WorldWideScience

Sample records for brachial cutaneous nerve

  1. Acquired brachial cutaneous dyschromatosis.

    Science.gov (United States)

    Hu, Stephanie W; Chu, Julie; Meehan, Shane; Kamino, Hideko; Pomeranz, Miriam Keltz

    2011-01-01

    Acquired brachial cutaneous dyschromatosis (ABCD) is a newly described disorder of pigmentary change that occurs on the dorsal aspects of the forearms in post-menopausal women. We report a case of a 62-year-old woman who developed an asymptomatic, reticulated, gray-brown eruption on the dorsal aspects of the forearms of gradual onset that is clinically and histopathologically consistent with ABCD. Whereas the original report found an association between hypertension and/or the use of anti-hypertensive medications in the original cohort, we propose that this entity may, in fact, be associated more closely with cumulative sun damage and may be related to such acquired disorders of the skin as poikiloderma of Civatte. Treatment of these lesions may prove to be a challenge, with an emphasis on rigorous sun protection and adjunctive measures with depigmentating agents, chemical peels, and lasers. PMID:22031642

  2. Nerve Transfers for Adult Traumatic Brachial Plexus Palsy (Brachial Plexus Nerve Transfer)

    OpenAIRE

    Rohde, Rachel S.; Wolfe, Scott W.

    2006-01-01

    Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution.

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

    Science.gov (United States)

    Liu, Ying; Xu, Xun-Cheng; Zou, Yi; Li, Su-Rong; Zhang, Bin; Wang, Yue

    2015-02-01

    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. PMID:25883637

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Liu, Ying; Xu, Xun-cheng; Zou, Yi; Li, Su-rong; Zhang, Bin; Wang, Yue

    2015-01-01

    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. PMID:25883637

  6. Absence of musculocutanous nerve and its distribution taken over by the lateral cord of brachial plexus, median nerve and radial nerve

    Directory of Open Access Journals (Sweden)

    Mohandas KG Rao

    2012-01-01

    Full Text Available

    Variations in the musculocutaneous nerve are very common. But, the absence of the nerve is rare. One such case of absence of musculocutaneous nerve which was observed in a male cadaver during routine dissection is reported here. In the present case there was total absence of a normal musculocutaneous nerve. The coracobrachialis which is normally supplied by the musculocutaneous nerve was innervated by a direct branch of lateral cord of brachial plexus, whereas biceps brachii and brachialis are supplied by branches from the lateral aspect of median nerve. Lateral cutaneous nerve of forearm was arising from the lateral aspect of median nerve in common with nerve to brachialis and was partly supplying the area of innervation of a normal lateral cutaneous nerve of forearm. The remaining of its area was supplied by the posterior cutaneous nerve of forearm, a branch of radial nerve. Further, a detailed literature review about the case was done and the surgical and clinical importance of the case was discussed.

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

    OpenAIRE

    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...

  8. 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.

  9. [Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 2: intraplexal nerve transfers].

    Science.gov (United States)

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

    2011-12-01

    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 number 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 concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In a previous paper extraplexual nerve transfers were analyzed; this literature review complements the preceding paper analyzing intraplexual nerve transfers, and thus completing the analysis of the nerve transfers available in brachial plexus surgery. PMID:22167282

  10. 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

  11. Femoral nerve transfer for treatment of brachial plexus root avulsion.

    Science.gov (United States)

    Gu, Y D; Cheng, X M; Chen, D S; Zhang, G M; Xu, J G; Chen, L; Zhang, L Y; Cai, P Q

    1998-11-01

    Femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles was performed to determine its protective effect on the hand intrinsic muscles. Seven cases of brachial plexus root avulsion treated from May of 1989 to October of 1991 were involved. The femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles was done at the same stage of multiple neurotization. The muscular branches derived from the femoral nerve were isolated and coapted with the thenar muscle branch of the median nerve and the deep branch of the ulnar nerve. A groin flap was harvested simultaneously to form a skin-tube pedicle that covered the nerve bridge. At the second stage, when regeneration of the median and ulnar nerves was found to reach as far as the level of the wrist, the femoral nerve was divided and the muscular branches of the thenar and hypothenar muscles were anastomosed with the regenerated median and ulnar nerves. All the cases were followed up for more than 6 years. Six months after femoral nerve transfer, muscle power of the interosseous muscles and adductor pollicis recovered to MRC3, whereas that of the abductor pollicis brevis recovered to MRC1 to 2. Five cases underwent second-stage transfer. Four to five years of follow-up revealed that the muscle power of the interosseous muscles and adductor pollicis was MRC2 in one case, MRC1 in three cases, and MRC0 in one case. As for the donor area, muscle power of the quadriceps femoris reduced to M3 to 4 within 1 month after femoral nerve transfer and recovered to normal at 3 months. In conclusion, femoral nerve transfer to the muscular branches of the thenar and hypothenar muscles has some protective effect on the hand intrinsic muscles. The outcome of the second stage, however, is not satisfactory. PMID:9810993

  12. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    OpenAIRE

    Bhakta Pradipta

    2008-01-01

    Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008)

  13. [Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 1: extraplexal nerve transfers].

    Science.gov (United States)

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

    2011-12-01

    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 number 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 concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In this first part extraplexual nerve transfers are analyzed, while intraplexual nerve transfers will be analyzed in the second part of this presentation. PMID:22167281

  14. Formation of median nerve without the medial root of medial cord and associated variations of the brachial plexus

    Directory of Open Access Journals (Sweden)

    Bhanu SP

    2010-02-01

    Full Text Available The anatomical variations in the formation, course and termination of brachial plexus are well documented and have clinical significance to surgeons, neurologists and anatomists. The present case report describes the unusual origin of median nerve, arising directly from the lateral cord without the union of lateral and medial roots of brachial plexus. A communicating branch existed between the ulnar nerve and anterior division of middle trunk. The lateral pectoral nerve was arising from anterior divisions of upper and middle trunks as two separate branches instead from lateral cord. The branches then joined together to form the lateral pectoral nerve. The medial cord instead of its five terminal branches, had only three branches, the ulnar nerve, medial pectoral nerve and a single trunk for the medial cutaneous nerve of arm and forearm which got separated at the middle of the arm. The variations of the lateral cord and its branches make it a complicated clinical and surgical approach which is discussed with the developmental background.

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

    Science.gov (United States)

    Jin, Hua; Yang, Qi; Ji, Feng; Zhang, Ya-jie; Zhao, Yan; Luo, Min

    2015-01-01

    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 C6 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 C6 brachial plexus injury site (1 × 106 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 C6 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. PMID:25883625

  16. Intercostal Nerve Neurotization for the Treatment of Obstetrical Brachial Plexus Palsy Patients

    OpenAIRE

    Terzis, Julia K.; Kostas, Ioannis

    2005-01-01

    In severe obstetrical brachial plexus palsy with proximal nerve root involvement, there is an insufficient number of motor axons to reconstruct the entire plexus, and neurotization procedures are the only possibility to achieve useful upper extremity function. One of the most useful neurotization procedures is intercostal nerve transfer. In our practice, intercostal nerve transfer was used for direct neurotization of primary nerve targets or for neurotization of transferred muscles. The best ...

  17. Dorsal ulnar cutaneous nerve conduction: reference values

    Directory of Open Access Journals (Sweden)

    Garibaldi Solange G.

    2002-01-01

    Full Text Available We investigated the reference values of the dorsal ulnar cutaneous nerve (DUC sensory nerve conduction (SNC in 66 healthy individuals. Measurements were processed using stimulating electrodes positioned between the ulnar bone and the flexor carpi ulnaris muscle, 11-13 cm proximal to the active electrode recording. Superficial recording electrodes were placed on the fourth intermetacarpal space. The mean sensory conduction velocity (SCV in males was 63.7 -- 0.16 x age ± 3.36 m/s and in females was 57.7 ± 3.37 m/s. The mean sensory nerve action potential (SNAP amplitude in males was 19.5 ± 10.7 µV and in females was 24.6 ± 5.8 µV. The mean SNAP duration was 0.96 ± 0.13 ms. No significant differences regarding the DUC-SCV, distal latency, and SNAP duration or amplitude were found between both sides of the same subject. The amplitude of the SNAP was higher in females than males. The effects of age on DUC-SCV were distinct for each gender.

  18. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    Directory of Open Access Journals (Sweden)

    Bhakta Pradipta

    2008-10-01

    Full Text Available Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008

  19. Response to comments on "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note"

    OpenAIRE

    Agarwa Anil; Bhagat Hemant; Sharma Manish S

    2008-01-01

    Abstract Response to comments on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008)

  20. Clunealgia: CT-guided therapeutic posterior femoral cutaneous nerve block.

    Science.gov (United States)

    Kasper, Jared M; Wadhwa, Vibhor; Scott, Kelly M; Chhabra, Avneesh

    2014-01-01

    Clunealgia is caused by neuropathy of inferior cluneal branches of the posterior femoral cutaneous nerve resulting in pain in the inferior gluteal region. Image-guided anesthetic nerve injections are a viable and safe therapeutic option in sensory peripheral neuropathies that provides significant pain relief when conservative therapy fails and surgery is not desired or contemplated. The authors describe two cases of clunealgia, where computed-tomography-guided technique for nerve blocks of the posterior femoral cutaneous nerve and its branches was used as a cheaper, more convenient, and faster alternative with similar face validity as the previously described magnetic-resonance-guided injection. PMID:24667042

  1. Lateral Antebrachial Cutaneous Nerve injury induced by phlebotomy

    Directory of Open Access Journals (Sweden)

    Azadi Arezoo

    2007-03-01

    Full Text Available Abstract Background Phlebotomy is one of the routine procedures done in medical labs daily. Case presentation A 52 yr woman noted shooting pain and dysesthesia over her right side anterolateral aspect of forearm, clinical examination and electrodiagnostic studies showed severe involvement of right side lateral antebrachial cutaneous nerve. Conclusion Phlebotomy around lateral aspect of antecubital fossa may cause lateral antebrachial cutaneous nerve injury, electrodiagnostic studies are needed for definite diagnosis.

