lot about CL during the 20th and early 21st centuries. However, the management and control of the disease remains a difficult task. This article was focused on the most common form of the disease, cutaneous leishmaniasis, and especially its epidemiological aspects and treatment.

  18. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso / Phrenic nerve block after interscalene brachial plexus block: case report / A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso

    Scientific Electronic Library Online (English)

    Luis Henrique, Cangiani; Luis Augusto Edwards, Rezende; Armando, Giancoli Neto.

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em pac [...] iente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2% com epinefrina a 1:200.000 e ropivacaína a 0,75% em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95%, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilato [...] rio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos. Abstract in english BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case

  19. Brachial plexus variations in its formation and main branches

    Scientific Electronic Library Online (English)

    Valéria Paula Sassoli, Fazan; André de Souza, Amadeu; Adilson L., Caleffi; Omar Andrade, Rodrigues Filho.

    Full Text Available OBJETIVOS: O plexo braquial apresenta uma estrutura anatômica complexa, desde sua origem, no pescoço, até sua ramificação terminal, na região axilar. Ele também apresenta relações importantes com outras estruturas anatômicas locais, o que o torna vulnerável ao aparecimento de uma série de variações [...] anatômicas, marcando sua importância clínica e cirúrgica. Os objetivos desse estudo foram de descrever as variações anatômicas do plexo braquial, desde sua origem até seus ramos terminais e correlacionar essas variações com o sexo e a cor dos indivíduos, bem como com o lado do corpo estudado. MÉTODOS: Vinte e sete cadáveres adultos, separados em sexo e cor, tiveram seus plexos braquiais avaliados à direita e à esquerda. RESULTADOS: Nossos resultados são extensos e descrevem um grande número de variações, incluindo algumas ainda não descritas na literatura. Nossos resultados mostram que o nervo frênico apresentou sua origem diretamente no plexo braquial em 20% dos casos. Assim, uma lesão das raízes do plexo braquial poderia resultar em uma inexplicada paralisia diafragmática. Não é esperado que o nervo torácico longo passe através do músculo escaleno médio entretanto, esse fato foi observado em 63% de nossos casos. Outra observaçõa foi a formação do fascículo posterior pelas divisões posteriores dos troncos superior e médio em 9% dos casos. Nesses casos, os nervos axilar e radial poderão não receber fibras de C7 e C8, como normalmente descrito na literatura. CONCLUSÃO: Os plexos braquiais estudados não mostraram que o sexo, a cor ou o lado do corpo influenciam de maneira importante na presença de variações anatômicas dessa estrutura. Abstract in english PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical impor [...] tance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.

  20. Brachial plexus variations in its formation and main branches

    Directory of Open Access Journals (Sweden)

    Valéria Paula Sassoli Fazan

    2003-01-01

    Full Text Available PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.OBJETIVOS: O plexo braquial apresenta uma estrutura anatômica complexa, desde sua origem, no pescoço, até sua ramificação terminal, na região axilar. Ele também apresenta relações importantes com outras estruturas anatômicas locais, o que o torna vulnerável ao aparecimento de uma série de variações anatômicas, marcando sua importância clínica e cirúrgica. Os objetivos desse estudo foram de descrever as variações anatômicas do plexo braquial, desde sua origem até seus ramos terminais e correlacionar essas variações com o sexo e a cor dos indivíduos, bem como com o lado do corpo estudado. MÉTODOS: Vinte e sete cadáveres adultos, separados em sexo e cor, tiveram seus plexos braquiais avaliados à direita e à esquerda. RESULTADOS: Nossos resultados são extensos e descrevem um grande número de variações, incluindo algumas ainda não descritas na literatura. Nossos resultados mostram que o nervo frênico apresentou sua origem diretamente no plexo braquial em 20% dos casos. Assim, uma lesão das raízes do plexo braquial poderia resultar em uma inexplicada paralisia diafragmática. Não é esperado que o nervo torácico longo passe através do músculo escaleno médio entretanto, esse fato foi observado em 63% de nossos casos. Outra observaçõa foi a formação do fascículo posterior pelas divisões posteriores dos troncos superior e médio em 9% dos casos. Nesses casos, os nervos axilar e radial poderão não receber fibras de C7 e C8, como normalmente descrito na literatura. CONCLUSÃO: Os plexos braquiais estudados não mostraram que o sexo, a cor ou o lado do corpo influenciam de maneira importante na presença de variações anatômicas dessa estrutura.

  1. Convulsion due to levobupivacaine in axillary brachial plexus block: Case report

    Directory of Open Access Journals (Sweden)

    Cevdet Düger

    2013-06-01

    Full Text Available Axillary brachial plexus block is an effective method of anaesthesia for the surgeries performed on the hand, forearm and distal third of the arm. However it has the risk of serious complications such as cardiovascular and central nervous system toxicity. Levobupivacaine is a long acting amide local anaesthetic used for epidural, caudal, spinal, infiltration and peripheral nerve blocks. Levobupivacaine is the S (- isomer of racemic bupivacaine and has a lower risk of cardiovascular, central nervous system toxicity than bupivacaine. However central system toxicity cases due to absorption of the drug into the systemic circulation has been reported. Here, we report a case having no vascular puncture during axillary brachial plexus block performance but developing convulsion due to levobupivacain after the intervention.

  2. Variation in the Formation of Sural Nerve –A Case Report

    Directory of Open Access Journals (Sweden)

    Tanvi Mahajan

    2014-07-01

    Full Text Available Sural nerve is a sensory nerve, which supplies the skin of the posterolateral aspect of the distal third of leg, lateral malleolus, along the lateral side of foot and little toe. The sural nerve’s anatomy is broadly studied in man, because it is one of the most frequently used sensory nerves in transplantation. The aim of the paper is to present a case of variant formation of the sural nerve and review of literature related to this case. Here is an unusual type of formation of sural nerve is reported. In this case, the medial sural cutaneous nerve and lateral sural cutaneous nerve were noticed to continue their course without any formation of a unique nerve trunk on the posterior side of left leg of 50 year old male cadaver. A transverse communicating branch connecting these two nerves was present. As the sural nerve is of significant diagnostic and therapeutic importance, detailed knowledge of the sural nerve’s anatomy and its contributing nerve is also of great importance

  3. Management of brachial plexus injuries in adults: Clinical evaluation and diagnosis.

    Science.gov (United States)

    Sinha, Sumit; Pemmaiah, Devi; Midha, Rajiv

    2015-01-01

    Brachial plexus injuries are devastating injuries that usually affect the younger population. The usual modes of injuries are roadside accidents, falls, and assaults. The affected individuals are crippled and may suffer from excruciating peripheral or central deafferentation pain for rest of their lives. The loss of functional capacity accounts for a significant number of man-hours lost at the workplace and consequent financial burden on the family. The results of brachial plexus reconstructive surgery have generally been unsatisfactory in the past. However, in recent decades, the efficacy of surgery has been proven beyond doubt, and there have been various published series in literature that have reported a good outcome after surgical management of these injuries. This has been made possible by the use of operating microscopes, better microsuture techniques for nerve graft and nerve or tendon transfer repair, and advanced perioperative electrophysiological techniques. The key to successful management lies in the proper clinical evaluation, supplemented with electrophysiology, preoperative imaging studies, and planning of surgical strategy. The partial injuries have a better outcome as compared with global palsies, and early referral should be emphasized. Selective combinations of nerve graft and transfers provide a moderate shoulder and elbow control. However, a multispecialty approach involving hand surgeons, plastic surgeons, and physiotherapists is required. PMID:26588627

  4. Unilateral hypoglossal nerve atrophy as a late complication of radiation therapy of head and neck carcinoma: a report of four cases and a review of the literature on peripheral and cranial nerve damages after radiation therapy

    International Nuclear Information System (INIS)

    The case histories of four patients who developed hemiatrophy of the tongue from 3 to 9 years after a course of curative radiation therapy for carcinomas of the head and neck are presented. These patients were subsequently followed from 11/2 to 6 years without local recurrence of the tumor, distant metastasis, or involvement of other cranial nerves, indicative of only a unilateral hypoglossal nerve atrophy. A review of the literature showed that peripheral and cranial nerve damages after radiation therapy have been reported for the optic nerve, hypoglossal nerve, oculomotor nerve, abducens nerve, recurrent laryngeal nerve, brachial plexus nerves, and peripheral nerves of the extremities. Review of clinical and experimental data indicated that in most cases, the damages were probably caused by extensive connective tissue fibrosis around and infiltrating the nerve trunks. Three possible types of peripheral and cranial nerve damages after radiation therapy are identified. (U.S.)

  5. Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

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    Marco Rosati

    2013-07-01

    Full Text Available Introduction: The thoracic outlet syndrome (TOS is a rare complication of clavicular fracture, occurring in 0.5-9% of cases . In the literature from 1965 – 2010, 425 cases of TOS complicating a claviclular fracture were described. However, only 5 were observed ??after a surgical procedure of reduction and fixation. The causes of this complication were due to the presence of an exuberant callus, to technical surgery errors or to vascular lesions. In this paper we describe a case of brachial plexus plasy after osteosynthesis of clavicle fracture. Case Report: A 48 year old female, presented to us with inveterate middle third clavicle fracture of 2 months duration. She was an alcoholic, smoker with an history of opiate abuse and was HCV positive. At two month the fracture was displaced with no signs of union and open rigid fixation with plate was done. The immediate postoperative patient had signs of neurologic injury. Five days after surgery showed paralysis of the ulnar nerve, at 10 days paralysis of the median nerve, radial and ulnar paresthesias in the territory of the C5-C6-C7-C8 roots. She was treated with rest, steroids and neurotrophic drugs. One month after surgery the patient had signs of complete denervation around the brachial plexus. Implant removal was done and in a month ulnar and median nerve functions recovered. At three months post implant removal the neurological picture returned to normal. Conclusion: We can say that TOS can be seen as arising secondary to an “iatrogenic compartment syndrome” justified by the particular anatomy of the space cost joint. The appropriateness of the intervention for removal of fixation devices is demonstrated by the fact that the patient has returned to her daily activities in the absence of symptoms and good functional recovery in about three months, despite fracture nonunion. Keywords: Brachial plexus palsy, clavicle fractures, outlet thoracic syndrome.

  6. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study

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    Prashant A Biradar

    2013-01-01

    Full Text Available Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomised, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of supraclavicular brachial plexus block as this is the most common type of brachial block performed in our institute. Methods: Sixty American Society of Anaesthesiologist?s physical status I and II patients undergoing elective hand, forearm and elbow surgery under brachial plexus block were randomly allocated to receive either 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of normal saline (group C, n=30 or 1.5% lidocaine (7 mg/kg with adrenaline (1:200,000 and 2 ml of dexamethasone (8 mg (group D, n=30. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade were assessed. The sensory and motor blockade of radial, median, ulnar and musculocutaneous nerves were evaluated and recorded at 5, 10, 20, 120 min, and at every 30 min thereafter. Results: Two patients were excluded from the study because of block failure. The onset of sensory and motor blockade (13.4±2.8 vs. 16.0±2.3 min and 16.0±2.7 vs. 18.7±2.8 min, respectively were significantly more rapid in the dexamethasone group than in the control group ( P=0.001. The duration of sensory and motor blockade (326±58.6 vs. 159±20.1 and 290.6±52.7 vs. 135.5±20.3 min, respectively were significantly longer in the dexamethasone group than in the control group ( P=0.001. Conclusion: Addition of dexamethasone to 1.5% lidocaine with adrenaline in supraclavicular brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade.

  7. Histological Consequences of Needle-Nerve Contact following Nerve Stimulation in a Pig Model

    Science.gov (United States)

    Steinfeldt, T.; Graf, J.; Schneider, J.; Nimphius, W.; Weihe, E.; Borgeat, A.; Wulf, H.; Wiesmann, T.

    2011-01-01

    Background. Nerve stimulation can facilitate correct needle placement in peripheral regional anesthesia. The aim of this study was to determine whether the high threshold current is associated with reduced nerve injury due to fewer needle-nerve contacts compared with low current. Methods. In anaesthetized pigs, thirty-two nerves of the brachial plexus underwent needle placement at low (0.2?mA) or high current (1.0?mA). The occurrence of needle-nerve contact was recorded. After 48 hours, the nerves were analyzed for occurrence of histological changes. Nerve injury was scored ranging from 0 (no injury) to 4 (severe injury). Results. The frequency of needle-nerve contact was 94% at low compared to 6% at high current. The score was significantly higher at low (median [interquartile range] 2.0 [1.0-2.0]) compared to high current (0.0 [0.0-1.0] P = .001). Conclusions. Inflammatory responses were directly related to needle-nerve contacts. Hence, posttraumatic inflammation may be diminished using higher current for nerve localization. PMID:21716736

  8. Descrição do plexo braquial do cachorro-do-mato (Cerdocyon thous Linnaeus, 1766) / Description of plexus brachial of crab-eating foxes (Cerdocyon thous Linnaeus, 1766)

    Scientific Electronic Library Online (English)

    Luane Lopes, Pinheiro; Érika, Branco; Damazio Campos, Souza; Luiza Helena Corrêa, Pereira; Ana Rita, Lima.

    2014-06-01

    Full Text Available O Cerdocyon thous é um canídeo que possui ampla distribuição na América do Sul e, salvo aspectos gerais, têm sua morfologia pouco conhecida na literatura, principalmente no que tange ao sistema nervoso. Com o objetivo de elucidar a composição anatômica do plexo braquial, estudaram-se três exemplares [...] machos provenientes de Paragominas-PA, doados após morte por atropelamento ao Laboratório de Pesquisa Morfológica Animal (LaPMA), da Universidade Federal Rural da Amazônia (UFRA). Os animais foram fixados em solução aquosa de formol 10% para posterior realização da dissecação bilateral da origem do plexo braquial. O plexo braquial do C. thous é derivado dos três últimos nervos espinhais cervicais e do primeiro nervo torácico (C6-T1). Os principais nervos que o compõem, com suas respectivas origens foram: n. supraescapular, n. subscapular e n. musculocutâneo (C6-C7), n. axilar (C7-C8), n. radial (C7-T1 e C7-C8), n. mediano, n. ulnar, n. toracodorsal e n. torácico lateral (C8-T1). Concluímos que o plexo braquial do C. thous assemelha-se ao descrito para os cães domésticos, apresentando pequenas diferenças quanto à composição de alguns nervos. Abstract in english The Cerdocyon thous is a canid that has a wide distribution in South America and, besides some general aspects, its morphology is little known in the literature, especially regarding the nervous system. With the aim of elucidating the anatomical composition of brachial plexus, we studied three male [...] specimens from Paragominas-PA, donated to the Morphological Laboratory of Animal Research (LaPMA), Federal Rural University of Amazonia (UFRA), after death by trampling. The animals were fixed in an aqueous solution of 10% formaldehyde for bilateral dissection of the origin of the brachial plexus. The brachial plexus of C. thous is derived from the last three cervical nerves and the first thoracic nerve (C6-T1). The main nerves that compose it, with their respective origins were the suprascapular nerve, subscapular nerve and musculocutaneous nerve (C6-C7), axillary nerve (C7-C8), radial nerve (C7-T1 and C7-C8), median nerve, ulnar nerve, thoracodorsal and thoracic lateral nerve (C8-T1). We conclude that the brachial plexus of C. thous is similar to that described for the domestic dogs, showing small differences in the composition of some nerves.

  9. Etiological factors of traumatic peripheral nerve injuries

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    Eser Filiz

    2009-01-01

    Full Text Available Background: Traumatic injury of peripheral nerves is a worldwide problem and can result in significant disability. Management of peripheral nerve injuries (PNIs requires accurate localization and the assessment of severity of the lesion. Aim: The purpose of this study is to analyze the data of patients with PNIs referred for electromyography to a tertiary care hospital. Materials and Methods: This is a retrospective study of clinical and electromyographic data of patients with PNIs seen over a period of eight-years (1999-2007 in a tertiary hospital. The data collected included: Demographic data, cause, type of lesion, anatomical location of the lesion, and the mechanism of lesion. Results: During the study period 938 patients were seen with nerve injuries and the distribution of nerve injuries was: PNIs: 1,165; brachial plexus lesions: 76; and lumbar plexus lesions: 7. The mean age was 31.8 years (range 2-81 years and the male to female ratio was 2.4:1. The most frequent nerve injuries were ulnar nerve in the upper extremity and sciatic nerve in the lower extremity. The most common cause of nerve injury was motor vehicle accidents. Two-thirds of the PNIs were partial. Conclusion: This study can serve as a guide to determine the epidemiology and classification of traumatic peripheral and plexus injuries.

  10. Ectopic pregnancy presenting with obturator nerve pain.

    OpenAIRE

    Ali, H S

    1998-01-01

    A 27 year old woman had a three day history of pain in the cutaneous distribution of the left obturator nerve before she developed the classical picture of ectopic pregnancy with lower abdominal pain and vaginal bleeding. A left tubal pregnancy was subsequently confirmed by laparoscopy. Referred pain along the obturator nerve has been reported in other pelvic conditions, but has not previously been reported as a manifestation of ectopic pregnancy. Ectopic pregnancy may present with a very wid...

  11. Brachial plexus block using lidocaine/epinephrine or lidocaine/xylazine in fat-tailed sheep

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    Safoura Ghadirian

    2013-09-01

    Full Text Available This blinded, randomized experimental study was designed to evaluate the analgesic effects of adding epinephrine or xylazine to lidocaine solution for brachial plexus block (BPB in sheep. Nine healthy, fat-tailed female lambs (26.6 ± 1.5 kg were randomly allocated into three groups: lidocaine 2%, 5 mg kg-1 (LID, n = 6, lidocaine (5 mg kg-1 with epinephrine 5 ?g mL-1 (LIDEP, n = 6 or lidocaine (5 mg kg-1 with xylazine 0.05 mg kg-1 (LIDXY, n = 6. Each animal was tested twice. The sheep received a total volume of 0.25 mL kg-1 for BPB. A nerve stimulator was used to locate the nerves of the brachial plexus. Onset and duration of analgesia of the forelimb were evaluated using superficial and deep pin prick and pinching of skin with a hemostat clamp. Heart and respiratory rates, and rectal temperature were recorded before and at predetermined intervals following the completion of the block. Brachial administration of LID, LIDEP or LIDXY produced forelimb analgesia within 11.3, 11.0 and 7.0 minutes, respectively. The mean duration of analgesia was 100.0 min in LID and 133.2 min in LIDEP group. The mean duration of analgesia in LIDXY group (186.8 min was significantly longer compared with LID group. In LIDEP group a significant increase in heart rate occurred 5 min after drug administration. Heart rate decreased from 35 to 80 min in sheep received LIDXY. In conclusion, the addition of xylazine to lidocaine solution for BBP provided a prolonged duration of action without any adverse effects in fat-tailed sheep.

  12. Desmoid Tumour of the Brachial Plexus

    OpenAIRE

    Mbaruku Neema; Benson Ndegwa Macharia; Ndiangui Francis; Koech Florentius; Orege Juliette

    2013-01-01

    Desmoid tumours of the brachial plexus are rare and may occur in extra-abdominal sites. The tumours are of fibroblastic origin and, although benign, are locally aggressive. Their relationship to critical neurovascular structures in their anatomic locations presents a challenge to the operating surgeons trying to adhere to the principles of surgery. Surprisingly little neurosurgical literature exists which was devoted to this topic despite the challenge these lesions present in surgery both at...

  13. Case report. Bee sting brachial block.

    OpenAIRE

    Hay, S M; Hay, F A; Austwick, D. H.

    1992-01-01

    A case of brachial plexus block is presented, following a bee sting in the posterior triangle of the neck. The onset of neurological symptoms was rapid as was their subsequent resolution. Delayed peripheral neurological symptoms believed to have an immunological basis have been reported in response to stings from bees and other Hymenoptera both in the central and peripheral nervous systems (Goldstein et al., 1960; Means et al., 1973; Bachman et al., 1982; Weatherall et al., 1987; Van Antwerpe...

  14. The spinal nerves that constitute the lumbosacral plexus and their distribution in the chinchilla

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    M. A. Martinez-Pereira

    2011-04-01

    Full Text Available In this study, the spinal nerves that constitute the lumbosacral plexus (plexus lumbosacrales (LSP and its distribution in Chinchilla lanigera were investigated. Ten chinchillas (6 males and 4 females were used in this research. The spinal nerves that constitute the LSP were dissected and the distribution of pelvic limb nerves originating from the plexus was examined. The iliohypogastric nerve arose from L1 and L2,, giving rise to the cranial and caudal nerves, and the ilioinguinal nerve arose from L3. The other branch of L3 gave rise to the genitofemoral nerve and 1 branch from L4 gave rise to the lateral cutaneous femoral nerve. The trunk formed by the union of L4–5 divided into medial (femoral nerve and lateral branches (obturator nerve. It was found that the LSP was formed by all the ventral branches of L4 at L6 and S1 at S3. At the caudal part of the plexus, a thick branch, the ischiadic plexus, was formed by contributions from L5–6 and S1. This root gave rise to the nerve branches which were disseminated to the posterior limb (cranial and caudal gluteal nerves, caudal cutaneous femoral nerve and ischiadic nerve. The ischiadic nerve divided into the caudal cutaneous surae, lateral cutaneous surae, common fibular and tibial nerve. The pudendal nerve arose from S1–2 and the other branch of S2 and S3 formed the rectal caudal nerve. The results showed that the origins and distribution of spinal nerves that constitute the LSP of chinchillas were similar to those of a few rodents and other mammals.

  15. The spinal nerves that constitute the lumbosacral plexus and their distribution in the chinchilla

    Scientific Electronic Library Online (English)

    M A, Martinez-Pereira; E M, Rickes.

    Full Text Available In this study, the spinal nerves that constitute the lumbosacral plexus (plexus lumbosacrales) (LSP) and its distribution in Chinchilla lanigera were investigated. Ten chinchillas (6 males and 4 females) were used in this research. The spinal nerves that constitute the LSP were dissected and the dis [...] tribution of pelvic limb nerves originating from the plexus was examined. The iliohypogastric nerve arose from L1 and L2, giving rise to the cranial and caudal nerves, and the ilioinguinal nerve arose from L3. The other branch of L3 gave rise to the genitofemoral nerve and 1 branch from L4 gave rise to the lateral cutaneous femoral nerve. The trunk formed by the union of L4-5 divided into medial (femoral nerve) and lateral branches (obturator nerve). It was found that the LSP was formed by all the ventral branches of L4 at L6 and S1 at S3. At the caudal part of the plexus, a thick branch, the ischiadic plexus, was formed by contributions from L5-6 and S1. This root gave rise to the nerve branches which were disseminated to the posterior limb (cranial and caudal gluteal nerves, caudal cutaneous femoral nerve and ischiadic nerve). The ischiadic nerve divided into the caudal cutaneous surae, lateral cutaneous surae, common fibular and tibial nerve. The pudendal nerve arose from S1-2 and the other branch of S2 and S3 formed the rectal caudal nerve. The results showed that the origins and distribution of spinal nerves that constitute the LSP of chinchillas were similar to those of a few rodents and other mammals.

  16. Unusual Relationship between the Piriform Muscle and Sciatic, Inferior Gluteal and Posterior Femoral Cutaneous Nerves / Relación Inusual entre el Músculo Piriforme y los Nervios Isquiático, Glúteo Inferior y Cutâneo Femoral Posterior

    Scientific Electronic Library Online (English)

    A. L, Jacomo; C. A. R, Martinez; S. O, Saleh; M, Andrade; F. E, Akamatsu.

    2014-06-01

    Full Text Available El síndrome del músculo piriforme se ha reconocido cada vez más como una causa de dolor en los miembros inferiores. Tensión excesiva o variaciones anatómicas del nervio y del músculo piriforme se cree son las causas subyacentes de pinzamiento del nervio isquiático. Se presenta una variación no descr [...] ita anteriormente. Durante una disección de rutina en un cadáver de sexo masculino, se observó una división más alta del nervio isquiático y la presencia de un músculo piriforme accesorio. El nervio isquiático se dividía bajo el músculo piriforme y el nervio fibular común pasaba sobre el músculo piriforme accesorio. Por otra parte, el nervio tibial cruzaba entre los músculos piriforme accesorio y gemelo superior. Además, ambos nervios se comunicaban con un ramo lateral bajo el margen inferior del músculo piriforme accesorio y el nervio glúteo inferior se originaba desde el nervio fibular. Variaciones anatómicas y relaciones entre el músculo piriforme y nervio isquiático pueden estar presentes hasta en el 17% de la población. Seis variaciones diferentes se han descrito en este artículo y ninguna es similar a nuestra descripción. A pesar del completo entendimiento de la fisiopatología del síndrome del músculo piriforme, aún queda por esclarecer y conocer las posibles variaciones anatómicas que pueden ser útiles tanto para su diagnóstico como para el tratamiento adecuado. Abstract in english Piriformis muscle syndrome has been increasingly recognized as a cause of leg pain. Overuse, strain, or anatomical variations of the relationship between the nerve and the piriformis muscle are thought to be the underlying causes of the entrapment of the sciatic nerve. We report a variation not prev [...] iously described which was found during a routine dissection. During routine dissection of the left gluteal region of an adult male cadaver we observed a high division of the sciatic nerve and the presence of an accessory piriformis muscle. The sciatic nerve divided beneath the piriformis muscle and the common fibular nerve passed over the accessory piriformis muscle, whereas the tibial nerve reflected anteriorly to pass between the accessory piriformis and the superior gemellus muscle. Additionally, both nerves communicated with a side branch under the inferior border of the accessory piriformis muscle and the inferior gluteal nerve originated from the fibular nerve. Anatomical variations in the relationship between the piriformis muscle and the sciatic nerve may be present in up to 17% of the population. Six different variations have been described and none of them is similar to our description. Though complete understanding of the physiopathology of the piriformis muscle syndrome remains to be elucidated, knowledge of the possible anatomical variations may be useful for its adequate diagnosis and treatment.

  17. Kaplan anastomosis of the ulnar nerve: a case report

    OpenAIRE

    Paraskevas Georgios; Ch Gekas Christos; Tzaveas Alexandros; Spyridakis Ioannis; Stoltidou Alexandra; Ph Tsitsopoulos Parmenion

    2008-01-01

    Abstract Introduction The sensory innervation of the hand is usually unvarying and anomalies in this area are uncommon. Case presentation We report the case of a rare ulnar nerve branch called a Kaplan anastomosis, which anastomosed the dorsal cutaneous branch with the ulnar nerve prior to its bifurcation into the superficial and deep ramus. Conclusion Many authors have reported unusual ulnar nerve branches and knowledge of these anatomical variations is important for the interpretation of pa...

  18. Dexmedetomidine Added to Ropivacaine Prolongs Axillary Brachial Plexus Block

    Directory of Open Access Journals (Sweden)

    Feroz Ahmad Dar

    2013-10-01

    Full Text Available Background and Objectives: We evaluated the effect of adding dexmedetomidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia.Methods: Eighty patients scheduled for elective forearm and hand surgery were divided into 2 equal groups in a randomized, double-blind fashion. The 4 main nerves in the axilla (musculocutaneus, radial, median, ulnar were identi?ed using neural stimulation. Patients were assigned randomly into 2 groups. In group R (n=40, 40ml (200 mg of 0.5% ropivacaine +1ml saline and in group RD (n=40, 40ml (200 mg of 0.5% ropivacaine +1ml dexmedetomidine (50µg were given. Motor and sensory block onset times, block durations, and duration of analgesia were recorded.Results: Demographic data and surgical characteristics were similar in both groups. Sensory and motor block onset times were shorter in group RD than in group R (P<0.05. Sensory and motor blockade durations were longer in group RD than in group R (P<0.001. Duration of analgesia was longer in group RD than in group R (P<0.001. Systolic arterial blood pressure levels in group RD at 10, 15, 30, 45, 60, 90, and 120 minutes were signi?cantly lower than those in group R (P<0.05. Diastolic arterial blood pressure levels in group RD at 60, 90, and 120 minutes were signi?cantly lower than those in group R (P<0.05. Heart rate levels in group RD, except basal measurements, were signi?cantly lower than those in group R (P<0.05. In group RD, bradycardia was observed in 7 patients, although there was no bradycardia in group R (P<0.05.Conclusions: Dexmedetomidine added to ropivacaine for axillary brachial plexus block shortens the onset time and prolongs the duration of the block and the duration of postoperative analgesia. However, dexmedetomidine also may lead to bradycardia. 

  19. Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    Björkman Anders

    2010-07-01

    Full Text Available Abstract Background As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries. Methods Seven consecutive male patients (median age 33; range 15-61 with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI, computed tomography myelography (CT-M or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (?-value. Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of the clinical findings and the radiological findings were estimated. Results The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (? = 0.76 compared with only fair (? = 0.34 for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87. Conclusions The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.

  20. COMPARATIVE STUDY OF ROPIVACAINE V/S ROPIVACAINE WITH MAGNESIUM SULPHATE FOR BRACHIAL PLUXUS BLOCK

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    Nagarjuna Reddy

    2015-09-01

    Full Text Available BACKGROUND : The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral ner ve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of tru nks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adju vants to the local anesthetics. AIM : To compare the efficacy of Ropivacaine and Ropivacaine with Magnesium Sulphate for Brachial Plexus Block by Supraclavicular technique, for upper limb orthopedic surgeries. DESIGN : A Prospective randomized comparative st udy . METHODS : Sixty adult patients of both sexes in the age group of 20 - 60 years belonging to ASA I/II category posted for various types of upper limb surgeries. The patients were randomly allocated into two groups. Supraclavicular brachial plexus block wa s performed. Group – I (Ropivacaine alone – 30 patients received 29ml of 0.75% Ropiva caine with 1ml of normal saline .Group – II (Ropivacaine+Magnesium – 30 patients received 29ml of 0.75% Ropivacaine with Magnesium Sulphate 250mg (1ml of 500mg drug diluted wi th 1ml of distilled water. The following parameters were observed after performing Supraclavicular Brachial Plexus block in both the groups: 1. Time of onset of block (Sensory and Motor 2. Total Duration of Analgesia 3. Total Duration of Motor Blockade 4 . Dermatomes/Nerves blocked 5. Complications if any. RESULTS : There was no significant difference in onset of sensory blockade between Group I ( 4.92±1.51 and Group II ( 4.86±1.58 ,There was no significant difference in onset of motor blockade between Group I (14.82±2.32 and Group II (13.7±2.82 ,When the duration of analgesia is compared, it is significantly longer in Group II ( 855.8 ± 73.66 than Group I ( 676 ± 89.55 , The changes in pulse rate were not significant between the two groups at various times o f recording., The changes in systolic and diastolic blood pressures are similar in both the groups., No complications were recorded during the procedure and also afterwards. CONCLUSION : Based on the present clinical comparative study addition of Magnesium Sulphate to Ropivacaine is a better choice than plain Ropivacaine for Brachial Plexus Block for upper limb surgeries.

  1. Terminal nerve: cranial nerve zero

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    Jorge Eduardo Duque Parra

    2006-12-01

    Full Text Available It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH. In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a common nerve that integrates the terminal nerve with the olfactory nerves and the vomeronasals nerves which seem to carry out the odors detection function as well as in the food search, pheromone detection and nasal vascular regulation.

  2. Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus

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    Vikas Trehan

    2010-01-01

    Full Text Available The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30 or medial clavicular approach (group M, n = 30 with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4, discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05. More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L. Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.

  3. Effects of the potassium channel blocking dendrotoxins on acetylcholine release and motor nerve terminal activity.

    OpenAIRE

    Anderson, A.J.; Harvey, A L

    1988-01-01

    1. The effects of the K+ channel blocking toxins, the dendrotoxins, on neuromuscular transmission and motor nerve terminal activity were assessed on frog cutaneous pectoris, mouse diaphragm and mouse triangularis sterni nerve-muscle preparations. Endplate potentials (e.p.ps) and miniature e.p.ps were recorded with intracellular microelectrodes, and nerve terminal spikes were recorded with extracellular electrodes placed in the perineural sheaths of motor nerves. 2. Dendrotoxin from green mamb...

  4. Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury

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    Singh Arun

    2007-01-01

    Full Text Available Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer. Materials and Methods: From February 2004 to February 2006, eight patients with posttraumatic brachial plexus injury with insufficient shoulder abduction were treated by trapezius muscle transfer. All patients with brachial plexus palsy were posttraumatic, often resulted from motor cycle accidents. Before operation a full evaluation of muscle function in the affected arm was carried out. All patients were treated with trapezius muscle transfer performed by the modified technique. S-shaped incision from the anterior border of the trapezius just above the clavicle to the Deltoid up to its insertion was made. The accessory nerve and its branches to the trapezius were secured. The trapezius was dissected and detached from its insertion along with the periosteum and sutured to the insertion of the Deltoid muscle. Results: All patients had improved functions and were satisfied with the outcome. The average increase in active abduction of shoulder was from 13.7 degrees (0 to 35 degrees preoperatively to 116 degrees (45 to 180 degrees postoperatively and of shoulder flexion from 24.3 degrees (15 to 30 degrees to 107 degrees (90 to 180 degrees. Conclusion: The modified technique proposed here for trapezius transfer is safe, convenient, simple and reliable for restoration of shoulder abduction and stability with clear subjective benefits.

  5. Anatomical aspects of the nerves of the leg and foot of the giant anteater (Myrmecophaga tridactyla, Linnaeus, 1758

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    V.S. Cruz

    2014-10-01

    Full Text Available Although distal stifle joint nerve distribution has been well established in domestic animals, this approach is scarcely reported in wild animals. Therefore, the aim of this study was to describe the nerves of the leg and foot of Myrmecophaga tridactyla with emphasis on their ramification, distribution, topography and territory of innervation. For this purpose, six adult cadavers fixed and preserved in 10% formalin solution were used. The nerves of the leg and foot of the M. tridactyla were the saphenous nerve (femoral nerve branch, fibular and tibial nerves and lateral sural cutaneous nerve (branches of the sciatic nerve and caudal sural cutaneous nerve (tibial nerve branch. The saphenous nerve branches to the skin, the craniomedial surface of the leg, the medial surface of the tarsal and metatarsal regions and the dorsomedial surface of the digits I and II (100% of cases, III (50% of cases and IV (25% of cases. The lateral sural cutaneous nerve innervates the skin of the craniolateral region of the knee and leg. The fibular nerve innervates the flexor and extensor muscles of the tarsal region of the digits and skin of the craniolateral surface of the leg and dorsolateral surface of the foot. The tibial nerve innervates the extensor muscles of the tarsal joint and flexor, adductor and abductor muscles of the digits and the skin of the plantar surface. The caudal sural cutaneous nerve innervates the skin of the caudal surface of the leg. The nerves responsible for the leg and foot innervation were the same as reported in domestic and wild animals, but with some differences, such as the more distal division of the common fibular nerve, the absence of dorsal metatarsal branches of the deep fibular nerve and a greater involvement of the saphenous nerve in the digital innervation with branches to the digits III and IV, in addition to digits I and II.

  6. Non-traumatic brachial plexopathies, clinical, radiological and neurophysiological findings from a tertiary centre.

    LENUS (Irish Health Repository)

    Mullins, G M

    2012-02-03

    OBJECTIVE: To establish the clinical characteristics, aetiology, neuro-physiological characteristics, imaging findings and other investigations in a cohort of patients with non-traumatic brachial plexopathy (BP). METHODS: A 3-year retrospective study of patients with non-traumatic BP identified by electromyography (EMG) and nerve conduction studies (NCS). Clinical information was retrieved from patients\\' medical charts. RESULTS: Twenty-five patients were identified. Causes of BP included neuralgic amyotrophy (NA) (48%), neoplastic (16%), radiation (8%), post infectious (12%), obstetric (4%), rucksack injury (4%), thoracic outlet syndrome (4%) and iatrogenic (4%). Patients with NA presented acutely in 50%. The onset was subacute in all others. Outcome was better for patients with NA. All patients with neoplastic disease had a previous history of cancer. MRI was abnormal in 3\\/16 patients (18.8%). PET scanning diagnosed metastatic plexopathy in two cases. CONCLUSIONS: NA was the most common cause of BP in our cohort and was associated with a more favourable outcome. The authors note potentially discriminating clinical characteristics in our population that aid in the assessment of patients with brachial plexopathies. We advise NCS and EMG be performed in all patients with suspected plexopathy. Imaging studies are useful in selected patients.

  7. Cutaneous Collagenous Vasculopathy

    Science.gov (United States)

    Ortleb, Melanie; Boyd, Alan S.; Powers, Jennifer

    2015-01-01

    Cutaneous collagenous vasculopathy is a rare microangiopathy of dermal blood vessels. Clinically indistinguishable from generalized essential telangiectasia, this condition is diagnosed by its unique histological appearance. In contrast to other primary telangiectatic processes, cutaneous collagenous vasculopathy has dilated vascular structures that contain deposits of eosinophilic hyaline material within the vessel walls. To date, cutaneous collagenous vasculopathy has been described in a total of 19 cases in the medical literature. The first several cases were described exclusively in middle-aged to elderly men. Though it has now been described in both men and women, cutaneous collagenous vasculopathy is still most often described in middle-aged to older adults. No particular disease or medication has been linked to the development of cutaneous collagenous vasculopathy, and the etiology remains unknown. In this case series, the authors present three additional patients diagnosed with cutaneous collagenous vasculopathy and discuss their clinical and histopathologic features.

  8. Obstetrical brachial plexus injuries: a MRI diagnostic approach

    International Nuclear Information System (INIS)

    Purpose: To demonstrate the utility of Magnetic Resonance (MR) imaging in the evaluation of the obstetric injuries of the brachial plexus. Material and methods: 23 patients with semiology of brachial plexus palsy have been evaluated with high field MR. Patients were evaluated with a brain coil in axial, oblique coronal and sagittal planes with T1, T2 and STIR sequences. Results: In four patients (17%) the study was normal. In 19 patients (83%) we got pathological findings (pseudomeningoceles, neuromas, tumour and arachnoid cyst). Conclusion: The MR is a non-invasive method that permits to determinate the site and range of the brachial plexus damage, allowing to plan therapy. (author)

  9. Primary cutaneous amyloidosis

    OpenAIRE

    Shah Mona; Padhiar Bela; Karia Umesh; Shah Bela; Rawal R; Bilimoria F

    1997-01-01

    Three cases of primary cutaneous amyloidosis are reported. Family history was negative. Systemic involvement was ruled out. Histopathology was confirmed by congored stain. Patients responded to oral colchicine.

  10. Sarcomas cutâneos primários Primary cutaneous sarcomas

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    Luiz Fernando Fróes Fleury Jr

    2006-06-01

    Full Text Available Os sarcomas com apresentação cutânea primária são tumores raros e de grande heterogeneidade histológica. Com a evolução da oncologia cutânea e da cirurgia dermatológica, os dermatologistas têm sido cada vez mais requisitados para o diagnóstico e orientação terapêutica de tumores menos freqüentes. Este artigo de revisão analisa os sarcomas cutâneos primários observando suas características clínicas, etiopatogênicas e histológicas, bem como aspectos do tratamento e evolução. Enfatiza os sarcomas de maior relevância para o dermatologista, como angiossarcoma, dermatofibrossarcoma protuberans, fibroxantoma atípico, leiomiossarcoma, lipossarcoma, tumor maligno de bainha de nervo periférico e sarcoma epitelióide. O sarcoma de Kaposi não é abordado devido a suas características individuais específicas.Soft tissue tumors represent a heterogeneous group of mesenchymal and neural lesions. The cutaneous presentation of these tumours is rare. With the evolution of dermatologic surgery and cutaneous oncology, dermatologists have emerged as specialists for skin cancer management. This article reviews primary cutaneous sarcomas with particular emphasis on the epidemiologic, clinical, and histological features of diagnosis, as well as treatment modalities and prognosis. The most frequent cutaneous sarcomas were reviewed, including angiosarcoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, leiomyosarcoma, liposarcoma, malignant nerve sheath tumor, and epithelioid sarcoma. Kaposi's sarcoma, due to specific characteristics, was omitted from this review.

  11. Radiological Imaging Findings of a Case with Vertebral Osteoid Osteoma Leading to Brachial Neuralgia

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    Erkan Gokce

    2013-01-01

    Full Text Available Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT findings. Because magnetic resonance imaging (MRI findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms.

  12. Reabilitação na paralisia parcial do plexo braquial / Rehabilitation after partial brachial plexus palsy

    Scientific Electronic Library Online (English)

    Kátia Torres, Batista; Hugo José de, Araújo.

    2013-03-01

    Full Text Available Muitas transferências musculares têm sido defendidas para restaurar os movimentos do membro superior após paralisia grave do plexo braquial. A paralisia dos músculos deltoide e supraespinal pode ser tratada por meio de transferência do músculo trapézio. A paralisia dos músculos extensores de punho, [...] mão e dedos, quando o nervo mediano está preservado, pode ser corrigida com emprego dos músculos pronador redondo, flexor ulnar do carpo e palmar longo. Os autores descrevem um caso de reabilitação de paciente portador de lesão parcial antiga do plexo braquial à direita, de predomínio em tronco superior, principalmente da raiz de C6 e de fascículo posterior. Foi evidenciada fraqueza dos músculos deltoide e extensores do punho e dos dedos, sem antecedentes de reparo microcirúrgico do plexo braquial. Foi realizada, inicialmente, cirurgia de transferência tendínea para ganho de extensão de punho, mão e dedos e, após um ano, transferência do músculo trapézio, para estabilização do ombro. O sucesso na transferência para tratamento de paralisia do plexo braquial requereu especialização do cirurgião, motivação do paciente e programa de reabilitação. Abstract in english A variety of muscle transfer techniques have been proposed to restore motion of the upper extremities following severe brachial plexus palsy. Paralysis of the deltoid and supraspinatus muscles can be treated with transfer of the trapezius muscle. Paralysis of the wrist, hand, and digital extensor mu [...] scles can be corrected using the pronator teres, flexor carpi ulnaris, and palmaris longus muscles if the median nerve is preserved. Here we describe the rehabilitation of a patient with an old partial injury to the right brachial plexus that primarily involved the upper trunk from the C6 root to the posterior cord. Weakness of the deltoid muscle, wrist, and digital extensor muscles was observed. Microsurgical repair of the brachial plexus had not been performed. Tendon transfer surgery was performed to improve wrist, hand, and digital extension. One year later, transfer of the trapezius muscle was performed to stabilize the shoulder. The success of muscle transfer in the treatment of the brachial plexus palsy required the surgeon's specialization, the patient's motivation, and a rehabilitation program.