  2. The usefulness of MR myelography for evaluation of nerve root avulsion in brachial plexus injury

    International Nuclear Information System (INIS)

    Myelography has been the most popular and reliable method for evaluation of nerve root avulsion in brachial plexus injury. However, it is invasive because it requires the use of contrast medium, dural puncture and exposure to radiation. In addition, it has a fault. When a nerve rootlet is not filled with contrast medium, it is impossible to evaluate it. It has sometimes been a problem in the injury to upper roots. Recently, MRI also has been used for diagnosis of brachial plexus injury. But it was not until recently that it has had a high resolution to detect affected nerve rootlets. We have used MR myelography with high resolution for diagnosis of brachial plexus injury. The purpose of this study is to investigate the usefulness of it. MR myelography was preoperatively performed in 14 cases, consisting of 13 traumatic brachial plexus injuries and an obstetrical palsy. In them, 12 cases had root avulsion injuries and 2 cases had infraclavicular injuries. A 1.5 Tesla MR system (Philips) and a cervical coil were used. Coronal sections with 2 mm-overcontiguous thickness were obtained by heavily T2-weighted sequence fast spin echo (TR/TE=3000/450). The fat signal was suppressed by a presaturation inversion-pulse. The scanning time was about five minutes. The three-dimensional image was reconstructed by using maximum intensity projection (MIP) method. MIP images and individual coronal images were used for evaluation for root avulsion. In evaluation the shape of a nerve sleon. In evaluation the shape of a nerve sleeve and nerve rootlets was compared on both sides. The abnormal shape of a nerve sleeve or the defect of nerve rootlets was diagnosed as root avulsion. The brachial plexus lesions were exposed operatively and examined with electrophysiologic methods (SEP and/or ESCP) in all cases. Operative findings were compared with MR myelography. Twenty-four roots had been diagnosed as normal and 46 roots had been diagnosed as root avulsion with MR myelography preoperatively. In the former only one root was diagnosed as postganglionic lesion (Zone 2) intraoperatively. In the latter all roots except two roots were diagnosed as preganglionic lesion intraoperatively. ESCPs of low amplitude were recorded in the two roots. The sensitivity and the specificity of MR myelography were 100% and 97.1% respectively. MR myelography has several advantages compared with conventional myelography. It is non-invasive and quick. It provides imaging of full column in multiple projections. It delineates the deformity of a nerve sleeve and/or the defect of nerve rootlets. Therefore, MR myelography is now superior to conventional myelography for evaluation of nerve root avulsion in brachial plexus injury. (author)

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    Bai, Lu; Han, Yan-ni; Zhang, Wen-tao; Huang, Wei; Zhang, Hong-lei

    2015-01-01

    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 B12 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. PMID:25788928

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Brachial plexus

    Science.gov (United States)

    The brachial plexus is a group of nerves that run from the lower neck through the upper shoulder area. These ... Damage to the brachial plexus nerves can cause muscle and sensation problems that are often associated with pain in the same area. Symptoms may ...

  8. 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 ...

  9. Unilateral variant origin of musculocutaneous nerve

    OpenAIRE

    Sontakke YA; Fulzele RR; Tamgire DW; Joshi M; Gajbe UL; Marathe RR

    2010-01-01

    Musculocutaneous nerve branch out from lateral cord of brachial plexus. It innervates coracobrachialis, biceps brachii and brachialis muscles and continues as the lateral cutaneous nerve of forearm without exhibiting any communication with median nerve or any other nerve. Here, unilateral variant origin of musculocutaneous nerve is reported. In an adult male cadaver, a branch of median nerve represents musculocutaneous nerve which supplies coracobrachialis, biceps brachii and brachialis muscl...

  10. 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...

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

    Science.gov (United States)

    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 insertion into the medial surface of the body of humerus. A variation in the course and branching of the nerve might lead to variant or dual innervation of a muscle and, if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both clinical diagnosis and surgical practice. PMID:24944720

  12. An ultrasound-guided technique for axillary brachial plexus nerve block in rabbits.

    Science.gov (United States)

    Fonseca, Carla; Server, Anna; Esteves, Marielle; Barastegui, David; Rosal, Marta; Fontecha, Cesar G; Soldado, Francisco

    2015-04-21

    Regional anesthesia techniques, such as nerve blocks, are routinely used in humans and can contribute to multimodal approaches to pain management in research animals. Ultrasound guidance is an emerging aspect of regional anesthesia that has the potential to optimize local delivery and distribution of anesthetic agents, thereby reducing the amounts of these agents that must be administered. The authors developed an ultrasound-guided technique for effective block of the axillary brachial plexus in rabbits. They used this technique to carry out nerve block in 14 rabbits. The procedure was accomplished in a relatively short amount of time and achieved successful nerve block in all rabbits with no adverse effects. Sonographic visualization of the distribution of the local anesthetic ropivacaine led to administration of smaller anesthetic doses in eight of the rabbits without affecting the duration of nerve block. The authors conclude that their technique is feasible and safe and provides effective analgesia of the thoracic limb in rabbits. They recommend that this technique be integrated into multimodal approaches to pain management in rabbits undergoing thoracic limb surgery. PMID:25897939

  13. Supra-Clavicular Brachial Plexus Block: Ultra-Sonography Guided Technique Offer Advantage Over Peripheral Nerve Stimulator Guided Technique

    Directory of Open Access Journals (Sweden)

    Krutika B Rupera

    2013-06-01

    Conclusion: Ultrasonography guided supraclavicular brachial plexus block is quick to perform, offers improved safety and accuracy in identifying the position of the nerves to be blocked and of the structures. [Natl J Med Res 2013; 3(3.000: 241-244

  14. Ultrasound-Guided Lateral Femoral Cutaneous Nerve Conduction Study

    Science.gov (United States)

    Park, Bum Jun; Joeng, Eui Soo; Choi, Jun Kyu; Kang, Seok; Yoon, Joon Shik

    2015-01-01

    Objective To verify the utility of the lateral femoral cutaneous nerve (LFCN) ultrasound-guided conduction technique compared to that of the conventional nerve conduction technique. Methods Fifty-eight legs of 29 healthy participants (18 males and 11 females; mean age, 42.7±14.9 years) were recruited. The conventional technique was performed bilaterally. The LFCN was localized by ultrasound. Cross-sectional area (CSA) of the LFCN and the distance between the anterior superior iliac spine (ASIS) and the LFCN was measured. The nerve conduction study was repeated with the corrected cathode location. Sensory nerve action potential (SNAP) amplitudes of the LFCN were recorded and compared between the ultrasound-guided and conventional techniques. Results Mean body mass index of the participants was 23.7±3.5 kg/m2, CSA was 4.2±1.9 mm2, and the distance between the ASIS and LFCN was 5.6±1.7 mm. The mean amplitude values were 6.07±0.52 µV and 6.66±0.54 µV using the conventional and ultrasound-guided techniques, respectively. The SNAP amplitude of the LFCN using the ultrasound-guided technique was significantly larger than that recorded using the conventional technique. Conclusion Correcting the stimulation position using the ultrasound-guided technique helped obtain increased SNAP amplitude. PMID:25750871

  15. Magnetic resonance imaging of the cervical nerve root avulsion in brachial plexus injuries. New imaging technique and classification

    International Nuclear Information System (INIS)

    The Author describes a new magnetic resonance (MR) imaging technique of the cervical nerve roots in traumatic brachial plexus injury. The overlapping coronal-oblique slice MR imaging procedure of the cervical nerve root was performed in 35 patients with traumatic brachial plexus injury. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet partial injuries, avulsion, and meningocele), after diagnosis by surgical exploration. In this study, the sensitivity of detection of the cervical nerve root avulsion in MR imaging was the same (92.9%) as that of myelography and CT myelography. The reliability and reproducibility of the MR imaging classification was prospectively in 10 patients with traumatic brachial plexus injury, assessed by eight independent observers, and its diagnostic accuracy was compared with that of myelography and CT myelography. In this study, interobserver reliability and intraobserver reproducibility showed that there were no statistically significant difference between both modalities. This new MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion, and the MR imaging information provided valiable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities. (author)

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

    Science.gov (United States)

    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

  17. Brachial plexus (image)

    Science.gov (United States)

    The brachial plexus is a group of nerves that originate from the neck region and branch off to give rise ... movement in the upper limb. Injuries to the brachial plexus are common and can be debilitating. If the ...

  18. Effects of electrical stimulation of motor and cutaneous nerves on spinal cord blood flow.

    Science.gov (United States)

    Seki, M; Maeda, M

    1993-10-01

    The effects of electrical stimulation of the motor and cutaneous branch of the radial nerve on spinal cord blood flow (SCBF) in the cervical region and the correlation between the changes in SCBF and the amplitudes of spinal cord evoked potentials were investigated in cats anesthetized with alpha-chloralose. When measured by the hydrogen clearance technique, with stimuli of the cutaneous branch, the SCBF significantly (P SCBF ending within 2 minutes. Stimulation of the cutaneous branch produced a large, prolonged, and significant increase in SCBF. The increase in SCBF produced by stimulation of the cutaneous nerve was significantly greater than that by stimulation of the motor branch. The SCBF was correlated linearly with the amplitude of the spinal cord evoked potential (r = 0.504; P SCBF caused by radial nerve stimulation may arise from changes in neuronal metabolism via peripheral nerve activation. PMID:8235864

  19. Altered Cutaneous Nerve Regeneration in a Simian Immunodeficiency Virus/Macaque Intracutaneous Axotomy Model

    OpenAIRE

    Ebenezer, Gigi J.; LAAST, VICTORIA A.; Dearman, Brandon; Hauer, Peter; Tarwater, Patrick M.; Adams, Robert J; Zink, M. Christine; McArthur, Justin C.; Mankowski, Joseph L.

    2009-01-01

    To characterize the regenerative pattern of cutaneous nerves in SIV-infected and uninfected macaques, excisional axotomies were performed in non-glabrous skin at 14-day intervals. Samples were examined after immunostaining for the pan-axonal marker PGP 9.5 and the Schwann cell marker p75 nerve growth factor receptor. Collateral sprouting of axons from adjacent uninjured superficial dermal nerve bundles was the initial response to axotomy. Both horizontal collateral sprouts and dense vertical ...

  20. Anatomic variations in the palmar cutaneous branch of the median nerve among adults in Lagos, Nigeria

    Science.gov (United States)

    Mofikoya, Bolaji O; Ugburo, Andrew O

    2012-01-01

    Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries. Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians. PMID:24027400

  1. Computed tomography myelography with coronal and oblique coronal views for diagnosis of nerve root avulsion in brachial plexus injury

    International Nuclear Information System (INIS)

    We describe a new computed tomography (CT) myelography technique with coronal and oblique coronal views to demonstrate the status of the cervical nerve rootlets that are involved in brachial plexus injury. We discuss the usefulness of this technique for the diagnosis of nerve root avulsion compared with that of CT myelography with axial view. CT myelography was performed with enhancement of the cervical subarachnoid space by using a contrast medium. Subsequently, coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified in the presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was based on the findings of extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyltransferase activity measurement in 25 patients and recovery by a natural course in 3 patients. The diagnostic accuracies of CT myelography with coronal and oblique coronal views and that with axial view were compared and correlated with the surgical findings or natural course in 57 cervical roots in 28 patients. Coronal and oblique coronal views were superior to axial views in the visualization of the rootlets and orientation of the exact level of the root. They showed 100% sensitivity, 96% specificity, and 98% diagnostic accuracy (26 true-positive findings, 27 true-negative findings, none false-positive findings, and one false-negative fisitive findings, and one false-negative findings) for diagnosing root avulsion. No statistically significant difference was observed between the coronal and oblique coronal views and the axial views. The information obtained using coronal and oblique coronal slice CT myelography enabled the assessment of the rootlets of the brachial plexus and provided valuable data for deciding the appropriate treatment strategy, namely, exploration, nerve repair, or primary reconstruction. (author)

  2. High-resolution sonography of the palmar cutaneous branch of the median nerve

    OpenAIRE

    Tagliafico, A; Puqliese, F.; Bianchi, S.; Bodner, G; PADUA, L.; M. Rubino; Martinoli, C

    2008-01-01

    OBJECTIVE. The aim of this study was to describe the potential value of high-resolution sonography for evaluation of the palmar cutaneous branch of the median nerve (MN). SUBJECTS AND METHODS. The volar wrists of 12 healthy volunteers and 22 consecutive patients with sensory deficit in the palmar triangle and thenar eminence suggesting neuropathy of the palmar cutaneous branch of the MN were examined with high-frequency sonography. Nine patients underwent carpal tunnel release, five had a his...

  3. The Brachial Plexus

    Science.gov (United States)

    Mr. Samuel J Schwarzlose (Amarillo College Biology)

    2010-08-20

    This project is designed to instruct students on the basic anatomy and physiology of the brachial plexus. Through exercises such as matching, coloring and labeling, students are introduced to the brachial plexus and its role in controlling the cutaneous sensation and movement of the upper limbs.

  4. 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

  5. Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients

    Scientific Electronic Library Online (English)

    Ximena, Illarramendi; Emanuel, Rangel; Alice Machado, Miranda; Ana Claudia Ribeiro de, Castro; Giselle de Oliveira, Magalhães; Sérgio Luiz Gomes, Antunes.

    2012-12-01

    Full Text Available It is important to understand the mechanisms that enable peripheral neurons to regenerate after nerve injury in order to identify methods of improving this regeneration. Therefore, we studied nerve regeneration and sensory impairment recovery in the cutaneous lesions of leprosy patients (LPs) before [...] and after treatment with multidrug therapy (MDT). The skin lesion sensory test results were compared to the histopathological and immunohistochemical protein gene product (PGP) 9.5 and the p75 nerve growth factor receptors (NGFr) findings. The cutaneous neural occupation ratio (CNOR) was evaluated for both neural markers. Thermal and pain sensations were the most frequently affected functions at the first visit and the most frequently recovered functions after MDT. The presence of a high cutaneous nerve damage index did not prevent the recovery of any type of sensory function. The CNOR was calculated for each biopsy, according to the presence of PGP and NGFr-immunostained fibres and it was not significantly different before or after the MDT. We observed a variable influence of MDT in the recovery from sensory impairment in the cutaneous lesions of LPs. Nociception and cold thermosensation were the most recovered sensations. The recovery of sensation in the skin lesions appeared to be associated with subsiding inflammation rather than with the regenerative activity of nerve fibres.

  6. Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients

    Directory of Open Access Journals (Sweden)

    Ximena Illarramendi

    2012-12-01

    Full Text Available It is important to understand the mechanisms that enable peripheral neurons to regenerate after nerve injury in order to identify methods of improving this regeneration. Therefore, we studied nerve regeneration and sensory impairment recovery in the cutaneous lesions of leprosy patients (LPs before and after treatment with multidrug therapy (MDT. The skin lesion sensory test results were compared to the histopathological and immunohistochemical protein gene product (PGP 9.5 and the p75 nerve growth factor receptors (NGFr findings. The cutaneous neural occupation ratio (CNOR was evaluated for both neural markers. Thermal and pain sensations were the most frequently affected functions at the first visit and the most frequently recovered functions after MDT. The presence of a high cutaneous nerve damage index did not prevent the recovery of any type of sensory function. The CNOR was calculated for each biopsy, according to the presence of PGP and NGFr-immunostained fibres and it was not significantly different before or after the MDT. We observed a variable influence of MDT in the recovery from sensory impairment in the cutaneous lesions of LPs. Nociception and cold thermosensation were the most recovered sensations. The recovery of sensation in the skin lesions appeared to be associated with subsiding inflammation rather than with the regenerative activity of nerve fibres.

  7. Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients

    OpenAIRE

    Ximena Illarramendi; Emanuel Rangel; Alice Machado Miranda; Ana Claudia Ribeiro de Castro; Giselle de Oliveira Magalhães; Sérgio Luiz Gomes Antunes

    2012-01-01

    It is important to understand the mechanisms that enable peripheral neurons to regenerate after nerve injury in order to identify methods of improving this regeneration. Therefore, we studied nerve regeneration and sensory impairment recovery in the cutaneous lesions of leprosy patients (LPs) before and after treatment with multidrug therapy (MDT). The skin lesion sensory test results were compared to the histopathological and immunohistochemical protein gene product (PGP) 9.5 and the p75 ner...

  8. 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.

  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. Schwannoma of Brachial Plexus

    OpenAIRE

    Kumar, Ameet; Akhtar, Saeed

    2010-01-01

    Brachial plexus tumours are a rare entity. Schwannomas are benign nerve sheath tumours and only about 5% arise from the brachial plexus. Due to its rarity and complex anatomical location they can pose a formidable challenge to surgeons. We present a case of a young patient who presented with an axillary swelling three months after a lymph node biopsy from the same axilla, which turned out to be a Schwannoma arising for the medial cord of the brachial plexus.

  11. 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.

  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

    2012-07-01

    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. 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 sens 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

  14. Pulsed Radiofrequency Neuromodulation Treatment on the Lateral Femoral Cutaneous Nerve for the Treatment of Meralgia Paresthetica

    OpenAIRE

    Choi, Hyuk Jai; Choi, Seok Keun; Kim, Tae Sung; Lim, Young Jin

    2011-01-01

    We describe a rare case of pulsed radiofrequency treatment for pain relief associated with meralgia paresthetica. A 58-year-old female presented with pain in the left anterior lateral thigh. An imaging study revealed no acute lesions compared with a previous imaging study, and diagnosis of meralgia paresthetica was made. She received temporary pain relief with lateral femoral cutaneous nerve blocks twice. We performed pulsed radiofrequency treatment, and the pain declined to 25% of the maxima...

  15. Cutaneous sensory nerve as a substitute for auditory nerve in solving deaf-mutes’ hearing problem: an innovation in multi-channel-array skin-hearing technology

    OpenAIRE

    Li, Jianwen; Li, Yan; Zhang, Ming; Ma, Weifang; Ma, Xuezong

    2014-01-01

    The current use of hearing aids and artificial cochleas for deaf-mute individuals depends on their auditory nerve. Skin-hearing technology, a patented system developed by our group, uses a cutaneous sensory nerve to substitute for the auditory nerve to help deaf-mutes to hear sound. This paper introduces a new solution, multi-channel-array skin-hearing technology, to solve the problem of speech discrimination. Based on the filtering principle of hair cells, external voice signals at different...

  16. Exercise increases cutaneous nerve density in diabetic patients without neuropathy

    Science.gov (United States)

    Singleton, John R; Marcus, Robin L; Jackson, Justin E; K Lessard, Margaret; Graham, Timothy E; Smith, Albert G

    2014-01-01

    Early diabetic neuropathy is characterized by loss of unmyelinated axons, resulting in pain, numbness, and progressive decline in intraepidermal nerve fiber density. Patients with type 2 diabetes, without neuropathy, were assigned to quarterly lifestyle counseling (N = 40) or structured, supervised weekly exercise (N = 60) for 1 year. Distal leg IENFD significantly increased in the exercise cohort and remained unchanged in the counseling cohort (1.5 ± 3.6 vs. ?0.1 ± 3.2 fibers/mm, P = 0.03). These results suggest preclinical injury to unmyelinated axons is potentially reversible, and that IENFD may be a responsive biomarker useful in future neuropathy prevention clinical trials. PMID:25493275

  17. 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.

  18. BILATERAL MULTIPLE VARIATIONS IN THE FORMATION OF THE BRACHIAL PLEXUS AND ITS TERMINAL NERVES: A CASE REPORT

    OpenAIRE

    Fabian, Flora M.; Nondoli, Hortensia G.; Mchonde, Gabriel J.