  13. Brachial and lumbar plexuses in chronic inflammatory demyelinating polyradiculoneuropathy: MRI assessment including apparent diffusion coefficient

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Yuko; Sato, Noriko; Yamashita, Fumio; Kida, Jiro; Takahashi, Tomoyuki [National Center Hospital of Neurology and Psychiatry, Department of Radiology, Kodaira, Tokyo (Japan); Okamoto, Tomoko [National Center Hospital of Neurology and Psychiatry, Department of Neurology, Kodaira, Tokyo (Japan); Sasaki, Masayuki; Komaki, Hirofumi [National Center Hospital of Neurology and Psychiatry, Department of Child Neurology, Kodaira, Tokyo (Japan); Matsuda, Hiroshi [Saitama Medial University Hospital, Department of Nuclear Medicine, Iruma-gun, Saitama (Japan)

    2011-01-15

    Our purpose was to clarify the magnetic resonance (MR) imaging characteristics of the brachial and lumbar plexuses in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) using various kinds of sequences, including diffusion-weighted images (DWI). We evaluated the MR imaging findings for lumbar and/or brachial nerve plexuses in 13 CIDP patients and 11 normal volunteers. The nerve swelling was evaluated in comparison with normal controls by coronal short tau inversion recovery (STIR), and signal abnormalities were evaluated by coronal STIR, T1-weighted images, and DWIs. The degrees of contrast enhancement and apparent diffusion coefficient (ADC) values of the plexus were also assessed. In the patient group, diffuse enlargement and abnormally high signals were detected in 16 out of 24 plexuses (66.7%) on STIR, a slightly high signal was detected in 12 of 24 plexuses (50%) on T1-weighted images, and a high-intensity signal was detected in 10 of 18 plexuses (55.6%) on DWIs with high ADC values. Contrast enhancement of the plexuses was revealed in 6 of 19 plexuses (31.6%) and was mild in all cases. There were statistically significant differences between the ADC values of patients with either swelling or abnormal signals and those of both normal volunteers and patients without neither swelling nor abnormal signals. There were no relationships between MR imaging and any clinical findings. STIR is sufficient to assist clinicians in diagnosing CIDP. T1-weighted images and DWIs seemed useful for speculating about the pathological changes in swollen plexuses in CIDP patients. (orig.)

  14. Brachial and lumbar plexuses in chronic inflammatory demyelinating polyradiculoneuropathy: MRI assessment including apparent diffusion coefficient

    International Nuclear Information System (INIS)

    Our purpose was to clarify the magnetic resonance (MR) imaging characteristics of the brachial and lumbar plexuses in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) using various kinds of sequences, including diffusion-weighted images (DWI). We evaluated the MR imaging findings for lumbar and/or brachial nerve plexuses in 13 CIDP patients and 11 normal volunteers. The nerve swelling was evaluated in comparison with normal controls by coronal short tau inversion recovery (STIR), and signal abnormalities were evaluated by coronal STIR, T1-weighted images, and DWIs. The degrees of contrast enhancement and apparent diffusion coefficient (ADC) values of the plexus were also assessed. In the patient group, diffuse enlargement and abnormally high signals were detected in 16 out of 24 plexuses (66.7%) on STIR, a slightly high signal was detected in 12 of 24 plexuses (50%) on T1-weighted images, and a high-intensity signal was detected in 10 of 18 plexuses (55.6%) on DWIs with high ADC values. Contrast enhancement of the plexuses was revealed in 6 of 19 plexuses (31.6%) and was mild in all cases. There were statistically significant differences between the ADC values of patients with either swelling or abnormal signals and those of both normal volunteers and patients without neither swelling nor abnormal signals. There were no relationships between MR imaging and any clinical findings. STIR is sufficient to assist clinicians in diagnosing CIDP. T1-weighted images and DWIs seemed useful for speculating about the pathological changes in swollen plexuses in CIDP patients. (orig.)

  15. Isolated axillary nerve involvement: a case report

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    betul tekin guveli

    2013-01-01

    Full Text Available Isolated axillary neuropathy is a rare condition. Trauma to the shoulder, especially dislocation of the shoulder is the most common cause. The other causes of axillary neuropathy are injection to the shoulder, carrying heavy backpacks and acute idiopathic brachial plexus neropathy. Differential diagnosis should be made especially between cervical 5-6 radiculopathy and upper truncus brachial plexopathy. Case: A 32-year-old man admitted with progressive atrophy and weakness of the right shoulder which developed after deep pain. In his neurological examination, abduction weakness and atrophy of the right shoulder was determined. Magnetic resonance imaging findings of cervical spine and right shoulder were normal. Electrophysiologic examination revealed reduced compound muscle action potential amplitude of the right axillary nerve, recorded from deltoid muscle, compared to the left side. On needle EMG, subacute neurogenic signs in the right deltoid and teres minor muscles which are innervated by the axillary nerve were detected. Etiological evaluation revealed no cause. It has been suggested that isolated axillary neuropathy may be associated with Personage-Turner syndrome. Antiinflammatory medications and physical therapy provided partial improvement. The aim of our presentation was to discuss the differential diagnosis, treatment options and etiologic causes of axillary neuropathy.

  16. Brachial plexus variations in its formation and main branches

    OpenAIRE

    Valéria de Paula Sassoli Fazan; André de Souza Amadeu; Adilson L. Caleffi; Omar Andrade Rodrigues Filho

    2003-01-01

    PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects ...

  17. Robotic intercostal nerve harvest: a feasibility study in a pig model.

    Science.gov (United States)

    Miyamoto, Hideaki; Serradori, Thomas; Mikami, Yoji; Selber, Jesse; Santelmo, Nicola; Facca, Sybille; Liverneaux, Philippe

    2016-01-01

    The aim of this study was to report the feasibility of robotic intercostal nerve harvest in a pig model. A surgical robot, the da Vinci Model S system, was installed after the creation of 3 ports in the pig's left chest. The posterior edges of the fourth, fifth, and sixth intercostal nerves were isolated at the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvesting procedures, requiring an average of 33 minutes, were successfully performed in 3 pigs without major complications. The advantages of robotic microsurgery for intercostal nerve harvest include elimination of physiological tremor, free movement of joint-equipped robotic arms, and amplification of the surgeon's hand motion by as much as 5 times. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvest for brachial plexus reconstruction. PMID:26207601

  18. Ultrasound-guided fine needle aspiration in the diagnosis of peripheral nerve sheath tumors in 4 dogs

    OpenAIRE

    da Costa, Ronaldo C.; Parent, Joane M.; Dobson, Howard; Ruotsalo, Kristiina; Holmberg, David; Duque, M. Carolina; Poma, Roberto

    2008-01-01

    Ultrasound-guided fine needle aspiration was used in establishing the diagnosis in 4 cases of malignant peripheral nerve sheath tumor. Sonographic and cytologic characteristics are discussed. Because of its availability and ease of use, axillary ultrasonography with fine needle aspiration can be an initial diagnostic step for suspected brachial plexus tumors.

  19. Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: technical note.

    Science.gov (United States)

    Hawasli, Ammar H; Chang, Jodie; Reynolds, Matthew R; Ray, Wilson Z

    2015-04-01

    Study Design?Technical report. Objective?To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods?In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results?The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion?The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI. PMID:25844283

  20. Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach

    DEFF Research Database (Denmark)

    Rothe, C; Steen-Hansen, C

    2014-01-01

    BACKGROUND: The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block the suprascapular nerve in a more superficial and proximal location. METHODS: Twelve healthy volunteers were included. We located the brachial plexus in transverse section with ultrasound, and by longitudinal slide, we identified the departure of the suprascapular nerve from the superior trunk. The suprascapular nerve was followed under ultrasound visualization into the subclavian triangle under the inferior belly of the omohyoid muscle. We performed in-plane ultrasound-guided selective suprascapular nerve block by injecting 1?ml of lidocaine, 20?mg/ml close to the nerve. Nerve identification was aided by nerve stimulation. We assessed sensory and motor block of the suprascapular, axillary, radial, median, and ulnar nerves before,15 and 30?min after performing the block. RESULTS: Eight volunteers demonstrated a selective suprascapular nerve block. Three had block failure and one volunteer did not receive the intervention. CONCLUSIONS: We describe a new ultrasound-guided low-volume local anaesthetic technique to selectively block the suprascapular nerve. The potential clinical role of this new approach remains to be determined.

  1. Intraneural lipoma of the ulnar nerve: A case report and review of literature

    OpenAIRE

    Balakrishnan, Chenicheri; Saini, Manmit S; DeMercurio, Jeffrey

    2006-01-01

    Intraneural lipomas of the peripheral nerve or its cutaneous branches are rare benign tumours. These slow-growing tumours present as asymptomatic swelling, and diagnosis is usually made at the time of exploration. In most cases, these tumours can be enucleated without damage to the nerve fibres.

  2. Cutaneous changes in chronic alcoholics

    OpenAIRE

    Rao Gatha

    2004-01-01

    BACKGROUND: Alcohol consumption can have a variety of cutaneous manifestations. Awareness of the cutaneous changes of alcohol abuse can allow early detection and intervention in an attempt to limit the adverse medical consequences. Hence a study was planned to determine the cutaneous changes in chronic alcoholics. AIMS: To determine the cutaneous changes in chronic alcoholics. METHODS: All the patients attending alcohol de-addiction camps were examined for cutaneous changes. The results were ...

  3. Cutaneous tuberculosis with leprosy

    OpenAIRE

    Pinto J; Pal G; Kamath N

    1991-01-01

    The association of cutaneous tuberculosis with leprosy has been reported rarely. Though both the diseases are caused by mycobacteriae, no true antagonism exists. This case report confirms the above view.

  4. The comparisan of effects of ropivacaine and ropivacaine plus neastigmine in axillary brachial block procedure

    Directory of Open Access Journals (Sweden)

    Beyaz?t Zencirci

    2007-08-01

    Full Text Available Purpose: Axillary block can be achieved either with transarterial, paresthesia technique or via nerve stimulator usage. The aim of this study was to compare the effects of ropivacaine and ropivacaine plus neostigmine on post-operative analgesia and motor block, administered for axillary block with nerve-stimulator technique in neurosurgical patients scheduled to undergo operation for carpal tunnel syndrome.Material and Methods: 44 ASA (American Society of Anesthesiologists II or I cases were randomly separated into two groups. Cases in the 1st group (Group RP treated with 0.75% ropivacaine (40 ml + 1 ml of NaCl 0.9% and 2nd (Group RN with 0.75% ropivacaine (40 ml + 1 ml (500 mcg of neostigmine. Sensorial and motor block beginning time, degree and total block times were also observed.Results: There was no statistically significant difference between the groups regarding the beginning time and rate of complete sensory, motor block observed, and also sensory and motor block duration times.Conclusion: Neostigmine supplementation to ropivacaine for axillary block had no additional effect on sensory and motor block beginning time, duration and also quality. We conclude that ropivacaine has adequate effect on sensory and motor block for brachial plexus block procedure without the need for additional adjuvant neostigmine supplementation.

  5. Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

    OpenAIRE

    Cihangir Tetik; Metin Uzun

    2014-01-01

    Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outl...

  6. Cutaneous histoplasmosis in AIDS

    OpenAIRE

    Chande C; Menon S; Gohil A; Lilani S; Bade J; Mohammad S; Joshi A.

    2010-01-01

    A patient with human immunodeficiency virus (HIV) infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient...

  7. Disseminated cutaneous leishmaniasis.

    OpenAIRE

    Khalifa E Sharquie; Rafid A. Najim

    2004-01-01

    ABSTRACT Disseminated cutaneous leishmaniasis DCL is a condition rarely seen in the Middle East. We report a case of disseminated cutaneous leishmaniasis in a 60-years-old lady. The patient first presented 1996 with an initial lesion, which started on the butterfly area of the face and spread, probably due to immunosuppression, to involve the whole face. The lesions consisted of nodules, which did not ulcerate. The histology showed abundance of macrophages filled with amastigotes L-D bodie...

  8. Recurrent cutaneous leishmaniasis*

    OpenAIRE

    Gomes, Ciro Martins; Damasco, Fabiana dos Santos; de Morais, Orlando Oliveira; de Paula, Carmen Déa Ribeiro; Sampaio, Raimunda Nonata Ribeiro

    2013-01-01

    We present a case of an 18-year-old male patient who, after two years of inappropriate treatment for cutaneous leishmaniasis, began to show nodules arising at the edges of the former healing scar. He was immune competent and denied any trauma. The diagnosis of recurrent cutaneous leishmaniasis was made following positive culture of aspirate samples. The patient was treated with N-methylglucamine associated with pentoxifylline for 30 days. Similar cases require special attention mainly because...

  9. Cutaneous lupus erythematosus

    DEFF Research Database (Denmark)

    Biazar, Cyrus; Sigges, Johanna; Patsinakidis, Nikolaos; Ruland, Vincent; Amler, Susanne; Bonsmann, Gisela; Kuhn, Annegret; Bygum, Anette

    2013-01-01

    In this prospective, cross-sectional, multicenter study, we assessed clinical and laboratory characteristics from patients with cutaneous lupus erythematosus (CLE) using the Core Set Questionnaire of the European Society of Cutaneous Lupus Erythematosus (EUSCLE). 1002 (768 females, 234 males) patients with different subtypes of CLE, such as acute CLE (ACLE, 304 patients), subacute CLE (SCLE, 236 patients), chronic CLE (CCLE, 397 patients), and intermittent CLE (ICLE, 65 patients), from 13 Europe...

  10. Neurinoma del plexo braquial simulando metastasis de adenocarcinoma de mama Schwannoma of the brachial plexus resembling a breast adenocarcinoma metastasis

    Directory of Open Access Journals (Sweden)

    Gregorio Rodríguez Boto

    2011-10-01

    Full Text Available Los neurinomas del plexo braquial son tumores infrecuentes que pueden confundirse con otras lesiones de índole tumoral. Se presenta el caso de una mujer de 40 años, tratada previamente de un adenocarcinoma de mama derecha en el pasado, que en el estudio de extensión realizado 5 años después se detectó una lesión localizada en el plexo braquial derecho. La paciente se encontraba asintomática. El diagnóstico radiológico de presunción fue metástasis de adenocarcinoma mamario. Se realizó un abordaje axilar derecho descubriendo una lesión bien delimitada en el plexo braquial. Con ayuda de la monitorización neurofisiológica intraoperatoria, se observó que la lesión dependía de la rama cubital y se pudo realizar una resección completa preservando la función de dicho nervio. El estudio anatomopatológico confirmó que se trataba de un neurinoma, descartando así la existencia de metástasis. La evolución postoperatoria fue satisfactoria. Seis años después de la intervención no existe recidiva tumoral. En nuestro conocimiento este es el primer caso publicado en la literatura de un neurinoma del plexo braquial dependiente de la rama cubital. La monitorización neurofisiológica intraoperatoria resulta fundamental para abordar este tipo de lesiones con baja morbilidad.Schwa nomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial plexus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.

  11. Neurinoma del plexo braquial simulando metastasis de adenocarcinoma de mama / Schwannoma of the brachial plexus resembling a breast adenocarcinoma metastasis

    Scientific Electronic Library Online (English)

    Gregorio, Rodríguez Boto; Angela, Moreno-Gutiérrez; Raquel, Gutiérrez-González; Ángel, Villar-Martín; Luis A., Arraez-Aybar; Javier, Serrano Hernando.

    2011-10-01

    Full Text Available Los neurinomas del plexo braquial son tumores infrecuentes que pueden confundirse con otras lesiones de índole tumoral. Se presenta el caso de una mujer de 40 años, tratada previamente de un adenocarcinoma de mama derecha en el pasado, que en el estudio de extensión realizado 5 años después se detec [...] tó una lesión localizada en el plexo braquial derecho. La paciente se encontraba asintomática. El diagnóstico radiológico de presunción fue metástasis de adenocarcinoma mamario. Se realizó un abordaje axilar derecho descubriendo una lesión bien delimitada en el plexo braquial. Con ayuda de la monitorización neurofisiológica intraoperatoria, se observó que la lesión dependía de la rama cubital y se pudo realizar una resección completa preservando la función de dicho nervio. El estudio anatomopatológico confirmó que se trataba de un neurinoma, descartando así la existencia de metástasis. La evolución postoperatoria fue satisfactoria. Seis años después de la intervención no existe recidiva tumoral. En nuestro conocimiento este es el primer caso publicado en la literatura de un neurinoma del plexo braquial dependiente de la rama cubital. La monitorización neurofisiológica intraoperatoria resulta fundamental para abordar este tipo de lesiones con baja morbilidad. Abstract in english Schwa nomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial ple [...] xus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.

  12. Effects of charybdotoxin, a blocker of Ca2+-activated K+ channels, on motor nerve terminals.

    OpenAIRE

    Anderson, A.J.; Harvey, A L; Rowan, E G; Strong, P N

    1988-01-01

    1. The contribution of Ca2+-activated K+ currents (IK,Ca) to the control of electrical excitability of motor nerve terminals and the control of acetylcholine release was assessed by studying the effects of the specific K(Ca) channel blocking toxins charybdotoxin and apamin. Electrical activity of the terminal regions of motor nerves was assessed by extracellular recording from an electrode placed in the perineural sheaths of nerves in the mouse triangularis sterni and frog cutaneous pectoris ...

  13. Kaplan anastomosis of the ulnar nerve: a case report

    Directory of Open Access Journals (Sweden)

    Paraskevas Georgios

    2008-04-01

    Full Text Available Abstract Introduction The sensory innervation of the hand is usually unvarying and anomalies in this area are uncommon. Case presentation We report the case of a rare ulnar nerve branch called a Kaplan anastomosis, which anastomosed the dorsal cutaneous branch with the ulnar nerve prior to its bifurcation into the superficial and deep ramus. Conclusion Many authors have reported unusual ulnar nerve branches and knowledge of these anatomical variations is important for the interpretation of pain and sensory loss in the area sustained during injuries or surgical procedures. Our finding is the fourth case of a Kaplan anastomosis to be described in the literature.

  14. External evaluation of the Radiation Therapy Oncology Group brachial plexus contouring protocol: several issues identified

    International Nuclear Information System (INIS)

    The aims of the study were to evaluate interobserver variability in contouring the brachial plexus (BP) using the Radiation Therapy Oncology Group (RTOG)-approved protocol and to analyse BP dosimetries. Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computed-tomography images and anteroposterior digitally reconstructed radiographs) and quantitatively (by volumetric and statistical analyses). Dose–volume histograms of BPs were calculated and compared. We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper, with a mean volume of 20.8cc (range 11–40.7?cc) compared with 33±4cc (25.1–39.4cc). The average values of mean dose, maximum dose, V60Gy, V66Gy and V70Gy for patients treated with conventional radiotherapy and IMRT were 42.2Gy versus 44.8Gy, 64.5Gy versus 68.5Gy, 6.1% versus 7.6%, 2.9% versus 2.4% and 0.6% versus 0.3%, respectively. This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping, especially when using IMRT, the RTOG atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term brachial-plexus regions (BPRs) to represent regions where BPs are likely to be present. Consequently, BPRs should in principle be contoured generously.

  15. Robotic phrenic nerve harvest: a feasibility study in a pig model.

    Science.gov (United States)

    Porto de Melo, P; Miyamoto, H; Serradori, T; Ruggiero Mantovani, G; Selber, J; Facca, S; Xu, W-D; Santelmo, N; Liverneaux, P

    2014-10-01

    The aim of this study was to report on the feasibility of robotic phrenic nerve harvest in a pig model. A surgical robot (Da Vinci S™ system, Intuitive Surgical(®), Sunnyvale, CA) was installed with three ports on the pig's left chest. The phrenic nerve was transected distally where it enters the diaphragm. The phrenic nerve harvest was successfully performed in 45 minutes without major complications. The advantages of robotic microsurgery for phrenic nerve harvest are the motion scaling up to 5 times, elimination of physiological tremor, and free movement of joint-equipped robotic arms. Robot-assisted neurolysis may be clinically useful for harvesting the phrenic nerve for brachial plexus reconstruction. PMID:25267395

  16. Surgical anatomy of the retroperitoneal spaces, Part IV: retroperitoneal nerves.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-03-01

    We present surgicoanatomical topographic relations of nerves and plexuses in the retroperitoneal space: 1) six named parietal nerves, branches of the lumbar plexus: iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, femoral. 2) The sacral plexus is formed by the lumbosacral trunk, ventral rami of S1-S3, and part of S4; the remainder of S4 joining the coccygeal plexus. From this plexus originate the superior gluteal nerve, which passes backward through the greater sciatic foramen above the piriformis muscle; the inferior gluteal nerve also courses through the greater sciatic foramen, but below the piriformis; 3) sympathetic trunks: right and left lumbar sympathetic trunks, which comprise four interconnected ganglia, and the pelvic chains; 4) greater, lesser, and least thoracic splanchnic nerves (sympathetic), which pass the diaphragm and join celiac ganglia; 5) four lumbar splanchnic nerves (sympathetic), which arise from lumbar sympathetic ganglia; 6) pelvic splanchnic nerves (nervi erigentes), providing parasympathetic innervation to the descending colon and pelvic splanchna; and 7) autonomic (prevertebral) plexuses, formed by the vagus nerves, splanchnic nerves, and ganglia (celiac, superior mesenteric, aorticorenal). They include sympathetic, parasympathetic, and sensory (mainly pain) fibers. The autonomic plexuses comprise named parts: aortic, superior mesenteric, inferior mesenteric, superior hypogastric, and inferior hypogastric (hypogastric nerves). PMID:20349652

  17. Long-term changes in neurotrophic factor expression in distal nerve stump following denervation and reinnervation with motor or sensory nerve.

    Science.gov (United States)

    Michalski, B; Bain, J R; Fahnestock, M

    2008-05-01

    Several factors have been proposed to account for poor motor recovery after prolonged denervation, including motor neuron cell death and incomplete or poor regeneration of motor fibers into the muscle. Both may result from failure of the muscle and the distal motor nerve stump to continue expression of neurotrophic factors following delayed muscle reinnervation. This study investigated whether regenerating motor or sensory axons modulate distal nerve neurotrophic factor expression. We found that transected distal tibial nerve up-regulated brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) mRNA, down-regulated neurotrophin-3 and ciliary neurotrophic factor mRNA, and that although these levels returned to normal with regeneration, the chronically denervated distal nerve stump continued to express these neurotrophic factors for at least 6 months following injury. A sensory nerve (the cutaneous saphenous nerve) sutured to distal tibial nerve lowered injury-induced BDNF and GDNF mRNA levels in distal stump, but repair with a mixed nerve (peroneal, containing muscle and cutaneous axons) was more effective. Repair with sensory or mixed nerves did not affect nerve growth factor or neurotrophin-3 expression. Thus, distal nerve contributed to a neurotrophic environment for nerve regeneration for at least 6 months, and sensory nerve repair helped normalize distal nerve neurotrophic factor mRNA expression following denervation. Furthermore, as BDNF and GDNF levels in distal stump increased following denervation and returned to control levels following reinnervation, their levels serve as markers for the status of regeneration by either motor or sensory nerve. PMID:18194437

  18. The amplitude of interlimb cutaneous reflexes in the leg is influenced by fingertip touch and vision during treadmill locomotion.

    Science.gov (United States)

    Forero, Juan; Misiaszek, John E

    2015-06-01

    Light touch at the fingertip has been shown to influence postural control during standing and walking. Interlimb cutaneous reflexes have been proposed to provide a neural link between the upper and lower limbs to assist in interlimb coordination during activities such as walking. In this study, we tested the hypothesis that cutaneous sensory pathways linking the arm and leg will be facilitated if subjects use light touch to assist with postural control during treadmill walking. To test this, interlimb cutaneous reflexes from the median nerve, serving the skin contact region, and radial nerve, serving an irrelevant sensory territory, were tested in the legs of subjects walking on treadmill in an unstable environment. Interlimb cutaneous reflexes were tested while subjects (a) touched or (b) did not touch a stable contact with their fingertip, and while the eyes were either (c) open or (d) closed. Reflexes arising from both nerves were facilitated when vision was removed that was then ameliorated when touch was provided. These changes in reflex amplitude during the eyes closed conditions were mirrored by changes in background muscle activity. We suggest that this facilitation of interlimb reflexes from both nerves arises from a generalized increase in excitability related to the postural anxiety of walking on a treadmill with the eyes closed, which is then restored by the provision of light touch. However, the influence of touch when the eyes were open differed depending upon the nerve stimulated. Radial nerve reflexes in the legs were suppressed when touch was provided, mirroring a suppression in the background muscle activity. In contrast, median nerve reflexes in the leg were larger when touch was provided with the eyes open, despite a suppression of background muscle activity. This nerve-specific effect of touch on the amplitude of the interlimb cutaneous reflexes suggests that touch sensory information from the median nerve was facilitated when that input was functionally relevant. PMID:25788011

  19. Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    O'Donnell, Brian

    2010-09-01

    We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. The mean (SD) block performance and onset times were 271 (67.9) seconds and 9.7 (3.7) minutes, respectively. Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.

  20. Update on cutaneous calciphylaxis

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2013-01-01

    Full Text Available Calciphylaxis is a devastating disorder with a mortality rate of 80% due to sepsis and organ failure. Hallmarks of this rare disease are arteriolar media calcification, thrombotic cutaneous ischemia, and necrotic ulcerations. Different mechanisms of vascular calcification can lead to calciphylaxis. Early diagnosis by deep cutaneous ulcer biopsy is most important for prognosis. Here, dermatologists play a significant role although treatment usually needs an interdisciplinary approach. Surgical procedures had been the cornerstone of treatment in the past including parathyroidectomy, but recently new medical treatments emerged aiming to normalize disturbances of minerals to reduce the serum concentration of sodium phosphate and to prevent precipitation and calcification. Multimodal therapy is warranted but only aggressive surgical debridement of cutaneous ulcers has shown significant outcome improvement.

  1. [Cutaneous heterotopic meningeal nodules].

    Science.gov (United States)

    Battistella, Maxime; Verola, Olivier; Moulonguet, Isabelle; Janin, Anne

    2009-04-01

    Cutaneous heterotopic meningeal nodules are rare lesions whose pathogenesis remain discussed. They are typically located on the scalp or the rachidian axis. They often are congenital and diagnosed during childhood or young adulthood. There are two admitted theories for pathogenesis of heterotopic meningeal nodules: (1) tumoral proliferation of ectopic arachnoïdal cells (true cutaneous meningioma), (2) meningocele-type developmental defect (rudimentary meningocele). Histological and immunohistochemical aspects are characteristic, showing arachnoidal cells, EMA+ and vimentine+, that infiltrate collagene and whorl around collagene or psammomatous bodies. We report the expression of progesterone receptor (PR) in a cutaneous heterotopic meningeal nodule on the scalp of a 23-year-old man, and propose this PR expression as a new diagnosis tool for such lesions. PMID:19364587

  2. Reconstruction of brachial pressure from finger arterial pressure during orthostasis

    DEFF Research Database (Denmark)

    Bogert, Lysander W J; Harms, Mark P M

    2004-01-01

    In patients with recurrent syncope, monitoring of intra-arterial pressure during orthostatic stress testing is recommended because of the potentially sudden and rapid development of hypotension. Replacing brachial arterial pressure (BAP) by the non-invasively obtained finger arterial pressure (FinAP) has advantages because catheterization in itself may provoke a syncope.

  3. Magnetic resonance imaging features of subacute idiopathic brachial neuritis

    International Nuclear Information System (INIS)

    A 60-year-old man presented with sudden onset of left shoulder pain followed 2 weeks later by the development of left shoulder girdle weakness. A clinical and electrophysiological diagnosis of subacute idiopathic brachial neuritis was made. The MRI features of subacute muscular denervation in this patient are discussed and the relevant literature reviewed. Copyright (1999) Blackwell Science Pty Ltd

  4. Genetic determinants of the ankle-brachial index

    DEFF Research Database (Denmark)

    Wassel, Christina L; Lamina, Claudia; Nambi, Vijay; Coassin, Stefan; Mukamal, Kenneth J; Ganesh, Santhi K; Jacobs, David R; Franceschini, Nora; Papanicolaou, George J; Gibson, Quince; Yanek, Lisa R; van der Harst, Pim; Ferguson, Jane F; Crawford, Dana C; Waite, Lindsay L; Allison, Matthew A; Criqui, Michael H; McDermott, Mary M; Mehra, Reena; Cupples, L Adrienne; Hwang, Shih-Jen; Redline, Susan; Kaplan, Robert C; Heiss, Gerardo; Rotter, Jerome I; Boerwinkle, Eric; Taylor, Herman A; Eraso, Luis H; Haun, Margot; Li, Mingyao; Meisinger, Christa; O'Connell, Jeffrey R; Shuldiner, Alan R; Tybjærg-Hansen, Anne; Frikke-Schmidt, Ruth; Kollerits, Barbara; Rantner, Barbara; Dieplinger, Benjamin; Stadler, Marietta; Mueller, Thomas; Haltmayer, Meinhard; Klein-Weigel, Peter; Summerer, Monika; Wichmann, H-Erich; Asselbergs, Folkert W; Navis, Gerjan; Leach, Irene Mateo; Brown-Gentry, Kristin; Goodloe, Robert; Assimes, Themistocles L; Becker, Diane M; Cooke, John P; Absher, Devin M; Olin, Jeffrey W; Mitchell, Braxton D; Reilly, Muredach P; Mohler, Emile R; North, Kari E; Reiner, Alexander P; Kronenberg, Florian; Murabito, Joanne M

    2012-01-01

    Candidate gene association studies for peripheral artery disease (PAD), including subclinical disease assessed with the ankle-brachial index (ABI), have been limited by the modest number of genes examined. We conducted a two stage meta-analysis of ?50,000 SNPs across ?2100 candidate genes to identify genetic variants for ABI.

  5. SURGICAL ANATOMY OF DORSAL ROOT ENTRY ZONE OF CERVICAL SPINAL NERVES : CADAVERIC STUDY

    OpenAIRE

    Mr.A.Arun Kumar; Sudha Seshayyan; V.Tamilalagan; Sindou, M

    2014-01-01

    Background: The main purpose of this study is to determine the detailed morphometric data of Dorsal Root Entry Zone (DREZ) of cervical spinal nerves. This knowledge is necessary for diagnosis, treatment and surgical management of pain due to many conditions like brachial plexus avulsion injury, post-herpetic neuralgia, phantom pain and cancer pain involved in cervical myelo-radiculopathy. There are fewer studies reported in this field of DREZ. Materials and Methods: Twenty five...

  6. Correlation between muscular and nerve signals responsible for hand grasping in non-human primates.

    Science.gov (United States)

    Sheshadri, Swathi; Kortelainen, Jukka; Nag, Sudip; Ng, Kian Ann; Bazley, Faith A; Michoud, Frederic; Patil, Anoop; Orellana, Josue; Libedinsky, Camilo; Lahiri, Amitabha; Chan, Louiza; Chng, Keefe; Cutrone, Annarita; Bossi, Silvia; Thakor, Nitish V; Delgado-Martinez, Ignacio; Yen, Shih-Cheng

    2014-01-01

    Neuroprosthetic devices that interface with the nervous system to restore functional motor activity offer a viable alternative to nerve regeneration, especially in proximal nerve injuries like brachial plexus injuries where muscle atrophy may set in before nerve re-innervation occurs. Prior studies have used control signals from muscle or cortical activity. However, nerve signals are preferred in many cases since they permit more natural and precise control when compared to muscle activity, and can be accessed with much lower risk than cortical activity. Identification of nerve signals that control the appropriate muscles is essential for the development of such a `bionic link'. Here we examine the correlation between muscle and nerve signals responsible for hand grasping in the M. fascicularis. Simultaneous recordings were performed using a 4-channel thin-film longitudinal intra-fascicular electrode (tf-LIFE) and 9 bipolar endomysial muscle electrodes while the animal performed grasping movements. We were able to identify a high degree of correlation (r > 0.6) between nerve signals from the median nerve and movement-dependent muscle activity from the flexor muscles of the forearm, with a delay that corresponded to 25 m/s nerve conduction velocity. The phase of the flexion could be identified using a wavelet approximation of the ENG. This result confirms this approach for a future neuroprosthetic device for the treatment of peripheral nerve injuries. PMID:25570451

  7. Etiology and mechanisms of ulnar and median forearm nerve injuries

    Directory of Open Access Journals (Sweden)

    Puzovi? Vladimir

    2015-01-01

    Full Text Available Bacgraund/Aim. Most often injuries of brachial plexus and its branches disable the injured from using their arms and/or hands. The aim of this study was to investigate the etiology and mechanisms of median and ulnar forearm nerves injuries. Methods. This retrospective cohort study included 99 patients surgically treated in the Clinic of Neurosurgery, Clinical Center of Serbia, from January 1st, 2000 to December 31st, 2010. All data are obtained from the patients' histories. Results. The majority of the injured patients were male, 81 (81.8%, while only 18 (18.2% were females, both mainly with nerve injuries of the distal forearm - 75 (75.6%. Two injury mechanisms were present, transection in 85 patients and traction and contusion in 14 of the patients. The most frequent etiological factor of nerve injuries was cutting, in 61 of the patients. Nerve injuries are often associated with other injuries. In the studied patients there were 22 vascular injuries, 33 muscle and tendon injuries and 20 bone fractures. Conclusion. The majority of those patients with peripheral nerve injuries are represented in the working age population, which is a major socioeconomic problem. In our study 66 out of 99 patients were between 17 and 40 years old, in the most productive age. The fact that the majority of patients had nerve injuries of the distal forearm and that they are operated within the first 6 months after injury, promises them good functional prognosis.

  8. Lateral Pectoral Nerve Injury Mimicking Cervical Radiculopathy.

    Science.gov (United States)

    Aktas, Ilknur; Palamar, Deniz; Akgun, Kenan

    2015-07-01

    The lateral pectoral nerve (LPN) is commonly injured along with the brachial plexus, but its isolated lesions are rare. Here, we present a case of an isolated LPN lesion confused with cervical radiculopathy. A 41-year-old man was admitted to our clinic because of weakness in his right arm. Previous magnetic resonance imaging (MRI) examination revealed right posterolateral protrusion at the C6-7 level. At the initial assessment, atrophy of the right pectoralis major muscle was evident, and mild weakness of the right shoulder adductor, internal rotator, and flexor muscles was observed. Therefore, electrodiagnostic evaluation was performed, and a diagnosis of isolated LPN injury was made. Nerve injury was thought to have been caused by weightlifting exercises and traction injury. Lateral pectoral nerve injury can mimic cervical radiculopathy, and MRI examination alone may lead to misdiagnosis. Repeated physical examinations during the evaluation and treatment phase will identify the muscle atrophy that occurs 1 or more months after the injury. PMID:25290103

  9. Cutaneous histoplasmosis in AIDS.

    Science.gov (United States)

    Chande, C; Menon, S; Gohil, A; Lilani, S; Bade, J; Mohammad, S; Joshi, A

    2010-01-01

    A patient with human immunodeficiency virus (HIV) infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient indicated by decline in CD4 counts. The same treatment was restarted and the patient is still being followed-up. PMID:20966584

  10. Cutaneous histoplasmosis in AIDS

    Directory of Open Access Journals (Sweden)

    Chande C

    2010-01-01

    Full Text Available A patient with human immunodeficiency virus (HIV infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient indicated by decline in CD4 counts. The same treatment was restarted and the patient is still being followed-up.

  11. US imaging of the musculocutaneous nerve

    Energy Technology Data Exchange (ETDEWEB)

    Tagliafico, Alberto Stefano [National Institute for Cancer Research, Department of Radiology, Genoa (Italy); Michaud, Johan [University of Montreal, Department of Physiatry, Montreal, Quebec (Canada); Marchetti, Alessandra; Garello, Isabella; Martinoli, Carlo [Universita di Genova, Radiology Department, Genova (Italy); Padua, Luca [Universita Cattolica del Sacro Cuore-Rome, Institute of Neurology, Rome (Italy); Fondazione Don Carlo Gnocchi, Rome (Italy)

    2011-05-15

    To describe the potential value of high-resolution sonography for evaluation of the musculocutaneous nerve (MCN). The normal anatomy of the MCN was evaluated on three cadaveric limbs and correlated with the US images obtained in 15 healthy subjects. Seven consecutive patients with MCN neuropathy were then evaluated with sonography using 17.5 and 12.5-MHz broadband linear array transducers. All patients had abnormal nerve conduction studies and underwent correlative MR imaging on a 1.5-T system. One-to-one comparison between cadaveric specimens and sonographic images showed that the MCN can be reliably identified from the axilla through the elbow, including the lateral antebrachial cutaneous (LAbC) nerve. In the patients group with MCN neuropathy, sonography allowed detection of a wide spectrum of abnormalities. In 5/7 cases, a spindle neuroma was depicted in continuity with the nerve. In one case, US identified focal swelling of the nerve and in another case US was negative. The neuroma was hyperintense on T2-weighted sequences in 75% of cases. In one patient, the nerve showed Gd-enhancement on fat-suppressed T1-weighted sequences. The nerve was never detected on unenhanced T1-scans. Owing to its small-size and out-of-plane course, the MCN may be more reliably depicted with sonography rather than with MR imaging. US is promising for evaluating traumatic injuries of the MCN. By providing unique information on the entire course of the nerve, US can be used as a valuable complement of clinical and electrophysiologic findings. (orig.)

  12. Cutaneous changes in chronic alcoholics

    Directory of Open Access Journals (Sweden)

    Rao Gatha

    2004-03-01

    Full Text Available BACKGROUND: Alcohol consumption can have a variety of cutaneous manifestations. Awareness of the cutaneous changes of alcohol abuse can allow early detection and intervention in an attempt to limit the adverse medical consequences. Hence a study was planned to determine the cutaneous changes in chronic alcoholics. AIMS: To determine the cutaneous changes in chronic alcoholics. METHODS: All the patients attending alcohol de-addiction camps were examined for cutaneous changes. The results were analyzed using Gausian test and compared with other reports. RESULTS: Out of 200 alcoholics examined for cutaneous changes, 182 (91% had cutaneous, nail, hair or oral cavity changes. Nail changes were found in 51 (25.5% alcoholics, koilonychia being the commonest (16%. Oral changes were present in 107 (53.5% alcoholics and changes due to nutritional deficiency in 20 (10%. Diseases due to poor hygiene were seen in 55 (27.5% alcoholics. Tinea versicolor (14% and seborrheic dermatitis (11.5% were the commonest cutaneous changes noted. CONCLUSION: Even though alcohol abuse has a variety of cutaneous manifestations and perhaps aggravates many diseases, there are no specific cutaneous signs of alcoholism. Knowledge of the spectrum of cutaneous manifestations of alcohol abuse can allow its early detection and treatment in an attempt to minimize the medical consequences.

  13. Primaty Cutaneous Histoplasmosis

    Directory of Open Access Journals (Sweden)

    Nair S

    2000-01-01

    Full Text Available A 29-year old woman presented with diffuse swelling of the base of the right thumb along with ulceration. X-ray indicated bony damage. Histopathology showed PAS positive intracellular organisms suggestive of histoplasmosis. We are reporting a very rare case of primary cutaneous histoplasmosis from this part of the country.

  14. Cutaneous leishmaniasis in Assam

    OpenAIRE

    Baishya B; Hazarika N

    1996-01-01

    A case of cutaneous leishmaniasis is being reported from Assam, a North Eastern state of India. Clinical feature and direct smear examination of the case confirmed the diagnosis. Dramatic resolution of the lesions with sodium antimony gluconate during 10 days of therapy was achieved.

  15. Cutaneous Leishmaniasis, Sri Lanka

    OpenAIRE

    Nawaratna, Sujeevi S. K.; Weilgama, Danister J.; Wijekoon, Chandana J.; Dissanayake, Manel; Rajapaksha, Kosala

    2007-01-01

    Cutaneous leishmaniasis (CL) is an emerging disease in Sri Lanka. Of 116 patients with clinical symptoms suggestive of CL, 86 were confirmed positive for Leishmania donovani. Most patients had single dry lesions, usually on the face. Patients were from 5 of the 7 agroclimatic zones in Sri Lanka.

  16. Treatment of Cutaneous Lupus

    OpenAIRE

    Chang, Aileen Y; Werth, Victoria P.

    2011-01-01

    Cutaneous lupus erythematosus (CLE) is an autoimmune, inflammatory skin disease seen in patients with or without systemic lupus erythematosus (SLE). The management of CLE includes treatment and prevention of lesions, as well as routine assessment for systemic disease. Treatment options include both topical and systemic therapies. Topical therapies include corticosteroids and calcineurin inhibitors. Systemic therapies generally fall under one of three categories: antimalarials, immunomodulator...

  17. CLINICAL COMPARISON BETWEEN 0.25% BUPIVACAINE AND BUPIVACAINE 0.25% AND TRAMADOL (2MG/KG IN BRACHIAL PHLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

    Directory of Open Access Journals (Sweden)

    Suresh

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES : Adjunc ts to local anaesthetics for brachial plexus block may enhance the quality and duration of analgesia. Tramadol a synthetic 4 - phenylpiperidine analog of codeine is known to produce antinociception and enhance the effect of local anaesthetics when given epid urally , intrathecally or in various peripheral nerve blocks. The purpose of this study was to assess the effect of Tramadol added to brachial plexus block by supraclavicular approach. METHODS : A prospective , randomized , single blinded study was conducted o n 60 ASA I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups. Patients in Group I (n=30 were given 38mL of 0.25% Bupivacaine plus 2ml NS and Group II (n = 30 w ere given 38 mL of 0.25% Bupivacaine plus 2 ml Tramadol (2mg/kg. The onset time and duration of sensory and motor blockade were recorded. Haemodynamic variables (i.e. heart rate , noninvasive blood pressure , oxygen saturation , and rescue analgesic require ments were recorded for 24 hrs postoperatively. RESULTS: the onset of sensory and motor block was significantly faster in Group II compared to Group I (P <0.05. Rescue analgesic requirements were significantly less in Group II compared to Group I (P , 0.05 . Haemodynamic variables did not differ between groups in the post - operative period. CONCLUSION: Tramadol (2mg/kg in combination with 38mL of Bupivacaine (0.25% hastened onset of sensory and motor block , and improved postoperative analgesia when used in brachial plexus block , without producing any adverse events.

  18. Inhibition of motoneurons during the cutaneous silent period in the spinal cord of the turtle

    DEFF Research Database (Denmark)

    Guzulaitis, Robertas; Hounsgaard, JØrn Dybkjær

    2012-01-01

    The transient suppression of motor activity in the spinal cord after a cutaneous stimulus is termed the cutaneous silent period (CSP). It is not known if CSP is due to suppression of the premotor network or direct inhibition of motoneurons. This issue was examined by intracellular recordings from motoneurons in the isolated carapace-spinal cord preparation from adult turtles during rhythmic scratch-like reflex. Electrical stimulation of cutaneous nerves induced CSP-like suppression of motor nerve firing during rhythmic network activity. The stimulus that generated the CSP-like suppression of motor activity evokes a polysynaptic compound synaptic potential in motoneurons and suppressed their firing. This compound synaptic potential was hyperpolarizing near threshold for action potentials and was associated with a substantial increase in conductance during the CSP in the motor pool. These results show that direct postsynaptic inhibition of motoneurons contributes to the CSP.