    2013-01-01

    Variations in formation of brachial plexus roots, trunks, divisions and cords are not uncommon and maybe of important in regional anaesthesia involving the upper limb. However, in the present case we are reporting a rare bilateral multiple variations observed during routine dissection on a 77-years-old embalmed male cadaver on left and right brachial plexus. Understanding the anatomical variations involving brachial plexus is important and might benefit the physicians, surgeons, anaesthesiolo...

  19. Brachial plexus variation involving the formation and branches of the cords

    Directory of Open Access Journals (Sweden)

    Fabian-Taylor FM

    2010-11-01

    Full Text Available This case report is aimed at reporting a rare variation of brachial plexus involving the cords and its branches in the right upper limb. The musculocutaneous nerve was missing. The whole medial cord continued as a medial root of median nerve. The lateral cord gave off the lateral root of median nerve and an additional root joined with posterior cord to form a short common trunk. The short common trunk divided into two roots: one joined the median nerve; and the second one continued down as ulnar nerve. Median nerve supplied biceps brachii and brachialis muscles. The coracobrachialis muscle was supplied by radial nerve. The cutaneous innervation to the upper limb was derived from radial and ulnar nerves.

  20. Brachial plexus myoclonus.

    OpenAIRE

    Banks, G.; Nielsen, V. K.; Short, M. P.; Kowal, C. D.

    1985-01-01

    Rhythmic myoclonus in an arm began abruptly following an injury and persisted continuously for six years. Topographical EMG showed abnormal activity confined to muscles innervated by the axillary and radial nerves from the posterior cord of the brachial plexus. Abduction of the arm above horizontal level stopped myoclonus and EMG discharges. EEG was normal. It is suggested that the myoclonus was caused by mechanical irritation of the posterior cord of the brachial plexus.

  1. MRI of brachial plexopathies

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) has become the primary imaging technique in the evaluation of brachial plexus pathology, and plays an important role in the identification, localization, and characterization of the cause. Improvements in MRI technique have helped in detecting changes in the signal intensity of nerves, subtle enhancement, and in detecting perineural pathology, thereby refining the differential diagnosis. The present review of the visualization of brachial plexus abnormalities using MRI is based on a review of 26 cases. The causes include trauma and a spectrum of non-traumatic causes, such as acute idiopathic/viral plexitis, metastases, immune-mediated plexitis, and mass lesions compressing the brachial plexus

  2. 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

  3. 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.

  4. MR neurography of the brachial plexus

    International Nuclear Information System (INIS)

    Magnetic resonance neurography was used to directly image the brachial plexus in patients with clinically suspected brachial plexus neuritis. The authors obtained spectral presaturation with inversion recovery and short T1 inversion recovery images parallel to the long axis of nerves using neurovascular array coils in 17 patients. In seven patients, the images revealed nerve swelling and hyperintensity in the the brachial plexus. In three patients with zoster paresis of the shoulder or upper extremity the images revealed marked hyperintensity in the roots. Direct nerve imaging may prove to be helpful in evaluating patients with brachial plexus neuritis. (author)

  5. The role of sensory nerve conduction study of the palmar cutaneous nerve in the diagnosis of carpal tunnel syndrome in patients with polyneuropathy

    Directory of Open Access Journals (Sweden)

    Ayse Tokcaer

    2007-01-01

    Full Text Available Background: Conventional methods in the diagnosis of carpal tunnel syndrome (CTS in patients with polyneuropathy (PNP are insufficient. Aims: We suggest that the comparison of the conduction of the median nerve with that of the neighboring peripheral nerves may be more beneficial in the diagnosis of entrapment neuropathy. Setting and Design: The median nerve sensory conduction in healthy volunteers, in cases of CTS, PNP cases without CTS and in cases of PNP in whom clinical findings point to CTS, were compared by palmar cutaneous nerve (PCN sensory conduction. Materials and Methods: Comparative parameters were difference of PCN-1st digits? nerve conduction velocities (NCV, PCN/1st digit NCVs ratio, difference of 5th-2nd digits? NCVs and 5th/2nd digits? NCVs ratio. Statistical Analysis: The statistical analysis was performed by the SPSS package for statistics. Student t test and receiver operating characteristic were used. Results: Although the ratio of PCN-1st digit did not differ significantly between the control group and the polyneuropathy group, there was a significant difference between CTS and PNP+CTS groups and the control group ( P < 0.001 and P < 0.001, respectively. The ratio of PCN-1st digit nerve conduction velocity was also significantly different between polyneuropathy and PNP+CTS groups ( P < 0.001. Conclusion: To diagnose CTS on a background of polyneuropathy in mild cases in which sensory conduction is preserved, the ratio of sensory nerve conduction velocities of the palmar cutaneous nerve and the median nerve 1st digit-wrist segment may be a criterion.

  6. Cutaneous sensory nerve as a substitute for auditory nerve in solving deaf-mutes' hearing problem: an innovation in multi-channel-array skin-hearing technology.

    Science.gov (United States)

    Li, Jianwen; Li, Yan; Zhang, Ming; Ma, Weifang; Ma, Xuezong

    2014-08-15

    The current use of hearing aids and artificial cochleas for deaf-mute individuals depends on their auditory nerve. Skin-hearing technology, a patented system developed by our group, uses a cutaneous sensory nerve to substitute for the auditory nerve to help deaf-mutes to hear sound. This paper introduces a new solution, multi-channel-array skin-hearing technology, to solve the problem of speech discrimination. Based on the filtering principle of hair cells, external voice signals at different frequencies are converted to current signals at corresponding frequencies using electronic multi-channel bandpass filtering technology. Different positions on the skin can be stimulated by the electrode array, allowing the perception and discrimination of external speech signals to be determined by the skin response to the current signals. Through voice frequency analysis, the frequency range of the band-pass filter can also be determined. These findings demonstrate that the sensory nerves in the skin can help to transfer the voice signal and to distinguish the speech signal, suggesting that the skin sensory nerves are good candidates for the replacement of the auditory nerve in addressing deaf-mutes' hearing problems. Scientific hearing experiments can be more safely performed on the skin. Compared with the artificial cochlea, multi-channel-array skin-hearing aids have lower operation risk in use, are cheaper and are more easily popularized. PMID:25317171

  7. Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report

    Directory of Open Access Journals (Sweden)

    Kawamura Kenji

    2006-09-01

    Full Text Available Abstract An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve. This case demonstrates an excellent result of an Oberlin's nerve transfer for restoration of flexion of the elbow joint in Erb's birth palsy. However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth.

  8. 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)

  9. 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.

  10. Determination of an Ideal Stimulation Site of the Medial Antebrachial Cutaneous Nerve Using Ultrasound and Investigation of the Efficiency

    Science.gov (United States)

    Oh, Chang Hoon; Park, Nam Su; Kim, Jae Min

    2014-01-01

    Objective To determine an ideal stimulation site of the medial antebrachial cutaneous nerve (MACN) using ultrasound measurement and to compare the efficiency of the new stimulation site with the conventional stimulation site on the nerve conduction study. Methods Both arms of 15 healthy participants were measured using ultrasound. The MACN was identified in the transverse view at each 0, 2, 4, 6, and 8 cm proximal sites from the medial epicondyle, and the distances to the median nerve and to the skin from the MACN were measured. The ideal stimulation site should be located at the level which can give the shortest distance from the skin and the longest distance from the median nerve in terms of volume conduction. To confirm the efficiency of the ideal site, we measured the amplitude of the MACN conduction study at the ideal site against one at the 4 cm proximal to the medial epicondyle (conventional site). Results The ultrasound showed the ideal stimulation site for the MACN could be the elbow crease line. However, the nerve conduction study revealed that the amplitudes of the MACN were significantly larger at the 4 cm proximal to the medial epicondyle compared with ones at the ideal site. Conclusion The ideal stimulation site based on the ultrasound did not permit better stimulation site for the nerve conduction study of the MACN compared with the conventional site. Careful adjustment of the stimulation site on the basis of this study would contribute to an accurate conduction study of the MACN. PMID:25566484

  11. Angiosomes of medial cord of brachial plexus

    OpenAIRE

    Suseelamma, D.; Deepthi, S.; Krishna Chaitanya, K.; Sharada, H. R.

    2013-01-01

    This anatomical study analyzed the neurovascular relationship of the brachial plexus. Ten formalized specimens of brachial plexuses were examined after injection of lead oxide in to the subclavian artery. The vascular, anatomical features of the brachial plexus were documented .The specimens were analyzed by dissection method, subjected for microscopic study. The vascular supply was markedly rich, often with true anastomotic channels found within the nerves. There was much variation in supply...

  12. MRI of the Brachial Plexus

    Directory of Open Access Journals (Sweden)

    Seyed Hassan Mostafavi

    2010-05-01

    Full Text Available Evaluation of the brachial plexus is a clinical chal-lenge. Physical examination has traditionally been a mainstay in evaluating and localizing pathology involving the brachial plexus. Physical examination is especially difficult in patients with scarring and fibrosis secondary to surgery or irradiation. Electrophysiologic studies may be used to detect abnormalities in nerve conduction, but are poor for localizing a lesion. "nMRI has become increasingly important in the evaluation of brachial plexus pathology, as the technology and resolution has improved. Correlation of imaging results with electrophysiologic findings increases the overall specificity and sensitivity. CT has increased sensitivity for depicting extrinsic masses that com-press the nerves; however, it offers poor soft tissue contrast to directly evaluate the nerves."nWith the advent of MRI, nerves that compose the brachial plexus can now be directly evaluated. Intrinsic and extrinsic pathology may be evaluated. Exact anatomic components of the brachial plexus, such as the roots, trunks, divisions, and cords may be identified. MRI has the additional benefit of multiplanar imaging and increased soft tissue contrast. The tissue resolution of MRI is constantly improving with new pulse sequences and coil designs."nWith radiography and CT, changes in the shape or position of the brachial plexus were used to assess the pathology. With MRI, the nerve can be directly visualized and evaluated for pathology. MRI sequences such as fat-saturated T2-weighted spin-echo, short-tau inversion recovery (STIR, and gadolinium-enhanced T1-weighted spin-echo sequences help in depicting subtle changes in the signal intensity of the nerves or enhancement and aid in refining the differential diagnosis. In addition, maximum intensity projections can make localization and visualization of the pathology most understandable for referring clinicians and surgeons.