  19. A coexisting anatomical variation of median and ulnar nerves in a cadaver palm.

    Science.gov (United States)

    Natsis, K; Karanassos, M Th; Papathanasiou, E; Noussios, G

    2012-11-01

    During a routine dissection we observed an anatomical variation of the median nerve and an atypical anastomosis in the palm region of a male cadaver. There were four distinct recurrent motor branches of the left median nerve, and the palmar cutaneous branch of the ulnar nerve communicated directly with the third common palmar digital nerve. The presence of such an anatomical variant in the hand should keep surgeons alert in the management of hand pathology especially in carpal tunnel syndrome, which is a routine operation for many medical centres. PMID:23197148

  20. Peripheral nerve sheath myxoma. Clinicopathological and immunohistochemical study of a morphologically distinctive myxoid peripheral nerve sheath tumor in the forelimb of a cat

    OpenAIRE

    Anfossi, Antonio; Mura, Antonica; Meloni, Floriana; Pintore, Laura; Bionda, Stefano; Leoni, Antonio; Antuofermo, Elisabetta

    2008-01-01

    Peripheral nerve sheath tumors (PNST) are a class of nervous system tumors which arise in both schwann cells and perineural fibroblasts. Benign and malignant PNSTs are reported to occur in all domestic animals. In cats they represent 3% of all cutaneous and subcutaneous neoplasms. Only in dogs mixoid PNST has been observed generally localized in the fingers. In humans, PNSTs are rare neoplasms, and nerve sheath myxomas are a distinct neoplasia most commonly found in limb extremities.

  1. Clinical and electrodiagnostic findings in breast cancer patients with radiation-induced brachial plexus neuropathy

    International Nuclear Information System (INIS)

    The clinical and neurophysiological characteristics of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients without signs of recurrent disease at least 60 months after radiotherapy (RT). Clinically, 35% (95% confidence limits: 25-47%) had RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-36%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%), assessment of a definite level was not possible. In most, symptoms began during or immediately after RT, thus being without significant latency. Numbness or paresthesias (71%, 52-86%) and pain (43%, 25-62%) were the most prominent symptoms, while the most prominent objective signs were decreased or absent muscle stretch reflexes (93%, 77-99%) closely followed by sensory loss (82%, 64-93%) and weakness (71%, 52-86%). Neurophysiological investigations were carried out in 46 patients (58%). The most frequent abnormalities in patients with RBP were signs of chronic partial denervation with increased mean duration of individual motor unit potentials, and decreased amplitude of compound muscle and sensory action potentials. Nerve conduction velocities were normal. (author)

  2. Anatomia do plexo braquial de macaco-barrigudo (Lagothrix lagothricha) / Anatomy of the brachial plexus of the Woolly-Monkey (Lagothrix lagothricha.)

    Scientific Electronic Library Online (English)

    Gessica Ariane M, Cruz; Marta, Adami.

    2010-10-01

    Full Text Available O macaco-barrigudo (Lagothrix lagothricha) é um antropóide pertencente à Família Atelidae que possui os maiores primatas neotropicais. Um cadáver fêmea de macaco-barrigudo foi fixado com solução de formaldeído a 10%, posteriormente dissecado com o auxílio de lupa estereoscópica e fotodocumentado. O [...] plexo braquial originou-se dos nervos espinhais C5 a C8 e T1, formando os troncos cranial, médio e caudal, dos quais derivaram os nervos periféricos que se assemelharam na origem e no território de inervação com os plexos de outros primatas, com exceção do nervo musculocutâneo que atravessou o músculo coracobraquial. Pesquisas sobre o plexo braquial de primatas fornecem dados que disponibilizam o acesso a informações valiosas sobre a morfologia destes animais e auxiliam no estabelecimento de parâmetros anatômicos entre as espécies, contribuindo também no tratamento de injúrias e procedimentos anestésicos. Abstract in english The woolly-monkey (Lagothrix lagothricha) is an antropoid belonging to the Atelidae Family which includes the largest neotropical primates. A female cadaver woolly-monkey was fixed in a 10% formaldehyde solution and dissected using a stereoscopic magnifying glass and photodocumented. The brachial pl [...] exus originated from the spinal nerves C5 to C8 and T1, forming the cranial, medium, and caudal stems, from which derived the peripheral nerves; those nerves had similar origin and innervation area when compared to plexuses from other primates, with the exception of the musculocutaneous nerve that crossed the coracobraquial muscle. Data from studies with brachial plexus from primates allow the access to valuable information regarding the morphology of those animals, and could also assist in the establishment of anatomical parameters among species, which could then contribute to anesthetic procedures and injury treatments.

  3. Anatomia do plexo braquial de macaco-barrigudo (Lagothrix lagothricha Anatomy of the brachial plexus of the Woolly-Monkey (Lagothrix lagothricha.

    Directory of Open Access Journals (Sweden)

    Gessica Ariane M Cruz

    2010-10-01

    Full Text Available O macaco-barrigudo (Lagothrix lagothricha é um antropóide pertencente à Família Atelidae que possui os maiores primatas neotropicais. Um cadáver fêmea de macaco-barrigudo foi fixado com solução de formaldeído a 10%, posteriormente dissecado com o auxílio de lupa estereoscópica e fotodocumentado. O plexo braquial originou-se dos nervos espinhais C5 a C8 e T1, formando os troncos cranial, médio e caudal, dos quais derivaram os nervos periféricos que se assemelharam na origem e no território de inervação com os plexos de outros primatas, com exceção do nervo musculocutâneo que atravessou o músculo coracobraquial. Pesquisas sobre o plexo braquial de primatas fornecem dados que disponibilizam o acesso a informações valiosas sobre a morfologia destes animais e auxiliam no estabelecimento de parâmetros anatômicos entre as espécies, contribuindo também no tratamento de injúrias e procedimentos anestésicos.The woolly-monkey (Lagothrix lagothricha is an antropoid belonging to the Atelidae Family which includes the largest neotropical primates. A female cadaver woolly-monkey was fixed in a 10% formaldehyde solution and dissected using a stereoscopic magnifying glass and photodocumented. The brachial plexus originated from the spinal nerves C5 to C8 and T1, forming the cranial, medium, and caudal stems, from which derived the peripheral nerves; those nerves had similar origin and innervation area when compared to plexuses from other primates, with the exception of the musculocutaneous nerve that crossed the coracobraquial muscle. Data from studies with brachial plexus from primates allow the access to valuable information regarding the morphology of those animals, and could also assist in the establishment of anatomical parameters among species, which could then contribute to anesthetic procedures and injury treatments.

  4. Peripheral nerve injuries in athletes. Treatment and prevention.

    Science.gov (United States)

    Lorei, M P; Hershman, E B

    1993-08-01

    Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8378668

  5. Normal tissue tolerance to external beam radiation therapy: Peripheral nerves

    International Nuclear Information System (INIS)

    Plexopathies and peripheral neuropathies appear progressively and with several years delay after radiotherapy. These lesions are observed principally after three clinical situations: supraclavicular and axillar irradiations for breast cancer, pelvic irradiations for various pathologies and limb irradiations for soft tissue sarcomas. Peripheral nerves and plexus (brachial and lumbosacral) are described as serial structures and are supposed to receive less than a given maximum dose linked to the occurrence of late injury. Literature data, mostly ancient, define the maximum tolerable dose to a threshold of 60 Gy and highlight also a great influence of fractionation and high fraction doses. For peripheral nerves, most frequent late effects are pain with significant differences of occurrence between 50 and 60 Gy. At last, associated pathologies (diabetes, vascular pathology, neuropathy) and associated treatments have probably to be taken into account as additional factors, which may increase the risk of these late radiation complications. (authors)

  6. Physical activity during daily life and brachial artery flow-mediated dilation in peripheral arterial disease

    OpenAIRE

    Payvandi, Laila; Dyer, Alan; McPherson, David; Ades, Philip; Stein, James; Liu, Kiang; Ferrucci, Luigi; Criqui, Michael H.; Guralnik, Jack M.; Lloyd-Jones, Donald; Kibbe, Melina R; Liang, Susan T; Kane, Bonnie; Pearce, William H.; Verta, Michael

    2009-01-01

    We determined whether higher levels of physical activity in daily life are associated with better brachial artery flow-mediated dilation (FMD) among individuals with lower extremity peripheral arterial disease (PAD). Participants were 111 men and women with PAD (ankle–brachial index (ABI) ? 0.95) who completed baseline testing in the Study to Improve Leg Circulation (SILC). We evaluated FMD of the brachial artery at baseline and at 60 seconds following 4 minutes of suprasystolic blood pressur...

  7. Une cause rare de plexopathie brachiale: une metastase d'un cancer du sein

    OpenAIRE

    Maâroufi, Mustapha; Kamaoui, Imane; Boubbou, Meriem; Sqalli, Nadia; Tizniti, Siham

    2014-01-01

    Nous rapportons le cas d'une patiente de 50 ans ayant une histoire de cancer du sein et qui accuse une symptomatologie d'atteinte du plexus brachial. L'IRM montre une masse qui envahie le plexus brachial compatible avec une métastase. L'IRM est très utile pour le diagnostic et l'orientation thérapeutique des plexopathies brachiales chez les femmes présentant un cancer du sein

  8. Trapezius transfer to treat flail shoulder after brachial plexus palsy

    Directory of Open Access Journals (Sweden)

    Diaz Humberto

    2007-01-01

    Full Text Available Abstract Background After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. Methods We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injuried; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41, the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years and the average follow-up was 17.5 months (range 6 to 52, reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. Results All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2°; the gain in shoulder flexion average 37.4°. All patients had stable shoulder (no subluxation of the humeral head on radiographs. Conclusion Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability.

  9. Delayed presentation of a traumatic brachial artery pseudoaneurysm.

    LENUS (Irish Health Repository)

    Forde, James C

    2009-09-01

    Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.

  10. Synovial sarcoma of nerve

    OpenAIRE

    Scheithauer, BW; Amrami, KK; Folpe, AL; Silva, AI; Edgar, MA; Woodruff, JM; Levi, AD; Spinner, RJ

    2011-01-01

    Tumors of peripheral nerve are largely neuroectodermal in nature and derived from 2 elements of nerve, Schwann or perineurial cells. In contrast, mesenchymal tumors affecting peripheral nerve are rare and are derived mainly from epineurial connective tissue. The spectrum of the latter is broad and includes lipoma, vascular neoplasms, hematopoietic tumors, and even meningioma. Of malignant peripheral nerve neoplasms, the vast majority are primary peripheral nerve sheath tumors. Malignancies of...

  11. Update on cutaneous tuberculosis

    Scientific Electronic Library Online (English)

    Maria Fernanda Reis Gavazzoni, Dias; Fred, Bernardes Filho; Maria Victória, Quaresma; Leninha Valério do, Nascimento; José Augusto da Costa, Nery; David Rubem, Azulay.

    2014-12-01

    Full Text Available Tuberculosis continues to draw special attention from health care professionals and society in general. Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and bacillus Calmette-Guérin. Depending on individual immunity, environmental factors and the type of inoculum, i [...] t may present varied clinical and evolutionary aspects. Patients with HIV and those using immunobiological drugs are more prone to infection, which is a great concern in centers where the disease is considered endemic. This paper aims to review the current situation of cutaneous tuberculosis in light of this new scenario, highlighting the emergence of new and more specific methods of diagnosis, and the molecular and cellular mechanisms that regulate the parasite-host interaction.

  12. Neurolysis and myocutaneous flap for radiation induced brachial plexus neuropathy

    International Nuclear Information System (INIS)

    Surgical treatment for radiation induced brachial plexus neuropathy is difficult. We followed 9 patients of radiation induced brachial plexus neuropathy who were surgically treated with neurolysis and myocutaneous flap coverage. Their ages ranged from 29 to 72 years old. Their diagnoses were breast cancer in 6 patients, lingual cancer in 1, thyroid cancer in 1 and malignant lymphoma in 1. Total dose of radiation ranged from 44 to 240 Gy. Interval from radiation therapy to our surgery ranged from 1 to 18 years (mean 6.7 years). Chief complaints were dysesthesia in 9 patients, motor weakness in 7 patients and dullach in scar formation of radiated skin in 7 patients. Preoperative neural functions were slight palsy in 1, moderate palsy in 5 and complete palsy in 3. In surgical treatment, neurolysis of the brachial plexus was done and it was covered by latissimus dorsi myocutaneous flap. We evaluated about dysesthesia and motor recovery after treatment for neuropathy. Follow up periods ranged from 1 to 11 years (average in 5 years). Dysesthesia improved in 6 patients and got worse in 3 patients. Motor weakness recovered in only 2 patients and got worse in 7 patients. From our results, intolerable dysesthesia which was first complaint of these patients improved. But motor function had not recovered. Our treatment was thought to be effective for extraneural factor like an compression neuropathy by scar formation and poor vascularity. But it was not effective for intraneural damage by radiation therapy. (author)

  13. Sarcoidosis cutánea / Cutaneous sarcoidosis

    Scientific Electronic Library Online (English)

    AP, Galeano; E, Vecchio; V, Calzinari; C, Velázquez; V, Dilzician; A, Guglielmone; G, Pacheco; M, Téllez.

    2013-12-30

    Full Text Available Presentamos el caso de una paciente de sexo femenino, de 50 años de edad, quien desarrolló sarcoidosis cutánea pura, sin hallazgos hasta la fecha de compromiso sistémico, demostrando buena respuesta al tratamiento con córticoesteroides sistémicos. [...] Abstract in english We report the case of a female patient, aged 50, who developed cutaneous sarcoidosis pure, without finding so far, systemic involvement, demonstrating good response to treatment with systemic corticosteroids. [...

  14. Cutaneous leishmaniasis: an overview.

    OpenAIRE

    Hepburn N

    2003-01-01

    Leishmaniasis is a major world health problem, which is increasing in incidence. In Northern Europe it is seen in travellers returning from endemic areas. The protozoa is transmitted by sandflies and may produce a variety of clinical syndromes varying from a simple ulcer to fatal systemic disease. This review considers the management of simple cutaneous leishmaniasis. Patients usually have a single ulcer that may heal spontaneously, requiring only topical, or no treatment at all. Lesions caus...

  15. Chronic zosteriform cutaneous leishmaniasis

    OpenAIRE

    Omidian M; Mapar M

    2006-01-01

    Cutaneous leishmanasis (CL) may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid. The zosteriform variant has rarely been reported. Unusual lesions may be morphologically attributed to an altered host response or owing to an atypical strain of parasites in these lesions. We report a patient with CL in a multidermatomal pattern on the back and buttock of a man in Khozestan province in the south of Iran. To our ...

  16. Chitosan against cutaneous pathogens

    OpenAIRE

    Champer, Jackson; Patel, Julie; Fernando, Nathalie; Salehi, Elaheh; Wong, Victoria; Kim, Jenny

    2013-01-01

    Propionibacterium acnes and Staphylococcus aureus are cutaneous pathogens that have become increasingly resistant to antibiotics. We sought to determine if chitosan, a polymer of deacetylated chitin, could be used as a potential treatment against these bacteria. We found that higher molecular weight chitosan had superior antimicrobial properties compared to lower molecular weights, and that this activity occurred in a pH dependent manner. Electron and fluorescence microscopy revealed that chi...

  17. Novel axillary approach for brachial plexus in robotic surgery: a cadaveric experiment.

    Science.gov (United States)

    Tetik, Cihangir; Uzun, Metin

    2014-01-01

    Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results. PMID:25140251

  18. Large and small nerve fiber function in painful diabetic neuropathy.

    Science.gov (United States)

    Heimans, J J; Bertelsmann, F W; Van Rooy, J C

    1986-06-01

    Vibratory perception thresholds (VPTs) and thermal discrimination thresholds (TDTs), reflecting large nerve fiber function and small nerve fiber function, respectively, were determined in 20 diabetics with painful sensory polyneuropathy and in 20 diabetics without neuropathic symptoms. VPTs were elevated in 27 patients and proved to be significantly higher in the group with painful neuropathy (p less than 0.01). Yet in three symptomatic patients, VPTs were normal. TDTs were abnormal in 35 cases and the difference between patients with and patients without symptoms was more pronounced (p less than 0.001). All patients with painful neuropathy had elevated TDTs. These findings confirm the relationship between pain in diabetic neuropathy and the affection of small fiber function. When monitoring of peripheral nerve function in patients with painful diabetic neuropathy is required, quantitation of thermal cutaneous sensation provides useful information on the function of small nerve fibers. PMID:3723133

  19. Primary Cutaneous Zygomycosis in India

    OpenAIRE

    Kaushik, Robin

    2012-01-01

    Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high morbidity and mortality. A retrospective analysis of the reported cases of cutaneous zygomycosis from India was made using various search engines and cross-referencing from available manuscripts. A total of 42 publications from India on the topic were identified, since the first reported case of primary cutaneous zygomycosis by Velia...

  20. Caseating Granulomas in Cutaneous Leishmaniasis

    OpenAIRE

    Aoun, Jessica; Habib, Robert; Charaffeddine, Khalil; Taraif, Suad; Loya, Asif; Khalifeh, Ibrahim

    2014-01-01

    Cutaneous leishmaniasis displays a wide spectrum of clinical and microscopic findings. The microscopic manifestations have been categorized into five groups. The type of granulomatous response defined in group V is usually tuberculoid in nature with exceedingly rare cases described with necrotizing granulomas in contrast to cutaneous infections with tuberculosis and other mycobacteria that are typically associated with necrotic granulomas. The old world countries endemic for cutaneous leishma...

  1. Karolinska Institutet 200 year anniversary - Symposium on Traumatic Injuries in the Nervous System: Injuries to the spinal cord and peripheral nervous system - Injuries and repair, pain problems, lesions to brachial plexus

    Directory of Open Access Journals (Sweden)

    MattiasK.Sköld

    2011-05-01

    Full Text Available The Karolinska Institutet 200 year anniversary symposium on injuries to the spinal cord and peripheral nervous system gathered expertise in the spinal cord, spinal nerve and peripheral nerve injury field spanning from molecular prerequisites for nerve regeneration to clinical methods in nerve repair and rehabilitation. The topics presented at the meeting covered findings on adult neural stem cells that when transplanted to the hypoglossal nucleus in the rat could integrate with its host and promote neuron survival. Studies on vascularization after intraspinal replantation of ventral nerve roots and microarray studies in ventral root replantation as a tool for mapping of biological patterns typical for neuronal regeneration were discussed. Different immune molecules in neurons and glia and their very specific roles in synapse plasticity after injury were presented. Novel strategies in repair of injured peripheral nerves with ethyl-cyanoacrylate adhesive showed functional recovery comparable to that of conventional epineural sutures. Various aspects on surgical techniques which are available to improve function of the limb, once the nerve regeneration after brachial plexus lesions and repair has reached its limit were presented. Mo

  2. Ciguatoxin enhances quantal transmitter release from frog motor nerve terminals.

    OpenAIRE

    Molgó, J.; Comella, J. X.; Legrand, A. M.

    1990-01-01

    1. Ciguatoxin (CTX), a marine toxin produced by the benthic dinoflagellate Gambierdiscus toxicus, is responsible for a complex endemic disease in man known as ciguatera fish poisoning. In the present study we have investigated the effects of purified CTX extracted for Gymnothorax javanicus moray-eel liver on frog isolated neuromuscular preparations with conventional electrophysiological techniques. 2. CTX (1-2.5 nM) applied to cutaneous pectoris nerve-muscle preparations induced, after a shor...

  3. Cutaneous sarcoidosis without systemic manifestations

    OpenAIRE

    Mohanty Rajesh; Singh S; Bhattamishra A

    2009-01-01

    A 38-year-old lady, housewife by profession presented with mildly pruritic polymorphic lesions on various parts of her body. The lesions appeared as smooth, violaceous and round papules. Histopathological examination showed classical features of cutaneous sarcoidosis. She had no systemic involvement. Cutaneous sarcoidosis has many morphological presentations and often mimics other dermatologic diseases. Treatment options are reviewed.

  4. Cutaneous sarcoidosis without systemic manifestations

    Directory of Open Access Journals (Sweden)

    Mohanty Rajesh

    2009-01-01

    Full Text Available A 38-year-old lady, housewife by profession presented with mildly pruritic polymorphic lesions on various parts of her body. The lesions appeared as smooth, violaceous and round papules. Histopathological examination showed classical features of cutaneous sarcoidosis. She had no systemic involvement. Cutaneous sarcoidosis has many morphological presentations and often mimics other dermatologic diseases. Treatment options are reviewed.

  5. Chronic zosteriform cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    Omidian M

    2006-01-01

    Full Text Available Cutaneous leishmanasis (CL may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid. The zosteriform variant has rarely been reported. Unusual lesions may be morphologically attributed to an altered host response or owing to an atypical strain of parasites in these lesions. We report a patient with CL in a multidermatomal pattern on the back and buttock of a man in Khozestan province in the south of Iran. To our knowledge, this is the first reported case of multidermatomal zosteriform CL. It was resistant to conventional treatment but responded well to a combination of meglumine antimoniate, allopurinol, and cryotherapy.

  6. Unusual thoracic outlet syndrome secondary to bullet lodge in brachial plexus

    Directory of Open Access Journals (Sweden)

    Iseri PK

    2004-03-01

    Full Text Available The cause of thoracic outlet syndrome (TOS is multifactorial, and includes anatomical anomalies and trauma. Most traumatic brachial plexopaties have an immediate onset; however, some may occur with such delayed onset that the original event is overlooked. We report a case of post-traumatic delayed onset TOS due to a bullet lodge to left brachial plexus.

  7. Pictorial essay: Role of magnetic resonance imaging in evaluation of brachial plexus pathologies

    Directory of Open Access Journals (Sweden)

    Malini Lawande

    2012-01-01

    Full Text Available Brachial plexopathies, traumatic and nontraumatic, often present with vague symptoms. Clinical examination and electrophysiological studies are useful but may not localize the lesion accurately. Magnetic resonance imaging (MRI with its multiplanar imaging capability and soft tissue contrast resolution plays an important role in evaluation of the abnormal brachial plexus.

  8. Unusual thoracic outlet syndrome secondary to bullet lodge in brachial plexus

    OpenAIRE

    Iseri PK; Budak F

    2004-01-01

    The cause of thoracic outlet syndrome (TOS) is multifactorial, and includes anatomical anomalies and trauma. Most traumatic brachial plexopaties have an immediate onset; however, some may occur with such delayed onset that the original event is overlooked. We report a case of post-traumatic delayed onset TOS due to a bullet lodge to left brachial plexus.

  9. Sensory nerves and pancreatitis

    OpenAIRE

    LI, QINGFU; Peng, Jie

    2014-01-01

    Sensory nerves are a kind of nerve that conduct afferent impulses from the periphery receptors to the central nervous system (CNS) and are able to release neuromediators from the activated peripheral endings. Sensory nerves are particularly important for microcirculatory response, and stimulation of pancreatic sensory nerves releases a variety of neuropeptides such as substance P (SP), calcitonin gene-related peptide (CGRP), etc., leading to neurogenic inflammation characterized as the local ...

  10. Brachial Plexus Involvement of Myeloid Sarcoma Detected by Reconstruction Magnetic Resonance Neurography.

    Science.gov (United States)

    Sugiyama, Atsuhiko; Ito, Shoichi; Sugita, Yasumasa; Shimada, Jun-Ichiro; Takeuchi, Masahiro; Hirano, Shigeki; Kuwabara, Satoshi

    2015-01-01

    Myeloid sarcoma is a rare hematological disorder that presents as an extramedullary mass of immature myeloid precursors. We herein present the case of a 57-year-old man with a seven-month history of progressive weakness in the right upper extremity. Reconstruction magnetic resonance neurography showed a marked enlargement of the right brachial plexus. Fluorodeoxyglucose positron emission tomography revealed a radioactive lesion in the sacrum, in addition to the right brachial plexus, and a biopsy of the sacrum revealed myeloid sarcoma. The brachial plexus lesion was also regarded as myeloid sarcoma because of the treatment response. Isolated myeloid sarcoma involving the brachial plexus is very rare and its diagnosis is difficult as there was neither a history of leukemia nor bone marrow involvement in this patient. In this case, reconstructed magnetic resonance neurography was useful for detecting the brachial plexus mass lesion which led to an early diagnosis and good recovery. PMID:26328656

  11. Characterization of a chondroitin sulfate hydrogel for nerve root regeneration

    Science.gov (United States)

    Conovaloff, Aaron; Panitch, Alyssa

    2011-10-01

    Brachial plexus injury is a serious medical problem that affects many patients annually, with most cases involving damage to the nerve roots. Therefore, a chondroitin sulfate hydrogel was designed to both serve as a scaffold for regenerating root neurons and deliver neurotrophic signals. Capillary electrophoresis showed that chondroitin sulfate has a dissociation constant in the micromolar range with several common neurotrophins, and this was determined to be approximately tenfold stronger than with heparin. It was also revealed that nerve growth factor exhibits a slightly stronger affinity for hyaluronic acid than for chondroitin sulfate. However, E8 chick dorsal root ganglia cultured in the presence of nerve growth factor revealed that ganglia cultured in chondroitin sulfate scaffolds showed more robust growth than those cultured in control gels of hyaluronic acid. It is hypothesized that, despite the stronger affinity of nerve growth factor for hyaluronic acid, chondroitin sulfate serves as a better scaffold for neurite outgrowth, possibly due to inhibition of growth by hyaluronic acid chains.

  12. The Safety of EXPAREL ® (Bupivacaine Liposome Injectable Suspension) Administered by Peripheral Nerve Block in Rabbits and Dogs

    OpenAIRE

    Brigitte M. Richard; Paul Newton; Ott, Laura R.; Dean Haan; Abram N. Brubaker; Cole, Phaedra I; Ross, Paul E.; Rebelatto, Marlon C.; Nelson, Keith G.

    2012-01-01

    A sustained-release DepoFoam injection formulation of bupivacaine (EXPAREL, 15?mg/mL) is currently being investigated for postsurgical analgesia via peripheral nerve block (PNB). Single-dose toxicology studies of EXPAREL (9, 18, and 30?mg/kg), bupivacaine solution (Bsol, 9?mg/kg), and saline injected around the brachial plexus nerve bundle were performed in rabbits and dogs. The endpoints included clinical pathology, pharmacokinetics, and histopathology evaluation on Day 3 and Day 15 (2/sex/g...

  13. The Physics of Nerves

    CERN Document Server

    Heimburg, Thomas

    2010-01-01

    The accepted model for nerve pulse propagation in biological membranes seems insufficient. It is restricted to dissipative electrical phenomena and considers nerve pulses exclusively as a microscopic phenomenon. A simple thermodynamic model that is based on the macroscopic properties of membranes allows explaining more features of nerve pulse propagation including the phenomenon of anesthesia that has so far remained unexplained.

  14. Corynebacterium ulcerans cutaneous diphtheria.

    Science.gov (United States)

    Moore, Luke S P; Leslie, Asuka; Meltzer, Margie; Sandison, Ann; Efstratiou, Androulla; Sriskandan, Shiranee

    2015-09-01

    We describe the case of a patient with cutaneous diphtheria caused by toxigenic Corynebacterium ulcerans who developed a right hand flexor sheath infection and symptoms of sepsis such as fever, tachycardia, and elevated C-reactive protein, after contact with domestic cats and dogs, and a fox. We summarise the epidemiology, clinical presentation, microbiology, diagnosis, therapy, and public health aspects of this disease, with emphasis on improving recognition. In many European countries, C ulcerans has become the organism commonly associated with cutaneous diphtheria, usually seen as an imported tropical disease or resulting from contact with domestic and agricultural animals. Diagnosis relies on bacterial culture and confirmation of toxin production, with management requiring appropriate antimicrobial therapy and prompt administration of antitoxin, if necessary. Early diagnosis is essential for implementation of control measures and clear guidelines are needed to assist clinicians in managing clinical diphtheria. This case was a catalyst to the redrafting of the 2014 national UK interim guidelines for the public health management of diphtheria, released as final guidelines in March, 2015. PMID:26189434

  15. Prognostic relevance of risk factors for obstetrical brachial plexopathy

    OpenAIRE

    Heise Carlos O.; Gherpelli José Luiz D.

    2006-01-01

    We did a case-control study to verify if the birthweight, forceps delivery or perinatal asphyxia have any significant effect on the prognosis of obstetrical brachial plexopathy. Group A was composed of 25 infants who completely recovered at the age of 6 months. Group B was composed of 21 infants who were still not able to remove a blindfold from the face with the affected limb in the sitting position at the age of 12 months. There was no statistical difference of the median birthweight or med...

  16. Obesity in children with brachial plexus birth palsy.

    Science.gov (United States)

    Singh, Avreeta K; Mills, Janith; Bauer, Andrea S; Ezaki, Marybeth

    2015-11-01

    Fetal macrosomia is associated with a 14-fold increased risk of brachial plexus birth palsy (BPBP), and is a predictor of childhood obesity. The purpose of this study was to identify the relationships between BPBP, fetal macrosomia, and childhood obesity. We retrospectively reviewed 214 children with BPBP. The average age was 8 years and 53% had a Narakas 1 grade BPBP. Overall, 49% of children were normal weight, 22% overweight, and 29% obese. Of the children with a history of fetal macrosomia, 41% were obese; a statistically significant difference. Overall quality of life scores, however, were not correlated with obesity. PMID:26163865

  17. Comparison of penile brachial index and penile arteriography

    International Nuclear Information System (INIS)

    Thirty patients complaining of erectile dysfunction were evaluated by measurement of the penile brachial index and arteriography. The PBIs were measured in five healthy controls. Half of the patients were studied in a vascular laboratory and the other half in a radiology-urology erectile dysfunction clinic. A poor correlation was found between PBI and arteriographic findings. No statistical difference was observed between the correlation coefficients for the two laboratory sites. Factors responsible for accurate and inaccurate assessments are discussed, and the process by which PBI measurements are obtained and their relationship to the physiology of erections is explained

  18. COMPARISON BETWEEN 0 . 5% BUPIVACAINE - DEXAMET HASONE COMBINATION & 0 . 5% BUPIVACAINE - CLONIDINE COMBINATION IN BRACHIAL PLEXUS BLOCKS BY SUPRACLAVICULAR APPROACH

    Directory of Open Access Journals (Sweden)

    Hari

    2015-05-01

    Full Text Available BACKGROUND: Brachial plexus blocks , alone or in combination with general anesthesia , has become one of the most important anesthesia techniques for surgeries in the upper limb . Prolongation of analgesia using perineural catheters are not yet popular , and we are in need for an adjuvant that can prolong the action of local anesthetics after single injection peripheral nerve blocks . Dexamethasone and clonidine are two commonly used adjuvants . This study was undertaken to compare the analgesic efficacy of dexamethasone and clonidine . MATERIALS AND METHODS: Ninety adult patients fitting under the inclusion criteria were assigned to three groups of thirty each and received ultrasound guided suprac lavicular brachial plexus block. They received either dexamethasone 8 mg (Group D or clonidine 1mcg/kg (Group C or saline 2 ml (Group S with 15 ml of 0 . 5% bupivacaine . The onset of sensory and motor blocks , duration of analgesia and the duration of motor block were assessed . RESULTS: The onset of sensory and motor block were comparable in all the three groups ( 17 . 50±2 . 86 minutes and 30 . 33±4 . 14 minutes ; 17 . 17±3 . 13 minutes and 31 . 0±4 . 8 minutes ; 18 . 33±3 . 55 minutes and 31 . 0±5 . 48 minutes for groups D , C and S respectively . The duration of analgesia and motor blockade was markedly prolonged in dexamethasone group (19 . 41±2 . 60 hours and 17 . 19±2 . 13 hours and moderately prolonged clonidine group (11 . 49±1 . 66 hours and 10 . 41±1 . 18 hours when compared to saline group (7 . 56±1 . 65 hours and 6 . 22±1 . 43 hours . CONCLUSION: Dexamethasone proves to be a better adjuvant compared to clonidine , as it considerably prolongs analgesia and is devoid of significant side effects . But the prolonged motor block is still a matter of concern and the search for an adjuvant that selectively prolongs analgesia without impairing motor function continues

  19. Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: Part 2. Upper extremity

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sungjun [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Hanyang University, Kuri Hospital, Department of Diagnostic Radiology, College of Medicine, Kuri City, Kyunggi-do (Korea); Choi, Jin-Young; Huh, Yong-Min; Song, Ho-Taek; Lee, Sung-Ah [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Kim, Seung Min [Yonsei University, Department of Neurology, College of Medicine, Seoul (Korea); Suh, Jin-Suck [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea); Yonsei University, Research Institute of Radiological Science, College of Medicine, Seoul (Korea)

    2007-02-15

    The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. (orig.)

  20. Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: Part 2. Upper extremity

    International Nuclear Information System (INIS)

    The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. (orig.)

  1. Effect of skilled and unskilled training on nerve regeneration and functional recovery

    Directory of Open Access Journals (Sweden)

    A.S. Pagnussat

    2012-08-01

    Full Text Available The most disabling aspect of human peripheral nerve injuries, the majority of which affect the upper limbs, is the loss of skilled hand movements. Activity-induced morphological and electrophysiological remodeling of the neuromuscular junction has been shown to influence nerve repair and functional recovery. In the current study, we determined the effects of two different treatments on the functional and morphological recovery after median and ulnar nerve injury. Adult Wistar male rats weighing 280 to 330 g at the time of surgery (N = 8-10 animals/group were submitted to nerve crush and 1 week later began a 3-week course of motor rehabilitation involving either "skilled" (reaching for small food pellets or "unskilled" (walking on a motorized treadmill training. During this period, functional recovery was monitored weekly using staircase and cylinder tests. Histological and morphometric nerve analyses were used to assess nerve regeneration at the end of treatment. The functional evaluation demonstrated benefits of both tasks, but found no difference between them (P > 0.05. The unskilled training, however, induced a greater degree of nerve regeneration as evidenced by histological measurement (P < 0.05. These data provide evidence that both of the forelimb training tasks used in this study can accelerate functional recovery following brachial plexus injury.

  2. Nerve sheath tumors of the head and neck - a radiological review

    International Nuclear Information System (INIS)

    Peripheral nerve sheath tumors of the head and neck - a review. Peripheral nerve sheath tumors are derived from neural crest and rare classified as neuroectodermal in origin. They can be divided into neurofibroma, schwannoma and neurogenic sarcoma. Neurofifromas are benign well circumscribed, nonencapsulated tumors which involve all elements of normal peripheral nerves. Schwannomas are beginning encapsulated tumors composed fundamentally by Schwann cells. Neurogenic sarcomas are malignant tumors which can be de novo or arise from preexisting neurofibroma or schwannoma. Peripheral nerve sheath tumors can arise from any nerve that contain myelin sheath, but are more frequent in extremities and trunk, being rare on cervical region. neurogenic tumors of head and neck can arise from cranial nerves, especially vagus nerve, brachial plexus and other small nervous plexus. Computed tomography and magnetic resonance imaging are the methods of choice in the evaluation of those tumors and can demonstrate lesions with several patterns. Areas of cystic degeneration are frequent in schwannomas, while neurofibromas are usually homogeneous. About 1/3 of those tumors are hyper vascularized and those who arise nervous spinal; roots can have an aspect of dumbbell which contain cervical and intravertebral components. (author)

  3. Metastatic Brachial Plexopathy in a Case of Recurrent Breast Carcinoma Demonstrated on {sup 18}F-FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Tripathi, Madhavi; Das, Chandan J.; Srivastava, Anurag; Bal, ChandraSekhar; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2014-03-15

    This case highlights the importance of recognition of the pattern of metastatic brachialplexopathy in breast cancer patients undergoing {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography/computed tomography (PET/CT) for evaluation of recurrent disease.This pattern can be appreciated on maximum intensity projection (MIP) and coronal {sup 18}F-FDG PET/CT images as a linear extension of tracer activity from superomedial aspect(supra/infraclavicular) to lateral aspect of the axilla closely related to the subclavian/axillary vessels). A 35-year-old woman diagnosed with infiltrating ductal carcinoma of the right breast had undergone six cycles of neoadjuvant chemotherapy, followed by wide local incision and radiotherapy. She had local recurrence, for which she was operated upon and given chemotherapy. She presented to her oncologist with pain and swelling in the right breast, nodules in the right axilla and restriction of movement of the right upper limb. The patient was referred for {sup 18}F-FDG PET/CT to evaluate the extent of recurrent/metastatic disease. Whole-body PET/CT was acquired 1 h following the intravenous injection of 296 MBq of {sup 18}F-FDG on a Biograph mCT scanner (Siemens). Evaluation of the MIP image revealed abnormal FDG accumulation at multiple sites in the thorax, along with a linear pattern of FDG uptake in the right lateral aspect of the upper chest (Fig. 1a, arrow). The coronal fused PET/CT image revealed a linear pattern of FDG uptake corresponding to an ill-defined mass extending from just behind the right clavicle into the right axilla (arrow). In addition, abnormal FDG accumulation was seen in a soft tissue density mass in the upper outer quadrant of the right breast, skin of the right breast laterally, both pectoral muscles (discrete foci) and in a few subpectoral nodes. Soft tissue nodular opacities in both lungs showed FDG accumulation suggestive of pulmonary metastasis (Fig. 1b, thick arrow). The patient was referred for magnetic resonance imaging (MRI) to demonstrate the brachial plexus involvement. Coronal diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) revealed a mass in the right axilla, with a b value of 1,000, infiltrating the cord and branches of the right brachial plexus visualised as linear hyperintensities (Fig. 1c, arrow). Brachial plexopathy in breast cancer patients can be metastatic (because major lymph drainage routes for the breast course through the axilla) or radiation induced, the former being the commoner of the two. Differentiation between the two pathologies is important for appropriate treatment planning. {sup 18}F-FDG PET/CT is a useful tool in the evaluation of patients with recurrent or metastatic breast cancer. Recognition of the pattern of brachial plexus involvement is thus essential for accurate interpretation of the {sup 18}F-FDG PET/CT study. To date, two case reports and one small case series have demonstrated the feasibility of PET for confirming metastatic brachial plexopathy when MRI was suspicious of the same or when the patient was symptomatic for the same. This case highlights the possibility of metastatic brachial plexopathy even when the patient may not be overtly symptomatic for the same. The typical pattern as seen on MIP and coronal images is linear, extending from the superomedial aspect (supra/infraclavicular) to the lateral aspect of axilla closely related to the subclavian/axillary vessels). The commonest finding on computed tomography (CT) is that of an axillary mass, but may range from no remarkable abnormality to minimal thickening. Moreover, CT would not be able to differentiate metastatic from radiation plexopathy. MRI is the first-line imaging modality for evaluating brachial plexopathy and can delineate both normal and abnormal anatomy of the brachial plexus, with the ability to differentiate nerves from the surrounding vessels and soft tissue with greater detail than CT. In this case, DWIBS was used to demonstrate the presence of a right axillary mass (discrete mass in relation

  4. Clonal analysis reveals nerve-dependent and independent roles on mammalian hind limb tissue maintenance and regeneration.

    Science.gov (United States)

    Rinkevich, Yuval; Montoro, Daniel T; Muhonen, Ethan; Walmsley, Graham G; Lo, David; Hasegawa, Masakazu; Januszyk, Michael; Connolly, Andrew J; Weissman, Irving L; Longaker, Michael T

    2014-07-01

    The requirement and influence of the peripheral nervous system on tissue replacement in mammalian appendages remain largely undefined. To explore this question, we have performed genetic lineage tracing and clonal analysis of individual cells of mouse hind limb tissues devoid of nerve supply during regeneration of the digit tip, normal maintenance, and cutaneous wound healing. We show that cellular turnover, replacement, and cellular differentiation from presumed tissue stem/progenitor cells within hind limb tissues remain largely intact independent of nerve and nerve-derived factors. However, regenerated digit tips in the absence of nerves displayed patterning defects in bone and nail matrix. These nerve-dependent phenotypes mimic clinical observations of patients with nerve damage resulting from spinal cord injury and are of significant interest for translational medicine aimed at understanding the effects of nerves on etiologies of human injury. PMID:24958860

  5. Brain imaging signatures of the relationship between epidermal nerve fibers and heat pain perception.

    Science.gov (United States)

    Tseng, Ming-Tsung; Kong, Yazhuo; Chiang, Ming-Chang; Chao, Chi-Chao; Tseng, Wen-Yih I; Hsieh, Sung-Tsang

    2015-11-15

    Although the small-diameter primary afferent fibers in the skin promptly respond to nociceptive stimuli and convey sensory inputs to the central nervous system, the neural signatures that underpin the relationship between cutaneous afferent fibers and pain perception remain elusive. We combined skin biopsy at the lateral aspect of the distal leg, which is used to quantify cutaneous afferent fibers, with fMRI, which is used to assess brain responses and functional connectivity, to investigate the relationship between cutaneous sensory nerves and the corresponding pain perception in the brain after applying heat pain stimulation to the dorsum of the right foot in healthy subjects. During painful stimulation, the degree of cutaneous innervation, as measured by epidermal nerve fiber density, was correlated with individual blood oxygen level-dependent (BOLD) signals of the posterior insular cortex and of the thalamus, periaqueductal gray, and rostral ventromedial medulla. Pain perception was associated with the activation of the anterior insular cortex and with the functional connectivity from the anterior insular cortex to the primary somatosensory cortex during painful stimulation. Most importantly, both epidermal nerve fiber density and activity in the posterior insular cortex showed a positive correlation with the strength of coupling under pain between the anterior insular cortex and the primary somatosensory cortex. Thus, our findings support the notion that the neural circuitry subserving pain perception interacts with the cerebral correlates of peripheral nociceptive fibers, which implicates an indirect role for skin nerves in human pain perception. PMID:26279210

  6. Cutaneous polyarteritis nodosa: A rare isolated cutaneous vasculitis

    Directory of Open Access Journals (Sweden)

    Praveen Kumar A Subbanna

    2012-01-01

    Full Text Available Cutaneous polyarteritis nodosa (CPAN is a rare form of cutaneous vasculitis that involves small and medium sized arteries of the dermis and subcutaneous tissue without systemic involvement. It presents with tender subcutaneous nodules, digital gangrene, livedo reticularis and subcutaneous ulcerations. The diagnosis is by skin biopsy and characteristic pathologic feature is a leukocytoclastic vasculitis in the small to medium-sized arterioles of the dermis. We report a rare case of benign cutaneous PAN in a 14-year-old girl who presented with history of fever, subcutaneous nodules with cutaneous ulcer and digital gangrene. The skin biopsy showed leukocytoclastic vasculitis with fibrinoid necrosis in the dermal vessels. She received treatment with steroids and lesions resolved completely over a period of month.

  7. Nerve conduction and excitability studies in peripheral nerve disorders

    DEFF Research Database (Denmark)

    Krarup, Christian; Moldovan, Mihai

    2009-01-01

    PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve excitability studies are relatively novel but are acquiring an increasingly important role in the study of peripheral nerves. RECENT FINDINGS: By measuring responses in nerve that are related to nodal fun...

  8. Low velocity gun shot wounds of the brachial plexus.

    Science.gov (United States)

    Vrettos, B C; Rochkind, S; Boome, R S

    1995-04-01

    28 patients with low velocity gunshot wounds of the brachial plexus were treated at Groote Schuur Hospital from 1980 to 1991. Delayed exploration of the brachial plexus (up to 7 months after injury) was performed in nine (30%) of the patients. The other 19 patients did not have exploration of the plexus; most of these patients showed signs of recovery within 2 to 4 weeks of injury. Injury to the subclavian or axillary artery occurred in nine (30%) of the cases. The average length of follow-up of the patients was 19 months (range 2-90 months). Of the 19 patients treated non-operatively, 15 (79%) had an excellent or good result and four (21%) a fair result. The indications for surgery were the absence of improvement within 3 months of injury or persistent pain. Surgery was indicated for significant pain in five of the nine patients; postoperatively two had complete relief of pain, two improvement in the pain and one no improvement. Of the nine surgically treated patients, three (33%) had a good result, two (22%) a fair result and four (45%) a poor result. The potential for recovery was not dependent on the severity of the injury at presentation or the presence of vascular injury but on the appearance of signs of recovery within 4 weeks of injury. PMID:7797973

  9. USE OF DEXMEDETOMIDINE ALONG WITH BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Rachana Gandhi

    2012-02-01

    Full Text Available Introduction: Supraclavicular brachial plexus block provides safe, effective, low cost anaesthesia with good postoperative analgesia. This study was conducted to compare the postoperative analgesic efficacy and safety of dexmedetomidine for brachial plexus blockade along with bupivacaine. Methodology: This prospective double blind study was conducted on 70 patients of age 18 to 60 years posted for various upper limb surgeries and randomly allocated into two equal groups of 35 each. Control group-C received injection bupivacaine (0.25% 38 milliliter plus 2 milliliter normal saline, dexmedetomidine group-D received injection bupivacaine (0.25% 38 milliliter plus dexmedetomidine 30 microgram (2 milliliter. Assessment of motor and sensory blockade, pulse, systolic blood pressure, respiration and side effects were noted every 5 minutes for first 30 minute and every 10 minute till end of surgery. Duration of analgesia and incidence of various complications following the procedure were observed. Results: It was observed that in control group onset of motor and sensory blockade was faster. Where as, dexmedetomidine group have better hemodynamic stability and greater postoperative analgesia. Only two cases of bradycardia and two cases of hypotension were noticed in dexmedetomidine group-D. [National J of Med Res 2012; 2(1.000: 67-69

  10. Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications

    Directory of Open Access Journals (Sweden)

    Shah Anand

    2007-01-01

    Full Text Available Background: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB. Materials and Methods: We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73 of patients received a continuous ISB; 11% (n=9 received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU, at 24h and at seven days. Results: Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5, 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. Conclusions: Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.

  11. Leishmaniasis cutánea / Cutaneous leishmaniasis

    Scientific Electronic Library Online (English)

    T. del, Rosal Rabes; F., Baquero-Artigao; M.J., García Miguel.

    2010-06-01

    Full Text Available Las leishmaniasis son enfermedades causadas por protozoos del género Leishmania. España es uno de los países en los que la leishmaniasis es endémica. Los casos adquiridos en nuestro país (tanto cutáneos como viscerales) se deben a Leishmania infantum, pero puede haber otros causados por otras especi [...] es en viajeros o inmigrantes. Las lesiones cutáneas aparecen fundamentalmente en áreas expuestas y tienden a la curación espontánea dejando cicatriz. El diagnóstico es difícil por la inespecificidad de la clínica y el lento crecimiento del parásito en cultivo. Existen distintas opciones terapéuticas, por lo que cada caso debe ser valorado individualmente según las características de la lesión, la especie causante y el potencial de afectación mucosa. En nuestro país, la primera línea de tratamiento está constituida por los antimoniales pentavalentes intralesionales. En casos refractarios o con riesgo de diseminación mucosa debe emplearse un tratamiento sistémico. Abstract in english Leishmaniasis are a group of diseases caused by protozoa of the genus Leishmania. Spain is one of the countries where leishmaniasis is endemic. All cases acquired in our country (both cutaneous and visceral) are caused by Leishmania infantum, although cases due to other species may appear in travele [...] rs or immigrants. Cutaneous lesions appear mainly in exposed areas and tend to heal spontaneously leaving scars. Diagnosis is often difficult due to the non-specific clinical manifestations and the slow growth of the parasite when cultured. There are different available treatment options and each case should be individually considered, taking into account the characteristics of the lesion, the species of Leishmania and the potential for mucosal spread. In Spain, intralesional pentavalent antimonials are the first-line therapeutic option. In those cases at risk for mucosal dissemination or refractory to local therapy, systemic treatment must be given.

  12. Miltefosine in cutaneous leishmaniasis

    International Nuclear Information System (INIS)

    To determine the efficacy of oral Miltefosine in patients with cutaneous leishmaniasis and its comparison with the most effective standard treatment, pentavalent antimony compound. Thirty patients, 12 years of age or older clinically and histopathologically diagnosed as cutaneous leishmaniasis were selected. Fifteen patients received orally administered Miltefosine 2.5mg/kg/day for 28 days and remaining 15 received injectable pentavalent antimony 20mg/kg/day for 28 days. Pre-treatment complete physical examination was done along with necessary laboratory investigations in all cases. These were repeated again after 2 weeks and at the end of treatment to note any deviation from the normal limits. Groups were almost matched in terms of age, weight, parasitological score. The efficacy was evaluated by ulcer size, before therapy, at 2 weeks and 4 weeks. Patients were followed-up at 3 and 6 months. Efficacy of two groups was statistically compared by calculating p-value by z-test. All patients completed the study without any serious complication. Lesions improved significantly and only scarring and post-inflammatory pigmentation was left. At 3 months, cure rate was 93% in group A and it was 73.33% in group B while at the end of 6 months, it was 86% and 66.6% respectively. This difference between efficacies of two groups was not found to be statistically significant (p-value >0.5). Miltefosine appears to be a safe and effective alternative to currently used therapies. The striking advantage of Miltefosine is its oral administration and it may also be helpful in regions where parasites are resistant to current agents. (author)

  13. Incidence of early posterior shoulder dislocation in brachial plexus birth palsy

    Directory of Open Access Journals (Sweden)

    Düppe Henrik

    2007-12-01

    Full Text Available Abstract Background Posterior dislocation of the shoulder in brachial plexus birth palsy during the first year of life is rare but the incidence increases with age. The aim was to calculate the incidence of these lesions in children below one year of age. Methods The incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malmö municipality, Sweden, 2000–2005. Results The incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies. Conclusion All children with a brachial plexus birth lesion (incidence 3.8‰ should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28‰ since such a condition may occur in 7% of children with a brachial plexus birth lesion.

  14. Cutaneous toxoplasmosis in two dogs.

    Science.gov (United States)

    Hoffmann, Aline Rodrigues; Cadieu, Jennifer; Kiupel, Matti; Lim, Ailam; Bolin, Steve R; Mansell, Joanne

    2012-05-01

    Cutaneous toxoplasmosis has been previously reported in human beings, rarely reported in cats, and reported in 1 dog with systemic toxoplasmosis. The present report describes 2 cases of cutaneous toxoplasmosis in 2 dogs treated with immunosuppressive therapy. One of the dogs developed generalized cutaneous pustules and pruritus, and the other dog only had a single subcutaneous nodule. Microscopically, skin biopsies showed moderate to severe pyogranulomatous and necrotizing dermatitis and panniculitis, with multifocal vasculitis and vascular thrombosis. Single or aggregates of protozoal tachyzoites were mostly intracytoplasmic and occasionally extracellular. The etiology was confirmed in both cases by immunohistochemistry and by polymerase chain reaction assays, which were followed by nucleic acid sequencing. Both patients were treated with clindamycin. The dog with generalized lesions developed pulmonary and neurological signs and was euthanized. The dog with a single nodule recovered completely with no remission of cutaneous lesions. PMID:22529142

  15. Primary cutaneous zygomycosis in India.

    Science.gov (United States)

    Kaushik, Robin

    2012-12-01

    Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high morbidity and mortality. A retrospective analysis of the reported cases of cutaneous zygomycosis from India was made using various search engines and cross-referencing from available manuscripts. A total of 42 publications from India on the topic were identified, since the first reported case of primary cutaneous zygomycosis by Veliath et al. (1976). There are 130 described cases of cutaneous zygomycosis with an overall mortality of 35 %. The commonest zygomycete identified was Apophysomyces elegans, and the commonest predisposing factor was breach of the skin. Surprisingly, diabetes was reported only in 36 cases (27.69 %). It is important to be aware of this unusual but fatal infection in order to manage it properly and have a good outcome. PMID:24293901

  16. Imaging the trigeminal nerve

    International Nuclear Information System (INIS)

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  17. Imaging the trigeminal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093, Lisboa (Portugal)], E-mail: borgalexandra@gmail.com; Casselman, Jan [Department of Radiology, A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals (Belgium)

    2010-05-15

    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  18. Cutaneous Lymphangioma circumscriptum - dermoscopic features*

    Scientific Electronic Library Online (English)

    António Fernandes, Massa; Nuno, Menezes; Armando, Baptista; Ana Isabel, Moreira; Eduarda Osório, Ferreira.

    2015-04-01

    Full Text Available Lymphangiomas are congenital lymphatic malformations and cutaneous lymphangioma circumscriptum is the most common type. It is clinically characterized by clusters of translucent vesicles and the presence of dermoscopically yellow lacunae surrounded by pale septa, as well as reddish to bluish lacunae [...] . In our case, the recently described hypopyon-like feature manifested, aiding in the sometimes difficult differential diagnosis of cutaneous lymphangioma circumscriptum with vascular lesions, further highlighting the importance of dermoscopy in what can be a diagnostic challenge.

  19. Cutaneous lesions of the nose

    OpenAIRE

    Altmeyer Peter; Paech Volker; Thrandorf Christina; Sand Daniel; Sand Michael; Bechara Falk G

    2010-01-01

    Abstract Skin diseases on the nose are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners and general plastic and dermatologic surgeons are regularly consulted regarding cutaneous lesions on the nose. This article is the second part of a review series dealing with cutaneous lesions on the head and face, which are frequently seen in daily practice by a dermatologic surgeon. In this review, we focus on those skin diseases on the nose where su...

  20. Carcinoma in cutaneous Lichen Planus

    OpenAIRE

    Rahul Shetty; Shashank Lamba; Archana Gulur; Sapna Patel; Ashish Kumar Gupta

    2013-01-01

    Carcinoma occurring in the cutaneous lesions of Lichen Planus though rarely mentioned in literature does occur and should be kept in mind while treating such lesions. We report a 16 year female who developed a squamous cell carcinoma in a long standing verrucous lichen planus in the lower leg. This case is being presented to indicate the possibility of malignant transformation of cutaneous lichen planus to carcinoma, especially in the hypertrophic forms and the need to have an early diagnosis...

  1. Cutaneous leishmaniasis with unusual presentation

    OpenAIRE

    Khatri M; Shafi M; Banghazil M

    1999-01-01

    Three cases of cutaneous leishmaniasis with unusual presentation seen at Central Hospital Tripoli, Libya are described. Case No. 1 and 2 had 102 and 109 noduloulcerative lesions with generalized almost bilaterally symmetrical distribution, suggestive of dissemination. Case No. 3 had large verrucous carcinoma but histopathology suggested lupoid (chronic cutaneous) leishmaniasis. Patient No. 2 developed hypersensitivity reaction to sodium stibogluconate after 10 days but responded well to the t...

  2. Dose Constraints to Prevent Radiation-Induced Brachial Plexopathy in Patients Treated for Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Amini, Arya [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of California Irvine School of Medicine, Irvine, California (United States); Yang Jinzhong; Williamson, Ryan [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); McBurney, Michelle L. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Erasmus, Jeremy [Department of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Allen, Pamela K.; Karhade, Mandar; Komaki, Ritsuko; Liao, Zhongxing; Gomez, Daniel; Cox, James [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Dong, Lei [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Welsh, James, E-mail: jwelsh@mdanderson.org [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)

    2012-03-01

    Purpose: As the recommended radiation dose for non-small-cell lung cancer (NSCLC) increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum dose tolerated by the brachial plexus. Methods and Materials: We identified 90 patients with NSCLC treated with definitive chemoradiation from March 2007 through September 2010, who had received >55 Gy to the brachial plexus. We used a multiatlas segmentation method combined with deformable image registration to delineate the brachial plexus on the original planning CT scans and scored plexopathy according to Common Terminology Criteria for Adverse Events version 4.03. Results: Median radiation dose to the brachial plexus was 70 Gy (range, 56-87.5 Gy; 1.5-2.5 Gy/fraction). At a median follow-up time of 14.0 months, 14 patients (16%) had brachial plexopathy (8 patients [9%] had Grade 1, and 6 patients [7%] had Grade {>=}2); median time to symptom onset was 6.5 months (range, 1.4-37.4 months). On multivariate analysis, receipt of a median brachial plexus dose of >69 Gy (odds ratio [OR] 10.091; 95% confidence interval [CI], 1.512-67.331; p = 0.005), a maximum dose of >75 Gy to 2 cm{sup 3} of the brachial plexus (OR, 4.909; 95% CI, 0.966-24.952; p = 0.038), and the presence of plexopathy before irradiation (OR, 4.722; 95% CI, 1.267-17.606; p = 0.021) were independent predictors of brachial plexopathy. Conclusions: For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. We developed a computer-assisted image segmentation method that allows us to rapidly and consistently contour the brachial plexus and establish the dose limits to minimize the risk of brachial plexopathy. Our results could be used as a guideline in future prospective trials with high-dose radiation therapy for unresectable lung cancer.

  3. Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

    Directory of Open Access Journals (Sweden)

    Alok Kumar

    2014-01-01

    Full Text Available Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques. Methods : A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60, or ultrasound guidance (group US, n = 60 for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction. Results: The median (range number of skin punctures were 2 (2-4 in group US and 3 (2-5 in group NS (P =0.27. Insufficient block was observed in three patient (5% of group US and four patients (6.67% of group NS (P > =0.35. Patient acceptance was similarly good in the two groups. Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine.

  4. The furcal nerve revisited

    Directory of Open Access Journals (Sweden)

    Nanjundappa S. Harshavardhana

    2014-10-01

    Full Text Available Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked is an independent nerve with its own ventral and dorsal branches (rootlets and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/ professionals involved in spine care.

  5. Cutaneous nociception and neurogenic inflammation evoked by PACAP38 and VIP

    DEFF Research Database (Denmark)

    Schytz, Henrik Winther; Holst, Helle; Arendt-Nielsen, Lars; Olesen, Jes; Ashina, Messoud

    2010-01-01

    Pituitary adenylate cyclase-activating peptide-38 (PACAP38) and vasoactive intestinal peptide (VIP) belong to the same secretin-glucagon superfamily and are present in nerve fibers in dura and skin. Using a model of acute cutaneous pain we explored differences in pain perception and vasomotor responses between PACAP38 and VIP in 16 healthy volunteers in a double-blind, placebo-controlled, crossover study. All participants received intradermal injections of 200 pmol PACAP38, 200 pmol VIP and plac...

  6. Vagus Nerve Stimulation

    OpenAIRE

    Howland, Robert H.

    2014-01-01

    The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuroendocrine-immune axis to maintain homeostasis through its afferent and efferent pathways. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, including manual or electrical stimulation. Left cervical VNS is an approved therapy for refractory epilepsy and for treatment resistant depression. Ri...

  7. Comparison of the inhibitory response to tendon and cutaneous afferent stimulation in the human lower limb.

    Science.gov (United States)

    Rogasch, Nigel C; Burne, John A; Türker, Kemal S

    2012-01-01

    A powerful early inhibition is seen in triceps surae after transcutaneous electrical stimulation of the Achilles tendon [tendon electrical stimulation (TES)]. The aim of the present study was to confirm results from surface electromyogram (SEMG) recordings that the inhibition is not wholly or partly due to stimulation of cutaneous afferents that may lie within range of the tendon electrodes. Because of methodological limitations, SEMG does not reliably identify the time course of inhibitory and excitatory reflex components. This issue was revisited here with an analysis of changes in single motor unit (SMU) firing rate [peristimulus frequencygram (PSF)] and probability [peristimulus time histogram (PSTH)] to reexamine the time course of inhibitory SMU events that follow purely cutaneous (superficial sural) nerve stimulation. Results were then compared with similar data from TES. When compared with the reflex response to TES, sural nerve stimulation resulted in a longer onset latency of the primary inhibition and a weaker effect on SMU firing probability and rate. PSF also revealed that decreased SMU firing rates persisted during the excitation phase in SEMG, suggesting that the initial inhibition was more prolonged than previously reported. In a further study, the transcutaneous SEMG Achilles tendon response was compared with that from direct intratendon stimulation with insulated needle electrodes. This method should attenuate the SEMG response if it is wholly or partly dependent on cutaneous afferents. However, subcutaneous stimulation of the tendon produced similar components in the SEMG, confirming that cutaneous afferents made little or no contribution to the initial inhibition following TES. PMID:22031770

  8. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    Directory of Open Access Journals (Sweden)

    Jeng JS

    2011-08-01

    Full Text Available Ta-Chen Su1, Pao-Ling Torng2, Jiann-Shing Jeng3, Ming-Fong Chen1, Chiau-Suong Liau1,41Division of Cardiology, Department of Internal Medicine, 2Department of Obstetrics and Gynecology, 3Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, 4Cardiovascular Center, Taipei Buddist Tzu-Chi Hospital, Hsin-Dian, Taipei, TaiwanBackground: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited.Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD, compliance (BAC, and resistance (BAR. Fasting blood levels of glucose, lipids, lipoprotein (a, high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured.Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity.Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than omnivores. Prevention of vitamin B12 deficiency might be beneficial for cardiovascular health in vegetarians.Keywords: postmenopausal women, vegetarians, carotid stiffness, brachial arterial distensibility

  9. Obstetrical Brachial Plexus Palsy: Electrodiagnostical Study and Functional Outcome

    Directory of Open Access Journals (Sweden)

    B. Eftekharsadat

    2010-01-01

    Full Text Available Obstetrical Brachial Plexus Palsy (OBPP is a complication of difficult delivery and resulted from excessive traction on the brachial plexus during delivery. Erb palsy, klumpke paralysis and panplexus palsy reported in 46, 0.6 and 20% of patients, respectively. Unilateral injury is more common than bilateral injury. Risk factors include macrosomia, multiparity, prior delivery of a child with OBPP, breech delivery shoulder dystocia, vacium and forceps assisted delivery and excessive maternal weight gain. The recovery rate is usually reported to be between 80 and 90%. We evaluated 42 children with OBPP. Out of them, we could follow only 28 cases during two years. Poor to moderate recovery occurred in 13 cases. Good to complete (expected recovery occurred in 15 cases. Most of the patients were females. Right side palsy was more prevalent than left side palsy. Vaginal delivery without forceps was the most mode of delivery. Vertex was the most common presentation. Most of the patients were term. The mean weight of the birth was 3.8 kg. Erb palsy and pan-plexus palsy consisted of 71.4 and 28.6% of lesions. In patients with Erb palsy, there were preganglionic palsy in 3 (15.8% and postganglionic palsy in 16 (84.2% cases, while all the patients with panplexus palsy had postganglionic palsy. All patients with complete recovery (9 of 15 had Erb palsy and postganglionic lesion. Erb palsy was present in 71.4% and panplexus palsy was present in 28.6% of cases. Also, 23.8% of cases had preganglionic and 76.2% of cases had postganglionic injures.

  10. Leishmaniasis cutánea Cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    Osvaldo Miranda Gómez

    2007-12-01

    Full Text Available La leishmaniasis es una enfermedad de la piel y las membranas mucosas causada por protozoos pertenecientes al género Leishmania. Según la Organización Mundial de la Salud, la enfermedad adquirió proporciones de epidemia en Afganistán y en los campamentos para refugiados de este país en Pakistán, después de la agresión de la Organización del Tratado del Atlántico Norte encabezada por los Estados Unidos a Afganistán en su cruzada contra el terrorismo, por lo que se decide presentar un caso con diagnóstico presuntivo de leishmaniasis cutánea, proveniente de una aldea donde se observó un incremento de casos confirmados con esta afección.Leishmaniasis is a disease of the skin and the mucous membranes caused by protozoa corresponding to the genus Leishmania. According to the World Health Organization, the disease acquired epidemic proportions in Afganistan and in the refugee camps of this country in Pakistan, after the aggression of the North Atlantic Treaty Organization headed by the United States to Afghanistan in its war against terrorism. That's why, it was decided to present a case with presumptive diagnosis of cutaneous leishmaniasis from a village, where it was observed an increase of cases confirmed with this affection.

  11. Leishmaniasis cutánea / Cutaneous leishmaniasis

    Scientific Electronic Library Online (English)

    Osvaldo, Miranda Gómez; Iván, González Barea.

    2007-12-01

    Full Text Available La leishmaniasis es una enfermedad de la piel y las membranas mucosas causada por protozoos pertenecientes al género Leishmania. Según la Organización Mundial de la Salud, la enfermedad adquirió proporciones de epidemia en Afganistán y en los campamentos para refugiados de este país en Pakistán, des [...] pués de la agresión de la Organización del Tratado del Atlántico Norte encabezada por los Estados Unidos a Afganistán en su cruzada contra el terrorismo, por lo que se decide presentar un caso con diagnóstico presuntivo de leishmaniasis cutánea, proveniente de una aldea donde se observó un incremento de casos confirmados con esta afección. Abstract in english Leishmaniasis is a disease of the skin and the mucous membranes caused by protozoa corresponding to the genus Leishmania. According to the World Health Organization, the disease acquired epidemic proportions in Afganistan and in the refugee camps of this country in Pakistan, after the aggression of [...] the North Atlantic Treaty Organization headed by the United States to Afghanistan in its war against terrorism. That's why, it was decided to present a case with presumptive diagnosis of cutaneous leishmaniasis from a village, where it was observed an increase of cases confirmed with this affection.

  12. Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound

    OpenAIRE

    Cary, Theodore W.; Reamer, Courtney B.; Sultan, Laith R.; Mohler, Emile R; Sehgal, Chandra M

    2014-01-01

    Purpose: To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view.

  13. Brachial Plexus Injury from CT-Guided RF Ablation Under General Anesthesia

    International Nuclear Information System (INIS)

    Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexus palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication

  14. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades.

    LENUS (Irish Health Repository)

    Walsh, Jennifer M

    2011-04-01

    We sought to compare the incidence and antecedents of neonatal brachial plexus injury (BPI) in 2 different 5-year epochs a decade apart following the introduction of specific staff training in the management of shoulder dystocia.

  15. The Safety of EXPAREL ® (Bupivacaine Liposome Injectable Suspension) Administered by Peripheral Nerve Block in Rabbits and Dogs

    Science.gov (United States)

    Richard, Brigitte M.; Newton, Paul; Ott, Laura R.; Haan, Dean; Brubaker, Abram N.; Cole, Phaedra I.; Ross, Paul E.; Rebelatto, Marlon C.; Nelson, Keith G.

    2012-01-01

    A sustained-release DepoFoam injection formulation of bupivacaine (EXPAREL, 15?mg/mL) is currently being investigated for postsurgical analgesia via peripheral nerve block (PNB). Single-dose toxicology studies of EXPAREL (9, 18, and 30?mg/kg), bupivacaine solution (Bsol, 9?mg/kg), and saline injected around the brachial plexus nerve bundle were performed in rabbits and dogs. The endpoints included clinical pathology, pharmacokinetics, and histopathology evaluation on Day 3 and Day 15 (2/sex/group/period). EXPAREL resulted in a nearly 4-fold lower Cmax versus Bsol at the same dose. EXPAREL was well tolerated at doses up to 30?mg/kg. The only EXPAREL-related effect seen was minimal to mild granulomatous inflammation of adipose tissue around nerve roots (8 of 24 rabbits and 7 of 24 dogs) in the brachial plexus sites. The results indicate that EXPAREL was well tolerated in these models and did not produce nerve damage after PNB in rabbits and dogs. PMID:22363842

  16. Karakteristik dan Faktor Risiko Obstetrical Brachial Plexus Palsy pada Bayi Baru Lahir

    OpenAIRE

    Andreas Vincent Handoyo; Yoyos Dias Ismiarto

    2010-01-01

    Obstetrical brachial plexus palsy (OBPP) is an injury of entire or part of brachial plexus correlated with delivery process. Incidence in developing countries is around 0.15%. Risk factors include intrapartum and intrauterine. Three types of OBPP are Duchenne Erb, Klumpke, and whole arm palsy. This was a retrospective study of characteristic and risk factors of OBPP in Hasan Sadikin Hospital, Bandung, period January 2002-April 2007. Data were collected from perinatology ward medical records, ...

  17. Coexistence of Brachial Plexus and Cervical Spine Metastases in a Patient With Breast Cancer: Case Report

    OpenAIRE

    Ece Ünlü; Sevgi Polat; Ebru Umay; Aytül Çakc?

    2012-01-01

    Metastatic involvement of the brachial plexus is a rare condition and is most commonly associated with breast cancer. In patients with breast cancer, brachial plexus metastases should be taken into account in case of severe pain spreading to the shoulder and arm followed by sensory and motor symptoms. Metastatic spinal tumors are the most common type of tumors of the spine. Breast cancer accounts for 21% of all vertebral metastases. Therefore, metastatic spinal tumors should principally be co...

  18. Global epidemiology of cutaneous zygomycosis.

    Science.gov (United States)

    Skiada, Anna; Rigopoulos, Dimitris; Larios, George; Petrikkos, George; Katsambas, Andreas

    2012-01-01

    The large majority of cases reported worldwide as zygomycosis are infections caused by fungi belonging to the order Mucorales. These infections are invasive, often lethal, and they primarily affect immunocompromised patients. Cutaneous zygomycosis is the third most common clinical presentation, after sinusitis and pulmonary disease. Most patients with cutaneous zygomycosis have underlying diseases, such as hematological malignancies and diabetes mellitus, or have received solid organ transplantation, but a large proportion of these patients are immunocompetent. Trauma is an important mode of acquiring the disease. The disease can be very invasive locally and penetrate from the cutaneous and subcutaneous tissues into the adjacent fat, muscle, fascia, and bone. The diagnosis of cutaneous zygomycosis is often difficult because of the nonspecific findings of the infection. The clinician must have a high degree of suspicion and use all available diagnostic tools, because early diagnosis leads to an improved outcome. The treatment of zygomycosis is multimodal and consists of surgical debridement, use of antifungal drugs, and reversal of underlying risk factors, when possible. The main antifungal drug used in the treatment of zygomycosis is amphotericin B. Posaconazole is sometimes used for salvage treatment, as continuation of treatment after initial administration of amphotericin B, or in combination. The mortality of cutaneous zygomycosis is lower in comparison with other forms of the disease, but it is still significant. When the disease is localized, mortality still ranges from 4% to 10%. PMID:23068150

  19. Cutaneous zygomycosis in immunocompetent patients in Mexico.

    Science.gov (United States)

    Ayala-Gaytán, Juan Jacobo; Petersen-Morfín, Santiago; Guajardo-Lara, Claudia Elena; Barbosa-Quintana, Alvaro; Morfín-Otero, Rayo; Rodriguez-Noriega, Eduardo

    2010-11-01

    We report three cases of traumatic cutaneous zygomycosis related to soil-contaminated skin lesions occurring after automobile accidents in individuals with no underlying disorders, which showed delayed development and diagnosis in comparison with typical zygomycosis cutaneous lesions. PMID:19735441

  20. Diagnostic value of ankle-brachial index and toe-brachial index in arterial disease of lower extremity

    Directory of Open Access Journals (Sweden)

    Lan LI

    2012-11-01

    Full Text Available Objective ?To investigate the clinical application and its influencing factors of ankle-brachial index (ABI and toe-brachial index (TBI in the diagnosis of arterial disease of lower extremity. Methods ?ABI and TBI were measured in 800 limbs of 402 patients with diabetes and/or hypertension hospitalized from July 2010 to February 2011. The patients were divided into narrow group (ABI < 0.9, normal group (0.9?ABI < 1.3, and calcification group (ABI?1.3 according to the value of ABI, and also into narrow group (TBI < 0.7 and normal group (TBI?0.7 according to the value of TBI. The correlation of ABI with TBI was analyzed, and the differences in age, obesity parameters, biochemical indicators and other factors were compared between the groups. Influence of high-sensitivity C-reactive protein (hs-CRP on ABI and TBI was further analyzed. Results ?Only when ABI < 0.9, ABI and TBI have significant correlation (r=0.826, P < 0.01. W hen the group comparison based on ABI values, it was shown that the age and hs-CRP were significantly higher in the narrow group than in the normal group and calcification group (P < 0.01. The comparison between groups based on TBI values indicated that the age, systolic blood pressure and hs-CRP in the narrow group were significantly higher than those in the normal group (P < 0.01 or P < 0.05. ABI and TBI in the normal hs-CRP group were significantly higher than those in high hs-CRP group (P < 0.05. Conclusion ?Hs-CRP may play an important role in the development and progression in peripheral arterial atherosclerosis. Therefore, ABI and TBI measurements in combination with hs-CRP level can improve early diagnosis of arterial disease of lower extremity.

  1. Optic nerve oxygenation

    DEFF Research Database (Denmark)

    Stefánsson, Einar; Pedersen, Daniella Bach

    2005-01-01

    The oxygen tension of the optic nerve is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The oxygen tension is autoregulated and moderate changes in intraocular pressure or blood pressure do not affect the optic nerve oxygen tension. If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. A disturbance in oxidative metabolism in the cytochromes of the optic nerve can be seen at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human glaucoma patients is six times higher at a perfusion pressure of 30 mmHg, which corresponds to a level where the optic nerve is hypoxic in experimental animals, as compared to perfusion pressure levels above 50 mmHg where the optic nerve is normoxic. Medical intervention can affect optic nerve oxygen tension. Lowering the intraocular pressure tends to increase the optic nerve oxygen tension, even though this effect may be masked by the autoregulation when the optic nerve oxygen tension and perfusion pressure is in the normal range. Carbonic anhydrase inhibitors increase the optic nerve oxygen tension through a mechanism of vasodilatation and lowering of the intraocular pressure. Carbonic anhydrase inhibition reduces the removal of CO2 from the tissue and the CO2 accumulation induces vasodilatation resulting in increased blood flow and improved oxygen supply. This effect is inhibited by the cyclo-oxygenase inhibitor, indomethacin, which indicates that prostaglandin metabolism plays a role. Laboratory studies suggest that carbonic anhydrase inhibitors might be useful for medical treatment of optic nerve and retinal ischemia, potentially in diseases such as glaucoma and diabetic retinopathy. However, clinical trials and needed to test this hypotheses.

  2. Parálisis obstétrica del plexo braquial. Revisión del estado actual de la enfermedad / Current concepts concerning obstetric brachial plexus palsy

    Scientific Electronic Library Online (English)

    Enrique Manuel, Vergara-Amador.

    2014-04-01

    Full Text Available El presente documento hace una revisión actual de la parálisis obstétrica del plexo braquial; se observan la etiología, aspectos demográficos, diagnóstico, cuándo deben ser observada sin cirugía y cuándo es el momento de operar. La clave de indicación de cirugía está dada cuando no ha habido recuper [...] ación del bíceps contra gravedad entre los tres y seis meses de edad. La cirugía está dirigida a la resección del neuroma y la utilización de injertos nerviosos. También tiene cabida en el tratamiento quirúrgico el uso de las transferencias nerviosas o neurotizaciones. La recuperación es lenta y se observaran resultados hasta los dos o tres años después de la cirugía. En los niños mayores de 18 meses, el tratamiento se enfoca, no en la microcirugía, sino en la reconstrucción mediante liberaciones, transferencias tendinosas y osteotomías. Abstract in english This article presents a review of current concepts in obstetric brachial plexus palsy (OBPP) looking at its aetiology, demographic aspects, diagnosis and when patients should be observed without surgery and when it is time to operate. Surgery is indicated when there has been no recovery of biceps ag [...] ainst gravity (active elbow flexion) against gravity between 3 to 6 months of age. Surgery is focused on neuroma resection and the use of nerve grafts. Nerve transfer or neurotisation also has a place in surgical treatment. Recovery is slow and results are usually observed 2 to 3 years after surgery. Treatment in children aged over 18 months will not consist of microsurgery reconstruction but rather tendon transfer, release and osteotomy.

  3. Cutaneous Lupus and the CLASI Instrument

    OpenAIRE

    Klein, Rachel S.; Morganroth, Pamela A.; Werth, Victoria P.

    2010-01-01

    This article provides an overview of cutaneous lupus erythematosus (CLE), including classification schemes, disease subtypes, and therapy. It also describes a novel clinical outcome instrument called the Cutaneous Lupus Erythematosus Disease Area and Severity Index, which quantifies cutaneous activity and damage in CLE.

  4. Reducing the risk of nerve injury during Bernese periacetabular osteotomy: a cadaveric study.

    Science.gov (United States)

    Kalhor, M; Gharehdaghi, J; Schoeniger, R; Ganz, R

    2015-05-01

    The modified Smith-Petersen and Kocher-Langenbeck approaches were used to expose the lateral cutaneous nerve of the thigh and the femoral, obturator and sciatic nerves in order to study the risk of injury to these structures during the dissection, osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely to occur if an osteotomy of the anterior superior iliac spine had been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected osteotomy of the pubis if the far cortex was penetrated by > 5 mm. This could be avoided by inclining the osteotome 45° medially and performing the osteotomy at least 2 cm medial to the iliopectineal eminence. The sciatic nerve could be injured during the first and last stages of the osteotomy if the osteotome perforated the lateral cortex of ischium and the ilio-ischial junction by > 10 mm. The femoral nerve could be stretched or entrapped during osteotomy of the pubis if there was significant rotational or linear displacement of the acetabulum. Anterior or medial displacement of Bernese peri-acetabular osteotomy. PMID:25922457

  5. Successful Outcome of Triangle Tilt as Revision Surgery in a Pediatric Obstetric Brachial Plexus Patient with Multiple Previous Operations

    OpenAIRE

    Rahul K. Nath; Halthore, Vishnu; Somasundaram, Chandra

    2014-01-01

    Introduction. Obstetric brachial plexus injury (OBPI) occurs during the process of labor and childbirth. OBPI has been reported to be associated with shoulder dystocia, macrosomia, and breech delivery. Its occurrence in uncomplicated delivery is possible as well. Case Presentation. The patient in the present report is a 6.5-year-old girl, who suffered a severe brachial plexus injury at birth and had many reconstructive surgical procedures at an outside brachial plexus center before presenting...

  6. Ectopic cutaneous schistosomiasis - Case report

    Scientific Electronic Library Online (English)

    Lívia de Souza, Mota; Samuel Freire de, Silva; Fabiana Carvalho de, Almeida; Ludmila de Sousa Ursino, Mesquita; Renata Dórea Leal, Teixeira; Aline Miranda, Soares.

    2014-07-01

    Full Text Available Schistosomiasis is best known in its visceral form but it can attack the skin, its ectopic cutaneous manifestation being rare and clinically difficult to diagnose. It is characterized by isolated or coalescent papules, erythematous, pruritic or asymptomatic, with zosteriform distribution, often loca [...] ted on the trunk. The authors report a case of a 28-year-old female patient with lesions on the abdomen, with positive stool results for Schistosoma and absence of active symptoms of visceral disease. The case reveals rare exuberant cutaneous manifestation and the importance of the diagnosis of this entity in patients from endemic regions.

  7. Cutaneous nociceptors lack sensitisation, but reveal ?-opioid receptor-mediated reduction in excitability to mechanical stimulation in neuropathy

    Directory of Open Access Journals (Sweden)

    Schmidt Yvonne

    2012-11-01

    Full Text Available Abstract Background Peripheral nerve injuries often trigger a hypersensitivity to tactile stimulation. Behavioural studies demonstrated efficient and side effect-free analgesia mediated by opioid receptors on peripheral sensory neurons. However, mechanistic approaches addressing such opioid properties in painful neuropathies are lacking. Here we investigated whether opioids can directly inhibit primary afferent neuron transmission of mechanical stimuli in neuropathy. We analysed the mechanical thresholds, the firing rates and response latencies of sensory fibres to mechanical stimulation of their cutaneous receptive fields. Results Two weeks following a chronic constriction injury of the saphenous nerve, mice developed a profound mechanical hypersensitivity in the paw innervated by the damaged nerve. Using an in vitro skin-nerve preparation we found no changes in the mechanical thresholds and latencies of sensory fibres from injured nerves. The firing rates to mechanical stimulation were unchanged or reduced following injury. Importantly, ?-opioid receptor agonist [D-Ala2,N-Me-Phe4,Gly5]-ol-enkephalin (DAMGO significantly elevated the mechanical thresholds of nociceptive A? and C fibres. Furthermore, DAMGO substantially diminished the mechanically evoked discharges of C nociceptors in injured nerves. These effects were blocked by DAMGO washout and pre-treatment with the selective ?-opioid receptor antagonist Cys2-Tyr3-Orn5-Pen7-amide. DAMGO did not alter the responses of sensory fibres in uninjured nerves. Conclusions Our findings suggest that behaviourally manifested neuropathy-induced mechanosensitivity does not require a sensitised state of cutaneous nociceptors in damaged nerves. Yet, nerve injury renders nociceptors sensitive to opioids. Prevention of action potential generation or propagation in nociceptors might represent a cellular mechanism underlying peripheral opioid-mediated alleviation of mechanical hypersensitivity in neuropathy.

  8. Cutaneous cancer and xeroderma pigmentosum; Cancer cutane et xeroderma pigmentosum

    Energy Technology Data Exchange (ETDEWEB)

    Ben Salah, H.; Bahri, M.; Mnejja, W.; Siala, W.; Daoud, J. [Centre Hospitalier Universitaire Habib-Bourguiba, Service de Radiotherapie Carcinologique, Sfax (Tunisia); Sallemi, T. [Centre Hospitalier Universitaire Habib-Bourguiba, Service d' Anatomie Pathologique, Sfax (Tunisia); Turki, H. [Centre Hospitalier Universitaire Habib-Bourguiba, Service de Dermatologie, Sfax (Tunisia)

    2007-11-15

    The cutaneous cancer at the patients affected by xeroderma pigmentosum is characterized by its multifocal character and its strong radiosensitivity. A premature care and a regular follow-up for life of these patients is indispensable for the detection and the treatment of new hurts. The precautionary measures are also important by the school eviction. (N.C.)

  9. Optic nerve sheath meningocele

    Directory of Open Access Journals (Sweden)

    Juan Carlos Mesa-Gutiérrez

    2008-10-01

    Full Text Available Juan Carlos Mesa-Gutiérrez, Silvia Muñoz Quiñones, Jorge Arruga GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainAbstract: A 53-year-old man presented with a 5-month history of visual loss in his left eye. Visual acuity could be corrected to 20/20 with an increased hyperopic correction. Dilated funduscopy showed faint choroidal folds and elevation of the left optic disc. The coronal view of T2-weighted magnetic resonance imaging demonstrated a fluid-filled dilated sheath surrounding normal optic nerves. General physical examination and cerebrospinal fluid analysis were normal. The subject was diagnosed as having dural ectasia of the optic nerve sheath and followed a course of acetazolamide 250 mg twice daily for three months, and displayed good anatomical and functional results during a 2-year follow-up period. Despite the fact that several authors have recommended an optic nerve decompression, most of the patients follow a benign clinical course. The role of corticosteroids is not described in the literature. Raised levels of proteins in the cerebrospinal fluid in the perioptic subarachnoidal space could be a determining factor. On the basis of an osmotic gradient between the cerebral subarachnoid space and perioptic subarachnoid space, carbonic anhydrase inhibitors could be beneficial. In contrast to other reports, we believe that surgical intervention could be reserved for patients with rapid or progressive optic nerve dysfunction.Keywords: optic nerve, perineural subaracnoid space, optic nerve meningocoele, optic nerve tumors

  10. Cutaneous horn overlying lichen planus

    OpenAIRE

    Ramam M; Singh O; Singh M.

    1991-01-01

    A 40 year old woman developed a cutaneous horn following the excision of a lesion of lichen planus on the left lower leg. Biopsy confirmed the presence of lichen planus at the base of the horn. Excision of the horn was curative.

  11. Sporotrichoid pattern of cutaneous nocardiosis

    Directory of Open Access Journals (Sweden)

    Inamadar A

    2003-01-01

    Full Text Available A young male patient, having linearly arranged nodular lesions on lower extremity was diagnosed to have lymphocutaneous variety of cutaneous nocardiosis. This is a rare entity and has to be differentiated form other causes of nodular lymphangitis. The patient responded dramatically to Cotrimoxazole therapy.

  12. Cutaneous cancer and xeroderma pigmentosum

    International Nuclear Information System (INIS)

    The cutaneous cancer at the patients affected by xeroderma pigmentosum is characterized by its multifocal character and its strong radiosensitivity. A premature care and a regular follow-up for life of these patients is indispensable for the detection and the treatment of new hurts. The precautionary measures are also important by the school eviction. (N.C.)

  13. Sporotrichoid pattern of cutaneous nocardiosis

    OpenAIRE

    Inamadar A; Palit A

    2003-01-01

    A young male patient, having linearly arranged nodular lesions on lower extremity was diagnosed to have lymphocutaneous variety of cutaneous nocardiosis. This is a rare entity and has to be differentiated form other causes of nodular lymphangitis. The patient responded dramatically to Cotrimoxazole therapy.

  14. Unusual presentation of cutaneous leishmaniasis

    OpenAIRE

    Lahiry Anup Kumar

    2002-01-01

    Cutaneous leis hmaniasis is endemic in some regions of Saudi Arabia. A case with uncommon hyperkeratotic type of lesion was seen. Being an endemic zone, a slit- skin smear was done and stained with Giemsa?s stain. Smears howed Leishman Donovan bodies within and outside the macrophages. Significant improvement, followed by complete resolution of the lesion was seen with ketoconazole treatment.

  15. Unusual Presentation of Cutaneous Leishmaniasis

    OpenAIRE

    Sindhu, P S; Ramesh, V.

    2012-01-01

    Two patients with mini-volcano type of skin lesions which showed histopathologic features of cutaneous leishmaniasis (CL) have been described. It was localised and linear in one case while widespread in the other. Both responded to sodium stibogluconate. The importance of recognising new emerging foci of CL is emphasised.

  16. Vitiligo associated with cutaneous amyloidosis

    OpenAIRE

    Rajkumar V; Okade R; Chakrabarty N; Yellappa K

    2001-01-01

    Vitiligo is known to be associated with a variety of dermatoses and systemic diseases. We describe a case of vitiligo developing in a patient having cutaneous amyloidosis. To our knowledge this is the first report of its kind in the literature.

  17. Vacuum Enhanced Cutaneous Biopsy Instrument

    Energy Technology Data Exchange (ETDEWEB)

    Collins, Joseph

    1999-06-25

    A syringe-like disposable cutaneous biopsy instrument equipped with a tubular blade at its lower end, and designed so that a vacuum is created during use, said vacuum serving to retain undeformed a plug of tissue cut from a patient's skin.