  13. 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

  14. Cross-neurotization of the caudal brachial plexus with the contralateral C-8 ventral nerve branch in the cat. Potential surgical applications, effects of graft collection on the healthy donor limb and results.

    Science.gov (United States)

    Carozzo, C; Cuvilliez, V; Escriou, C; Hidalgo, A; Tadié, M; Moissonnier, P

    2005-05-01

    Contralateral transfer of the right, eighth ventral nerve branch (C8) (C8 cross-transfer - C8CT) was performed in 6 adult cats, in which the caudal part of the left brachial plexus (C8 and T1) had been severed, in order to mimic nerve root avulsion. Clinical and electrophysiological parameters, muscle contraction force measurements and histology were used to evaluate the effects of the surgery in a 14- to 36-month follow-up. The right forelimb (donor side) was clinically normal (no lameness) in all the cats at the end of the study. Electromyography performed 14 days after surgery revealed denervation fibrillation potentials in both forelimbs. Fibrillation potentials disappeared in all the cats at the end of the study. Direct stimulation of the right C8 ventral branch induced motor and sensory evoked potentials in the left limb muscles in all the cats. The left to right contraction ratio of the extensor carpi radialis muscle was approximately 1. This experimental study demonstrates that C8CT enables re-innervation of the contralateral brachial plexus and allows the establishment of new functional neuromuscular units. This can in turn enable the restoration of function, and could potentially lead to partial recovery after caudal brachial plexus avulsion in the cat. PMID:16107084

  15. 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

    Directory of Open Access Journals (Sweden)

    Karina Hunter

    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 distal 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.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 the 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.

  16. 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.

  17. The cutaneous cervical plexus nerves of the crab-eating macaque (Macaca fascicularis), eastern grey kangaroo (Macropus giganteus), and koala (Phascolarctos cinereus).

    Science.gov (United States)

    Kato, K; Hopwood, P; Sato, T

    1990-12-01

    The origin, course and distribution of the cutaneous nerves of the cervical plexus were examined in the crab-eating macaque (4 body-halves), the grey kangaroo (5 body-halves) and koala (3 body-halves). The cutaneous nerves, n. auricularis magnus, nn. supraclaviculares, n. transversus colli, and n. transversus cervicis, were recognized. Cranial and caudal branches were identified in the latter 2 nerves. Some intermediate, relatively small branches were recognized between these main nerves. The n. occipitalis minor was not recognized in all our specimens. Four segmental nerves, C2 to C5, gave rise to all the cutaneous nerves and branches of the cervical plexus described. However, between species there was some variation. In the crab-eating macaque the n. auricularis magnus and n. transversus colli tended to arise from a lower segment than in the grey kangaroo and koala. In the grey kangaroo the nn. supraclaviculares arose from a lower segment than in the crab-eating macaque and koala. PMID:2093157

  18. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury

    Directory of Open Access Journals (Sweden)

    Faruquee Sajedur

    2008-05-01

    Full Text Available Abstract Background Purpose of this study was to evaluate the functional outcome of spinal accessory to suprascapular nerve transfer (XI-SSN done for restoration of shoulder function and partial transfer of ulnar nerve to the motor branch to the biceps muscle for the recovery of elbow flexion (Oberlin transfer. Methods This is a prospective study involving 15 consecutive cases of upper plexus injury seen between January 2004 and December 2005. The average age of patients was 35.6 yrs (15–52 yrs. The injury-surgery interval was between 2–6 months. All underwent XI-SSN and Oberlin nerve transfer. The coaptation was done close to the biceps muscle to ensure early recovery. The average follow up was 15 months (range 12–36 months. The functional outcome was assessed by measuring range of movements and also on the grading scale proposed by Narakas for shoulder function and Waikakul for elbow function. Results Good/Excellent results were seen in 13/15 patients with respect to elbow function and 8/15 for shoulder function. The time required for the first sign of clinical reinnervation of biceps was 3 months 9 days (range 1 month 25 days to 4 months and for the recovery of antigravity elbow flexion was 5 months (range 3 1/2 months to 8 months. 13 had M4 and two M3 power. On evaluating shoulder function 8/15 regained active abduction, five had M3 and three M4 shoulder abduction. The average range of abduction in these eight patients was 66 degrees (range 45–90. Eight had recovered active external rotation, average 44 degrees (range 15–95. The motor recovery of external rotation was M3 in 5 and M4 in 3. 7/15 had no active abduction/external rotation, but they felt that their shoulder was more stable. Comparable results were observed in both below and above 40 age groups and those with injury to surgery interval less than 3 or 3–6 months. Conclusion Transfer of ulnar nerve fascicle to the motor branch of biceps close to the muscle consistently results in early and good recovery of elbow flexion. Shoulder abduction and external rotation show modest but useful recovery and about half can be expected to have active movements. Two patients in early fifties also achieved good results and hence this procedure should be offered to this age group also. Surgery done earlier to 6 months gives consistently good results.

  19. Multiple Variations of the Branches of the Brachial Plexus with Bilateral Connections between Ulnar and Radial Nerves / Múltiples Variaciones de los Ramos del Plexo Braquial con Conexiones Bilaterales entre los Nervios Ulnar y Radial

    Scientific Electronic Library Online (English)

    Nasirudeen Oladipupo, Ajayi; Lelika, Lazarus; Kapil Sewsaran, Satyapal.

    2012-06-01

    Full Text Available Fueron observadas durante una disección de rutina de los miembros superiores de un cadáver caucásico masculino, múltiples variaciones de los ramos del plexo braquial. En el lado izquierdo, el nervio musculocutáneo estaba ausente y los músculos del compartimento anterior del brazo estaban inervados p [...] or el nervio mediano. El nervio mediano se encontraba formado de tres raíces dos provenientes del fascículo lateral y uno del fascículo medial del plexo braquial. En el lado derecho, en la mitad distal del brazo, el nervio musculocutáneo generó un largo ramo comunicante con el nervio mediano. Además, en el brazo, en ambos miembros superiores existían ramos comunicantes entre los nervios ulnar y radial. La coexistencia de estas variaciones aparece ser única y no ha sido relatada en la literatura consultada. Son discutidas la significancia anatómica y clínica de estas variaciones. Abstract in english During routine dissection of the upper limbs of a Caucasian male cadaver, multiple variations of the branches of the brachial plexus were observed. On the left side, the musculocutaneous nerve was absent and the muscles of the anterior compartment of the arm were innervated by the median nerve. The [...] median nerve was also formed from three roots viz; two from the lateral and one from the medial cord of the brachial plexus. On the right side, the musculocutaneous nerve contributed a long communicating branch to the median nerve in the distal half of the arm. There were also communicating branches between the ulnar and radial nerves in both limbs at the humeral level. The co-existence of these variations appears to be unique and has not been reported in the literature reviewed. The anatomic and clinical significance of these variations is discussed.

  20. 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 appropriahnique 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

  1. Cutaneous field stimulation of sensory nerve fibers reduces itch without affecting contact dermatitis.

    OpenAIRE

    Wallengren, Joanna

    2002-01-01

    Background: A new technique, cutaneous field stimulation (CFS), which activates electrically unmyelinated C-fibers, is used to treat localized itch. Its action is similar to that of capsaicin, the pungent agent in hot peppers, which enhances delayed allergic reactions. The aim of the study was to investigate how experimental contact dermatitis responds to CFS. Methods: Twelve patients with contact dermatitis in response to nickel were treated by CFS for 1 h each for four consecutive da...

  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

    Directory of Open Access Journals (Sweden)

    Mônica Duarte Pimentel

    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 em 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 (pPURPOSE: 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 axillary 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<0,01. There was no significant difference in the number of lymph nodes dissected between the two groups (p=0,06. CONCLUSIONS: patients with ICBN preservation had less pain and more preservation of cutaneous sensitivity, with no decreased number of axillary lymph nodes removed during the axillary dissection.

  3. Angiosomes of medial cord of brachial plexus

    Directory of Open Access Journals (Sweden)

    D. Suseelamma

    2013-04-01

    Full Text Available This anatomical study analyzed the neurovascular relationship of the brachial plexus. Ten formalized specimens of brachial plexuses were examined after injection of lead oxide in to the subclavian artery. The vascular, anatomical features of the brachial plexus were documented .The specimens were analyzed by dissection method, subjected for microscopic study. The vascular supply was markedly rich, often with true anastomotic channels found within the nerves. There was much variation in supply, depending on the branching pattern of subclavian artery. [Int J Res Med Sci 2013; 1(2.000: 79-82

  4. 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.

  5. 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.

  6. Peripheral communications of intercostobrachial nerve Peripheral communications of the intercostobrachial nerve in relation to the alar thoracic artery

    Science.gov (United States)

    Rustagi, Shaifaly Madan; Sharma, Mona; Singh, Nidhi; Mehta, Vandana; Suri, Rajesh K; Rath, Gayatri

    2015-01-01

    The intercostobrachial nerve (ICBN) is often encountered during axillary dissection for axillary lymph node dissection (ALND) for diagnostic and therapeutic surgery for mastectomy. The present report is a case observed in the Department of Anatomy at Vardhman Mahavir Medical College, Delhi during routine dissection of the upper extremity of a male cadaver for first year undergraduate medical students. On the right side, the medial cord of brachial plexus gave two medial cutaneous nerves of arm. Both the nerves were seen communicating with the branches of the ICBN. The ICBN and one of its branches were surrounding the termination of an alar thoracic artery. These peripheral neural connections of the ICBN with the branches of the medial cord can be a cause of sensory impairment during axillary procedures done for mastectomy or exploration of long thoracic nerves. The alar thoracic artery found in relation to the ICBN could further be a cause of vascular complications during such procedures. PMID:25802820

  7. Dorsal ulnar cutaneous nerve conduction: reference values / Condução nervosa do nervo cutâneo ulnar dorsal: valores de referência

    Scientific Electronic Library Online (English)

    Solange G., Garibaldi; Anamarli, Nucci.