  18. Obstetric brachial plexus palsy: 20 years’ experience at a tertiary center in Turkey

    Directory of Open Access Journals (Sweden)

    Gönu?l Acar

    2013-03-01

    Full Text Available Aim: The aim of this study was to examine cases of obstetric brachial plexus palsy (OBPP treated over 20 years at a single tertiary center.Material and Method: We retrospectively reviewed 777 cases of OBPP who were observed at the Pediatric Neurology Department at Istanbul Medical Faculty between March 1989 and December 2010. The patients were evaluated in terms of demographic characteristics, treatment methods, surgical approaches, complications and functional levels according to Narakas Clasification Scale. Results: Out of a total of 777 OBPP patients, 393 were female and 384 were male. The mean birth weight was 3968.9 g. Three of the patients were siblings. OBPP was bilateral in 3 patients; right sided in 463 patients and left sided in 311 patients. In terms of concomitant conditions, 82 patients had torticollis, 62 had Horner’s syndrome, 47 had broken clavicle, 3 had broken humerus, 3 had cerebral palsy and 1 had facial paralysis. According to the Narakas classification, 430 patients (55% were evaluated as stage 1 OBPP, 219 (28.5% were evaluated as stage 2, 66 (8.5% were evaluated as stage 3 and 62 (8% were evaluated as stage 4. One third of the patients (%33 underwent Vojta and neurodevelopmental therapy in addition to routine physiotherapy. Complete recovery was observed in 439 (%56 of all patients, in 66% of the patients with stage 1 OBPP, in 56% of the patients with stage 2 OBPP, in 35% of the patients with stage 3 OBPP and in 18% of the patients with stage 4 OBPP. Botulinum Toxin Type A was applied in 97 cases; 30 patients underwent primary nerve surgery and 94 underwent multiple surgical procedures (25 of them required a second surgery and 15 required a third surgery. Various joint contractures were seen in 200 patients.Conclusions: Despite physiotherapy, Botulinum Toxin Type A application and surgical intervention, one out of three patients had difficulty using their arm and developed contractures and disabilities that affected their every day life. In conclusion, OBPP continues to be a severe problem leading to functional impairment and disability. (Turk Arch Ped 2013; 48: 13-6

  19. Peripheral Nerve Dysfunction Secondary to Lymphomatous Infiltration of the Nervous System by Non-Hodgkin's Lymphoma

    Directory of Open Access Journals (Sweden)

    Grimm S

    2014-01-01

    Full Text Available Lymphomatous meningitis (metastasis of lymphoma cells into the cerebrospinal-fluid spaces [CSF] and neurolymphomatosis (lymphomatous infiltration of a peripheral nerve or root are neurologic complications of non-Hodgkin?s lymphoma (NHL that frequently result in significant neurologic dysfunction. Leptomeningeal metastases most commonly present as cerebral dysfunction (hydrocephalus causing headache or apraxia of gait, encephalopathy, or seizures, cranial neuropathy (diplospia, facial weakness, vertigo, hearing loss, and tongue weakness, and spinal-nerve root dysfunction (incomplete cauda equina syndrome ? asymmetric lower- extremity weakness, sensory loss, or incontinence. Diagnosis is made by finding leptomeningeal enhancement on magnetic resonance imaging (MRI of the brain or spine or demonstration of lymphomatous cells by CSF cytology or flow cytometry. Treatment consists of focal radiotherapy for areas of bulky disease followed by intra-CSF chemotherapy or systemic chemotherapy. Neurolymphomatosis typically presents as a painful, sensorimotor peripheral neuropathy affecting multiple limbs in an asymmetric fashion with rapid evolution although variability in presentation can occur. Diagnosis is made by demonstration of enhancement of nerve roots on MRI of the brachial or lumbosacral plexus or peripheral nerves or by increased hyper-metabolic activity following the course of affected nerves on fluordeoxyglucose positron emission tomography (FDG-PET. Treatment of neurolymphomatosis consists of focal radiotherapy (if significant neurologic dysfunction is present and high-dose intravenous methotrexate therapy. Standard systemic chemotherapy agents are not effective since they do not penetrate the physiologic ?nerve-blood barrier?. Other disorders that must be differentiated from these entities include peripheral-nerve or nerve root compression and paraneoplastic neuropathy.

  20. A novel chondroitin sulfate hydrogel for nerve repair

    Science.gov (United States)

    Conovaloff, Aaron William

    Brachial plexus injuries affect numerous patients every year, with very debilitating results. The majority of these cases are very severe, and involve damage to the nerve roots. To date, repair strategies for these injuries address only gross tissue damage, but do not supply cells with adequate regeneration signals. As a result, functional recovery is often severely lacking. Therefore, a chondroitin sulfate hydrogel that delivers neurotrophic signals to damaged neurons is proposed as a scaffold to support nerve root regeneration. Capillary electrophoresis studies revealed that chondroitin sulfate can physically bind with a variety of neurotrophic factors, and cultures of chick dorsal root ganglia demonstrated robust neurite outgrowth in chondroitin sulfate hydrogels. Outgrowth in chondroitin sulfate gels was greater than that observed in control gels of hyaluronic acid. Furthermore, the chondroitin sulfate hydrogel's binding activity with nerve growth factor could be enhanced by incorporation of a synthetic bioactive peptide, as revealed by fluorescence recovery after photobleaching. This enhanced binding was observed only in chondroitin sulfate gels, and not in hyaluronic acid control gels. This enhanced binding activity resulted in enhanced dorsal root ganglion neurite outgrowth in chondroitin sulfate gels. Finally, the growth of regenerating dorsal root ganglia in these gels was imaged using label-free coherent anti-Stokes scattering microscopy. This technique generated detailed, high-quality images of live dorsal root ganglion neurites, which were comparable to fixed, F-actin-stained samples. Taken together, these results demonstrate the viability of this chondroitin sulfate hydrogel to serve as an effective implantable scaffold to aid in nerve root regeneration.

  1. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    la Cour, M; Kiilgaard, Jens Folke; Eysteinsson, T; Wiencke, A K; Bang, K; Dollerup, J; Jensen, P K; Stefánsson, E

    2000-01-01

    To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide.

  2. Lymphoma Nerve Infiltration

    Directory of Open Access Journals (Sweden)

    Baehring JM

    2014-01-01

    Full Text Available Neurolymphomatosis (NL denotes the invasion of cranial nerves, nerve roots, plexus, or nerves by Non-Hodgkin lymphoma (NHL or leukaemia. This occurs in the absence (primary NL or presence (primary NL of systemic NHL. Clinical patterns include a painful polyneuropathy or polyradiculopathy, cranial neuropathy, painless polyneuropathy, and peripheral mononeuropathy. Integration of clinical information, imaging findings, as well as histopathologic examination of involved nerves or non-neural tissue, and cerebrospinal fluid analysis are needed to establish the diagnosis. Timely recognition of the disease and its exact neuroanatomical extent is the basis for successful therapy using systemic chemotherapy and localized irradiation of bulky disease sites. More complex regimens are required when cerebrospinal fluid and systemic disease sites are affected.

  3. Herpes Zoster ophthalmicus with occulomotor nerve palsy

    Directory of Open Access Journals (Sweden)

    Hayati Kandi?

    2010-09-01

    Full Text Available Dear Editor;A 79-year-old male patient was admitted to our emergency department with a complaining of eruption over his face for 10 days and inability to open his eyes for a few days. The patient had hypertension and diabetes mellitus. He had no history of smoking, alcohol. On examination, there was vesicular cutaneous eruption, erosions and crusts, as well as ptosis, in some areas in the ophthalmic division of the trigeminal nerve on the left side of his face (Figure 1. The patient did not have extraocular muscle palsy. Patient was cachectic and dehydrated appearance. Other systemic examinations were unremarkable. Laboratory investigations showed total white cell count of 16500 (neutrophil: 15000, N: 5200–12400, and CRP: 15 mg/dL (N: 0.1–0.5. A clinical diagnosis of ophthalmic zoster with occulomotor nerve palsy was made and the valasiclovir 3g/d was given to patient, wet dressing with an aluminum acetate solution 0,5%. The patient’s lesions had markedly improved within 10 days.

  4. Idiopathic facial nerve paresis

    Directory of Open Access Journals (Sweden)

    Anitha Kumari Abbina

    2013-04-01

    Full Text Available This is an Image of 4-year-old boy presentedwith a 2-weeks history of pull in the angle ofmouth and difficulty in chewing the food. Onphysical examination flattened naso-labial foldand corner of mouth drooping towards rightside were noted with weakness of lower facialmuscles. Nerve conduction studies of facialnerve showed decreased conduction in the leftfacial nerve with prolonged latencies. Diagnosismade by the neurologist was idiopathic left facialnerve paresis. Neurologist prescribed drugs andreferred the case to physiotherapy.

  5. Origen y Trayecto Anómalos del Nervio Musculocutáneo Anomalus Origin and Traject of Musculocutaneous Nerve

    Directory of Open Access Journals (Sweden)

    Jorge Roberto Marcante Carlotto

    2009-06-01

    Full Text Available El nervio musculocutáneo se origina del fascículo lateral en el plexo braquial y sus fibras emergen principalmente de las raíces nerviosas anteriores de C5 y C6. Durante la disección de rutina del plexo braquial en un cadáver formolizado, fue encontrada una variación del origen y trayecto de este nervio. El nervio musculocutáneo se originaba de la cara lateral del nervio mediano y después del origen, cruzaba anteriormente al músculo coracobraquial, sin perforarlo, de medial hacia lateral y de proximal hacia distal, para después ramificarse. Las variaciones anatómicas encontradas contribuyen para el estudio de la anatomía y sirven para el cirujano en intervenciones en la fosa axilar y en la parte anterior del brazo, previniendo, así, complicaciones operatorias.The musculocutaneous is originated from the lateral fascicle in the brachial plexus and its fibers emerge mainly from the anterior nervous roots C5 and C6. During the routine dissection of the brachial plexus in a formolized corpse, its origin variation and passage was found. The nerve was originated on the lateral face of the median nerve and after its origin, crossed anteriorly to the coracobrachial muscle, without perforating it, from medial to lateral, proximal to distal, after to branch off. The anatomical variations found contribute to the anatomy study and they serve as alert for the surgeon in interventions in the axillary's cavity and in the previous store of the arm, preventing, thus, operational complications.

  6. Use of a Collagen-Based Device for Closure of Low Brachial Artery Punctures

    International Nuclear Information System (INIS)

    Purpose. To report our experience with the Angioseal vascular closure device for hemostasis of distal brachial artery puncture. Methods. Between September 2003 and August 2005, 64 Angioseal vascular closure devices were inserted in 64 patients (40 men, 24 women; mean age 65 years) immediately after diagnostic or therapeutic arterial angiographies performed through a 5 Fr to 7 Fr sheath via the distal brachial artery. Ultrasound examination of the brachial artery preceded the angiography in all cases and only arteries wider than 4 mm were closed by the Angioseal. In cases of a sonographically evident thin subcutaneous space of the cubital fossa, tissue tumescence, using 1% Lidocaine, was performed prior to the arterial closure. Results. The deployment success rate was 100%. No major complications were encountered; only 2 patients developed puncture site hematoma, and these were followed conservatively. Conclusions. Closure of low brachial artery punctures with the Angioseal is simple and safe. No additional manual compression is required. We recommend its use after brachial artery access interventions, through appropriately wide arteries, to improve early patient ambulation and potentially reduce possible puncture site complications

  7. A STUDY OF BRACHIAL ARTERY WITH HIGH UP DIVISION AND ITS CLINICAL SIGNIFICANCE

    Directory of Open Access Journals (Sweden)

    Jitendra Gupta*, Ravi Jain, Manish Patil

    2012-10-01

    Full Text Available Anomalies of the forelimb arterial tree are fairly common. In present study we observed the brachial artery with its high up division into radial and ulnar arteries in the middle of the arm. The findings were noted after thorough dissection of the upper limbs of both sides (axilla, arm, cubital fossa, forearm and palm in twenty cadavers in the Department of Anatomy, R. D. Gardi Medical College, Ujjain, in the period of August 2010 to July 2012. After dissection each dissected part was numbered and arteries were painted and Photographic documentation of the variation was taken. An unusually short segment brachial artery was noted in the 2 cadaver. This short segment brachial artery bifurcated more proximally at the level of insertion of coracobrachialis in the middle of the left arm into radial and ulnar arteries. Further distribution of these two arteries was normal in both cadavers. No other variation was found particularly in relation to the cords of the brachial plexus and their branches. The short segment brachial artery with high up bifurcation as noted in the present study is fairly common. The variations can be explained in the light of embryological development. In addition, knowledge of such variation is important for carrying out surgical procedures in the arm in the arm and measurement of blood pressure routinely.

  8. Brachial plexopathy : a case-control study of the relation to physical exposures at work

    DEFF Research Database (Denmark)

    Jepsen, JØrgen Riis

    2015-01-01

    Background Work-related upper limb disorders constitute a diagnostic challenge. However, patterns of neurological abnormalities that reflect brachial plexus dysfunction are frequent in limbs with pain, weakness and/or numbness/tingling. There is limited evidence about the association between occupational physical exposures and brachial plexopathy. Methods 80 patients with brachial plexopathy according to defined criteria and 65 controls of similar age and sex without upper limb complaints were recruited by general practitioners. Patients and controls completed a questionnaire on physical and psychosocial work-exposures and provided psychophysical ratings of their perceived exposures. The exposures of cases and controls were compared by a Wilcoxon rank sum test. Odds ratios and dose–response relationships were studied by logistic regression. Results Whether assessed as the extent during the workday or days/week, most physical exposures, in particular upper limb posture and repetition, were significant risk indicators with clear dose–response relationships. These findings were supported by psychophysical responses that also identified perceived work pace and the use of force as risk indicators. The identified psychosocial relations were limited to measures reflecting physical exposures. Conclusions While the identified risk indicators have previously been associated to upper limb symptoms as well as to diagnosed disorders other than brachial plexopathy, this study indicates an association between physical and work-exposures and brachial plexopathy. Longitudinal studies should be conducted in order to exclude bias from information and selection, both of which may occur with the applied case–control design.

  9. Ontology-based image navigation: exploring 3.0-T MR neurography of the brachial plexus using AIM and RadLex.

    Science.gov (United States)

    Wang, Kenneth C; Salunkhe, Aditya R; Morrison, James J; Lee, Pearlene P; Mejino, José L V; Detwiler, Landon T; Brinkley, James F; Siegel, Eliot L; Rubin, Daniel L; Carrino, John A

    2015-01-01

    Disorders of the peripheral nervous system have traditionally been evaluated using clinical history, physical examination, and electrodiagnostic testing. In selected cases, imaging modalities such as magnetic resonance (MR) neurography may help further localize or characterize abnormalities associated with peripheral neuropathies, and the clinical importance of such techniques is increasing. However, MR image interpretation with respect to peripheral nerve anatomy and disease often presents a diagnostic challenge because the relevant knowledge base remains relatively specialized. Using the radiology knowledge resource RadLex®, a series of RadLex queries, the Annotation and Image Markup standard for image annotation, and a Web services-based software architecture, the authors developed an application that allows ontology-assisted image navigation. The application provides an image browsing interface, allowing users to visually inspect the imaging appearance of anatomic structures. By interacting directly with the images, users can access additional structure-related information that is derived from RadLex (eg, muscle innervation, muscle attachment sites). These data also serve as conceptual links to navigate from one portion of the imaging atlas to another. With 3.0-T MR neurography of the brachial plexus as the initial area of interest, the resulting application provides support to radiologists in the image interpretation process by allowing efficient exploration of the MR imaging appearance of relevant nerve segments, muscles, bone structures, vascular landmarks, anatomic spaces, and entrapment sites, and the investigation of neuromuscular relationships. PMID:25590394

  10. Peripheral nerve function in patients with painful diabetic neuropathy treated with continuous subcutaneous insulin infusion.

    Science.gov (United States)

    Bertelsmann, F W; Heimans, J J; Van Rooy, J C; Dankmeijer, H F; Visser, S L; Van der Veen, E A

    1987-10-01

    In order to study the effects of improved metabolic control on painful diabetic polyneuropathy, 15 patients were treated with continuous subcutaneous insulin infusion over a 12 month period. Polyneuropathy was assessed by pain score, neurological examinations, nerve conduction studies and determination of sensory thresholds and cardiovascular reflexes. Improved metabolic control was confirmed by significantly improved levels of glycosylated haemoglobin (11.7 +/- 0.3% at entry to the study, to 8.7 +/- 0.3% after 12 months; mean +/- SEM). Symptomatic relief was confirmed by significantly improved pain scores. Thresholds for thermal cutaneous sensation improved significantly from 6.0 +/- 0.8 degrees C at entry to the study to 2.7 +/- 0.7 degrees C after 12 months (mean +/- SEM). These findings suggest a selective improvement of peripheral small nerve fibre function after continuous subcutaneous insulin infusion. The importance of quantitating thermal cutaneous sensation in longitudinal studies of patients with diabetic neuropathy was confirmed. PMID:3681313

  11. Cutaneous manifestations of viral hepatitis.

    Science.gov (United States)

    Akhter, Ahmed; Said, Adnan

    2015-02-01

    There are several extrahepatic cutaneous manifestations associated with hepatitis B and hepatitis C virus infection. Serum sickness and polyarteritis nodosa are predominantly associated with hepatitis B infection, whereas mixed cryoglobulinemia associated vasculitis and porphyria cutanea tarda are more frequently seen in hepatitis C infection. The clinico-pathogenic associations of these skin conditions are not completely defined but appear to involve activation of the host immune system including the complement system. Management of the aforementioned cutaneous manifestations of viral hepatitis is often similar to that done in cases without viral hepatitis, with control of immune activation being a key strategy. In cases associated with hepatitis B and C, control of viral replication with specific antiviral therapy is also important and associated with improvement in most of the associated clinical manifestations. PMID:25809574

  12. Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

    Directory of Open Access Journals (Sweden)

    Sanjeev Bhoi

    2012-01-01

    Full Text Available Background: Patients require procedural sedation and analgesia (PSA for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED. Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure. Statistical analysis: Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison. Results: Fifty US guided nerve blocks were sciatic- 4 (8%, femoral-7 (14%, brachial- 29 (58%, median -6 (12%, and radial 2 (4% nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10 and at 1 hour was 2(IQR 0-4. Median reduction in VAS score was 7.44 (IQR 8-10(75%, 1-2(25% (P=0.0001. Median procedure time was 9 minutes (IQR 3, 12 minutes and median time to reduction of pain was 5 minutes (IQR 1,15 minutes. No immediate or late complications noticed at 3 months. Conclusion: Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

  13. Ectopic cutaneous schistosomiasis - Case report*

    OpenAIRE

    Nunes, Kathia Monielly Tenorio; Cardoso, Alberto Eduardo Cox; Pereira, Fabio de Souza Guedes; Batista, Luiz Henrique Carvalho; Houly, Ricardo Luiz Simoes

    2013-01-01

    Schistosomiasis mansoni is a systemic disease caused by a helminth of the schistosoma genus. The disease is generally asymptomatic or gastrointestinal symptoms may predominate. Skin lesions related to the disease are rarely diagnosed, even in endemic areas. The authors report the case of a young girl diagnosed with cutaneous schistosomiasis with involvement of the abdomen, back and scapular region. Schistosoma eggs were found in the lesions by histopathologic exam. There was no...

  14. Cutaneous leishmaniasis in Jodhpur district

    Directory of Open Access Journals (Sweden)

    Kalla Gyaneshwar

    1996-01-01

    Full Text Available Cutaneous leishmaniasis is a disease with a wide geographical distribution in a range of climate and with different epidemiological patterns. In Rajasthan a new endemic zone of the disease has been found at Jodhpur district. The clincial features of 21 smear positive cases of oriental sore from Jodhpur district studied during a period of 1 year have been described. Also the importance of intralesional berberine sulphate in the treatment of oriental sore has been highlighted.

  15. Cutaneous mycobacterial spindle cell pseudotumour

    OpenAIRE

    Tan, Geok Chin; Yap, Yen Piow; Shiran, Mohd Sidik; Sabariah, Abdul Rahman; PATHMANATHAN, RAJADURAI

    2009-01-01

    Mycobacterial spindle cell pseudotumour (MSCP) has been reported in various sites, including skin, lymph nodes, bone marrow, lung and spleen. Cutaneous lesions are extremely rare and the differential diagnoses include various spindle cell lesions. Literature review shows that this lesion has preponderance for upper limb involvement and occurs largely in immunosuppressed individuals. We report a case of MSCP of the skin due to atypical mycobacterium and discuss the risk of misdiagnosis as a sa...

  16. Cutaneous Hemangiosarcoma in a Dog

    OpenAIRE

    Tsuji, Naho; FURUKAWA, Satoshi; OZAKI, Kiyokazu

    2013-01-01

    A male golden retriever of unknown age presented with multiple cutaneous and subcutaneous masses from the left elbow to the digits. Histopathologically, multiple tumor foci had formed from the dermis to the subcutaneous tissue. Tumor foci consisted of a vascular structure, alveolar structure and solid proliferative area. The borders among these areas were not clear. Some neoplastic cells resembled a mature endothelium, while others were large pleomorphic cells. Immunohistochemically, the tumo...

  17. Caseous necrosis in cutaneous leishmaniasis.

    OpenAIRE

    Peltier, E; Wolkenstein, P.; Deniau, M; Zafrani, E S; Wechsler, J.

    1996-01-01

    A case of late stage cutaneous leishmaniasis with focal caseous necrosis is reported. The patient, a 30 year old Tunisian man, presented with idiopathic bone marrow aplasia. Microscopically, minimal changes were observed in the epidermis: slight hyperkeratosis and moderate acanthosis. Lesions predominated in the dermis. Epithelioid granulomas were found in the lower dermis. Some of these lesions were clearly surrounded by a ring of lymphocytes and were rarely confluent. A peculiar histologica...

  18. Cutaneous leishmaniasis in Jodhpur district

    OpenAIRE

    Kalla Gyaneshwar; Singhi M

    1996-01-01

    Cutaneous leishmaniasis is a disease with a wide geographical distribution in a range of climate and with different epidemiological patterns. In Rajasthan a new endemic zone of the disease has been found at Jodhpur district. The clincial features of 21 smear positive cases of oriental sore from Jodhpur district studied during a period of 1 year have been described. Also the importance of intralesional berberine sulphate in the treatment of oriental sore has been highlighted.

  19. Occupationally Acquired American Cutaneous Leishmaniasis

    OpenAIRE

    Maria Edileuza Felinto Brito; Maria Sandra Andrade; Éricka Lima de Almeida; Ângela Cristina Rapela Medeiros; Roberto Pereira Werkhäuser; Ana Isabele Freitas de Araújo; Sinval Pinto Brandão-Filho; Alzira Maria Paiva Almeida; Eduardo Henrique Gomes Rodrigues

    2012-01-01

    We report two occupationally acquired cases of American cutaneous leishmaniasis (ACL): one accidental laboratory autoinoculation by contaminated needlestick while handling an ACL lesion sample, and one acquired during field studies on bird biology. Polymerase chain reaction (PCR) assays of patient lesions were positive for Leishmania, subgenus Viannia. One isolate was obtained by culture (from patient 2 biopsy samples) and characterized as Leishmania (Viannia) naiffi through an indirect immun...

  20. Many faces of cutaneous leishmaniasis

    OpenAIRE

    Bari Arfan Ul; Rahman Simeen

    2008-01-01

    Background: Cutaneous leishmaniasis (CL) is known for its clinical diversity and increasing numbers of new and rare variants of the disease are being reported these days. Aim: The aim of this descriptive study was to look for and report the atypical presentations of this common disease occurring in Pakistan. Methods: The study was carried out in three hospitals (MH, Rawalpindi; PAF Hospital, Sargodha; and CMH, Muzaffarabad) from 2002 to 2006. Military and civilian patients of all ages, b...

  1. Unusual presentation of cutaneous leiomyoma

    Directory of Open Access Journals (Sweden)

    Sapnashree Bhaskar

    2014-01-01

    Full Text Available Herein, we report a case of leiomyoma cutis because of its rarity and unusual presentation. The case presented with a solitary leiomyoma lesion which was painless. However, the adjacent normal appearing area was tender. A biopsy of the lesion as well as of a portion of the adjacent normal appearing area was taken, which confirmed the diagnosis of cutaneous leiomyoma. This may suggest the dormant nature of the disease which has not yet become apparent.

  2. Cutaneous manifestations of internal malignancy

    Directory of Open Access Journals (Sweden)

    A Ayyamperumal

    2012-01-01

    Full Text Available Background: Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases or nonspecific lesions. Aims: The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy. Materials and Methods: 750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC and marker studies. Results: Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93% patients. Conclusion: Cutaneous metastases (specific lesions were seen in 20 patients (2.66%: contiguous in 6 (0.8%, and non-contiguous in 14 (1.86%. Nonspecific skin changes were seen in 32 patients (4.26%. None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis.

  3. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block

    DEFF Research Database (Denmark)

    Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V; Aasvang, Eske K; Lundstrøm, Lars H; Lange, Kai H W

    2015-01-01

    BACKGROUND AND OBJECTIVES: The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. METHODS: Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 9...

  4. Cutaneous manifestations of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Al Roujayee Abdulaziz

    2007-01-01

    Full Text Available Inflammatory bowel disease (IBD has many extraintestinal manifestations, and skin lesions are one of the most frequently described extraintestinal findings. Reports indicate an incidence of cutaneous manifestations ranging from 2 to 34%, Cutaneous manifestations are usually related to the activity of the bowel disease but may have an independent course. In this review we aim to address the various cutaneous manifestations associated with IBD, their impact on the disease course, and the treatment options available.

  5. Cutaneous Side Effects of Antiosteoporosis Treatments

    OpenAIRE

    Musette, P; Kaufman, J. -M.; Rizzoli, René; Cacoub, P; Brandi, M.L.; Reginster, J.-Y.

    2011-01-01

    Cutaneous adverse reactions are reported for many therapeutic agents and, in general, are observed in between 0% and 8% of treated patients depending on the drug. Antiosteoporotic agents are considered to be safe in terms of cutaneous effects, however there have been a number of case reports of cutaneous adverse reactions which warrant consideration. This was the subject of a working group meeting of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis in ...

  6. Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association

    Energy Technology Data Exchange (ETDEWEB)

    Capek, Stepan [Mayo Clinic, Department of Neurosurgery, Rochester, Minnesota (United States); St. Anne' s University Hospital Brno, International Clinical Research Center, Brno (Czech Republic); Hebert-Blouin, Marie-Noelle [McGill University, Department of Neurologic Surgery, Montreal, Quebec (Canada); Puffer, Ross C.; Spinner, Robert J. [Mayo Clinic, Department of Neurosurgery, Rochester, Minnesota (United States); Martinoli, Carlo [Universita degli Studi di Genova, Department of Radiology, Genova (Italy); Frick, Matthew A.; Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, MN (United States)

    2015-04-29

    In neurolymphomatosis (NL), the affected nerves are typically described to be enlarged and hyperintense on T2W MR sequences and to avidly enhance on gadolinium-enhanced T1WI. This pattern is highly non-specific. We recently became aware of a ''tumefactive pattern'' of NL, neuroleukemiosis (NLK) and neuroplasmacytoma (NPLC), which we believe is exclusive to hematologic diseases affecting peripheral nerves. We defined a ''tumefactive'' appearance as complex, fusiform, hyperintense on T2WI, circumferential tumor masses encasing the involved peripheral nerves. The nerves appear to be infiltrated by the tumor. Both structures show varying levels of homogenous enhancement. We reviewed our series of 52 cases of NL in search of this pattern; two extra outside cases of NL, three cases of NLK, and one case of NPLC were added to the series. We identified 20 tumefactive lesions in 18 patients (14 NL, three NLK, one NPLC). The brachial plexus (n = 7) was most commonly affected, followed by the sciatic nerve (n = 6) and lumbosacral plexus (n = 3). Four patients had involvement of other nerves. All were proven by biopsy: the diagnosis was high-grade lymphoma (n = 12), low-grade lymphoma (n = 3), acute leukemia (n = 2), and plasmacytoma (n = 1). We present a new imaging pattern of ''tumefactive'' neurolymphomatosis, neuroleukemiosis, or neuroplasmacytoma in a series of 18 cases. We believe this pattern is associated with hematologic diseases directly involving the peripheral nerves. Knowledge of this association can provide a clue to clinicians in establishing the correct diagnosis. Bearing in mind that tumefactive NL, NLK, and NPLC is a newly introduced imaging pattern, we still recommend to biopsy patients with suspicion of a malignancy. (orig.)

  7. Cystic schwannoma of the right brachial plexus causing thoracic outlet syndrome

    OpenAIRE

    SÖNMEZ, Osman Fikret; TÜMKAYA, Levent; Kanat, Ayhan; DEM?R, Zafer; BA?, Orhan

    2012-01-01

    A rare case of a schwannoma of the right brachial plexus presenting with a cystic lesion is presented here. A 36-year-old man was admitted to our department with numbness, pain and progressive, lingering paralysis in the right arm. The MRI showed a cystic lesion with a diameter of 4 cm, in the right brachial plexus. In the ensuing electromyographic studies, the lesion was determined to cause thoracic outlet syndrome. The patient was prepared for surgery and the lesion was totally removed. Aft...

  8. The toe-brachial index in the diagnosis of peripheral arterial disease

    DEFF Research Database (Denmark)

    HØyer, Christian; Sandermann, Jes

    2013-01-01

    Peripheral arterial disease (PAD) can be diagnosed noninvasively by segmental blood pressure measurement and calculating an ankle-brachial index (ABI) or toe-brachial index (TBI). The ABI is known to be unreliable in patients with vascular stiffness and fails to detect the early phase of arteriosclerotic development. The toe vessels are less susceptible to vessel stiffness, which makes the TBI useful. However, the diagnostic limits used in guidelines, clinical settings, and experimental studies vary substantially. This review provides an overview of the evidence supporting the clinical use of the TBI.

  9. Identification of CNS neural circuitry involved in the innervation of C7 spinal nerve: a viral transsynaptic tracing study

    Directory of Open Access Journals (Sweden)

    WEI Hai-feng

    2012-02-01

    Full Text Available ?Abstract? Objective: Contralateral C7 spinal nerve transfer is a useful operation for the treatment of brachial plexus root avulsion. The recovery of the independent function at the ipsilateral side, however, depends on neural circuitry reorganization in the central nervous system (CNS. This study tried to locate the CNS neuronal elements involved in the innervation of C7 spinal nerve. Method: Pseudorabies virus (PRV, TK/gG-, 2 ?, which expressed green fluorescent protein (GFP, was injected into the left C7 spinal nerve in 20 adult Sprague Dawley rats. After rats survived for 6 h, 12 h, 24 h and 36 h, the C1-C7 segments of the spinal cord and brain were processed using a polyclonal immunohistochemical antibody against PRV. Results: PRV-labeled neurons were found mainly in gray matter of the C1-C7 segments of the spinal cord and at the following structures of the brain: lateral vestibular nucleus, lateral paragigantocellular nucleus, A5 cells, red nucleus, primary and secondary motor cortexes, primary and secondary somatosensory cortexes. Although located bilaterally, the PRV-labeled neurons existed predominantly in the ipsilateral side of the spinal cord and the contralateral side of the brain at 6-12 h after injection (p.i.. The number of PRV-labeled neurons in the CNS was increasing with rat? survival time and the distribution of these neurons turned bilateral with no obvious dominance to either side at 24 h and 36 h (p.i.. Conclusion: By use of transsynaptic tracing technique with PRV, the anatomically connected set of neurons, which modulates the activity of C7 spinal nerve, is located successfully in the CNS. Key words: Brachial plexus; Innervation; Spinal nerves; Central nervous system

  10. Sensory neuronopathy involves the spinal cord and brachial plexus: a quantitative study employing multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM)

    International Nuclear Information System (INIS)

    Sensory neuronopathy (SNN) is a distinctive subtype of peripheral neuropathies, specifically targeting dorsal root ganglion (DRG). We utilized MRI to demonstrate the imaging characteristics of DRG, spinal cord (SC), and brachial plexus at C7 level in SNN. We attempted multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM) methods in nine patients with sensory neuronopathy and compared with those in 16 disease controls and 20 healthy volunteers. All participants underwent MRI for the measurement of DRG, posterior column (PC), lateral column, and spinal cord area (SCA) at C7 level. DRG diameters were obtained through its largest cross section, standardized by dividing sagittal diameter of mid-C7 vertebral canal. We also made comparisons of standardized anteroposterior diameter (APD) and left-right diameters of SC and PC in these groups. Signal intensity and diameter of C7 spinal nerve were assessed on TIRM. Compared to control groups, signal intensities of DRG and PC were higher in SNN patients when using MEDIC, but the standardized diameters were shorter in either DRG or PC. Abnormal PC signal intensities were identified in eight out of nine SNN patients (89 %) with MEDIC and five out of nine (56 %) with T2-weighted images. SCA, assessed with MEDIC, was smaller in SNN patients than in the other groups, with significant reduction of its standardized APD. C7 nerve root diameters, assessed with TIRM, were decreased in SNN patients. MEDIC and TIRM sequences demonstrate increased signal intensities and decreased area of DRG and PC, and decreased diameter of nerve roots in patients with SNN, which can play a significant role in early diagnosis. (orig.)

  11. Sensory neuronopathy involves the spinal cord and brachial plexus: a quantitative study employing multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM)

    Energy Technology Data Exchange (ETDEWEB)

    Bao, Yi-Fang; Tang, Wei-Jun; Li, Yu-Xin; Geng, Dao-Ying [Fudan University, Department of Radiology, Huashan Hospital, Shanghai (China); Zhu, Dong-Qing; Chen, Xiang-Jun [Fudan University, Department of Neurology, Huashan Hospital, Shanghai (China); Zee, Chi-Shing [University of Southern California Keck School of Medicine, Department of Radiology, Los Angeles, CA (United States)

    2013-01-15

    Sensory neuronopathy (SNN) is a distinctive subtype of peripheral neuropathies, specifically targeting dorsal root ganglion (DRG). We utilized MRI to demonstrate the imaging characteristics of DRG, spinal cord (SC), and brachial plexus at C7 level in SNN. We attempted multiple-echo data image combination (MEDIC) and turbo inversion recovery magnitude (TIRM) methods in nine patients with sensory neuronopathy and compared with those in 16 disease controls and 20 healthy volunteers. All participants underwent MRI for the measurement of DRG, posterior column (PC), lateral column, and spinal cord area (SCA) at C7 level. DRG diameters were obtained through its largest cross section, standardized by dividing sagittal diameter of mid-C7 vertebral canal. We also made comparisons of standardized anteroposterior diameter (APD) and left-right diameters of SC and PC in these groups. Signal intensity and diameter of C7 spinal nerve were assessed on TIRM. Compared to control groups, signal intensities of DRG and PC were higher in SNN patients when using MEDIC, but the standardized diameters were shorter in either DRG or PC. Abnormal PC signal intensities were identified in eight out of nine SNN patients (89 %) with MEDIC and five out of nine (56 %) with T2-weighted images. SCA, assessed with MEDIC, was smaller in SNN patients than in the other groups, with significant reduction of its standardized APD. C7 nerve root diameters, assessed with TIRM, were decreased in SNN patients. MEDIC and TIRM sequences demonstrate increased signal intensities and decreased area of DRG and PC, and decreased diameter of nerve roots in patients with SNN, which can play a significant role in early diagnosis. (orig.)

  12. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... in the United States have some form of epilepsy. You are about to see a vagus nerve ... the implantation of a vagus nerve stimulator for epilepsy. My name is Dr. Stephanie Einhaus and I ...

  13. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... of a vagus nerve stimulator for epilepsy. My name is Dr. Stephanie Einhaus and I am a ... an implantation of a vagus nerve stimulator. My name is Dr. Stephanie Einhaus and we’ve enjoyed ...

  14. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... where they’ve done everything they can with standard treatment, then yes, they should be considered for vagus nerve stimulation. Someone has emailed us a question, does vagus nerve stimulation help prevent ...

  15. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... emailed in previously was do small electrical appliances, cellular phones, or metal detectors affect vagus nerve stimulation? The ... been asked does vagus nerve stimulator therapy cause sleep disturbances? The answer to that question is no, ...

  16. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... dissect down to the vagus nerve and wrap these electrodes around the nerve and then connect them ... the trachea and we’re dissecting down between these two to what’s called the carotid sheath. The ...

  17. Biocompatibility of Different Nerve Tubes

    OpenAIRE

    Hisham Fansa; Felix Stang; Gerburg Keilhoff

    2009-01-01

    Bridging nerve gaps with suitable grafts is a major clinical problem. The autologous nerve graft is considered to be the gold standard, providing the best functional results; however, donor site morbidity is still a major disadvantage. Various attempts have been made to overcome the problems of autologous nerve grafts with artificial nerve tubes, which are “ready-to-use” in almost every situation. A wide range of materials have been used in animal models but only few have been applied to date...

  18. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

    OpenAIRE

    Radi Shahien; Abdalla Bowirrat

    2011-01-01

    Radi Shahien, Abdalla BowirratDepartment of Neurology, Ziv Medical Center, Zfat, IsraelAbstract: We report a complication related to epidural analgesia for delivery in a 24-year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paraly...

  19. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    Kiilgaard, Jens Folke; Pedersen, D B; Eysteinsson, T; la Cour, M; Bang, K; Jensen, P K; Stefánsson, E

    2004-01-01

    The authors have previously reported that carbonic anhydrase inhibitors such as acetazolamide and dorzolamide raise optic nerve oxygen tension (ONPO(2)) in pigs. The purpose of the present study was to investigate whether timolol, which belongs to another group of glaucoma drugs called beta blockers, has a similar effect. In addition, the effect of dorzolamide and timolol in combination was studied.

  20. Brachial artery flow velocity variation: another victory for hand-carried ultrasound?

    OpenAIRE

    Schmidt, Gregory A.

    2009-01-01

    Dynamic predictors are clearly superior to static pressures in predicting whether a patient will respond to a fluid bolus. Hand-carried ultrasound (HCUS) can measure changes in blood flow velocity in the brachial artery that parallel arterial pulse pressure variation. The potential for HCUS to guide fluid therapy non-invasively must overcome problems of sensitivity and applicability.

  1. A clinical assessment tool for ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    Sultan, S F

    2012-05-01

    Competency in anesthesia traditionally has been determined subjectively in practice. Optimal training in procedural skills requires valid and reliable forms of assessment. The objective was to examine a procedure-specific clinical assessment tool for ultrasound-guided axillary brachial plexus block for inter-rater reliability and construct validity in a clinical setting.

  2. Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis

    Directory of Open Access Journals (Sweden)

    Rohini V Bhat Pai

    2013-01-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.

  3. Contralateral brachial plexus palsy and Horner syndrome following vestibular schwannoma resection: A complication of patient positioning

    Directory of Open Access Journals (Sweden)

    Matthew R. Fusco, MD

    2014-09-01

    Conclusions: We present the first known cases of submandibular gland inflammation and hemorrhage resulting in brachial plexopathy and Horner syndrome opposite the site of tumor resection. This case underscores the importance of adequate and safe patient positioning in skull based neurosurgical procedures.

  4. Robot-Assisted Surgery of the Shoulder Girdle and Brachial Plexus

    OpenAIRE

    Facca, Sybille; Hendriks, Sarah; Mantovani, Gustavo; Selber, Jesse C; Liverneaux, Philippe

    2014-01-01

    New developments in the surgery of the brachial plexus include the use of less invasive surgical approaches and more precise techniques. The theoretical advantages of the use of robotics versus endoscopy are the disappearance of physiological tremor, three-dimensional vision, high definition, magnification, and superior ergonomics.

  5. Paraneoplastic cutaneous manifestations: concepts and updates*

    OpenAIRE

    da Silva, Josenilson Antônio; Mesquita, Kleyton de Carvalho; Igreja, Ana Carolina de Souza Machado; Lucas, Isabella Cristina Rodrigues Naves; Freitas, Aline Ferreira; de Oliveira, Sandra Maximiano; Costa, Izelda Maria Carvalho; Campbell, Iphis Tenfuss

    2013-01-01

    The skin often signals systemic changes. Some neoplastic diseases that affect internal organs may trigger several cutaneous manifestations. Although these dermatoses are relatively unusual, the recognition of some typical paraneoplastic dermatoses may lead to the early diagnosis of a neoplasm and determine a better prognosis. In this review article, we discuss the paraneoplastic cutaneous manifestations strongly associated with neoplasms, which include acanthosis nigricans m...

  6. Coinfection of Cutaneous Leishmaniasis and HIV Infection

    OpenAIRE

    Lartey, Margaret; Adusei, L; Hanson-Nortey, L; Addy, JH

    2006-01-01

    Cutaneous leishmaniasis has recently been discovered in some parts of Ghana. The case of an HIV infected patient presenting with cutaneous leishmaniasis at the Korle-Bu Teaching Hospital is discussed. The diagnosis of leishmaniasis was confirmed by histology. Also highlighted is the fact that this is the first reported case of dual infection of HIV and Leishmaniasis in Ghana.

  7. Leishmania donovani and Cutaneous Leishmaniasis, Sri Lanka

    OpenAIRE

    Siriwardana, H. V. Yamuna D.; Noyes, Harry A.; Beeching, Nicholas J; Chance, Michael L.; Karunaweera, Nadira D; Bates, Paul A.

    2007-01-01

    To investigate the relationship of cutaneous leishmaniasis isolates from Sri Lanka to known species, we performed DNA sequencing and microsatellite analyses. We identified Leishmania donovani as the agent of Sri Lanka cutaneous leishmaniasis and showed that these parasites are closely related to those causing visceral leishmaniasis in the Indian subcontinent.

  8. New Clinicoepidemiologic Profile of Cutaneous Leishmaniasis, Morocco

    OpenAIRE

    Rhajaoui, Mohamed; Nasereddin, Abedelmajeed; Fellah, Hajiba; Azmi, Kifaya; Amarir, Fatima; Al-Jawabreh, Amer; Ereqat, Suheir; Planer, Joseph; Abdeen, Ziad

    2007-01-01

    During the past 20 years, cutaneous leishmaniasis has emerged as a major public health threat in Morocco. We describe distribution of Leishmania major and L. tropica in Morocco and a new focus of cutaneous leishmaniasis due to L. infantum. We recommend using molecular techniques to diagnose suspected leishmaniasis cases.

  9. Widespread Cutaneous Reactions: A spectrum of disease

    OpenAIRE

    Bendl, Bernard J.; Bendl, Christopher F.

    1992-01-01

    The three cutaneous reaction patterns of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis share many clinical features. Each is multifactorial in etiology; together they account for most severe cutaneous drug eruptions. In some respects, they can represent a progression in the severity of drug eruptions. Controversy continues to cloud the clinical delineation, etiology, and treatment.

  10. Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: Dose-limiting toxicity in apical tumor sites

    International Nuclear Information System (INIS)

    Background and purpose: We report frequency of brachial plexopathy in early-stage non-small cell lung cancer treated with stereotactic body radiotherapy. Materials and methods: 276 T1-T2, N0 or peripheral T3, N0 lesions were treated in 253 patients with stereotactic radiotherapy at Indiana University and Richard L. Roudebush VAMC from 1998 to 2007. Thirty-seven lesions in 36 patients were identified as apical lesions, defined as epicenter of lesion superior to aortic arch. Brachial plexus toxicity was scored for these apical lesions according to CTCAE v. 3.0 for ipsilateral shoulder/arm neuropathic pain, motor weakness, or sensory alteration. Results: The 37 apical lesions (19 Stage IA, 16 IB, and 2 IIB) were treated with stereotactic body radiotherapy to a median total dose of 57 Gy (30-72). The associated brachial plexus of 7/37 apical lesions developed grade 2-4 plexopathy (4 pts - grade 2, 2 pts - grade 3, 1 pt - grade 4). Five patients had ipsilateral shoulder/arm neuropathic pain alone, one had pain and upper extremity weakness, and one had pain progressing to numbness of the upper extremity and paralysis of hand and wrist. The median of the maximum brachial plexus doses of patients developing brachial plexopathy was 30 Gy (18-82). Two-year Kaplan-Meier risk of brachial plexopathy for maximum brachial plexus dose >26 Gy was 46% vs 8% for doses ?26 Gy (p = 0.04 for likelihood ratio test). Conclusions: Stereotactic body radiotherapy for apical lesions carries a risk of brachial plexopathy. Brachial plexus maximum dose should be kept <26 Gy in 3 or 4 fractions.

  11. Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Objective: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures. Design: Prospective study. Materials and methods: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24 h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24 h as well as 2 and 4 weeks later. Results: Ankle-brachial-indices increased significantly at 24 h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r = 0.3833, p = 0.009) as well as 4 weeks after angioplasty (r = 0.4596, p = 0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention. Conclusion: Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may reflect endothelial dysfunction caused by contrast material. The recovery of transcutaneous oximetry levels following angioplasty is counterbalanced by the adverse effects of the contrast material. Ankle-brachial-indices remains the most favourable parameter in evaluating the success of angioplasty procedures while transcutaneous oximetry serves as an indirect method in assessing endothelial dysfunction caused by contrast material

  12. Transcutaneous oximetry compared to ankle-brachial-index measurement in the evaluation of percutaneous transluminal angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Wildgruber, Moritz [Department of Vascular Surgery, Technical University of Munich, Ismaninger Strasse 22, D-81675 Munich (Germany)], E-mail: moritzwildgruber@web.de; Wolf, Oliver [Department of Vascular Surgery, Technical University of Munich, Ismaninger Strasse 22, D-81675 Munich (Germany); Weiss, Wolfgang; Berger, Hermann [Department of Interventional Radiology, Technical University of Munich, Ismaninger Strasse 22, D-81675 Munich (Germany); Lutzenberger, Werner [MEG-Center, Medical School, University of Tuebingen, Otfried-Mueller Strasse 47, D-72076 Tuebingen (Germany); Eckstein, Hans-Henning [Department of Vascular Surgery, Technical University of Munich, Ismaninger Strasse 22, D-81675 Munich (Germany); Heider, Peter [Department of Vascular Surgery, Technical University of Munich, Ismaninger Strasse 22, D-81675 Munich (Germany)], E-mail: heiderpeter@t-online.de

    2007-11-15

    Objective: To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures. Design: Prospective study. Materials and methods: 60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24 h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24 h as well as 2 and 4 weeks later. Results: Ankle-brachial-indices increased significantly at 24 h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r = 0.3833, p = 0.009) as well as 4 weeks after angioplasty (r = 0.4596, p = 0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention. Conclusion: Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may reflect endothelial dysfunction caused by contrast material. The recovery of transcutaneous oximetry levels following angioplasty is counterbalanced by the adverse effects of the contrast material. Ankle-brachial-indices remains the most favourable parameter in evaluating the success of angioplasty procedures while transcutaneous oximetry serves as an indirect method in assessing endothelial dysfunction caused by contrast material.

  13. Cutaneous lesions in new born

    Directory of Open Access Journals (Sweden)

    Sachdeva Meenakshi

    2002-11-01

    Full Text Available Five hundred unselected newborn babies delivered in the Department of Obstetrics and Gynaecology, Unit II of SGBT Hospital attached to Government Medical College, Amritsar during April 2000 to October 2000 were examined for cutaneous lesions daily for the first five days after birth. Different cutaneous lesions were seen in 474(94. 8% newborns. The physiological skin changes observed in order of frequency were Epstein pearls in 305(61%, Mongolian spot in 301(60. 2%, superficial cutaneous desquamation in 200(40%, icterus in 128(25. 6%, milia in 119(23. 8%, sebaceous gland hyperplasia in 107 (21. 4%, occipital alopecia in 94(18. 8%, lanugo in 72(14. 4%, peripheral cyanosis in 47(9. 4%, breast hypertrophy in 29(5. 8% and miniature puberty in 28(5. 6% newborns. Of the transient non-infective skin diseases, erythema toxicum neonatorum was observed most commonly in 105(21 %, followed by miliaria rubra in 103(20. 6% and acne neonatorum in 27(5. 4% newborns. The naevi and other developmental defects in the descending order were salmon patch in 69(13. 8%, congenital melanocytic noevi in 10(2%, accessory tragi in 3(0.6%, spina bifida in 2(0.4%, hydrocephalus in 1(0.2% and poliosis in 1(0.2% newborns. Cradle cap was the only dermatitis observed in 50(10% newborns. One (0.2% case each of Harlequin ichthyosis and labial cyst was seen.

  14. Many faces of cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    Bari Arfan Ul

    2008-01-01

    Full Text Available Background: Cutaneous leishmaniasis (CL is known for its clinical diversity and increasing numbers of new and rare variants of the disease are being reported these days. Aim: The aim of this descriptive study was to look for and report the atypical presentations of this common disease occurring in Pakistan. Methods: The study was carried out in three hospitals (MH, Rawalpindi; PAF Hospital, Sargodha; and CMH, Muzaffarabad from 2002 to 2006. Military and civilian patients of all ages, both males and females, belonging to central and north Punjab province and Kashmir were included in the study. Clinical as well as parasitological features of cutaneous leishmaniasis were studied. The unusual lesions were photographed and categorized accordingly using simple descriptive statistics. Results: Out of 718 patients of cutaneous leishmaniasis, 41 (5.7% had unusual presentations. The commonest among unusual morphologies was lupoid leishmaniasis 14 (34.1%, followed by sporotrichoid 5 (12.1%, paronychial 3 (7.3%, lid leishmaniasis 2 (4.9%, psoriasiform 2 (4.9%, mycetoma-like 2 (4.9%, erysipeloid 2 (4.9%, chancriform 2 (4.9%, whitlow 1 (2.4%, scar leishmaniasis 1 (2.4%, DLE-like 1 (2.4%, ?squamous cell carcinoma?-like 1 (2.4%, zosteriform 1 (2.4%, eczematous 1 (2.4%, verrucous 1 (2.4%, palmar/plantar 1 (2.4% and mucocutaneous 1 (2.4%. Conclusion: In Pakistan, an endemic country for CL, the possibility of CL should be kept in mind while diagnosing common dermatological diseases like erysipelas, chronic eczema, herpes zoster, paronychia; and uncommon disorders like lupus vulgaris, squamous cell carcinoma, sporotrichosis, mycetoma and other deep mycoses.

  15. Cutaneous Leishmaniasis with Unusual Presentation

    Directory of Open Access Journals (Sweden)

    N Bagherani

    2009-05-01

    Full Text Available "nThis case report states a 25-year-old woman, residing in the city of Dezfool, Khuzestan Province, south of Iran with the diagnosis of cutaneous leishmaniasis in June 2008. Her skin lesion had de­veloped from 8 months earlier as a nodule on her left arm, 1×3 cm in diameter. Because of sever­ity of the lesion, we prescribed meglumine antimoniate intralesionally with giving up her breast feeding. After 6 months follow-up, no recurrence was seen.

  16. Cutaneous hemangiosarcoma in a dog.

    Science.gov (United States)

    Tsuji, Naho; Furukawa, Satoshi; Ozaki, Kiyokazu

    2013-06-01

    A male golden retriever of unknown age presented with multiple cutaneous and subcutaneous masses from the left elbow to the digits. Histopathologically, multiple tumor foci had formed from the dermis to the subcutaneous tissue. Tumor foci consisted of a vascular structure, alveolar structure and solid proliferative area. The borders among these areas were not clear. Some neoplastic cells resembled a mature endothelium, while others were large pleomorphic cells. Immunohistochemically, the tumor cells were usually strongly positive for CD31 and often positive for PROX-1, the lymphatic endothelial cell marker. Based on these findings, the tumor was diagnosed as a hemangiosarcoma with lymphatic differentiation. PMID:23914061

  17. Nerve sheath tumors of the head and neck - a radiological review; Tumores da bainha nervosa em cabeca e pescoco - estudo revisional

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Ricardo Pires de; Carramao, Cintia Fernandes; Soares, Aldemir Humberto [Hospital Heliopolis, Sao Paulo, SP (Brazil). Servico de Diagnostico por Imagem; Chacra Junior, Jose; Rapoport, Abrao [Hospital Heliopolis, Sao Paulo, SP (Brazil). Servico de Cirurgia de Cabeca e Pescoco

    1997-01-01

    Peripheral nerve sheath tumors of the head and neck - a review. Peripheral nerve sheath tumors are derived from neural crest and rare classified as neuroectodermal in origin. They can be divided into neurofibroma, schwannoma and neurogenic sarcoma. Neurofifromas are benign well circumscribed, nonencapsulated tumors which involve all elements of normal peripheral nerves. Schwannomas are beginning encapsulated tumors composed fundamentally by Schwann cells. Neurogenic sarcomas are malignant tumors which can be de novo or arise from preexisting neurofibroma or schwannoma. Peripheral nerve sheath tumors can arise from any nerve that contain myelin sheath, but are more frequent in extremities and trunk, being rare on cervical region. neurogenic tumors of head and neck can arise from cranial nerves, especially vagus nerve, brachial plexus and other small nervous plexus. Computed tomography and magnetic resonance imaging are the methods of choice in the evaluation of those tumors and can demonstrate lesions with several patterns. Areas of cystic degeneration are frequent in schwannomas, while neurofibromas are usually homogeneous. About 1/3 of those tumors are hyper vascularized and those who arise nervous spinal; roots can have an aspect of dumbbell which contain cervical and intravertebral components. (author) 51 refs., 5 figs.

  18. Pathology of the vestibulocochlear nerve

    Energy Technology Data Exchange (ETDEWEB)

    De Foer, Bert [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: bert.defoer@GZA.be; Kenis, Christoph [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: christophkenis@hotmail.com; Van Melkebeke, Deborah [Department of Neurology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Deborah.vanmelkebeke@Ugent.be; Vercruysse, Jean-Philippe [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: jphver@yahoo.com; Somers, Thomas [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Thomas.somers@GZA.be; Pouillon, Marc [Department of Radiology, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: marc.pouillon@GZA.be; Offeciers, Erwin [University Department of ENT, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium)], E-mail: Erwin.offeciers@GZA.be; Casselman, Jan W. [Department of Radiology, AZ Sint-Jan AV Hospital, Ruddershove 10, Bruges (Belgium); Consultant Radiologist, Sint-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk (Belgium); Academic Consultent, University of Ghent (Belgium)], E-mail: jan.casselman@azbrugge.be

    2010-05-15

    There is a large scala of pathology affecting the vestibulocochlear nerve. Magnetic resonance imaging is the method of choice for the investigation of pathology of the vestibulocochlear nerve. Congenital pathology mainly consists of agenesis or hypoplasia of the vestibulocochlear nerve. Tumoral pathology affecting the vestibulocochlear nerve is most frequently located in the internal auditory canal or cerebellopontine angle. Schwannoma of the vestibulocochlear nerve is the most frequently found tumoral lesion followed by meningeoma, arachnoid cyst and epidermoid cyst. The most frequently encountered pathologies as well as some more rare entities are discussed in this chapter.

  19. Pathology of the vestibulocochlear nerve

    International Nuclear Information System (INIS)

    There is a large scala of pathology affecting the vestibulocochlear nerve. Magnetic resonance imaging is the method of choice for the investigation of pathology of the vestibulocochlear nerve. Congenital pathology mainly consists of agenesis or hypoplasia of the vestibulocochlear nerve. Tumoral pathology affecting the vestibulocochlear nerve is most frequently located in the internal auditory canal or cerebellopontine angle. Schwannoma of the vestibulocochlear nerve is the most frequently found tumoral lesion followed by meningeoma, arachnoid cyst and epidermoid cyst. The most frequently encountered pathologies as well as some more rare entities are discussed in this chapter.

  20. COMPARISON OF THE EFFECTS OF FENTANYL AND DEXMEDETOMIDINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK ACHIEVED WITH ROPIVACAINE

    Directory of Open Access Journals (Sweden)

    Soma C.

    2015-07-01

    Full Text Available BACKGROUND & OBJECTIVES: Supraclavicular block of brachial plexus provides complete and reliable anaesthesia for upper limb surgeries. Ropivacaine, is an affective local anaesthetic in for brachial plexus anaesthesia. It is a potent blocker of A? and C fibres, rendering good sensory effect but le ss motor blockade. We evaluated the anaesthetic quality and length of analgesia with the addition of either fentanyl or dexmedetomidine to ropivacaine for Supraclavicular brachial plexus block. METHODS: In a prospective clinical trial, 90 patients were ran domly allocated to either receive 30 ml ropivacaine 0.5% (Group R, 30 ml ropivacaine 0.5% with fentanyl 50 mcg (Group RF or 30 ml ropivacaine 0.5% with dexmedetomedine 50 mcg (Group RD in Supraclavicular brachial plexus. The characteristics for anaesthe sia and analgesia were assessed for the three groups. OBSERVATIONS: Demographic profile was comparable in the groups. The onset of analgesia and time to complete analgesia was enhanced in Group RD and Group RF compared to Group R. Prolongation of sensory b lockade and motor blockade with extended duration of postoperative analgesia was observed in Group RD and Group RF compared to Group R. There were minimum haemodynamic disturbances and side - effects in any group except f or Grade 3 sedation score which was f requently noted in patients receiving dexmedetomidine as adjunct. RESULTS: Compared to the use of ropivacaine 0.5%, 30 ml alone for supraclavicular brachial plexus block, the addition of 50 mcg fentanyl or 50 mcg dexmedetomidine to ropivacaine enhanced onset of block and also increased duration of surgical anaesthesia with prolongation of post - operative analgesia. Furthermore blockade characteristics improved better with addition of dexmedetomodine than fentanyl without increasing incidence of unwanted s ide - effects.

  1. An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre

    Directory of Open Access Journals (Sweden)

    Darshan Kumar A Jain

    2012-01-01

    Full Text Available Background: Epidemiological studies on traumatic brachial plexus injuries are few and these studies help us to improve the treatment, rehabilitation of these patients and to allocate the resources required in their management. Epidemiological factors can vary in different countries. We wanted to know the situation in an Indian centre. Materials and Methods: Data regarding age, sex, affected side, mode of injury, distribution of paralysis, associated injuries, pain at the time of presentation and the index procedure they underwent were collected from 304 patients. Additional data like the vehicle associated during the accident, speed of the vehicle during the accident, employment status and integration into the family were collected in 144 patients out of the 304 patients. Results: Road traffic accidents accounted for 94% of patients and of the road traffic accidents 90% involved two wheelers. Brachial plexus injury formed a part of multitrauma in 54% of this study group and 46% had isolated brachial plexus injury. Associated injuries like fractures, vascular injuries and head injuries are much less probably due to the lower velocity of the vehicles compared to the western world. The average time interval from the date of injury to exploration of the brachial plexus was 127 days and 124 (40.78% patients presented to us within this duration. Fifty-seven per cent had joined back to work by an average of 8.6 months. It took an average of 6.8 months for the global brachial plexus-injured patients to write in their non-dominant hand.

  2. Referred pain and cutaneous responses from deep tissue electrical pain stimulation in the groin

    DEFF Research Database (Denmark)

    Aasvang, E K; Werner, M U

    2015-01-01

    BACKGROUND: Persistent postherniotomy pain is located around the scar and external inguinal ring and is often described as deep rather than cutaneous, with frequent complaints of pain in adjacent areas. Whether this pain is due to local pathology or referred/projected pain is unknown, hindering mechanism-based treatment. METHODS: Deep tissue electrical pain stimulation by needle electrodes in the right groin (rectus muscle, ilioinguinal/iliohypogastric nerve and perispermatic cord) was combined with assessment of referred/projected pain and the cutaneous heat pain threshold (HPT) at three prespecified areas (both groins and the lower right arm) in 19 healthy subjects. The assessment was repeated 10 days later to assess the reproducibility of individual responses. RESULTS: Deep electrical stimulation elicited pain at the stimulation site in all subjects, and in 15 subjects, pain from areas outside the stimulation area was reported, with 90-100% having the same response on both days, depending on the location. Deep pain stimulation significantly increased the cutaneous HPT (P0.474, P?0.040) at the two test days for the majority of test areas. CONCLUSION: Our results corroborate a systematic relationship between deep pain and changes in cutaneous nociception. The individual referred/projected pain patterns and cutaneous responses are variable, but reproducible, supporting individual differences in anatomy and sensory processing. Future studies investigating the responses to deep tissue electrical stimulation in persistent postherniotomy pain patients may advance our understanding of underlying pathophysiological mechanisms and strategies for treatment and prevention. TRIAL REGISTRY NUMBERS: ClinicalTrials.gov (NCT01701427).

  3. Nervios Digitales Palmares Comunes del Ramo Superficial del Nervio Ulnar y Nervios Digitales Plantares Comunes del Ramo Superficial del Nervio Plantar Lateral: Un Error Anatómico en Terminologia Anatomica / Common Palmar Digital Nerves from the Superficial Branch of the Ulnar Nerve and Common Plantar Digital Nerves from Superficial Branch of the Lateral Nerve: An Anatomical Error in Terminologia Anatomica

    Scientific Electronic Library Online (English)

    Mariano, del Sol; Bélgica, Vásquez.

    2014-09-01

    Full Text Available Terminologia Anatomica contempla la existencia de nervios digitales palmares comunes del ramo superficial del nervio ulnar y nervios digitales plantares comunes del ramo superficial del nervio plantar lateral. De acuerdo a la mayoría de los textos clásicos y estudios anatómicos de las regiones de la [...] palma de la mano y de la planta del pie, solo existiría un nervio digital palmar común (IV) originado del ramo superficial del nervio ulnar y un nervio digital plantar común (IV) con origen en el ramo superficial del nervio plantar lateral. Realizamos una revisión anatómica de la inervación cutánea de la palma de la mano observando el comportamiento de los nervios mediano y ulnar y de la planta del pie a través de los nervios plantares medial y lateral, comentamos la literatura relacionada y concluimos que debe corregirse la Terminologia Anatomica, en el término A14.2.03.046(Nn. digitales palmares comunes) y en el término A14.2.07.071(Nn. digitales plantares comunes), los cuales deberían denominarse N. digital palmar común y N. digital plantar común, ambos corresponderían al IV nervio digital palmar común y IV nervio digital plantar común, respectivamente. Abstract in english Terminologia Anatomica contemplates the existence of common palmar digital nerves from the superficial branch of the ulnar nerve and common plantar digital nerves from the superficial branch of the lateral plantar nerve. According to most classical texts and anatomical studies of the regions palmar [...] and plantar, there would only be common palmar digital nerve (IV) originated from the superficial branch of the ulnar nerve and common plantar digital nerve (IV) arising from the superficial branch of lateral plantar nerve. We conducted an anatomical review of the cutaneous innervation of the palm observing the behavior of the median and ulnar nerves, and the foot through the medial and lateral plantar nerves. In this study we discuss the related literature and conclude that Terminologia Anatomica must be corrected in the A14.2.03.046 term (Nn. common palmar digital) and in A14.2.07.071 term (Nn. common plantar digital ), which should be called: common palmar digital nerve and common plantar digital nerve, corresponding to both the IV common palmar digital nerve and IV common plantar digital nerve, respectively.

  4. Limitations of Conduits in Peripheral Nerve Repairs

    OpenAIRE

    Moore, Amy M.; Kasukurthi, Rahul; Magill, Christina K.; Farhadi, H. Francis; Borschel, Gregory H; Mackinnon, Susan E.

    2009-01-01

    Nerve conduits have emerged as alternatives to autologous nerve grafts, but their use in large-diameter nerve deficits remains untested. We report four patients who underwent repair of large-diameter nerves using absorbable nerve conduits and discuss the failed clinical outcomes. The reported cases demonstrate the importance of evaluating the length, diameter, and function of nerves undergoing conduit repair. In large-diameter nerves, the use of conduits should be carefully considered.

  5. Neuronal changes resulting in up-regulation of alpha-1 adrenoceptors after peripheral nerve injury.

    Science.gov (United States)

    Drummond, Peter D

    2014-07-15

    Under normal conditions, the sympathetic neurotransmitter noradrenaline inhibits the production and release of pro-inflammatory cytokines. However, after peripheral nerve and tissue injury, pro-inflammatory cytokines appear to induce the expression of the alpha1A-adrenoceptor subtype on immune cells and perhaps also on other cells in the injured tissue. In turn, noradrenaline may act on up-regulated alpha1-adrenoceptors to increase the production of the pro-inflammatory cytokine interleukin-6. In addition, the release of inflammatory mediators and nerve growth factor from keratinocytes and other cells may augment the expression of alpha1-adrenoceptors on peripheral nerve fibers. Consequently, nociceptive afferents acquire an abnormal excitability to adrenergic agents, and inflammatory processes build. These mechanisms could contribute to the development of sympathetically maintained pain in conditions such as post-herpetic neuralgia, cutaneous neuromas, amputation stump pain and complex regional pain syndrome. PMID:25221588

  6. Traumatic third nerve palsy.

    OpenAIRE

    Elston, J S

    1984-01-01

    Twenty patients with a traumatic third nerve palsy had sustained a closed head injury with prolonged loss of consciousness in a high-speed deceleration accident. Sixteen were male, and the average age was 25 years. Seven had skull or facial fractures, 15 damage to the anterior visual pathways, and 16 other permanent neurological damage. Nineteen developed the misdirection/regeneration syndrome. Thirteen had strabismus surgery, and an area of binocular single vision was enlarged or achieved in...

  7. Peripheral nerve hyperexcitability syndromes.

    Science.gov (United States)

    Küçükali, Cem Ismail; Kürtüncü, Murat; Akçay, Halil ?brahim; Tüzün, Erdem; Öge, Ali Emre

    2015-01-01

    Peripheral nerve hyperexcitability (PNH) syndromes can be subclassified as primary and secondary. The main primary PNH syndromes are neuromyotonia, cramp-fasciculation syndrome (CFS), and Morvan's syndrome, which cause widespread symptoms and signs without the association of an evident peripheral nerve disease. Their major symptoms are muscle twitching and stiffness, which differ only in severity between neuromyotonia and CFS. Cramps, pseudomyotonia, hyperhidrosis, and some other autonomic abnormalities, as well as mild positive sensory phenomena, can be seen in several patients. Symptoms reflecting the involvement of the central nervous system occur in Morvan's syndrome. Secondary PNH syndromes are generally seen in patients with focal or diffuse diseases affecting the peripheral nervous system. The PNH-related symptoms and signs are generally found incidentally during clinical or electrodiagnostic examinations. The electrophysiological findings that are very useful in the diagnosis of PNH are myokymic and neuromyotonic discharges in needle electromyography along with some additional indicators of increased nerve fiber excitability. Based on clinicopathological and etiological associations, PNH syndromes can also be classified as immune mediated, genetic, and those caused by other miscellaneous factors. There has been an increasing awareness on the role of voltage-gated potassium channel complex autoimmunity in primary PNH pathogenesis. Then again, a long list of toxic compounds and genetic factors has also been implicated in development of PNH. The management of primary PNH syndromes comprises symptomatic treatment with anticonvulsant drugs, immune modulation if necessary, and treatment of possible associated dysimmune and/or malignant conditions. PMID:25719304

  8. Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe atherosclerosis

    DEFF Research Database (Denmark)

    Eldrup, Nikolaj; Sillesen, Henrik; Prescott, Eva; Nordestgaard, Børge G

    2006-01-01

    We examined the ability of ankle brachial index, C-reactive protein and central augmentation index to identify individuals in the general population with severe atherosclerosis, diagnosed as those with ischaemic cardiovascular disease.

  9. Brachial Plexopathy due to Myeloid Sarcoma in a Patient With Acute Myeloid Leukemia After Allogenic Peripheral Blood Stem Cell Transplantation.

    Science.gov (United States)

    Ha, Yumi; Sung, Duk Hyun; Park, Yoonhong; Kim, Du Hwan

    2013-04-01

    Myeloid sarcoma is a solid, extramedullary tumor comprising of immature myeloid cells. It may occur in any organ; however, the invasion of peripheral nervous system is rare. Herein, we report the case of myeloid sarcoma on the brachial plexus. A 37-year-old woman with acute myelogenous leukemia achieved complete remission after chemotherapy. One year later, she presented right shoulder pain, progressive weakness in the right upper extremity and hypesthesia. Based on magnetic resonance images (MRI) and electrophysiologic study, a provisional diagnosis of brachial plexus neuritis was done and hence steroid pulse therapy was carried out. Three months later the patient presented epigastric pain. After upper gastrointestinal endoscopy, myeloid sarcoma of gastrointestinal tract was confirmed pathologically. Moreover, 18-fluoride fluorodeoxyglucose positron emission tomography showed a fusiform shaped mass lesion at the brachial plexus overlapping with previous high signal lesion on the MRI. Therefore, we concluded the final diagnosis as brachial plexopathy due to myeloid sarcoma. PMID:23705126

  10. The effect of reactive artery hyperaemia on the radial strain of the brachial artery: Definition of optimum cuff position

    Directory of Open Access Journals (Sweden)

    Rafati Rafati

    2008-06-01

    Full Text Available Instruction: Measurement of brachial artery diameter variation by ultrasound methods has commonly been used to test the endothelial function. It is known that the artery diameter is increased by flow stimulation. Therefore in the present study, the effect of external obstruction, as flow stimulation, on the radial strain of the brachial artery was assessed. Also the biomechanical behavior of the artery due to the changes in obstruction cuff position was evaluated. Methods: Firstly, for evaluating the effect of flow stimulation on healthy men's brachial artery, 200 mmHg pressure and 5 minutes of obstruction was applied. Then, without flow stimulation, it was evaluated by ultrasonic method. In order to evaluate the optimum cuff position with maximum biomechanical variation of the brachial artery, arteries of two regions including the proximal brachial (upper arm and middle forearm of 10 healthy men were obstructed by 200 mmHg of stress. By acquiring artery diameter variation and estimation of radial strain, multiple frames of the B-mode ultrasonic images were saved on personal computer and maximum artery diameter in the systolic phase, artery diameter in the end of the diastolic phase and the shape of offline were measured. According to relative diameter variations, radial strain percentages were estimated. The effects of external obstruction and the position of this obstruction on the radial strain of the brachial artery were analyzed by t-test. Results: In the first stage, the results of ultrasonic evaluation of the left brachial artery showed that the radial strain induced by stress (200 mmHg was significantly increased 3.5 times compared to the normal condition without stress. Evaluation of the obstruction's location and its effect on the relative brachial artery diameter showed that with the application of 200 mmHg obstruction in 1/3 of the superior arm and the middle forearm, the radial strain of the artery were 10.44 ± 2.63 % and 4.97 ± 3.61 %, respectively. The statistical analysis of the brachial artery radial strain showed a significant difference between the two obstruction's locations and 33% increase of the obstructed brachial artery's diameter variation in 1/3 of the superior arm. Conclusion: The brachial artery's radial strain is increased by the external obstruction of the artery. This increase seems to be larger in the upper arm region of the artery compared to the middle forearm region.

  11. Cutaneous plasmacytosis: a case report and review of pulmonary findings

    OpenAIRE

    Weeranut Chantachaeng; Leena Chularojanamontri

    2011-01-01

    Primary cutaneous plasmacytosis is an uncommon cutaneous disorder with multiple cutaneous nodules and plaques mainly on face and trunk. This entity is thought to be a reactive process with unknown etiology. Pulmonary involvement could be found as a part of systemic plasmacytosis whereas cutaneous plasmacytosis was also reported with other pulmonary disorders. This report presents the case of cutaneous plasmacytosis and the review of pulmonary findings reported in plasmacytosis.

  12. An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2009-07-01

    Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary brachial plexus block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary brachial plexus block.

  13. Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy

    OpenAIRE

    Rahul K Nath; Somasundaram, Chandra

    2012-01-01

    Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5–9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad ...

  14. Cutaneous findings in five cases of malaria

    Directory of Open Access Journals (Sweden)

    Jignesh B Vaishnani

    2011-01-01

    Full Text Available Malaria is an infectious disease caused by protozoa of the genus Plasmodium. Cutaneous lesions in malaria are rarely reported and include urticaria, angioedema, petechiae, purpura, and disseminated intravascular coagulation (DIC. Here, five malaria cases associated with cutaneous lesions have been described. Out of the five cases of malaria, two were associated with urticaria and angioedema, one case was associated with urticaria, and other two were associated with reticulated blotchy erythema with petechiae. Most of the cutaneous lesions in malaria were nonspecific and reflected the different immunopathological mechanism in malarial infection.

  15. Paronychia-like cutaneous leishmaniasis.

    Science.gov (United States)

    Chiheb, S; El Machbouh, L; Marnissi, F

    2015-01-01

    Chronic paronychia is an inflammatory recalcitrant disorder affecting the nail folds. We report one patient with paronychia  revealing ungueal leishmaniasis. A 34-year-old man, resident in the north of Morocco, presented with a 6-month history of an inflamed proximal nail fold of  the left thumb, resistant to antibiotics and anti-fungal treatments. En bloc excision of the proximal nail fold was done. The histopathological exam showed epithelioid  granulomas  with giant  cells and the presence of  leshmania  amastigotes, leading to the diagnosis of ungueal leishmaniasis. Clinical aspects of cutaneous leishmaniasis can be very misleading. The paronychial form is rarely described. In endemic areas  it is necessary for the physician to be aware of atypical skin presentations of  leishmaniasis. PMID:26632940

  16. Hand function after nerve repair.

    OpenAIRE

    Lundborg, Göran; Rosén, Birgitta

    2007-01-01

    Treatment of injuries to major nerve trunks in the hand and upper extremity remains a major and challenging reconstructive problem. Such injuries may cause long-lasting disabilities in terms of lost fine sensory and motor functions. Nowadays there is no surgical repair technique that can ensure recovery of tactile discrimination in the hand of an adult patient following nerve repair while very young individuals usually regain a complete recovery of functional sensibility. Post-traumatic nerve...

  17. The Dehiscent Facial Nerve Canal

    OpenAIRE

    Sertac Yetiser

    2012-01-01

    Accidental injury to the facial nerve where the bony canal defects are present may result with facial nerve dysfunction during otological surgery. Therefore, it is critical to know the incidence and the type of facial nerve dehiscences in the presence of normal development of the facial canal. The aim of this study is to review the site and the type of such bony defects in 144 patients operated for facial paralysis, myringoplasty, stapedotomy, middle ear exploration for sudden hearing loss, a...

  18. Cutaneous leucocytoclastic vasculitis associated with acute sarcoidosis.

    OpenAIRE

    Johnston, C; KENNEDY, C

    1984-01-01

    A case of acute sarcoidosis associated with the simultaneous appearance of cutaneous leucocytoclastic vasculitis and erythema nodosum is reported. Circulating immune complexes were demonstrated and may have been important in the pathogenesis of both types of skin lesion.

  19. Cutaneous myiasis in an elderly debilitated patient.

    OpenAIRE

    S. Roche; Cross, S; Burgess, I; Pines, C.; Cayley, A C

    1990-01-01

    A 77 year old woman, with chronic immobility, developed bed sores which became infested with maggots. This progressed to cutaneous myiasis which is an uncommon complication of this particular phenomenon.

  20. Cutaneous vasculitis presenting on the penis.

    OpenAIRE

    Burrows, N P; Sonnex, C.; Roberts, S O; Carne, C A

    1993-01-01

    Cutaneous vasculitis is frequently located on the lower limbs. We describe a patient who developed palpable purpura affecting the penis as the presenting sign of more widespread lesions of Henoch-Schönlein purpura.

  1. Severe aortic coarctation in an adult patient with normal brachial blood pressure

    DEFF Research Database (Denmark)

    Leetmaa, Tina H; NØrgaard, Bjarne L

    2014-01-01

    The present case shows that a normal brachial blood pressure (BP) does not exclude severe coarctation and should be considered in normotensive patients presenting with a systolic murmur and/or unexplained severe left ventricular hypertrophy. Congenital coarctation of the aorta is a narrowing of the descending aorta, usually located distal to the origin of the subclavian artery, causing hypertension in the upper part of the body. This condition may be undiagnosed until adult life where the clinical presentation most often is high BP in the upper extremities. A 57-year-old patient with severe aortic coarctation and left ventricular hypertrophy presented with normal brachial BP. However, standard suprasternal view by echocardiography indicated coarctation. Multislice computed tomographic (CT) angiography revealed an uncommon location of the aortic narrowing with the right and left subclavian arteries originating below the area of coarctation, explaining the equally low BP in both upper extremities.

  2. Magnetic resonance imaging of the shoulder in children with brachial plexus birth palsy

    International Nuclear Information System (INIS)

    Five patients suffering from Erb-Duchenne brachial plexus birth palsy were prospectively studied with MRI. A group of 11 healthy children was used as a control to understand the MRI anatomy of the normal growing glenohumeral joint. A hypoplastic and flattened posterior part of the glenoid fossa and a blunt posterior labrum were found in all patients. Four patients had a blunt anterior labrum and a flattened humeral head. Three patients presented with a posterior subluxation of the humeral head. These results suggest that MRI provides a non-ionising and non-invasive method of demonstrating the early abnormalities of the shoulder associated with obstetrical brachial plexus paralysis, which may prompt orthopaedic correction. (orig.)

  3. Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients.

    Science.gov (United States)

    Ciaramitaro, Palma; Mondelli, Mauro; Logullo, Francesco; Grimaldi, Serena; Battiston, Bruno; Sard, Arman; Scarinzi, Cecilia; Migliaretti, Giuseppe; Faccani, Giuliano; Cocito, Dario

    2010-06-01

    The objectives of this study were (1) epidemiological analysis of traumatic peripheral nerve injuries; (2) assessment of neuropathic pain and quality of life in patients affected by traumatic neuropathies. All consecutive patients with a diagnosis of traumatic neuropathies from four Italian centres were enrolled. Electromyography confirmed clinical level and site diagnosis of peripheral nerve injury. All patients were evaluated by disability scales, pain screening tools, and quality of life tests. 158 consecutive patients for a total of 211 traumatic neuropathies were analysed. The brachial plexus was a frequent site of traumatic injury (36%) and the radial, ulnar, and peroneal were the most commonly involved nerves with 15% of iatrogenic injuries. Seventy-two percent of the traumatic neuropathies were painful. Pain was present in 66% and neuropathic pain in 50% of all patients. Patients had worse quality of life scores than did the healthy Italian population. Moreover, there was a strong correlation between the quality of life and the severity of the pain, particularly neuropathic pain (Short Form-36 [SF-36] p < 0.005; Beck Depression Inventory [BDI] p < 0.0001). Traumatic neuropathies were more frequent in young males after road accidents, mainly in the upper limbs. Severe neuropathic pain and not only disability contributed to worsening the quality of life in patients with traumatic neuropathies. PMID:20626775

  4. Brachial-ankle pulse wave velocity and symptomatic cerebral infarction in patients with type 2 diabetes: a cross-sectional study

    OpenAIRE

    Muramatsu Chie; Mitsuhashi Naomi; Kubo Sayaka; Onuma Tomio; Ogawa Osamu; Kawamori Ryuzo

    2003-01-01

    Abstract Background Recently a new automatic device that measures brachial-ankle pulse wave velocity using an oscillometric method has been developed. However, the practical significance of brachial-ankle pulse wave velocity measurement remains uncertain. The purpose of this study was to examine the association between brachial-ankle pulse wave velocity and symptomatic cerebral infarction in patients with type 2 diabetes. Methods One thousand sixty six patients with type 2 diabetes were studi...

  5. Nodular cutaneous amyloidosis and carpal tunnel syndrome due to the amyloidogenic transthyretin His 114 variant.

    Science.gov (United States)

    Mochizuki, H; Kamakura, K; Masaki, T; Hirata, A; Tokuda, T; Yazaki, M; Motoyoshi, K; Ikeda, S

    2001-06-01

    This is the second report of transthyretin (TTR) amyloidosis in a patient who had ATTR Tyr114His diagnosed by mass spectrometry and gene analysis. This case had some clinical features that differed from those of the first reported cases. The patient, 73-year-old man, complained of generalized cutaneous tubercula that had started at age 68. These tubercula gradually increased in size and became generalized. He felt a slight numbness in his extremities. Clinical and electrophysiological examinations revealed that he had bilateral carpal tunnel syndrome (CTS), whereas there was no clear evidence of sensory and/or motor polyneuropathy. Autonomic symptoms were not present. Biopsy studies revealed that both his tuberculum and his sural nerve contained TTR-related amyloid. In his sural nerve, amyloid deposits were observed mainly in the perineurium, not in the endoneurium, and there was no significant depletion of myelinated fibers. The features of this patient were clinically characterized by generalized cutaneous amyloid deposits and late-onset CTS with a lack of overt polyneuropathy and autonomic dysfunction. The unique clinical features in this case seemed to be consistent with the distribution of amyloid deposits. PMID:11409031

  6. Modulation of cutaneous flexor responses induced in man by vibration-elicited proprioceptive or exteroceptive inputs.

    Science.gov (United States)

    Martin, B J; Roll, J P; Hugon, M

    1990-10-01

    The effects of muscle tendon or skin vibration on the early and late components of polyphasic cutaneous responses elicited in the flexor carpi radialis by electrical stimulation of the radial nerve at the wrist were studied in the human, with all muscles at rest. Both early and late flexor responses were enhanced by flexor vibration and depressed by extensor vibration; facilitation was accompanied by a reduction of latency. Furthermore, when an "antagonist vibration response" was present, inhibition of the flexor reflexes was replaced by a facilitation. Palm skin vibration depressed both components of the flexor reflex, while dorsal or "back-hand" skin vibration induced either a facilitation or an inhibition. In addition, back-hand vibration modified the location of the sensations evoked by electrical stimulation of the nerve. In all cases, vibratory stimulus attenuated the perceived intensity of the electrical stimulus. These observations indicate that proprioceptive or exteroceptive information can modulate the gain of the cutaneous reflex loops in a flexible way, under supraspinal control. These data also suggest a possible impairment of the protective withdrawal reflex under vibratory environmental conditions at rest and eventually in active muscles. PMID:2241733

  7. Atypical Presentation of Cutaneous Lupus Mucinosis

    OpenAIRE

    Goerig, Ryan; Vogeler, Chad; Keller, Matthew

    2013-01-01

    Objective: To describe the epidemiological, clinical, and serological features of cutaneous lupus mucinosis and its relationship to systemic lupus erythematosus as well as elucidate the histopathological features of cutaneous lupus mucinosis and describe how these features differ from tumid lupus erythematosus. Design: Case review and assessment of the literature. Setting: University academic setting. Participant: One patient. Results: The authors report a case of antinuclear antibody negativ...

  8. Primary-localized-cutaneous-amyloidosis: Lichen amyloidosus

    Directory of Open Access Journals (Sweden)

    Miki? Dragan

    2004-01-01

    Full Text Available This case report presented a female patient with primary-localized-cutaneous--amyloidosis in the form of lichen amyloidosus. Primary-localized-cutaneous--amyloidosis is a rare idiopathic dermatosis caused by abnormal deposition of amyloid composed primarily of degenerated keratin filaments. In order to establish the final diagnosis, detailed clinical and laboratory investigations were performed, with a particular emphasis on pathohistological analysis of skin specimens, special stains, and electron microscopy.

  9. Cutaneous gene therapy--an update

    DEFF Research Database (Denmark)

    Christensen, R; Jensen, Uffe Birk; Jensen, T G

    2001-01-01

    In this paper we review various strategies for gene transfer into the skin, their applications and show some of our own examples. The skin is the most accessible somatic tissue. Inherited skin diseases, such as epidermolysis bullosa and ichthyosis, and various systemic metabolic disorders are under investigation as potential candidate diseases for cutaneous gene transfer. Research is directed against genetic therapy of wounds and malignancies as well. So far, cutaneous gene transfer only has bee...

  10. Drug Discovery Algorithm for Cutaneous Leishmaniasis

    OpenAIRE

    Grogl, Max; Hickman, Mark; ELLIS, WILLIAM; Hudson, Thomas; John S. Lazo; Sharlow, Elizabeth R.; Johnson, Jacob; Berman, Jonathan; Sciotti, Richard J.

    2013-01-01

    Cutaneous leishmaniasis is clinically widespread but lacks treatments that are effective and well tolerated. Because all present drugs have been grandfathered into clinical use, there are no examples of a pre-clinical product evaluation scheme that lead to new candidates for formal development. To provide oral agents for development targeting cutaneous leishmaniasis, we have implemented a discovery scheme that incorporates in vitro and in vivo testing of efficacy, toxicity, and pharmacokineti...

  11. Cutaneous leishmaniasis: diagnostic pitfall. Case report

    OpenAIRE

    Asmae EL Hatimi; Salim Guellouj; Sanae Chehbouni; Kawtar Inani; Hanane Baybay; Fatima Zahra Mernissi

    2014-01-01

    Introduction: Cutaneous Leishmaniasis is a parasitic infection encountered in our daily dermatologic practice. Case report: We present a case of 57 year-old man of Moroccan origin, with erythematous squamous and indurated plaque on the abdomen, treated as sarcoidosis with corticosteroids with no improvement. Discussion: Cutaneous Leishmaniasis is endemic in 88 countries. Aside from its classical presentation it can manifest in multiple different ways. In our case, the diagnostic of ...

  12. Recurrent cutaneous leishmaniasis Leishmaniose recidiva cútis

    OpenAIRE

    Ciro Martins Gomes; Fabiana dos Santos Damasco; Orlando Oliveira de Morais; Carmen Déa Ribeiro de Paula; Raimunda Nonata Ribeiro Sampaio

    2013-01-01

    We present a case of an 18-year-old male patient who, after two years of inappropriate treatment for cutaneous leishmaniasis, began to show nodules arising at the edges of the former healing scar. He was immune competent and denied any trauma. The diagnosis of recurrent cutaneous leishmaniasis was made following positive culture of aspirate samples. The patient was treated with N-methylglucamine associated with pentoxifylline for 30 days. Similar cases require special attention mainly because...

  13. Management of cutaneous metastases using electrochemotherapy

    OpenAIRE

    Matthiessen, Louise Wichmann; Chalmers, Richard Ling; Sainsbury, David Christopher George; Veeramani, Sivakumar; Kessell, Gareth; Humphreys, Alison Claire; Bond, Jane Elisabeth; Muir, Tobian; Gehl, Julie

    2011-01-01

    Background. Cutaneous metastases may cause considerable discomfort as a consequence of ulceration, oozing, bleeding and pain. Electrochemotherapy has proven to be highly effective in the treatment of cutaneous metastases. Electrochemotherapy utilises pulses of electricity to increase the permeability of the cell membrane and thereby augment the effect of chemotherapy. For the drug bleomycin, the effect is enhanced several hundred-fold, enabling once-only treatment. The primary endpoint of thi...