    2002-06-01

    Full Text Available Investigamos os valores de referência da condução nervosa sensitiva do nervo cutâneo ulnar dorsal em 66 indivíduos normais, por técnica de condução nervosa antidrômica. A velocidade de condução sensitiva (VCS) média, em homens foi 63,7 -- 0,16 x idade ± 3,36 m/s e nas mulheres 57,7 ± 3,37 m/s. A amp [...] litude média do potencial de ação nervoso sensitivo (PANS) em homens foi 19,5 ± 10,7 µV e nas mulheres foi 24,6 ± 5,8 µV. A duração média do PANS foi 0,96 ± 0,13 ms. A dominância manual não interferiu nos valores da VCS, latência distal, amplitude e duração do PANS. Nas mulheres a amplitude do PANS foi maior do que nos homens. Os efeitos da idade na VCS foram distintos para cada sexo. Abstract in english We investigated the reference values of the dorsal ulnar cutaneous nerve (DUC) sensory nerve conduction (SNC) in 66 healthy individuals. Measurements were processed using stimulating electrodes positioned between the ulnar bone and the flexor carpi ulnaris muscle, 11-13 cm proximal to the active ele [...] ctrode recording. Superficial recording electrodes were placed on the fourth intermetacarpal space. The mean sensory conduction velocity (SCV) in males was 63.7 -- 0.16 x age ± 3.36 m/s and in females was 57.7 ± 3.37 m/s. The mean sensory nerve action potential (SNAP) amplitude in males was 19.5 ± 10.7 µV and in females was 24.6 ± 5.8 µV. The mean SNAP duration was 0.96 ± 0.13 ms. No significant differences regarding the DUC-SCV, distal latency, and SNAP duration or amplitude were found between both sides of the same subject. The amplitude of the SNAP was higher in females than males. The effects of age on DUC-SCV were distinct for each gender.

  8. 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

  9. 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.

  10. Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

    Science.gov (United States)

    Moore, M.P.; Stauber, E.; Thomas, N.J.

    1989-01-01

    Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

  11. Variations in branching pattern of Brachial Plexus: A cadaveric study

    OpenAIRE

    Pensi, Dr Chandraprabha A.; Dr. Swati Aterkar; Dr. Hardik Khatri; Chauhan, Dr Hiteshkumar M.; Darji, Dr Apurva P.

    2013-01-01

    Brachial plexus is formed by ventral primary rami of C5 to T1. The aim of the present study is to study the variations in branching pattern of the brachial plexus. In present study 100 brachial plexuses from 50 well embalmed Human cadavers were studied in anatomy department, B.J. Medical College, Ahmedabad. Out of 100 upper limbs, three upper limbs show multiple communications between Medial & Lateral root of median nerve. In one cadaver, we found that median nerve was formed by two later...

  12. 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)

  13. Anatomical and Biometric Aspects of the Cutaneous Distribution of the Superficial Fibular Nerve / Aspectos Anatómicos y Biométricos de la Distribución Cutánea del Nervio Fibular Superficial

    Scientific Electronic Library Online (English)

    Carla, Gabrielli; Ilário, Froehner Junior; Maria Terezinha, Teixeira Braga.

    2005-06-01

    Full Text Available El propósito de esta investigación fue estudiar la ramificación cutánea del nervio fibular superficial (NFS), con enfoques topográfico y biométrico, para proveer mayores detalles anatómicos a las cirugías del pie y tobillo. Fueron analizados 30 miembros inferiores, derechos e izquierdos, de 15 cadáv [...] eres de individuos brasileños adultos, de sexo masculino. La ramificación cutánea del nervio fue disecada y las medidas fueron tomadas con cinta métrica y paquímetro digital. El nervio se observó en la superficie como tronco único en 66,7% de los casos y dividido en dos ramos en 33,3%. Cuando se presentó como tronco único, emergió a nivel del tercio distal de la pierna en 75%, en el límite entre los tercios medio y distal en 20%, y, en el tercio medio en 5%. Cuando se presentó dividido, los dos ramos tuvieron la misma topografía en 60% de los casos, en general, el tercio distal de la pierna. Al salir a la superficie, el promedio del diámetro externo del nervio, cuando era único, fue de 3,1 ± 0,8 mm, y cuando estaba dividido, uno de sus ramos, el nervio cutáneo dorsal medial (nCDM) del pie, midió 2,4 ± 0,9 mm, y el otro, el nervio cutáneo dorsal intermedio (nCDI) del pie, 2,1 ± 0,6 mm. El nCDM se comunicó con el nervio fibular profundo en 53,3% y el nCDI con el nervio sural en 33,3%. En su distribución en el dorso del pie, el nCDM estuvo relacionado principalmente con el 1er hueso metatarsiano y los dos primeros espacios interóseos, mientras que el nCDI, se relacionó en general, con el cuarto hueso metatarsiano y el tercero y cuarto espacios interóseos. La emergencia y ramificación cutánea del NFS presentan importantes variaciones que deben ser conocidas para evitar lesiones iatrogénicas durante procedimientos quirúrgicos el en pie y tobillo Abstract in english The objective of this research was to study the cutaneous branching of the superficial fibular nerve (SFN), with a topographic and biometric focus, aiming to provide further anatomical details for foot and ankle surgery in general. There were analyzed 30 right and left lower limbs of 15 corpses of m [...] ale adult Brazilian individuals. The cutaneous branching of the nerve was dissected and measurements taken with a tape measure and digital caliper. The nerve emerged at the surface as a single trunk in 66.7% and divided into two branches in 33.3% of the cases. When a single trunk emerged, it appeared at the level of the third distal of the leg in 75%, at the boundary between the middle and distal thirds in 20%, and, in the middle third in 5%. When divided, in most cases (60%), the two branches had the same topography, in general, in the distal third of the leg. The average width of the nerve, at its emergence, when single, was 3.1 ± 0.8 mm, when divided, one of its branches, the medial dorsal cutaneous nerve (MDCn) of the foot, measured 2.4 ± 0.9 mm, and the other, the intermediate dorsal cutaneous nerve (IDCn) of the foot 2.1 ± 0.6 mm. The MDCn communicated with the deep fibular nerve in 53.3%, and the IDCn with the sural nerve in 33.3%. In its distribution in the dorsum of the foot, the MDCn was related mainly with the first metatarsal bone and the first and second interosseous spaces, and the IDCn, in general, with the fourth metatarsal bone and the third and fourth interosseous spaces. There are important variations in the emergence and cutaneous branching of the SFN, which must be known in order to avoid iatrogenic injury during surgical procedures on the foot and ankle

  14. Anatomical and Biometric Aspects of the Cutaneous Distribution of the Superficial Fibular Nerve Aspectos Anatómicos y Biométricos de la Distribución Cutánea del Nervio Fibular Superficial

    Directory of Open Access Journals (Sweden)

    Carla Gabrielli

    2005-06-01

    Full Text Available The objective of this research was to study the cutaneous branching of the superficial fibular nerve (SFN, with a topographic and biometric focus, aiming to provide further anatomical details for foot and ankle surgery in general. There were analyzed 30 right and left lower limbs of 15 corpses of male adult Brazilian individuals. The cutaneous branching of the nerve was dissected and measurements taken with a tape measure and digital caliper. The nerve emerged at the surface as a single trunk in 66.7% and divided into two branches in 33.3% of the cases. When a single trunk emerged, it appeared at the level of the third distal of the leg in 75%, at the boundary between the middle and distal thirds in 20%, and, in the middle third in 5%. When divided, in most cases (60%, the two branches had the same topography, in general, in the distal third of the leg. The average width of the nerve, at its emergence, when single, was 3.1 ± 0.8 mm, when divided, one of its branches, the medial dorsal cutaneous nerve (MDCn of the foot, measured 2.4 ± 0.9 mm, and the other, the intermediate dorsal cutaneous nerve (IDCn of the foot 2.1 ± 0.6 mm. The MDCn communicated with the deep fibular nerve in 53.3%, and the IDCn with the sural nerve in 33.3%. In its distribution in the dorsum of the foot, the MDCn was related mainly with the first metatarsal bone and the first and second interosseous spaces, and the IDCn, in general, with the fourth metatarsal bone and the third and fourth interosseous spaces. There are important variations in the emergence and cutaneous branching of the SFN, which must be known in order to avoid iatrogenic injury during surgical procedures on the foot and ankleEl propósito de esta investigación fue estudiar la ramificación cutánea del nervio fibular superficial (NFS, con enfoques topográfico y biométrico, para proveer mayores detalles anatómicos a las cirugías del pie y tobillo. Fueron analizados 30 miembros inferiores, derechos e izquierdos, de 15 cadáveres de individuos brasileños adultos, de sexo masculino. La ramificación cutánea del nervio fue disecada y las medidas fueron tomadas con cinta métrica y paquímetro digital. El nervio se observó en la superficie como tronco único en 66,7% de los casos y dividido en dos ramos en 33,3%. Cuando se presentó como tronco único, emergió a nivel del tercio distal de la pierna en 75%, en el límite entre los tercios medio y distal en 20%, y, en el tercio medio en 5%. Cuando se presentó dividido, los dos ramos tuvieron la misma topografía en 60% de los casos, en general, el tercio distal de la pierna. Al salir a la superficie, el promedio del diámetro externo del nervio, cuando era único, fue de 3,1 ± 0,8 mm, y cuando estaba dividido, uno de sus ramos, el nervio cutáneo dorsal medial (nCDM del pie, midió 2,4 ± 0,9 mm, y el otro, el nervio cutáneo dorsal intermedio (nCDI del pie, 2,1 ± 0,6 mm. El nCDM se comunicó con el nervio fibular profundo en 53,3% y el nCDI con el nervio sural en 33,3%. En su distribución en el dorso del pie, el nCDM estuvo relacionado principalmente con el 1er hueso metatarsiano y los dos primeros espacios interóseos, mientras que el nCDI, se relacionó en general, con el cuarto hueso metatarsiano y el tercero y cuarto espacios interóseos. La emergencia y ramificación cutánea del NFS presentan importantes variaciones que deben ser conocidas para evitar lesiones iatrogénicas durante procedimientos quirúrgicos el en pie y tobillo

  15. 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.