  14. Management of cutaneous metastases using electrochemotherapy

    DEFF Research Database (Denmark)

    Matthiessen, Louise Wichmann; Chalmers, Richard Ling

    2011-01-01

    Cutaneous metastases may cause considerable discomfort as a consequence of ulceration, oozing, bleeding and pain. Electrochemotherapy has proven to be highly effective in the treatment of cutaneous metastases. Electrochemotherapy utilises pulses of electricity to increase the permeability of the cell membrane and thereby augment the effect of chemotherapy. For the drug bleomycin, the effect is enhanced several hundred-fold, enabling once-only treatment. The primary endpoint of this study is to evaluate the efficacy of electrochemotherapy as a palliative treatment.

  15. Assessment of cutaneous drug delivery using microdialysis

    DEFF Research Database (Denmark)

    Kreilgaard, Mads

    2002-01-01

    During the last decade microdialysis has been successfully applied to assess cutaneous drug delivery of numerous substances, indicating the large potential for bioequivalence/bioavailability evaluation of topical formulations. The technique has been shown to be minimally invasive and supply pharmacokinetic information directly in the target organ for cutaneous drug delivery with high temporal resolution without further intervention with the tissue after implantation. However, there are a few cha...

  16. Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

    OpenAIRE

    Healey, Scott; O'Neill, Bridie; Bilal, Haris; Waterworth, Paul

    2013-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘does retraction of the sternum during median sternotomy result in brachial plexus injuries or peripheral neuropathies?’ Altogether 58 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, date, journal and country of publication, patient group studied, study type, relevant outcomes and results of these papers...

  17. Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease

    OpenAIRE

    Naidu Otikunta; Rajasekhar Durgaprasad; Latheef SAA

    2011-01-01

    Abstract Background Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients. Methods We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control sub...

  18. Sensory Evaluation of the Hands in Children with Brachial Plexus Birth Injury

    Science.gov (United States)

    Palmgren, Tove; Peltonen, Jari; Linder, Tove; Rautakorpi, Sanna; Nietosvaara, Yrjana

    2007-01-01

    The aim of this study was to examine sensory changes of the hand in brachial plexus birth injury (BPBI). Ninety-five patients (43 females, 52 males) comprising two age groups, 6 to 8 years (mean age 7y 6mo) and 12 to 14 years (mean age 13y 2mo), were included. Sixty-four had upper (cervical [C] 5-6), 19 upper and middle (C5-7), and 12 had total…

  19. Severe aortic coarctation in an adult patient with normal brachial blood pressure

    DEFF Research Database (Denmark)

    Leetmaa, Tina H; Nørgaard, Bjarne L; Mølgaard, Henning; Jensen, Jesper M

    2014-01-01

    The present case shows that a normal brachial blood pressure (BP) does not exclude severe coarctation and should be considered in normotensive patients presenting with a systolic murmur and/or unexplained severe left ventricular hypertrophy. Congenital coarctation of the aorta is a narrowing of the descending aorta, usually located distal to the origin of the subclavian artery, causing hypertension in the upper part of the body. This condition may be undiagnosed until adult life where the clinic...

  20. Casein improves brachial and central aortic diastolic blood pressure in overweight adolescents

    DEFF Research Database (Denmark)

    Arnberg, Karina; Larnkjær, Anni; Michaelsen, Kim F.; Jensen, Signe Marie; Hoppe, Camilla; Mølgaard, Christian

    2013-01-01

    Arterial stiffness, blood pressure (BP) and blood lipids may be improved by milk in adults and the effects may be mediated via proteins. However, limited is known about the effects of milk proteins on central aortic BP and no studies have examined the effects in children. Therefore, the present trial examined the effect of milk and milk proteins on brachial and central aortic BP, blood lipids, inflammation and arterial stiffness in overweight adolescents. A randomised controlled trial was conduc...

  1. Endovascular Treatment of Infected Brachial Pseudoaneurysm in an Intravenous Drug Abuser: A Case Report.

    Science.gov (United States)

    Boieru, Raluca; Georg, Yannick; Ramlugun, Dharmesh; Martinot, Martin; Camin, Amelie; Matysiak, Lucien; Kretz, Benjamin

    2015-10-01

    We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound. PMID:26142880

  2. Perceptions of the ankle brachial index amongst podiatrists registered in Western Australia

    OpenAIRE

    Chen Pamela Y; Lawford Kaye M; Shah Naiya; Pham Julie; Bower Virginia M

    2012-01-01

    Abstract Background The ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. Despite its usefulness, it is evident within the literature that many practitioners forgo using this screening tool due to limiting factors such as time. There is also no recommended technique for ABI measurement. The purpose of this study is to investigate the perceptions of the use of ABI clinically among Western Australian podiatrists. Met...

  3. Endothelial function in a cardiovascular risk population with borderline ankle–brachial index

    OpenAIRE

    Kari Syvänen; Päivi Korhonen; Auli Partanen; et. al.

    2011-01-01

    Kari Syvänen1, Päivi Korhonen2, Auli Partanen3, Pertti Aarnio11Department of Surgery, Satakunta Hospital District, Pori, Finland; 2Central Satakunta Health Federation of Municipalities, Harjavalta, Finland; 3Department of Biostatistics, University of Turku, Turku, FinlandIntroduction: The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle–brachial index (ABI). Traditionally ABI values > 1.00–1.40 have been considered ...

  4. Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury

    OpenAIRE

    Singh Arun; Karki Durga

    2007-01-01

    Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer. Materials and Methods: From February 2004 to February 2006, eight p...

  5. Casein improves brachial and central aortic diastolic blood pressure in overweight adolescents : A randomised, controlled trial

    DEFF Research Database (Denmark)

    Arnberg, Karina; Larnkjær, Anni

    2013-01-01

    Arterial stiffness, blood pressure (BP) and blood lipids may be improved by milk in adults and the effects may be mediated via proteins. However, limited is known about the effects of milk proteins on central aortic BP and no studies have examined the effects in children. Therefore, the present trial examined the effect of milk and milk proteins on brachial and central aortic BP, blood lipids, inflammation and arterial stiffness in overweight adolescents. A randomised controlled trial was conducted in 193 overweight adolescents aged 12–15 years. They were randomly assigned to drink 1 litre of water, skimmed milk, whey or casein for 12 weeks. The milk-based test drinks contained 35 g protein/l. The effects were compared with the water group and a pretest control group consisting of thirty-two of the adolescents followed 12 weeks before the start of the intervention. Outcomes were brachial and central aortic BP, pulse wave velocity and augmentation index, serum C-reactive protein and blood lipids. Brachial and central aortic diastolic BP (DBP) decreased by 2·7% (P = 0·036) and 2·6%(P = 0·048), respectively, within the casein group and the changes were significantly different from those of the pretest control group (P = 0·040 and P = 0·034, respectively). There was a significant increase in central aortic DBP, and in brachial and central systolic BP in the whey group compared with the water group (P = 0·003, P = 0·009 and P = 0·002, respectively). There were no changes in measures of arterial stiffness or blood lipid concentrations. A high intake of casein improves DBP in overweight adolescents. Thus, casein may be beneficial for younger overweight subjects in terms of reducing the longterm risk of CVD. In contrast, whey protein seems to increase BP compared with drinking water; however, water may be considered an active control group.

  6. Casein improves brachial and central aortic diastolic blood pressure in overweight adolescents: a randomised, controlled trial

    DEFF Research Database (Denmark)

    Arnberg, Karina; Larnkjær, Anni

    2013-01-01

    Arterial stiffness, blood pressure (BP) and blood lipids may be improved by milk in adults and the effects may be mediated via proteins. However, limited is known about the effects of milk proteins on central aortic BP and no studies have examined the effects in children. Therefore, the present trial examined the effect of milk and milk proteins on brachial and central aortic BP, blood lipids, inflammation and arterial stiffness in overweight adolescents. A randomised controlled trial was conducted in 193 overweight adolescents aged 12–15 years. They were randomly assigned to drink 1 litre of water, skimmed milk, whey or casein for 12 weeks. The milk-based test drinks contained 35 g protein/l. The effects were compared with the water group and a pretest control group consisting of thirty-two of the adolescents followed 12 weeks before the start of the intervention. Outcomes were brachial and central aortic BP, pulse wave velocity and augmentation index, serum C-reactive protein and blood lipids. Brachial and central aortic diastolic BP (DBP) decreased by 2·7% (P= 0·036) and 2·6% (P = 0·048), respectively, within the casein group and the changes were significantly different from those of the pretest control group (P = 0·040 and P = 0·034, respectively). There was a significant increase in central aortic DBP, and in brachial and central systolic BP in the whey group compared with the water group (P = 0·003, P= 0·009 and P = 0·002, respectively). There were no changes in measures of arterial stiffness or blood lipid concentrations. A high intake of casein improves DBP in overweight adolescents. Thus, casein may be beneficial for younger overweight subjects in terms of reducing the longterm risk of CVD. In contrast, whey protein seems to increase BP compared with drinking water; however, water may be considered an active control group.

  7. Degeneration of primary afferent terminals following brachial plexus extensive avulsion injury in rats

    OpenAIRE

    Muñetón-Gómez, Vilma; Taylor, J.S.; Averill, Sharon; Priestley, John V; Nieto-Sampedro, Manuel

    2004-01-01

    Important breakthroughs in the understanding regeneration failure in an injured CNS have been made by studies of primary afferent neurons. Dorsal rhizotomy has provided an experimental model of brachial plexus (BP) avulsion. This is an injury in which the central branches of primary afferents are disrupted at their point of entry into the spinal cord, bringing motor and sensory dysfunction to the upper limbs. In the present work, the central axonal organization of primary afferents was examin...

  8. Exercise-induced brachial artery vasodilation: effects of antioxidants and exercise training in elderly men

    OpenAIRE

    Donato, Anthony J.; Uberoi, Abhimanyu; Bailey, Damian M; Walter Wray, D.; Richardson, Russell S.

    2009-01-01

    Aging, vascular function, and exercise are thought to have a common link in oxidative stress. Of the 28 subjects studied (young, 26 ± 2 yr; old, 71 ± 6 yr), 12 took part in a study to validate an antioxidant cocktail (AOC: vitamins C, E, and ?-lipoic acid), while the remaining 8 young and 8 old subjects performed submaximal forearm handgrip exercise with placebo or AOC. Old subjects repeated forearm exercise with placebo or AOC following knee-extensor (KE) exercise training. Brachial arterial...

  9. Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

    Science.gov (United States)

    Healey, Scott; O'Neill, Bridie; Bilal, Haris; Waterworth, Paul

    2013-07-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does retraction of the sternum during median sternotomy result in brachial plexus injuries or peripheral neuropathies?' Altogether 58 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, date, journal and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Caudal placement of the retractor or relieving the pressure superiorly by removing the upper blades of a retractor (P = 0.02) and use of a caudally placed symmetrical retractor has been shown to reduce neuropathy. Positioning of the patient with 'hands up' positioning showed significant reduction in the incidence of brachial plexus injuries. Furthermore, how wide the retractor is opened and use of an asymmetrical retractor for internal mammary artery (IMA) harvesting are also important factors in quantifying risk of postoperative neuropathy. Wider sternal retraction and longer bypass time did increase the risk of developing postoperative neuropathy. Three asymmetrical retractors were looked at that demonstrates the Delacroix-Chevalier to be the safest (P < 0.05). We conclude that median sternotomy risks brachial plexus injury and where possible the sternum should be opened as small a distance as possible with symmetrical retractor and using a caudally placed retractor. PMID:23513004

  10. Application of a functional hand orthosis in individuals with brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    Kátia Vanessa Pinto de Meneses

    2012-04-01

    Full Text Available One of the diseases that cause severe disability and that directly affect the individual’ssocial participation and quality of life is the brachial plexus injury. One of the interventions widelyused in the rehabilitation program of the individual who suffered brachial plexus injury is themanufacture and prescription of orthoses. However the majority of currently available orthosis forbrachial plexus injuries, are used in order to positioning the upper limb and to relieve pain, withoutoffering the functionality to injured limb. The aim of this study was to describe the fi rst tests of aprototype orthosis for hand function, known as Functional Glove in adult patients with paralysis inthe hand and wrist due to brachial plexus. This research consisted of experimental studie, attendedby three patients. Three instruments were used: Unimanual Function Test, Bimanual Function Testand Satisfaction Questionnaire. The results showed that the patients managed control the openingand closing of the orthosis by means of myoelectric signals picked up by surface electrodes placedover the selected muscles, allowing manipulation of objects in unimanual and bimanual activities.The patients reported high index of satisfaction with the use of Functional Glove.

  11. Coexistence of Brachial Plexus and Cervical Spine Metastases in a Patient With Breast Cancer: Case Report

    Directory of Open Access Journals (Sweden)

    Ece Ünlü

    2012-03-01

    Full Text Available Metastatic involvement of the brachial plexus is a rare condition and is most commonly associated with breast cancer. In patients with breast cancer, brachial plexus metastases should be taken into account in case of severe pain spreading to the shoulder and arm followed by sensory and motor symptoms. Metastatic spinal tumors are the most common type of tumors of the spine. Breast cancer accounts for 21% of all vertebral metastases. Therefore, metastatic spinal tumors should principally be considered in patients with history of malignancy. Coexistence of two metastatic involvements in same patient is the rarest condition. In this case report, we present a patient with a history of breast cancer who was admitted with complaints of severe pain and weakness in the left shoulder, and in whom we detected metastases in both the brachial plexus and the cervical spine. In addition, within the framework of this case report, we aimed to emphasize the importance of electrophysiological studies in detecting two metastatic lesions. Turk J Phys Med Re­hab 2012;58:63-5.

  12. What Are Nerve Blocks for Headache?

    Science.gov (United States)

    ... blocks for headache? Print Email What are nerve blocks for headache? ACHE Newsletter Sign up for our ... your e-mail address below. What are nerve blocks for headache? A nerve block is the injection ...

  13. Nerve Injuries of the Upper Extremity

    Science.gov (United States)

    ... within the “insulated cable.” Nerves serve as the “wires” of the body that carry information to and ... cut, both the nerve and the insulation are broken. Injury to a nerve can stop the transmission ...

  14. Bilateral brachial pull-through technique for stenting in a patient with stenosis of the vertebral artery origin: technical case report

    Energy Technology Data Exchange (ETDEWEB)

    Kusaka, N.; Nishiguchi, M.; Takayama, K.; Nishiura, T. [National Hospital Organization Iwakuni Clinical Center, Department of Neurosurgery, Iwakuni, Yamaguchi (Japan); Tamiya, T. [Kagawa University of Medicine, Department of Neurological Surgery, Kida-gun, Kagawa (Japan)

    2007-10-15

    Stenting for stenosis of the proximal vertebral artery (VA) is commonly performed via a femoral approach. However, iliofemoral occlusive disease such as arteriosclerosis obliterans sometimes prevents safe transfemoral access. In certain situations where both femoral access and ipsilateral brachial access are difficult because of a concomitant vascular diseases or particular anatomic setting, a contralateral brachial approach using the brachiobrachial pull-through technique may allow efficient and accurate stenting. A case of VA origin symptomatic stenosis successfully treated with stenting using the new pull-through technique from the contralateral brachial artery to the brachial artery on the affected side is described. (orig.)

  15. Cold and warm cutaneous sensation in diabetic patients.

    Science.gov (United States)

    Ijff, G A; Bertelsmann, F W; Nauta, J J; Heimans, J J

    1991-01-01

    The assessment of cutaneous thresholds for thermal sensation is now recognized as a valuable method to detect small nerve fibre function in diabetes. Methods commonly used do not allow separate measurements of warm and cold perception. However, there is evidence that the fibre subtypes which signal cold and warm sensation are different (A-delta-fibres and C-fibres, respectively). To investigate if diabetes affects cold and warm sensation equally, thresholds were assessed separately in 30 diabetic patients (age 47.9 +/- 15.1 (+/- SD) years; duration of diabetes, 19.1 +/- 13.3 years). Comparisons were made with 71 non-diabetic control subjects (age 59.7 +/- 22.1 years). Thermal discrimination thresholds for cold and warm sensation were determined for the left foot with a two-alternative forced choice method. In both diabetic patients and in the control group cooling thresholds were smaller than warming thresholds. In diabetic patients log thermal discrimination thresholds for warmth increased 0.1 per decade (p less than 0.001), a relationship comparable to that seen in non-diabetic patients. There was no relationship between cooling thresholds and age in diabetic patients despite a significant (p less than 0.001) deterioration with age in control subjects. This difference in the influence of age on cold sensitivity was significant (p less than 0.03). Both warm and cold sensation were not related to the duration of diabetes. We conclude that assessment of warm threshold is preferred for the detection of minor disturbances of small nerve fibre function in diabetes. PMID:1825963

  16. The Surgical Management of Facial Nerve Injury

    OpenAIRE

    Rovak, Jason M.; Tung, Thomas H.; Mackinnon, Susan E

    2004-01-01

    The surgical management of facial nerve injuries is dependent upon a thorough understanding of facial nerve anatomy, nerve physiology, and microsurgical techniques. When possible, primary neurorrhaphy is the “gold standard” repair technique. Injuries resulting in long nerve gaps or a significant delay between the time of injury and repair requires alterative techniques, such as nerve grafts, nerve transfers, regional muscle transfers, free tissue transfers, and static procedures. Scrupulous t...

  17. Autonomic markers of emotional processing: skin sympathetic nerve activity in humans during exposure to emotionally-charged images

    Directory of Open Access Journals (Sweden)

    RachaelBrown

    2012-10-01

    Full Text Available The sympathetic innervation of the skin primarily subserves thermoregulation, but the system has also been commandeered as a means of expressing emotion. While it is known that the level of skin sympathetic nerve activity (SSNA is affected by anxiety, the majority of emotional studies have utilized the galvanic skin response as a means of inferring increases in SSNA. The purpose of the present study was to characterize the changes in SSNA when showing subjects neutral or emotionally-charged images from the International Affective Picture System. Skin sympathetic nerve activity was recorded via tungsten microelectrodes inserted into cutaneous fascicles of the common peroneal nerve in ten subjects. Neutral images, positively-charged images (erotica or negatively-charged images (mutilation were presented in blocks of fifteen images of a specific type, each block lasting two minutes. Images of erotica or mutilation were presented in a quasi-random fashion, each block following a block of neutral images. Both images of erotica or images of mutilation caused significant increases in SSNA, but the increases in SSNA were greater for mutilation. The increases in SSNA were often coupled with sweat release and cutaneous vasoconstriction, however, these markers were not always consistent with the SSNA increases. We conclude that SSNA, comprising cutaneous vasoconstrictor and sudomotor activity, increases with both positively-charged and negatively-charged emotional images. Measurement of SSNA provides a more comprehensive assessment of sympathetic outflow to the skin than does the use of sweat release alone as a marker of emotional processing.

  18. Phylogenetic dichotomy of nerve glycosphingolipids.

    OpenAIRE

    Okamura, N; Stoskopf, M; Hendricks, F.; Kishimoto, Y

    1985-01-01

    Galactocerebrosides and sulfatides are major characteristic components of vertebrate myelin. In contrast, glucocerebroside is the major glycosphingolipid of shrimp nerve. In this study, the concentrations of these glycosphingolipids in the nervous systems of animals from several evolutionary branches were determined by use of high-performance liquid chromatography. In nerves of protostome animals only glucose-containing glycosphingolipids were detected, whereas glycosphingolipids from deutero...

  19. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... That’s what the vagus nerve is. It’s a big nerve in the neck and it delivers impulses ... treat them as early as possible. There’s a big trend in the United States to do that. ...

  20. Somatic neurofibromatosis type 1 (NF1) inactivation events in cutaneous neurofibromas of a single NF1 patient.

    Science.gov (United States)

    Emmerich, Denise; Zemojtel, Tomasz; Hecht, Jochen; Krawitz, Peter; Spielmann, Malte; Kühnisch, Jirko; Kobus, Karolina; Osswald, Monika; Heinrich, Verena; Berlien, Peter; Müller, Ute; Mautner, Victor-F; Wimmer, Katharina; Robinson, Peter N; Vingron, Martin; Tinschert, Sigrid; Mundlos, Stefan; Kolanczyk, Mateusz

    2015-06-01

    Neurofibromatosis type 1 (NF1) (MIM#162200) is a relatively frequent genetic condition that predisposes to tumor formation. The main types of tumors occurring in NF1 patients are cutaneous and subcutaneous neurofibromas, plexiform neurofibromas, optic pathway gliomas, and malignant peripheral nerve sheath tumors. To search for somatic mutations in cutaneous (dermal) neurofibromas, whole-exome sequencing (WES) was performed on seven spatially separated tumors and two reference tissues (blood and unaffected skin) from a single NF1 patient. Validation of WES findings was done using routine Sanger sequencing or Sequenom IPlex SNP genotyping. Exome sequencing confirmed the existence of a known familial splice-site mutation NM_000267.3:c.3113+1G>A in exon 23 of NF1 gene (HGMD ID CS951480) in blood, unaffected skin, and all tumor samples. In five out of seven analyzed tumors, we additionally detected second-hit mutations in the NF1 gene. Four of them were novel and one was previously observed. Each mutation was distinct, demonstrating the independent origin of each tumor. Only in two of seven tumors we detected an additional somatic mutation that was not associated with NF1. Our study demonstrated that somatic mutations of NF1 are likely the main drivers of cutaneous tumor formation. The study provides evidence for the rareness of single base pair level alterations in the exomes of benign NF1 cutaneous tumors. PMID:25293717

  1. Origem do plexo braquial de mocós (Kerodon rupestris wied, 1820) / Origin of brachial plexus of rock cavies (Kerodon rupestris wied, 1820)

    Scientific Electronic Library Online (English)

    Jailson José, Santana; José Fernando Gomes de, Albuquerque; Carlos Eduardo Bezerra de, Moura; Wirton Peixoto, Costa; Moacir Franco de, Oliveira; Raimundo Alves, Barreto Júnior; Maria Angélica, Miglino.

    Full Text Available O mocó, Kerodon rupestris, um mamífero roedor da família dos cavídeos muito parecido com preá, é um animal altamente adaptado às condições de calor e de escassez de água e de alimento, principalmente nos períodos das grandes secas que assolam periodicamente a região do semi-árido nordestino. Verific [...] a-se que na literatura há escassez de dados referentes à anatomia funcional dos mocós e, em especial de trabalhos envolvendo a anatomia do sistema nervoso. Objetivando elucidar o comportamento anatômico do plexo braquial de mocó e com o propósito de contribuir para o desenvolvimento da neuroanatomia comparada, procedeu-se esta pesquisa, na qual foram utilizados dez animais adultos de diferentes idades (nove machos e uma fêmea) que vieram a óbito no Centro de Multiplicação de Animais Silvestres (CEMAS) da Escola Superior de Agricultura de Mossoró-ESAM. Após a fixação em solução aquosa de formol a 10,00%, realizou-se a dissecação bilateral da origem dos plexos braquiais, sendo os resultados registrados em desenhos esquemáticos, e suas disposições agrupadas em tabelas para posterior análise estatística, fundamentada na freqüência percentual. Observando-se que o plexo braquial de mocó é resultante de comunicações estabelecidas, principalmente, entre os ramos ventrais dos três últimos nervos cervicais e dos dois primeiros nervos torácicos, havendo contribuição do quinto nervo cervical em 35,00% dos casos. O plexo braquial originou-se mais freqüentemente a partir de C6, C7, C8, T1 e T2, consiguando-se em 40,00% das dissecações. Abstract in english Rock cavy, Kerodon rupestris a rodent mammal of the Caviidae family, very similar to the cavy is highly adapted to the conditions of heat, shortage of water and food, mainly during the great droughts periods that periodically devastate the northeastern semi-arid area of Brazil. In the literature a s [...] hortage of data is verified regarding the functional anatomy of the rock cavies especially of works that involve the anatomy of the brachial plexus. Aiming at to elucidate the behavior of the brachial plexus of rock cavies and with the purpose of contributing for the development of the compared anatomy, this research was accomplished. Ten animals of different ages were used (nine males and one female) coming from the Wild Animals Multiplication Center (CEMAS) of the Superior School of Agriculture of Mossoró-ESAM. After the slaughter, bilateral dissection of the brachia plexuses took place, and the results were registered in schematic drawings, and the dispositions grouped in tables for subsequent statistical analysis grounded in the percentile frequency. It was observed that the brachium plexus of rock cavy is the result from established communications, mainly, among the ventral ramus of the last three cervical nerves and of the first two thoracic nerves, having a contribution of the fifth cervical nerve in 35.00% of the cases. In 40.00% of the dissections the most frequent plexus was of the type C6, C7, C8, T1 and T2.

  2. Cutaneous blood flow in psoriasis

    International Nuclear Information System (INIS)

    The disappearance rate of 133Xe was studied in 20 patients with psoriasis vulgaris, using an epicutaneous labeling technique in involved skin lesions or normal-appearing skin of the proximal extensor site of the forearm. Control experiments were performed in 10 normal subjects. Calculations of the cutaneous blood flow (CBF) in psoriatic skin lesions were performed using a tissue-to-blood partition coefficient for 133Xe, lambda c,pso, of 1.2 ml/100 g/min. lambda c,pso was estimated after the relative content of water, lipids, and proteins had been analyzed in psoriatic skin biopsies of 6 patients with untreated psoriasis. The mean relative content of water was markedly reduced to 23.5 +/- 1.5% (SEM), and lipids and proteins were markedly increased to 2.5 +/- 0.7% and 74.0 +/- 2.2, respectively, compared to previously published data for normal skin (water 72.5%, lipids 1%, proteins 26.5%). Mean CBF in untreated psoriatic skin was 63.5 +/- 9.0 ml/100 g/min. This was significantly higher than the mean CBF in 10 normal subjects, 6.3 +/- 0.5 ml/100 g/min (p much less than 0.0001). Mean CBF in normal-appearing skin in patients with psoriasis was 11.0 +/- 1.3 ml/100 g/min. This was significantly higher than CBF in normal subjects (p less than 0.0002)

  3. Origin and distribution of the axillary nerve in the giant anteater (Myrmecophaga tridactyla

    Directory of Open Access Journals (Sweden)

    Daniela Cristina de Oliveira Silva

    2012-09-01

    Full Text Available The giant anteater (Myrmecophaga tridactyla, a mammal belonging to the order Xenarthra and family Myrmecophagidae, is an endangered species. For this reason, additional knowledge about its anatomy is of interest, especially the forelimb, which plays important roles in feeding and defense. The goal of this study was to learn more about the origin and distribution of the axillary nerve of Myrmecophaga tridactyla by studying two individuals (one male and one female that belong to the Research Laboratory of Wild Animals (UFU. The study material consisted of corpses fixed and preserved in 10% aqueous formalin solution. Dissection of the material followed standard procedures. In both animals, the axillary nerve was found in the ventral branch of the sixth cervical (C6 and seventh (C7 spinal nerve. This nerve showed symmetry in relation to its position in the two specimens and branched into the teres major, teres minor and deltoid muscles. In both specimens the axillary nerve originated in the cranial cutaneous branch of the lower leg.

  4. The molecular pathology of cutaneous melanoma.

    Science.gov (United States)

    Bogenrieder, Thomas; Herlyn, Meenhard

    2010-01-01

    Cutaneous melanoma is a highly aggressive cancer with still limited, but increasingly efficacious, standard treatment options. Recent preclinical and clinical findings support the notion that cutaneous melanoma is not one malignant disorder but rather a family of distinct molecular diseases. Incorporation of genetic signatures into the conventional histopathological classification of melanoma already has great implications for the management of cutaneous melanoma. Herein, we review our rapidly growing understanding of the molecular biology of cutaneous melanoma, including the pathogenic roles of the mitogen-associated protein kinase (MAPK) pathway, the phosphatidylinositol 3 kinase [PI3K]/phosphatase and tensin homologue deleted on chromosome 10 [PTEN]/Akt/mammalian target of rapamycin [mTOR])PTEN (phosphatase and tensin homolog) pathway, MET (hepatocyte growth factor), Notch signaling, and other key molecules regulating cell cycle progression and apoptosis. The mutation Val600Glu in the BRAF oncogene (designated BRAF(V600E)) has been associated with clinical benefit from agents that inhibit BRAF(V600E) or MEK (a kinase in the MAPK pathway). Cutaneous melanomas arising from mucosal, acral, chronically sun-damaged surfaces sometimes have oncogenic mutations in KIT, against which several inhibitors have shown clinical efficacy. These findings suggest that prospective genotyping of patients with melanoma, combined with the growing availability of targeted agents, which can be used to rationally exploit these findings, should be used increasingly as we work to develop new and more effective treatments for this devastating disease. PMID:22112480

  5. Isolated Ocular Motor Nerve Palsies.

    Science.gov (United States)

    Kung, Nathan H; Van Stavern, Gregory P

    2015-10-01

    An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing neurologic signs or symptoms. When occurring in patients aged 50 or older, the most common cause is microvascular ischemia, but serious etiologies such as aneurysm, malignancy, and giant cell arteritis should always be considered. In this article, the authors review the clinical approach, anatomy, and differential diagnosis of each isolated ocular motor nerve palsy and discuss the clinical characteristics, pathophysiology, and treatment of microvascular ischemia. PMID:26444399

  6. GRP nerves in pig antrum

    DEFF Research Database (Denmark)

    Holst, J J; Poulsen, Steen Seier

    1987-01-01

    We extracted gastrin-releasing peptide (GRP) and its C-terminal decapeptide corresponding to 6.4 and 6.8 pmol/g from pig antrum mucosa. By immunohistochemistry GRP was localized to mucosal, submucosal, and myenteric nerve fibers. A few nerve cell bodies were also identified. Using isolated perfused pig antrum with intact vagal innervation, we found concomitant, atropine-resistant release of GRP and gastrin during electrical stimulation of the vagal nerves. Intra-arterial GRP at 10(-11)-10(-10) m...

  7. Nerve entrapment syndromes in musicians.

    Science.gov (United States)

    Wilson, Robert J; Watson, Jeffry T; Lee, Donald H

    2014-09-01

    Nerve entrapment syndromes are common in instrumental musicians. Carpal tunnel syndrome, ulnar neuropathy at the elbow, and thoracic outlet syndrome appear to be the most common. While electrodiagnostic studies may confirm the diagnosis of nerve entrapment, they may be falsely normal in musicians. Non-operative treatment with instrument and technique modification may help. Involvement with the musician's teacher to implement appropriate treatment is recommended. Outcomes for both non-operative and operative treatment for various nerve entrapment syndromes have yielded mostly good to excellent results, similar to the general population. PMID:24644143

  8. Nanofibrous nerve conduit-enhanced peripheral nerve regeneration.

    Science.gov (United States)

    Jiang, Xu; Mi, Ruifa; Hoke, Ahmet; Chew, Sing Yian

    2014-05-01

    Fibre structures represent a potential class of materials for the formation of synthetic nerve conduits due to their biomimicking architecture. Although the advantages of fibres in enhancing nerve regeneration have been demonstrated, in vivo evaluation of fibre size effect on nerve regeneration remains limited. In this study, we analyzed the effects of fibre diameter of electrospun conduits on peripheral nerve regeneration across a 15-mm critical defect gap in a rat sciatic nerve injury model. By using an electrospinning technique, fibrous conduits comprised of aligned electrospun poly (?-caprolactone) (PCL) microfibers (981?±?83 nm, Microfiber) or nanofibers (251?±?32 nm, Nanofiber) were obtained. At three months post implantation, axons regenerated across the defect gap in all animals that received fibrous conduits. In contrast, complete nerve regeneration was not observed in the control group that received empty, non-porous PCL film conduits (Film). Nanofiber conduits resulted in significantly higher total number of myelinated axons and thicker myelin sheaths compared to Microfiber and Film conduits. Retrograde labeling revealed a significant increase in number of regenerated dorsal root ganglion sensory neurons in the presence of Nanofiber conduits (1.93 ± 0.71 × 10(3) vs. 0.98 ± 0.30 × 10(3) in Microfiber, p?nerve regeneration. These results could provide useful insights for future nerve guide designs. PMID:22700359

  9. Cutaneous sarcoidosis: A rare case report

    Directory of Open Access Journals (Sweden)

    Bindu Suparna M, Joshi Shivani

    2014-07-01

    Full Text Available Sarcoidosis is a Greek word (Sarco means flesh and Eido means type or like. Cutaneous sarcoidosis occurs in up to one third of patients with systemic sarcoidosis. This disease is characterised by the presence of non – caseating epitheloid cell granulomas in the skin. Cutaneous sarcoidosis presents as a diagnostic challenge to the dermatopathologists due to its varied presentations and almost identical histologic pictures. Hence, exclusion of infectious causes and compatibility with clinical and radiologic picture serve as significant criteria to come up to a diagnosis. Sometimes; skin lesions are the first manifestation of systemic sarcoidosis. This is not a contagious or allergic disease. There is a risk of development of systemic manifestations at a later date; for which a close follow up is a must. We are presenting a case of cutaneous sarcoidosis, which later on progress to sarcoidosis with systemic manifestations.

  10. Subacute cutaneous lupus erythematosus presenting as poikiloderma.

    LENUS (Irish Health Repository)

    Hughes, R

    2012-02-01

    Subacute cutaneous lupus erythematosus (SCLE) is a recognised variant of lupus erythematosus (LE), which accounts for 10-15% of all cases of cutaneous LE, occurring most commonly in young to middle-aged white women. Diagnosis is based on the detection of anti-Ro\\/SS-A antibodies in the skin and serum, characteristic clinical and histological cutaneous involvement, and relatively mild systemic involvement. Several unusual variants of SCLE have been reported including erythrodermic SCLE, SCLE with vitiligo-like lesions, acral SCLE and bullous SCLE. Poikoilodermatous SCLE is a recognised but rare variant of SCLE. There are currently only two case reports, comprising five individual cases, in the literature. We present a case of SCLE in which the main clinical findings were an extensive photodistributed poikilodermatous rash and alopecia.

  11. Diffuse cutaneous leishmaniasis in coexistence with leprosy.

    Science.gov (United States)

    Patrao, Ninon A R; Bhat, Ramesh M; Dandekeri, Sukumar; Kambil, Srinath M

    2015-12-01

    Cutaneous leishmaniasis and leprosy are diseases both caused by intracellular pathogens that represent a major health predicament even today. Both these diseases have some characteristics in common, such as the involvement of mucocutaneous tissue, a course with a chronic granulomatous response, a broad clinical spectrum in relation to the host's immunity, and they often affect the poor population in tropical countries. Co-infection of the two diseases, although known to occur, is rarely encountered and reported. Even though new cases of leprosy are diagnosed in the region of coastal Karnataka of India, cutaneous leishmaniasis is rarely reported. We hereby describe a patient who presented with concurrent leprosy and diffuse cutaneous leishmaniasis. PMID:26266674

  12. Histopathological spectrum in cutaneous leishmaniasis: A study in Oman

    OpenAIRE

    Venkataram Mysore; Moosa Mohammed; Devi Leena

    2001-01-01

    Cutaneous leishmaniasis presents a spectrum of manifestations both clinically and histologically. Several previous studies have established the value of histological examination in the diagnosis of cutaneous leishmaniasis. Different reaction patterns have been reported. Forty caes of cutaneous leishmaniasis were studied in the Sultanate of Oman, with particular reference to the different histological features. Clinical features were correlated with the histological patterns. Four histological...

  13. Cutaneous Silicone Granuloma Mimicking Breast Cancer after Ruptured Breast Implant

    OpenAIRE

    Waseem Asim Ghulam El-Charnoubi; Trine Foged Henriksen; Jens Joergen Elberg

    2011-01-01

    Cutaneous manifestations due to migration of silicone from ruptured implants are rare. Migrated silicone with cutaneous involvement has been found in the chest wall, abdominal wall, and lower extremities. We describe a case of cutaneous silicone granuloma in the breast exhibiting unusual growth mimicking breast cancer after a ruptured implant.

  14. Recurrence of Prostate Cancer with Cutaneous Metastasis after Radical Prostatectomy

    OpenAIRE

    Patel, Parth; Patel, Jay; Siddiqui, Sameer

    2015-01-01

    While cutaneous metastases are already extremely rare in primary metastatic prostatic adenocarcinoma, cutaneous manifestations in recurrent prostate cancer have rarely been described prior to this report. Here we present the case report of a 93-year-old male who underwent radical prostatectomy but eventually suffered from a previously undescribed recurrence of prostatic adenocarcinoma with distant cutaneous metastases to proximal right lower leg.

  15. Normal tissue tolerance to external beam radiation therapy: Peripheral nerves; Dose de tolerance a l'irradiation des tissus sains: les nerfs peripheriques

    Energy Technology Data Exchange (ETDEWEB)

    Henriques de Figueiredo, B.; Dejean, C.; Sargos, P.; Kantor, G. [Departement de radiotherapie, institut Bergonie, centre regional de lutte contre le cancer, 33 - Bordeaux (France); Huchet, A.; Mamou, N. [Service d' oncologie medicale et de radiotherapie, CHU Saint-Andre, 33 - Bordeaux (France); Loiseau, H. [Service de neurochirurgie, CHU Pellegrin, 33 - Bordeaux (France)

    2010-07-15

    Plexopathies and peripheral neuropathies appear progressively and with several years delay after radiotherapy. These lesions are observed principally after three clinical situations: supraclavicular and axillar irradiations for breast cancer, pelvic irradiations for various pathologies and limb irradiations for soft tissue sarcomas. Peripheral nerves and plexus (brachial and lumbosacral) are described as serial structures and are supposed to receive less than a given maximum dose linked to the occurrence of late injury. Literature data, mostly ancient, define the maximum tolerable dose to a threshold of 60 Gy and highlight also a great influence of fractionation and high fraction doses. For peripheral nerves, most frequent late effects are pain with significant differences of occurrence between 50 and 60 Gy. At last, associated pathologies (diabetes, vascular pathology, neuropathy) and associated treatments have probably to be taken into account as additional factors, which may increase the risk of these late radiation complications. (authors)

  16. Diagnosis of Cutaneous Leishmaniasis by Multiplex PCR

    Directory of Open Access Journals (Sweden)

    M Heiat

    2010-07-01

    Full Text Available Introduction: Annually, more than 14 million people are reported to be infected with Leishmaniasis all over the world. In Iran, this disease is seen in the form of cutaneous and visceral leishmaniasis, of which the cutaneous form is more wide spread. In recent years, cutaneous leishmaniaisis is diagnosed by PCR utilizing specific primers in order to amplify different parasite genes including ribosomal RNA genes, kinetoplast DNA or tandem repeating sequences. The aim of this research was to detect early stage cutaneous leishmaniasis using Multiplex-PCR technique. Methods: In this study, 67 samples were prepared from patients with cutaneous leishmaniasis. DNA was extracted with phenolchloroform. Each specimen was analyzed using two different pairs of PCR primers. The sensitivity of each PCR was optimized on pure Leishmania DNA prior to use for diagnosis. Two standard parasites L. major and L. tropica were used as positive control. Results: DNA amplification fragments were two 115 bp and 683 bp for AB and UL primers, respectively. The sensitivity of two primers was not equal for detection of L. major and L. tropica. The sensivity of PCR with AB primer was 35 cells, while that for UL primer was 40 cells. Conclusion: The results of this study indicate that PCR is a sensitive diagnostic assay for cutaneous leishmaniasis and could be employed as the new standard for routine diagnosis when species identification is not required. However, the ability to identify species is especially important in prognosis of the disease and in deciding appropriate therapy, especially in regions where more than one type of species and disease are seen by clinicians.

  17. Decreased Nerve Conduction Velocity in Football Players

    Directory of Open Access Journals (Sweden)

    Daryoush Didehdar

    2014-06-01

    Full Text Available Background: Lower limbs nerves are exposed to mechanical injuries in the football players and the purpose of this study is to evaluate the influence of football on the lower leg nerves. Materials and Methods: Nerve conduction studies were done on 35 male college students (20 football players, 15 non active during 2006 to 2007 in the Shiraz rehabilitation faculty. Standard nerve conduction techniques using to evaluate dominant and non dominant lower limb nerves. Results: The motor latency of deep peroneal and tibial nerves of dominant leg of football players and sensory latency of superficial peroneal, tibial and compound nerve action potential of tibial nerve of both leg in football players were significantly prolonged (p<0.05. Motor and sensory nerve conduction velocity of tibial and common peroneal in football players were significant delayed (p<0.05. Conclusion: It is concluded that football is sport with high contact and it causes sub-clinical neuropathies due to nerve entrapment.

  18. Análise comparativa da origem do plexo branquial de catetos (Tayassu tajacu) / Comparative analysis of the origin of the brachial plexus of the collared peccary (Tayassu tajacu)

    Scientific Electronic Library Online (English)

    Carlos Eduardo B., Moura; José Fernando G., Albuquerque; Marcela S., Magalhães; Naisandra Bezerra, Silva; Moacir F., Oliveira; Paula C., Papa.

    2007-09-01

    Full Text Available O cateto (Tayassu tajacu) pertence à familia Tayassui-dae e é caracterizado por "colar" de pêlos brancos ao redor do pescoço que se estende bilateralmente cranialmente aos ombros. Pode ser encontrado do sudoeste dos Estados Unidos da América até a Argentina. Na literatura verificou-se a falta de dad [...] os a respeito da anatomia funcional do cateto especialmente trabalhos que envolvem a anatomia do plexo braquial. Visando elucidar o comportamento do plexo braquial do cateto e com a finalidade de contribuir para o desenvolvimento da anatomia comparada, realizou-se esta pesquisa. Utilizou-se 30 animais de idades diferentes (13 fêmeas e 17 machos) provenientes do Centro de Multiplicação de Animais Silvestres, Universidade Federal Rural do Semi-árido, Mossoró, Rio Grande do Norte. Após o abate, realizou-se a dissecação bilateral dos plexos braquiais e registraram-se os resultados através de desenhos esquemáticos e as disposições agrupadas em tabelas para subseqüente análise estatística e obtidas as freqüências percentuais. Observou-se que o plexo braquial de catetos é resultado das comunicações estabelecidas, principalmente, entre os ramos ventrais dos três últimos nervos espinhais cervicais (C6, C7 e C8) e dos dois primeiros nervos espinhais torácicos (T1 e T2), tendo uma contribuição do quarto e quinto nervos cervicais em 16,67% e 50,00% dos casos, respectivamente. Em 40,00% das dissecações a formação do plexo, mais freqüente, foi do tipo C6, C7, C8, T1 e T2. Os principais nervos derivados do plexo braquial dos catetos e suas respectivas origens foram: nervo supraescapular (C6 e C7), nervo subscapular (C5, C6 e C7 ou C6 e C7), nervo axilar (C6 e C7), nervo músculocutâneo (C7 e C8), nervo mediano (C7, C8, T1 e T2), nervo ulnar (C8, T1 e T2), nervo radial (C8, T1 e T2), nervos peitorais craniais (C7) e caudais (C7 e C8), nervo toracodorsal (C6, C7 e C8), nervo torácico longo (C7 e C8) e nervo torácico lateral (C8, T1 e T2). Abstract in english Collared peccary (Tayassu tajacu) belongs to the Tayassuidae family, characterized by a "collar" of white hairs that cross behind the neck and extend bilaterally in front of the shoulders. It can be found from south-western United States to Argentina. In the literature a shortage of data is verified [...] regarding the functional anatomy of the collared peccaries, especially of studies that involve the anatomy of the brachial plexus. To elucidate the behavior of this plexus of collared peccaries and with the purpose to contribute for the development of compared anatomy, this study was accomplished. Thirty animals of different ages were used (17 males and 13 females) coming from the Wild Animal Multiplication Center of the "Universidade Federal Rural do Semiárido" Mossoró, Rio Grande do Norte, Brazil. After slaughter bilateral dissection of the brachial plexuses took place, and the results were registered in schematic drawings and the dispositions grouped in tables for subsequent statistical analysis based on the percentile frequency. It was found that the Plexus brachialis of collared peccaries is the result of established communications, mainly among the Rami ventrales of the last three cervical nerves and of the first two thoracic nerves, having a contribution of the fourth and fifth cervical nerves in 16.67% and 50.00% of the cases, respectively. In 40.00% of the dissections the most frequent plexus was of the type C6, C7, C8, T1 and T2. The main nerves derived from brachial plexus of the collared peccaries and its respective origins had been: Nervus suprascapularis (C6, C7), Nn. subscapulares (C5, C6 e C7 or C6 e C7), N. axillaris (C6, C7), N. musculocutaneus (C7, C8), N. medianus (C7, C8, T1, T2), N. radialis (C8, T1, T2), N. ulnaris (C8, T1, T2), cranialis (C7), and caudalis (C7, C8) Nn. pectorales , N. thoracodorsalis (C6, C7, C8), N. thoracicus longus (C7, C8), and N. thoracicus lateralis (C8, T1, T2).

  19. Análise comparativa da origem do plexo branquial de catetos (Tayassu tajacu Comparative analysis of the origin of the brachial plexus of the collared peccary (Tayassu tajacu

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo B. Moura

    2007-09-01

    Full Text Available O cateto (Tayassu tajacu pertence à familia Tayassui-dae e é caracterizado por "colar" de pêlos brancos ao redor do pescoço que se estende bilateralmente cranialmente aos ombros. Pode ser encontrado do sudoeste dos Estados Unidos da América até a Argentina. Na literatura verificou-se a falta de dados a respeito da anatomia funcional do cateto especialmente trabalhos que envolvem a anatomia do plexo braquial. Visando elucidar o comportamento do plexo braquial do cateto e com a finalidade de contribuir para o desenvolvimento da anatomia comparada, realizou-se esta pesquisa. Utilizou-se 30 animais de idades diferentes (13 fêmeas e 17 machos provenientes do Centro de Multiplicação de Animais Silvestres, Universidade Federal Rural do Semi-árido, Mossoró, Rio Grande do Norte. Após o abate, realizou-se a dissecação bilateral dos plexos braquiais e registraram-se os resultados através de desenhos esquemáticos e as disposições agrupadas em tabelas para subseqüente análise estatística e obtidas as freqüências percentuais. Observou-se que o plexo braquial de catetos é resultado das comunicações estabelecidas, principalmente, entre os ramos ventrais dos três últimos nervos espinhais cervicais (C6, C7 e C8 e dos dois primeiros nervos espinhais torácicos (T1 e T2, tendo uma contribuição do quarto e quinto nervos cervicais em 16,67% e 50,00% dos casos, respectivamente. Em 40,00% das dissecações a formação do plexo, mais freqüente, foi do tipo C6, C7, C8, T1 e T2. Os principais nervos derivados do plexo braquial dos catetos e suas respectivas origens foram: nervo supraescapular (C6 e C7, nervo subscapular (C5, C6 e C7 ou C6 e C7, nervo axilar (C6 e C7, nervo músculocutâneo (C7 e C8, nervo mediano (C7, C8, T1 e T2, nervo ulnar (C8, T1 e T2, nervo radial (C8, T1 e T2, nervos peitorais craniais (C7 e caudais (C7 e C8, nervo toracodorsal (C6, C7 e C8, nervo torácico longo (C7 e C8 e nervo torácico lateral (C8, T1 e T2.Collared peccary (Tayassu tajacu belongs to the Tayassuidae family, characterized by a "collar" of white hairs that cross behind the neck and extend bilaterally in front of the shoulders. It can be found from south-western United States to Argentina. In the literature a shortage of data is verified regarding the functional anatomy of the collared peccaries, especially of studies that involve the anatomy of the brachial plexus. To elucidate the behavior of this plexus of collared peccaries and with the purpose to contribute for the development of compared anatomy, this study was accomplished. Thirty animals of different ages were used (17 males and 13 females coming from the Wild Animal Multiplication Center of the "Universidade Federal Rural do Semiárido" Mossoró, Rio Grande do Norte, Brazil. After slaughter bilateral dissection of the brachial plexuses took place, and the results were registered in schematic drawings and the dispositions grouped in tables for subsequent statistical analysis based on the percentile frequency. It was found that the Plexus brachialis of collared peccaries is the result of established communications, mainly among the Rami ventrales of the last three cervical nerves and of the first two thoracic nerves, having a contribution of the fourth and fifth cervical nerves in 16.67% and 50.00% of the cases, respectively. In 40.00% of the dissections the most frequent plexus was of the type C6, C7, C8, T1 and T2. The main nerves derived from brachial plexus of the collared peccaries and its respective origins had been: Nervus suprascapularis (C6, C7, Nn. subscapulares (C5, C6 e C7 or C6 e C7, N. axillaris (C6, C7, N. musculocutaneus (C7, C8, N. medianus (C7, C8, T1, T2, N. radialis (C8, T1, T2, N. ulnaris (C8, T1, T2, cranialis (C7, and caudalis (C7, C8 Nn. pectorales , N. thoracodorsalis (C6, C7, C8, N. thoracicus longus (C7, C8, and N. thoracicus lateralis (C8, T1, T2.

  20. Cutaneous toxoplasmosis in an immunosuppressed dog

    Directory of Open Access Journals (Sweden)

    T.S. Oliveira

    2014-06-01

    Full Text Available A seven-year-old female spayed Schnauzer was presented with cutaneous ulcerated nodular lesions shortly after the beginning of an immunosuppressive treatment for immune-mediated hemolytic disease. Cytology was performed and a great number of neutrophils and banana-shaped organisms were observed. Biopsy showed a neutrophilic and histiocytic dermatitis and panniculitis with myriads of intralesional bradyzoites cysts and tachyzoites. PCR analysis was positive for Toxoplasma gondii and negative for Neospora caninum. Immunohistochemistry confirmed intralesional T. gondii antigens. This study reports a rare case of cutaneous toxoplasmosis in an immunosuppressed dog.

  1. Cutaneous gene therapy--an update

    DEFF Research Database (Denmark)

    Christensen, R; Jensen, Uffe Birk

    2001-01-01

    In this paper we review various strategies for gene transfer into the skin, their applications and show some of our own examples. The skin is the most accessible somatic tissue. Inherited skin diseases, such as epidermolysis bullosa and ichthyosis, and various systemic metabolic disorders are under investigation as potential candidate diseases for cutaneous gene transfer. Research is directed against genetic therapy of wounds and malignancies as well. So far, cutaneous gene transfer only has been used experimentally, but several clinical trials are under preparation.

  2. Diffuse cutaneous leishmaniasis in HIV positive woman

    OpenAIRE

    Niloofar Mehrolhasani

    2014-01-01

    A 29 years old woman was come to our dermatology clinic with a 1 month history of lesions on her face and extremity. She was diagnosed with HIV from 6 months ago and since then she was on treatment for HIV. Clinical examination was notable for painless indurated erythematous plauqe on her face and erythematous papule on her extremities (Fig. 1, 2). The Patient was from Bam (Iran), in which cutaneous leishmaniasis is endemic. She has history of cutaneous leishmaniasis 4 years ago. In that time...

  3. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available VAGUS NERVE STIMULATOR IMPLANTATION LEBONHEUR CHILDREN’S MEDICAL CENTER, MEMPHIS, TN Broadcast October 28, 2004 NARRATOR Approximately 1% of children in the United States have some form of epilepsy. You ...

  4. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... vagus nerve stimulation is its lack of side effects. Patients who are getting this are patients who ... in contradistinction to medication, there are no side effects that are cognitive. A lot of the epilepsy ...

  5. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... Soccer is really not a contact sport. The only thing we’d probably really restrict is football. ... vagus nerve stimulation help prevent seizures? We would only do it in a patient who is having ...

  6. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... the electrodes, so when the patient turns their head, it will not pull on the nerve. So ... is the one that goes closest to the head and that is the one that’s furthest away ...

  7. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... us. One of the questions was does the implant have to be replaced after a period of ... tests when someone has a vagus nerve stimulator implant? That’s also a very good question. The answer ...

  8. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... hazards of other kinds of medical treatment or tests when someone has a vagus nerve stimulator implant? ... close, we’re going to perform a computer test on it to make sure the connection is ...

  9. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... under the age of 12. One of the benefits of this type of therapy is that the ... back and forth to program the device. Another benefit of vagus nerve stimulation is its lack of ...

  10. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... watching a live surgical procedure performed on a young child for the implantation of a vagus nerve ... here, surgical tech. Nicki Friedman. This is a young 9-year-old who has a history of ...

  11. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... a live surgical procedure performed on a young child for the implantation of a vagus nerve stimulator ... have a comprehensive epilepsy center here that this child is participating in its program and this is ...

  12. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... that’s underneath the skin, and it will automatically cause the device to trigger. This is very powerful. ... also been asked does vagus nerve stimulator therapy cause sleep disturbances? The answer to that question is ...

  13. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... of vagus nerve stimulation is its lack of side effects. Patients who are getting this are patients who ... that, in contradistinction to medication, there are no side effects that are cognitive. A lot of the epilepsy ...

  14. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... and his parents also recognize some spells during sleep at night, where he probably has some seizures ... been asked does vagus nerve stimulator therapy cause sleep disturbances? The answer to that question is no, ...

  15. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... about to see a vagus nerve stimulation, a safe and effective treatment for children with uncontrollable seizures ... device has proven to be very reliable and safe. Again, there’s been over 4,800 children implanted ...

  16. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... staff is excellent and the care is world class here. We have a 5-bed epilepsy monitoring ... emailed in previously was do small electrical appliances, cellular phones, or metal detectors affect vagus nerve stimulation? The ...

  17. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... seems to afford them the best long-term function. STEPHANIE EINHAUS, M.D. So I think the ... small. That nerve has a lot of different functions. It has to do with stomach function, mobility ...

  18. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... this is we now have long-term outcome data for patients with vagus nerve stimulators, that have ... call drop attacks, which is a real ugly type of seizure where they fall and hurt themselves ...

  19. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... nerve stimulator to try to improve his seizure control. So what you’ll see here is there ... the patient or the patient’s caregivers have some control over the device. It does automatically fire however ...

  20. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available VAGUS NERVE STIMULATOR IMPLANTATION LEBONHEUR CHILDREN’S MEDICAL CENTER, MEMPHIS, TN Broadcast October 28, 2004 NARRATOR Approximately 1% of children in the United States have some form of ...

  1. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... this is we now have long-term outcome data for patients with vagus nerve stimulators, that have ... currently having. Some patients don’t have as big an effect. It is extraordinarily rare to make ...

  2. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... ve attached the electrodes out of the chest wall here. You can see there’s a little bit ... on each side of your neck and another function of this nerve, a branch of it, has ...

  3. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... States have some form of epilepsy. You are about to see a vagus nerve stimulation, a safe ... under the skin for the stimulator, which is about the same size as a pacemaker for the ...

  4. Experimental nerve regeneration. A review.

    Science.gov (United States)

    Wong, B J; Mattox, D E

    1991-06-01

    The aim of peripheral nerve repair is to restore motor and sensory function, which requires more than just 10-0 sutures and a good microscope. The past decade has seen an explosion in the understanding of how nerves grow, and this information is being used to develop better treatments for nerve injuries. In the future, treatment will not be limited to the operating room, because postoperative adjuvant therapies will become increasingly more important in the management of nerve repairs. At the same time, advancement in manufacturing techniques, a better understanding of biomaterials, and the use of the laser will replace the time-honored techniques of surgical repair in many clinical settings. PMID:1762787

  5. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... vagus nerve stimulation is its lack of side effects. Patients who are getting this are patients who are already refractory to other drugs. If you can see here on the screen, ...

  6. Ultrasound-guided pain interventions - a review of techniques for peripheral nerves.

    Science.gov (United States)

    Soneji, Neilesh; Peng, Philip Wenn Hsin

    2013-04-01

    Ultrasound has emerged to become a commonly used modality in the performance of chronic pain interventions. It allows direct visualization of tissue structure while allowing real time guidance of needle placement and medication administration. Ultrasound is a relatively affordable imaging tool and does not subject the practitioner or patient to radiation exposure. This review focuses on the anatomy and sonoanatomy of peripheral non-axial structures commonly involved in chronic pain conditions including the stellate ganglion, suprascapular, ilioinguinal, iliohypogastric, genitofemoral and lateral femoral cutaneous nerves. Additionally, the review discusses ultrasound guided intervention techniques applicable to these structures. PMID:23614071

  7. Biochemical engineering nerve conduits using peptide amphiphiles.

    OpenAIRE

    A Tan; Rajadas, J.; Seifalian, A M

    2012-01-01

    Peripheral nerve injury is a debilitating condition. The gold standard for treatment is surgery, requiring an autologous nerve graft. Grafts are harvested from another part of the body (a secondary site) to treat the affected primary area. However, autologous nerve graft harvesting is not without risks, with associated problems including injury to the secondary site. Research into biomaterials has engendered the use of bioartificial nerve conduits as an alternative to autologous nerve grafts....

  8. Effect of salt intake and potassium supplementation on brachial-ankle pulse wave velocity in Chinese subjects: an interventional study

    Scientific Electronic Library Online (English)

    Y., Wang; J.J., Mu; L.K., Geng; D., Wang; K.Y., Ren; T.S., Guo; C., Chu; B.Q., Xie; F.Q., Liu; Z.Y., Yuan.

    2015-01-01

    Full Text Available Accumulating evidence has suggested that high salt and potassium might be associated with vascular function. The aim of this study was to investigate the effect of salt intake and potassium supplementation on brachial-ankle pulse wave velocity (PWV) in Chinese subjects. Forty-nine subjects (28-65 ye [...] ars of age) were selected from a rural community of northern China. All subjects were sequentially maintained on a low-salt diet for 7 days (3.0 g/day NaCl), a high-salt diet for an additional 7 days (18.0 g/day NaCl), and a high-salt diet with potassium supplementation for a final 7 days (18.0 g/day NaCl+4.5 g/day KCl). Brachial-ankle PWV was measured at baseline and on the last day of each intervention. Blood pressure levels were significantly increased from the low-salt to high-salt diet, and decreased from the high-salt diet to high-salt plus potassium supplementation. Baseline brachial-ankle PWV in salt-sensitive subjects was significantly higher than in salt-resistant subjects. There was no significant change in brachial-ankle PWV among the 3 intervention periods in salt-sensitive, salt-resistant, or total subjects. No significant correlations were found between brachial-ankle PWV and 24-h sodium and potassium excretions. Our study indicates that dietary salt intake and potassium supplementation, at least in the short term, had no significant effect on brachial-ankle PWV in Chinese subjects.

  9. Brachial Plexopathy in Apical Non-Small Cell Lung Cancer Treated With Definitive Radiation: Dosimetric Analysis and Clinical Implications

    International Nuclear Information System (INIS)

    Purpose: Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients. Methods and Materials: Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received ?50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines. Results: Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received ?78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving ?1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively. Conclusions: RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of patients.

  10. New technique for CT during arterial portography performed with left brachial artery approach

    International Nuclear Information System (INIS)

    A new technique of CT during arterial portography (CTAP) performed with a left brachial artery approach is presented. We used 4-F, 50-cm J-shaped sheath introducer with a straight dilator and angled 4-F catheter with side holes. Catheter insertion to the superior mesenteric artery (SMA) can be performed without any trouble by the help of a J-shaped long sheath introducer positioned in the aortic arch. In our experience, 10 min compression of the puncture site and 2 h observation after catheter removal brought no local complication. This method can be performed safely on outpatient basis. (orig.)

  11. Vagal nerve stimulator: Evolving trends

    OpenAIRE

    Ogbonnaya, Sunny; Kaliaperumal, Chandrasekaran

    2013-01-01

    Over three decades ago, it was found that intermittent electrical stimulation from the vagus nerve produces inhibition of neural processes, which can alter brain activity and terminate seizures. This paved way for the concept of vagal nerve stimulator (VNS). We describe the evolution of the VNS and its use in different fields of medicine. We also review the literature focusing on the mechanism of action of VNS producing desired effects in different conditions. PUBMED and EMBASE search was per...

  12. Unilateral traumatic oculomotor nerve paralysis

    International Nuclear Information System (INIS)

    The present authors report a case of unilateral traumatic oculomotor nerve paralysis which shows interesting CT findings which suggest its mechanism. A 60-year-old woman was admitted to our hospital with a cerebral concussion soon after a traffic accident. A CT scan was performed soon after admission. A high-density spot was noted at the medial aspect of the left cerebral peduncle, where the oculomotor nerve emerged from the midbrain, and an irregular, slender, high-density area was delineated in the right dorsolateral surface of the midbrain. Although the right hemiparesis had already improved by the next morning, the function of the left oculomotor nerve has been completely disturbed for the three months since the injury. In our case, it is speculated that an avulsion of the left oculomotor nerve rootlet occurred at the time of impact as the mechanism of the oculomotor nerve paralysis. A CT taken soon after the head injury showed a high-density spot; this was considered to be a hemorrhage occurring because of the avulsion of the nerve rootlet at the medial surface of the cerebral peduncle. (J.P.N.)

  13. Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography

    Scientific Electronic Library Online (English)

    Eduardo D. E., Papa; Izo, Helber; Manes R., Ehrlichmann; Claudia Maria Rodrigues, Alves; Marcia, Makdisse; Livia N., Matos; Jairo Lins, Borges; Renato D., Lopes; Edson, Stefanini; Antonio Carlos, Carvalho.

    2013-12-01

    Full Text Available OBJECTIVES: To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease. METHODS: We analyzed prospective data from [...] 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of

  14. Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration

    International Nuclear Information System (INIS)

    Unfavorable complex anatomy or congenital anomalies of supra-aortic vessel take-off may increase carotid artery stenting (CAS) procedural difficulties and complications through the femoral route. We assessed the feasibility, safety, and efficacy of CAS through the right brachial approach in patients in whom left internal carotid artery stenosis and bovine aortic arch configuration were identified with computed tomography (CT) angiography. Bovine configuration of the aortic arch and left carotid artery stenosis were easily identified by CT angiography and successfully treated through the right brachial approach technique. (orig.)

  15. Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration

    Energy Technology Data Exchange (ETDEWEB)

    Montorsi, Piero; Galli, Stefano; Ravagnani, Paolo; Ghulam Ali, Sarah; Trabattoni, Daniela; Fabbiocchi, Franco; Lualdi, Alessandro; Ballerini, Giovanni; Andreini, Daniele; Pontone, Gianluca; Annoni, Andrea; Bartorelli, Antonio L. [Institute of Cardiology University of Milan, Centro Cardiologico Monzino, IRCCS, Milan (Italy)

    2009-08-15

    Unfavorable complex anatomy or congenital anomalies of supra-aortic vessel take-off may increase carotid artery stenting (CAS) procedural difficulties and complications through the femoral route. We assessed the feasibility, safety, and efficacy of CAS through the right brachial approach in patients in whom left internal carotid artery stenosis and bovine aortic arch configuration were identified with computed tomography (CT) angiography. Bovine configuration of the aortic arch and left carotid artery stenosis were easily identified by CT angiography and successfully treated through the right brachial approach technique. (orig.)

  16. Cutaneous Manifestations in POEMS Syndrome: Case Report and Review

    Science.gov (United States)

    Marinho, Flauberto Sousa; Pirmez, Rodrigo; Nogueira, Renata; Cuzzi, Tullia; Sodré, Celso Tavares; Silva, Marcia

    2015-01-01

    The authors report a case of sensorimotor polyneuropathy, diffuse cutaneous hyperpigmentation, skin sclerodermiform thickening and papular lesions in the infraclavicular and abdominal region. Besides weight loss, there were diabetes mellitus and hypothyroidism. The alterations were consistent with POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes) syndrome, which is a rare systemic disease with monoclonal proliferation of plasmacytes and slow progression. Cutaneous alterations are present in 68% of patients with diffuse cutaneous hyperpigmentation, plethora and acrocyanosis. Leukonychia, necrotizing vasculitis, hypertrichosis and cutaneous thickening of sclerodermiform type are also cited. The onset of multiple cutaneous angiomas in this syndrome has been observed in 24–44% of patients. PMID:26034475

  17. Caseating Granulomas in Cutaneous Leishmaniasis

    Science.gov (United States)

    Aoun, Jessica; Habib, Robert; Charaffeddine, Khalil; Taraif, Suad; Loya, Asif; Khalifeh, Ibrahim

    2014-01-01

    Background Caseating granulomas are often associated with a mycobacterial infection (TB) and are thought to be exceedingly rare in cutaneous leishmaniasis (CL). However, no large series has accurately documented the incidence of caseating granulomas in CL. Methods A multiregional cohort consisting of 317 patients with CL [Syria (157), Pakistan (66), Lebanon (47), Saudi Arabia (43), Ethiopia (2) and Iran (2)] was reviewed. Clinical [age, sex, disease duration, lesion type and geographic and anatomic location] and microscopic data [presence of and type of granuloma, Ridley's parasitic index (PI) and pattern (RP)] were documented. Presence of microorganisms was evaluated using special stains (GMS, PAS, AFB and Gram) and polymerase chain reaction (PCR) for TB and CL. All cases included in this study were confirmed as CL by PCR followed by restriction fragment length polymorphism analysis for molecular speciation and were negative for other organisms by all other studies performed. Categorical and continuous factors were compared for granuloma types using Chi-square, t-test or Mann-Whitney test as appropriate. Results Granulomas were identified in 195 (61.5%) cases of CL and these were divided to 49 caseating (25.2%), 9 suppurative (4.6%) and 137 tuberculoid without necrosis (70.2%). Caseating and tuberculoid granuloma groups were significantly different in terms of the geographical source, with more cases harboring caseating granulomas in Saudi Arabia (p<0.0001). Histologically, both groups were also different in the distribution of their RP (p<0.0001) with a doubling RP3 in caseating granulomas (31% vs. 15%) as opposed to doubling of RP5 in tuberculoid granuloma group (38% vs. 19%). Time needed to achieve healing (RP5) was notably shorter in tuberculoid vs. caseating group (4.0 vs. 6.2 months). Parasitic Index, CL species and other considered variables did not differ for the granuloma type groups. Conclusion In our multiregional large cohort, a notable 18.2% of all CL cases harbored caseating granulomas therefore; CL should be considered part of the differential diagnosis for cases with caseating granulomas in endemic regions, especially considering that the regions included in our cohort are also endemic for TB. Of note, cases of CL with caseating granulomas also showed a slower healing process, with no association with specific species, which may be due to worse host immune response in such cases or to a more aggressive leishmania strains. PMID:25340702

  18. Comparison of nerve graft integration after segmentar resection versus epineural burying in crushed rat sciatic nerves

    Directory of Open Access Journals (Sweden)

    Cunha Marco Túlio Rodrigues da

    1997-01-01

    Full Text Available The aim of the present paper is to compare and correlate the take of nerve segments in a severely crushed nerve. Forty adult Wistar rats had their right sciatic nerve by a "Péan-Murphy" forceps for 40 minutes. In Group 1 (n=20, a segmentar serection in the crushed sciatic nerve was made. A sural nerve segment from the opposite hindpaw was placed in the gap. In Group 2 (n=20, a lontudinal insision in the epineurium of the lesioned sciatic nerve was made. A sural nerve segment was buried underneath the epineurium. The crushed sciatic nerves undergone Wallerian degeneration and endoneurial fibrosis. Sciatic nerves from Group 2 had significant better histological aspects than those from Group 1. Sural nerve grafts presented better degrees of regeneration than crushed sciatic nerves. Sural nerve grafts from Group 2 (burying method integrated as well as those from Group 1 (segmentar resection.

  19. Gender Disparity between Cutaneous and Non-Cutaneous Manifestations of Lyme Borreliosis

    OpenAIRE

    Strle, Franc; Wormser, Gary P.; Mead, Paul; Dhaduvai, Kanthi; Longo, Michael V.; Adenikinju, Omosalewa; Soman, Sandeep; Tefera, Yodit; Maraspin, Vera; Lotri?-Furlan, Stanka; Ogrinc, Katarina; Cimperman, Jože; Ruži?-Sablji?, Eva; Stupica, Daša

    2013-01-01

    Cutaneous manifestations of Lyme borreliosis in Europe include erythema migrans (EM) and acrodermatitis chronica atrophicans (ACA); the most common non-cutaneous manifestations are Lyme neuroborreliosis (LNB) and Lyme arthritis. The purpose of this study was to evaluate the gender distribution of patients with these clinical manifestations of Lyme borreliosis. Data on gender were obtained from the clinical records of patients with Lyme borreliosis aged ?15 years who had been evaluated at the ...

  20. Cutaneous ulcer in an immunosuppressed patient with adult onset Still's disease: primary cutaneous histoplasmosis?

    Scientific Electronic Library Online (English)

    Michelle Larissa Zini, Lise; Ronaldo Nunes, Godinho; Flávia Moojen, Brollo; Henrique Luiz, Staub.

    2014-06-01

    Full Text Available Histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum.Primary infection occurs through inhalation of spores from the air. Immunocompetent individuals are usually asymptomatic, but may develop pulmonary disease. Immunocompromised patients tend to present systemic histoplasmosis with [...] cutaneous lesions occurring by secondary invasion. In this case report, we describe a probable primary cutaneous histoplasmosis (PCH) in a patient with adult onset Still's disease under immunosuppression.

  1. Cutaneous tuberculosis in children: The Indian perspective

    Directory of Open Access Journals (Sweden)

    Singal Archana

    2010-01-01

    Full Text Available Cutaneous tuberculosis continues to be a significant medical problem even with the advent of highly effective antituberculous drugs. It constitutes about 1.5% of all extra pulmonary tuberculosis. The prevalence in children varies from 18 to 54% in India. There is no gender predilection and the infection occurs with increased frequency in 10-14 year age group. Intrafamilial source of TB has been observed very frequently. A concomitant TB lymphadenitis is most common while involvement of other systemic organs like lung, bone and abdomen has also been observed. Protective efficacy of BCG is debatable and not yet fully defined. Of all the clinical types, scrofuloderma (SFD is the most commonly encountered variant followed by lupus vulgaris (LV and tuberculosis verrucosa cutis (TBVC. Lichen scrofulosorum (LS is generally found to be associated with systemic TB focus in about 72% of cases. The impact of HIV on childhood cutaneous TB seems to be minimal. Similar to adults, the diagnosis of cutaneous tuberculosis relies mainly on histopathology, culture on LJ medium or radiometric BACTEC 460 TB culture system and PCR. In addition Mantoux positivity and a positive therapeutic trial with anti-tubercular drugs may be a good pointer to tubercular infection. A thorough clinical evaluation and exhaustive investigations to pin-point associated systemic focus is advocated as the latter has an impact on the duration of treatment. Cutaneous TB in children is treated as per the recommendations of therapy for extrapulmonary TB.

  2. A rapidly enlarging cutaneous hemangioma in pregnancy

    Directory of Open Access Journals (Sweden)

    Marwan Ma’ayeh

    2014-10-01

    Full Text Available This is a case of a rapidly enlarging cutaneous pedunculated tumor on a patient’s thumb during her pregnancy. This was excised and identified as a hemangioma. A literature search identified a possible hormonal factor in causing an accelerated growth of this tumor.

  3. A rapidly enlarging cutaneous hemangioma in pregnancy.

    LENUS (Irish Health Repository)

    Ma'ayeh, Marwan

    2014-06-18

    This is a case of a rapidly enlarging cutaneous pedunculated tumor on a patient\\'s thumb during her pregnancy. This was excised and identified as a hemangioma. A literature search identified a possible hormonal factor in causing an accelerated growth of this tumor.

  4. Fibromodulin Enhances Angiogenesis during Cutaneous Wound Healing

    Directory of Open Access Journals (Sweden)

    Zhong Zheng, PhD

    2014-12-01

    Conclusions: Altogether, we demonstrated that in addition to reducing scar formation, FMOD also promotes angiogenesis. As blood vessels organize and regulate wound healing, its potent angiogenic properties will further expand the clinical application of FMOD for cutaneous healing of poorly vascularized wounds.

  5. Old World cutaneous leishmaniasis: diagnosis and treatment

    OpenAIRE

    Masmoudi, Abderrahmen; Hariz, Wala; Marrekchi, Slaheddine; Amouri, Mariem; Turki, Hamida

    2013-01-01

    Cutaneous leishmaniasis is a major world health problem. Diagnosis is suspected on evocative clinical presentation in patients living in or coming from endemic areas. Several methods have been used. The smear is a simple investigation used in endemic regions. The culture enables to identify the specimen. PCR has a high sensitivity. Montenegro’s reaction is used in the epidemiological study.

  6. Ecoepidemiology of Cutaneous Leishmaniasis Outbreak, Israel

    OpenAIRE

    Singer, Shepherd Roee; Abramson, Nitsa; Shoob, Hanna; Zaken, Ora; Zentner, Gary; Stein-Zamir, Chen

    2008-01-01

    A total of 161 cases of cutaneous leishmaniasis caused by Leishmania tropica occurred in the Jerusalem district during 2004–2005; 127 (79%) cases were in a town just outside Jerusalem. Environmental models suggest that in the context of global warming, this outbreak has the potential to extend into Jerusalem.

  7. Mefloquine in the treatment of cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    Correia Dalmo

    1999-01-01

    Full Text Available Three cases of cutaneous leishmaniasis were treated orally with a mefloquine dose of 4.2mg/kg/day for six days in the Teaching Hospital of the Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG, Brazil. Three weeks later a new series was repeated. No patient was cured.

  8. Cutaneous malignant melanoma in Northern Ireland.

    OpenAIRE

    Pedlow, P. J.; Walsh, M. Y.; Patterson, C.C.; Atkinson, R. J.; Lowry, W S

    1997-01-01

    The results of two 5-year studies, for 1974-78 and 1984-88, of cutaneous malignant melanoma (CMM) in Northern Ireland show changes in the presentation of the disease. Although there is some evidence of earlier diagnosis, the rise in incidence has produced an overall increase in the number of cases with advanced disease.

  9. Revisiting determinants of prognosis in cutaneous melanoma.

    Science.gov (United States)

    Weiss, Sarah A; Hanniford, Douglas; Hernando, Eva; Osman, Iman

    2015-12-01

    The American Joint Committee on Cancer staging system for cutaneous melanoma is based on primary tumor thickness and the presence of ulceration, mitoses, lymph node spread, and distant metastases as determinants of prognosis. Although this cutaneous melanoma staging system has evolved over time to more accurately reflect patient prognosis, improvements are still needed, because current understanding of the particular factors (genetic mutation, expression alteration, host response, etc) that are critical for predicting patient outcomes is incomplete. Given the clinical and biologic heterogeneity of primary melanomas, new prognostic tools are needed to more precisely identify patients who are most likely to develop advanced disease. Such tools would affect clinical surveillance strategies and aid in patient selection for adjuvant therapy. The authors reviewed the literature on prognostic molecular and immunologic markers in primary cutaneous melanoma, their associations with clinicopathologic and survival outcomes, and their potential for incorporation into current staging models. Overall, the studies considered in this review did not define prognostic markers that could be readily incorporated into the current staging system. Therefore, efforts should be continued in these and other directions to maximize the likelihood of identifying clinically useful prognostic biomarkers for cutaneous melanoma. Cancer 2015;121:4108-4123. © 2015 American Cancer Society. PMID:26308244

  10. SURGICAL ANATOMY OF DORSAL ROOT ENTRY ZONE OF CERVICAL SPINAL NERVES : CADAVERIC STUDY

    Directory of Open Access Journals (Sweden)

    A.Arun Kumar

    2014-06-01

    Full Text Available Background: The main purpose of this study is to determine the detailed morphometric data of Dorsal Root Entry Zone (DREZ of cervical spinal nerves. This knowledge is necessary for diagnosis, treatment and surgical management of pain due to many conditions like brachial plexus avulsion injury, post-herpetic neuralgia, phantom pain and cancer pain involved in cervical myelo-radiculopathy. There are fewer studies reported in this field of DREZ. Materials and Methods: Twenty five adult formalin fixed cadavers are taken for this study. Conventional Spinal cord dissection is followed as per Cunningham’s Dissection Mannual. Findings: The parameters included are Number of dorsal rootlets, Longitudinal Length of DREZ, Distance between two successive DREZ, Length of dorsal rootlets, Distance between right and left DREZ, Distance between DREZ and Ligamentum denticulatum, Cranial angles of Superior & inferior rootlets. Results: Results were noted for all the parameters and are compared with the previous studies. The significant observations are obtained. Conclusion: Surgical anatomy of Dorsal Root Entry Zone (DREZ of cervical spinal nerves will be useful for the neurosurgeons doing Drezotomy procedure, in which the nociceptive fibres alone are specifically severed with preservation of other sensations

  11. Brachial Plexus Lesion Due to Pathological Fracture of Clavicle in a Patient With Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Hatice Rana Erdem

    2011-10-01

    Full Text Available Primary hyperparathyroidism (PHPT is the third most common endocrine disorder. The clinical manifestations primarily involve the kidneys and the skeletal system. Pathologic bone fractures and proximal myopathies are rare conditions associated with PHPT. Early brachial plexus lesion secondary to clavicle fracture is very rare as well. The present case is of importance since it includes all of the three above-mentioned rare conditions. A 43-year-old female patient presented with complaints of pain and weakness in the right arm and limitation of movements in the right shoulder after a minor trauma. According to clinical, laboratory and radiological examination, she was diagnosed as having PHPT and traumatic right brachial plexus lesion due to pathologic fracture of clavicle, as well as hyperparathyroidism associated with secondary osteoporosis and myopathy. The patient underwent parathyroid surgery. After the surgery, a rehabilitation program including range of motion and strengthening exercises was given. PHPT may be diagnosed in an advanced stage of the disease. Therefore, clinicians should keep in mind that PHPT may present with complications of hyperparathyroidism. Turk J Phys Med Rehab 2011;57 Suppl 2: 361-5.

  12. Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Buarque de Gusmão

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS: 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION: Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS: The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

  13. Endovascular salvage of a right brachial artery-right atrium hemodialysis graft using a covered endoprosthesis.

    Science.gov (United States)

    Anaya-Ayala, Javier E; Ismail, Nyla; Reardon, Michael J; Peden, Eric K

    2012-01-01

    Creation of a functional hemodialysis access in patients with exhausted peripheral access sites and concomitant central venous occlusive disease (CVOD) is a multifaceted challenge; often requiring complex, innovative solutions, not without their own complications. We present a 57-year-old hemodialysis patient with a history of hypercoagulable disorder and multiple failed arteriovenous accesses. Because of inadequate peripheral access sites and chronic occlusions in superior vena cava, brachiocephalic veins and inferior vena cava, in addition to multiple transhepatic catheter related issues; we decided to perform a right brachial artery to right atrium (RA) hemodialysis graft. The access was used without complications for 18 months at which point he had his first episode of thrombosis; open thrombectomy and percutaneous balloon angioplasty (PTA) at the atrial anastomosis were done with success. The following three months, he endured two more thrombectomies and PTAs. During the last intervention we performed an intravascular Ultrasound (IVUS) through the atrial anastomosis, which demonstrated stenosis; and the decision was made to extend the outflow anastomosis with a covered stent into the atrium. Therefore a 10 cm x 10 mm Viabahn stent-graft (W. L. Gore and Associates, Flagstaff, Ariz.) was deployed and post dilated with 8 mm balloon within the graft component. Repeat injection and Intravascular Ultrasound (IVUS) demonstrated significant improvement and free outflow. The brachial-RA hemodialysis graft could be use immediately and at 5 months has remained fully functional and no reinterventions have been necessary. PMID:22522413

  14. Midazolam with Bupivacaine for Improving Analgesia Quality in Brachial Plexus Block for Upper Limb Surgeries

    International Nuclear Information System (INIS)

    To compare the onset, duration and postoperative pain scores of supraclavicular block with bupivacaine alone and bupivacaine-midazolam combination. A randomized controlled clinical trial was conducted on 50 ASA-I or II adult patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Patients were randomly allocated into two groups of 25 each. Patients in group A were administered 30 ml of 0.5% bupivacaine with midazolam 50 micro g kg/sup -1/. Hemodynamic variables (heart rate, noninvasive blood pressure, oxygen saturation), pain scores, rescue analgesic requirements and sedation score were recorded for 24 hours postoperatively, and compared using ANOVA with significance at p <0.05. The onset and duration of sensory and motor block was significantly faster and longer in group B compared to group A (p < 0.001). Pain scores were significantly lower in group B for 24 hours postoperatively (p < 0.001). Demand for rescue analgesic were significantly less in group B. Hemodynamics and sedation scores did not differ between the groups in the studied period. Bupivacaine (0.5%) in combination with Midazolam (50 micro g kg/sup -1/) quickened the onset as well as prolonged the duration of sensory and motor blockade of the brachial plexus for upper limb surgery. It improved postoperative analgesia without producing any adverse events compared to plain bupivacaine (0.5%) in equal volume. (author)

  15. Adult Sandhoff disease with 2 mutations in the HEXB gene presenting as brachial amyotrophic diplegia.

    Science.gov (United States)

    Kang, Sa-Yoon; Song, Sook Keun; Lee, Jung Seok; Choi, Jay Chol; Kang, Ji-Hoon

    2013-12-01

    Sandhoff disease is a rare autosomal recessive metabolic disorder of GM2 gangliosides. It is caused by a lack of functional N-acetyl-?-D-glucosaminidase A and B because of mutations in the HEXB gene. We describe a 55-year-old woman with adult Sandhoff disease presenting as brachial amyotrophic diplegia. The assay of total hexosaminidase involving A and B showed decreased level of these activities. Hex-A was 4.6 nmol·min·mL (normal: 7.0-20.0 nmol·min·mL) and Hex-B was 0.1 nmol·min·mL (normal: 1.0-10.0 nmol·min·mL), respectively. Analysis of HEXB gene demonstrated 2 point mutations that were located at the exon 5 (c.619A>G) and exon 11 (c.1250C>T). Compound heterozygosity of these 2 mutations may trigger the development of distinct adult Sandhoff disease phenotype. Sandhoff disease should be considered in the differential diagnosis of lower motor neuron disease, such as brachial amyotrophic diplegia, even if the age at onset is more than 50 years. PMID:24263030

  16. Ankle Brachial Index: simple non-invasive estimation of peripheral artery disease

    Science.gov (United States)

    Pieniak, Marcin; Cie?licki, Krzysztof; ?yli?ski, Marek; Górski, Piotr; Murgrabia, Agnieszka; Cybulski, Gerard

    2014-11-01

    According to international guidelines, patients with Peripheral Artery Disease (PAD) are burdened with high cardiovascular risk. One of the simplest, non-invasive methods for PAD detection is the ankle-brachial index (ABI) measurement. The ABI is calculated as the ratio of systolic blood pressure at the ankle (pressure in the posterior tibial artery or the dorsal artery) to the systolic pressure in the arm (in the brachial artery) when the body is in a horizontal position. The physiological value of the ABI is assumed to be between 1 and 1.3; however, these limits vary from study to study. A value less than 0.9 indicates PAD. Some authors propose also measuring the ABI on both sides of the body to highlight possible differences in blood pressure between the opposite arterial segments. The aim of this study was to perform a meta-analysis of the ABI diagnostic criteria used in different publications. Additionally, ABI measurements were performed on 19 healthy patients in age ranged from 20 to 63 years. The results showed a slight dependence between age and the differences between the values obtained from left and right sides of the body.

  17. The cutaneous radiation syndrome: diagnosis and treatment

    International Nuclear Information System (INIS)

    Accidental exposure to ionising radiation may occur during such catastrophic events as the Chernobyl accident in 1986 or for days and weeks as in Goiania in 1987 and in the military camp during the training of soldiers in Lilo/Georgia in 1997 as well as in medical institutions. The cutaneous symptoms after radiation exposure are based on a combination of inflammatory processes and alteration of cellular proliferation as a result of a specific pattern of transcriptionally activated pro-inflammatory cytokines and growth factors. They follow a time course consisting of prodromal erythema, manifestation, chronic stage, late stage and they are referred to as Cutaneous Radiation Syndrome. The time course depends on several factors such as the applied radiation dose, radiation quality, individual radiation sensitivity, the extent of contamination and absorption and volume of the skin. For diagnostics of the cutaneous radiation syndrome the following procedures are used: 7.5 MHz to 20 MHz-B-scan-sonography, thermography, capillary microscopy, profilometry, nuclear magnetic resonance imaging, bone scintigraphy and histology. Based on the results of experimental and clinical research of the last years pharmacotherapy of the cutaneous radiation syndrome includes topic or systemic application of corticosteroids, gamma-interferon, pentoxifylline and vitamin E and superoxide dismutase. The treatment depends on the stage of the cutaneous radiation syndrome. Due to the complexity of the clinical manifestations of radiation disease in most patients an interdisciplinary treatment in specialized centres is necessary. Dermatologists are asked to perform in most cases life-long therapy and follow-up of the patients. (author)

  18. Evaluation of the nerve-injured patient.

    Science.gov (United States)

    Novak, Christine B

    2003-04-01

    The evaluation of patients with nerve injury or nerve compression requires an accurate history and subjective report to determine the tests that are the most useful in providing the essential information. Motor and sensory evaluation is necessary inglobal mixed-nerve injuries, but in cases of nerve compression, tests of provocation give more accurate information for detecting the site of nerve compression. There is no gold standard test in the evaluation of patients with nerve injury or compression; therefore, a battery of valid and reliable sensory and motor tests provides the most complete information to formulate a treatment plan. PMID:12737348

  19. Imaging the ocular motor nerves

    International Nuclear Information System (INIS)

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0 T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.

  20. Imaging the ocular motor nerves

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Teresa [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: T.A.Ferreira@lumc.nl; Verbist, Berit [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: B.M.Verbist@lumc.nl; Buchem, Mark van [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.A.van_Buchem@lumc.nl; Osch, Thijs van [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.J.P.van_Osch@lumc.nl; Webb, Andrew [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: A.Webb@lumc.nl

    2010-05-15

    The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0 T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.