    1351-13-01

    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.

  16. 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.

  17. Angiosomes of the brachial plexus: an anatomical study.

    Science.gov (United States)

    Levy, Sidney M; Taylor, G Ian; Baudet, Jacques; Guérin, Jean; Casoli, Vincent; Pan, Wei-Ren; Houseman, Nicholas D

    2003-12-01

    This anatomical study analyzed the neurovascular relationships of the brachial plexus. Ten fresh cadaveric brachial plexuses were examined after injection of the arterial system. The vascular anatomical features of the brachial plexus were documented with microdissection after lead oxide/gelatin injection. The specimens were analyzed by using radiography (including digital subtraction techniques) and light-microscopic, macroscopic, and digital photography. Four angiosomes, based on the subclavian, axillary, vertebral, and dorsal scapular arteries, were observed. As noted in previous angiosome studies, connections between angiosome territories lay within tissues, in this case, nerve trunks. Nutrient vessels penetrated nerve trunks at points of branching within the brachial plexus, with a Y-shaped mode of division on entry. The vascular supply was markedly rich, often with true anastomotic connections occurring within the nerves. There was much variation in supply, depending on the vascular anatomical features of the subclavian artery. PMID:14663223

  18. 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...

  19. MRI diagnosis of brachial plexus preganglionic injury

    International Nuclear Information System (INIS)

    Objective: To evaluate MRI in diagnosing brachial plexus preganglionic injury. Methods: Twenty cases with brachial plexus preganglionic injury underwent MR scanning before operation. MR imaging was obtained by GE Signa EXCITE 1.5 T scanner. The scanning sequences included SE T1WI, FSE T2WI, T2WI STIR and 3 D Fast imaging employing steady state with phase cycled (3D-FIESTA-c). All the patients had exploration of the supraclavicular plexus and electrophysiology examination. And the accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were calculated with the standards of surgical and EMG results. Results: Among the 73 pairs of injured roots, MR imaging detected the abnormalities in 63 pairs. The accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were 86.5% (83/96), 86.3% (63/73), 87.0% (20/23), respectively. The direct signs of brachial plexus preganglionic injury included (1) lack or mutilation of nerve root in 54 pairs (85.7%), (2) coarsening, bending, stiff course and unable to be traced to the intervertebral foramen continuously in 9 pairs (14.3%). The indirect signs included (1) cystic cerebrospinal fluid gathering in the vertebral canal, posttraumatic spinal meningocele in 46 pairs (73.0%), (2) abnormal shape of nerve sleeve in 13 pairs (20.6%), (3) displacement and deformity of spinal cord in 50 pairs (79.4%), (4) abnormal signal of paravertebr79.4%), (4) abnormal signal of paravertebral muscles in 19 patients. Conclusion: MRI can distinctly show the nerve rootlets within the vertebral canal, so it is helpful in making a correct diagnosis of brachial plexus preganglionic injuries. (authors)

  20. Sonographic evaluation of brachial plexus pathology

    International Nuclear Information System (INIS)

    Pre-operative US examinations of the brachial plexus were performed with the purpose of exploring the potential of this technique in recognizing lesions in the region and defining their sonographic morphology, site, extent, and relations to adjacent anatomic structures, and comparing them to the surgical findings to obtain maximal confirmation. Twenty-eight patients with clinical, electro-conductive, and imaging findings suggestive of brachial plexus pathology were included in this study. There were four main etiology groups: post-traumatic brachial plexopathies; primary tumors (benign and malignant); secondary tumors; and post irradiation injuries. Twenty-one of the 28 patients underwent surgery. Advanced imaging (mostly MRI) served as an alternative gold standard for confirmation of the findings in the non-surgically treated group of patients. The US examinations were performed with conventional US units operating at 5- to 10-MHz frequencies. The nerves were initially localized at the level of the vertebral foramina and then were followed longitudinally and axially down to the axillary region. Abnormal US findings were detected in 20 of 28 patients. Disruption of nerve continuity and focal scar tissue masses were the principal findings in the post-traumatic cases. Focal masses within a nerve or adjacent to it and diffuse thickening of the nerve were the findings in primary and secondary tumors. Post-irradiation changes presented as nerve thickening. Color Doppler wanted as nerve thickening. Color Doppler was useful in detecting internal vascularization within masses and relation of a mass to adjacent vessels. The eight sonographically negative cases consisted either of traumatic neuromas smaller than 12 mm in size and located in relatively small branches of posterior location or due to fibrotic changes of diffuse nature. Sonography succeeded in depicting a spectrum of lesions of traumatic, neoplastic, and inflammatory nature in the brachial plexus. It provided useful information regarding the lesion site, extent, and anatomic relationships; thus, the principal aims of the study were therefore met. Once the technique of examination is mastered, sonography should be recommended as part of the pre-operative evaluation process post-ganglionic brachial plexus pathology. Most disadvantages are related to the restricted field of view and inability to overcome bonny obstacles particularly in evaluating pre-ganglionic region. As sonography is frequently employed for investigation of the supraclavicular region, awareness of the radiologist to the findings described may enable the early recognition of pathologies involving or threatening to involve the brachial plexus. (orig.)

  1. Follow-up studies of the obstetrical brachial plexus injury

    OpenAIRE

    Strömbeck, Christina

    2006-01-01

    Aims: The overall aim of these studies were to investigate the influence of different kinds of treatment of the obstetrical brachial plexus lesion, and to study functioning and participation in adolescents with OBPP Methods: Study 1 involved 247 children with obstetrical brachial plexus palsy (OBPP) of different severity, some of whom had been operated on, with nerve reconstruction being carried out during the first year of life, and with others not having been operated ...

  2. Brachial Plexus Morphology and Vascular Supply in the Wistar Rat

    OpenAIRE

    Almeida, Ma; Casal, D.; Mafra, M.; Mascarenhas-lemos, L.; Martins-ferreira, J.; Ferraz-oliveira, M.; Amarante, J.; Goyri-o Neill, J.

    2013-01-01

    Introduction: The rat is probably the animal species most widely used in experimental studies on nerve repair. The aim of this work was to contribute to a better understanding of the morphology and blood supply of the rat brachial plexus. Material and Methods: Thirty adult rats were studied regarding brachial plexus morphology and blood supply. Intravascular injection and dissection under an operating microscope, as well as light microscopy and scanning electron microscopy techniques were u...

  3. Schwannoma of the brachial plexus presenting as a cystic swelling

    OpenAIRE

    Somayaji, K. S. G.; Rajeshwari, A.; Gangadhara, K. S.

    2004-01-01

    Schwannomas are benign nerve sheath tumours. A small percentage of these tumours arise from the brachial plexus. Cystic degeneration and hemorrhagic necrosis can occur in these tumours in up to 40% of the cases. Detailed preoperative evaluation and careful dissection during surgery will avoid post operative neurological complications. We report a case of schwannoma of the brachial plexus presenting as a cystic neck swelling which was successfully managed by us.

  4. MR evaluation of brachial plexus injuries

    International Nuclear Information System (INIS)

    Ten cases of brachial plexus injury were subjected to magnetic resonance (MR) to demonstrate the roots, trunks, divisions or cord abnormalities. Both normal and abnormal brachial plexuses were imaged in sagittal, axial, coronal and axial oblique planes. Myelography, using water soluble contrast agents, was performed in seven cases. MR demonstrated one traumatic meningocele, one extradural cerebrospinal fluid (CSF) collection, trunk and/or root neuromas in four, focal root fibrosis in two and diffuse fibrosis in the remaining two cases. Results of MR were confirmed at surgery in four cases with neuromas, while myelography was normal in two and was not carried out in the remaining two. In two cases, where MR demonstrated diffuse fibrosis of the brachial plexus, myelography showed C7 and T1 traumatic meningocele in one and was normal in the other. Both these patients showed excellent clinical and electrophysiological correlation with MR findings and in one of them surgical confirmation was also obtained. In the other two cases with focal nerve root fibrosis, myelography was normal in one and showed a traumatic meningocele in another. Operative findings in these cases confirmed focal root fibrosis but no root avulsion was observed although seen on one myelogram. Focal fibrosis, however, was noted at operation in more roots than was observed with MR. Initial experience suggests that MR may be the diagnostic procedure of choice for complete evaluation of brachial plexus injcomplete evaluation of brachial plexus injuries. (orig.)

  5. Median nerve fascicle transfer versus ulnar nerve fascicle transfer to the biceps motor branch in C5-C6 and C5-C7 brachial plexus injuries: nonrandomized prospective study of 23 consecutive patients.

    Science.gov (United States)

    Cho, Alvaro Baik; Paulos, Renata Gregorio; de Resende, Marcelo Rosa; Kiyohara, Leandro Yoshinobu; Sorrenti, Luiz; Wei, Teng Hsiang; Bolliger Neto, Raul; Mattar Júnior, Rames

    2014-10-01

    The purpose of this study was to observe whether the results of the median nerve fascicle transfer to the biceps are equivalent to the classical ulnar nerve fascicle transfer, in terms of elbow flexion strength and donor nerve morbidity. Twenty-five consecutive patients were operated between March 2007 and July 2013. The patients were divided into two groups. In Group 1 (n?=?8), the patients received an ulnar nerve fascicle transfer to the biceps motor branch. In Group 2 (n?=?15), the patients received a median nerve fascicle transfer to the biceps motor branch. Two patients with follow-up less than six months were excluded. Both groups were similar regarding age (P?=?0.070), interval of injury (P?=?0.185), and follow-up period (P?=?0.477). Elbow flexion against gravity was achieved in 7 of 8 (87.5%) patients in Group 1, versus 14 of 15 (93.3%) patients in Group 2 (P?=?1.000). The level of injury (C5-C6 or C5-C7) did not affect anti-gravity elbow flexion recovery in both the groups (P?=?1.000). It was concluded that the median nerve fascicle transfer to the biceps is as good as the ulnar nerve fascicle transfer, even in C5-C7 injuries. PMID:24753064

  6. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    OpenAIRE

    Thomas, Jimmy

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasin...

  7. Imaging tumours of the brachial plexus

    International Nuclear Information System (INIS)

    Tumours of the brachial plexus are rare lesions and may be classified as benign or malignant. Within each of these groups, they are further subdivided into those that are neurogenic in origin (schwannoma, neurofibroma and malignant peripheral nerve sheath tumour) and those that are non-neurogenic. Careful pre-operative diagnosis and staging is essential to the successful management of these lesions. Benign neurogenic tumours are well characterized with pre-operative MRI, appearing as well-defined, oval soft-tissue masses, which are typically isointense on T1-weighted images and show the ''target sign'' on T2-weighted images. Differentiation between schwannoma and neurofibroma can often be made by assessing the relationship of the lesion to the nerve of origin. Many benign non-neurogenic tumours, such as lipoma and fibromatosis, are also well characterized by MRI. This article reviews the imaging features of brachial plexus tumours, with particular emphasis on the value of MRI in differential diagnosis. (orig.)

  8. Bilateral brachial plexus injury following acute carbon monoxide poisoning

    Science.gov (United States)

    2013-01-01

    Background Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage. We report the first case of bilateral brachial plexus injury following CO poisoning and review all previous CO-induced neuropathy described in literature. Case presentation After being unconscious for three hours, a 42 years old man experienced bilateral brachial weakness associated with edema of the face and the upper limbs. Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. Creatine kinase was elevated. Electroneuromyogram patterns were compatible with the diagnosis of bilateral C5 D1 brachial axonal plexus injury predominant on the left side. Clinical course after hyperbaric oxygen therapy was marked by a complete recovery of neurological disorders. Conclusion Peripheral neuropathy is an unusual complication of CO intoxication. Bilateral brachial plexus impairment is exceptional. Various mechanisms have been implicated including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without any sequelae. PMID:24314014

  9. Pleural effusion and atelectasis during continuous interscalene brachial plexus block -A case report-

    OpenAIRE

    Yang, Chun Woo; Jung, Sung Mee; Cho, Choon Kyu; Kwon, Hee Uk; Kang, Po Soon; Lim, Young Su; Oh, Jin Young; Yi, Jin Woong

    2010-01-01

    An interscalene brachial plexus block is an effective means of providing anesthesia-analgesia for shoulder surgery. However, it has a multitude of potential side effects such as phrenic nerve block. We report a case of a patient who developed atelectasis of the lung, and pleural effusion manifested as chest discomfort during a continuous interscalene brachial plexus block for postoperative analgesia.

  10. Schwannoma of the brachial plexus; report of two cases involving the C7 root

    OpenAIRE

    Rashid, Mamoon; Salahuddin, Omer; Yousaf, Shumaila; Qazi, Uzair A.; Yousaf, Kanwal

    2013-01-01

    Brachial plexus schwannomas are rare tumors. They are benign nerve sheath tumors and only about 5% of Schwannoma arise from the brachial plexus. They pose a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present two cases who presented with a supraclavicular swelling, that were proven to be schwannoma on histopathology.

  11. Evaluation of brachial plexus injury by CT myelography

    International Nuclear Information System (INIS)

    Objective: To evaluate the diagnostic value of CT myelography (CTM) in brachial plexus injury. Methods: Twenty-seven patients with brachial plexus injury were examined by using cervical CTM with spiral scan and bone reconstruction algorithm. CT images were reviewed by the senior radiologists, who determined if the nerve root avulsion was presented. The criteria of diagnosing nerve root avulsion were loss of normal nerve root appearance in the Isovist filled thecal sac in consecutive CTM slices plus companion signs. The sensitivity, specificity, and accuracy of CTM in diagnosing nerve root injuries were calculated with operation findings and follow-up results as gold standard. Results: Direct sign of nerve root avulsion was the loss of normal nerve root defect seen in the Isovist filled thecal sac in consecutive CTM slices. Indirect signs included: (1) Pseudomeningocele bulge: The leak of Isovist into nerve root sheath, and extended into foramina; (2) Arachnoid cyst: displacement of spinal cord; (3) Dissymmetry of subarachnoid cavity: deformity of thecal sac, partially lack of Isovist into arachnoid space; (4) Non-integrity of dural cap sule wall: one side of cap sule cavity was obstructed. Part of the surface of spinal cord was exposed. Brachial plexus injury could be diagnosed by direct sign with one of the indirect signs. Of the 27 patients (128 nerve roots), 91 nerve root avulsions were found on CTM, and 37 was found normal. Compared with operation findings, 84 wer. Compared with operation findings, 84 were true positive, 7 false positive, 34 true negative, and 3 false negative. Based on these results, the sensitivity, specificity, and accuracy were 96.6%, 82.9%, and 92.2%, respectively. Conclusion: CTM is accurate in detecting nerve root avulsion of brachial plexus. (authors)

  12. New approaches in imaging of the brachial plexus

    International Nuclear Information System (INIS)

    Imaging plays an essential role for the detection and analysis of pathologic conditions of the brachial plexus. Currently, several new techniques are used in addition to conventional 2D MR sequences to study the brachial plexus: the 3D STIR SPACE sequence, 3D heavily T2w MR myelography sequences (balanced SSFP = CISS 3D, True FISP 3D, bFFE and FIESTA), and the diffusion-weighted (DW) neurography sequence with fiber tracking reconstruction (tractography). The 3D STIR sequence offers complete anatomical coverage of the brachial plexus and the ability to slice through the volume helps to analyze fiber course modification and structure alteration. It allows precise assessment of distortion, compression and interruption of postganglionic nerve fibers thanks to the capability of performing maximum intensity projections (MIP) and multiplanar reconstructions (MPRs). The CISS 3D, b-SSFP sequences allow good visualization of nerve roots within the spinal canal and may be used for MR myelography in traumatic plexus injuries. The DW neurography sequence with tractography is still a work in progress, able to demonstrate nerves tracts, their structure alteration or deformation due to pathologic processes surrounding or located along the postganglionic brachial plexus. It may become a precious tool for the understanding of the underlying molecular pathophysiologic mechanisms in diseases affecting the brachial plexus and may play a role for surgical planning procedures in the near fuurgical planning procedures in the near future.

  13. Evaluation of brachial plexus with MR echo planar imaging: initial experience

    International Nuclear Information System (INIS)

    Objective: To determine the optimal sequences and scan parameters of Brachial Plexus MRI. Methods: Eighteen volunteers were underwent conventional MRI and echo planar imaging scanning. The images acquired were compared with the standard anatomical pictures. Results: Ventral rami, ganglion, trunks, cords and some peripheral nerves of brachial plexus were demonstrated very well by echo planar imaging with the post-processing techniques such as MIP, thin slice MIP and MPR. In 18/18 cases the postganglions on both sides and 17/18 cases the preganglions of brachial plexus on both sides could be visualized in EPI pre-processed and post-processed images. Conclusion: Echo planar imaging is an effective technique of accurately displaying brachial plexus and adjacent structures. It has potential value in the diagnosis and treatment of brachial plexus diseases. It is also a potential technique to demonstrate other peripheral nerves accurately. (authors)

  14. Brachial plexus neuropathy

    OpenAIRE

    Hubka, Michael J.; King, Laurie; Cassidy, J. David; Donat, Jr

    1992-01-01

    Branchial plexus neuropathy is characterized by acute onset of intense pain in the shoulder or arm followed shortly by focal muscle weakness. This presentation may mislead the clinician into diagnosing shoulder or cervical spine pathology. Although brachial plexus neuropathy is not common, it should be considered in the differential diagnosis of pain and weakness of the arm. We present a patient with brachial plexus neuropathy who was originally misdiagnosed as having a cervical disc herniation.

  15. The excimer lamp induces cutaneous nerve degeneration and reduces scratching in a dry-skin mouse model.

    Science.gov (United States)

    Kamo, Atsuko; Tominaga, Mitsutoshi; Kamata, Yayoi; Kaneda, Kazuyuki; Ko, Kyi C; Matsuda, Hironori; Kimura, Utako; Ogawa, Hideoki; Takamori, Kenji

    2014-12-01

    Epidermal hyperinnervation, which is thought to underlie intractable pruritus, has been observed in patients with atopic dermatitis (AD). The epidermal expression of axonal guidance molecules has been reported to regulate epidermal hyperinnervation. Previously, we showed that the excimer lamp has antihyperinnervative effects in nonpruritic dry-skin model mice, although epidermal expression of axonal guidance molecules was unchanged. Therefore, we investigated the antipruritic effects of excimer lamp irradiation and its mechanism of action. A single irradiation of AD model mice significantly inhibited itch-related behavior 1 day later, following improvement in the dermatitis score. In addition, irradiation of nerve fibers formed by cultured dorsal root ganglion neurons increased bleb formation and decreased nerve fiber expression of nicotinamide mononucleotide adenylyl transferase 2, suggesting degenerative changes in these fibers. We also analyzed whether attaching a cutoff excimer filter (COF) to the lamp, thus decreasing cytotoxic wavelengths, altered hyperinnervation and the production of cyclobutane pyrimidine dimer (CPD), a DNA damage marker, in dry-skin model mice. Irradiation with COF decreased CPD production in keratinocytes, as well as having an antihyperinnervative effect, indicating that the antipruritic effects of excimer lamp irradiation with COF are due to induction of epidermal nerve degeneration and reduced DNA damage. PMID:24940652

  16. Myelography in obstetric palsies of brachial plexus

    International Nuclear Information System (INIS)

    The use of myelography in obstetric palsies of brachial plexus is aimed at diagnosing root avulsion.This kind of lesion appears as the disappearance of the slightly-transparent nerve roots which might be combined either with pseudo-meningocele or with deformation of radicular pouch. This study 69 operated patients who had previously undergone myelography have been considered. In 74.2% of cases mylographic findings were confirmed at surgery.False positives and false negatives were 9.7% and 3.2%, respectively. Uncorrect diagnoses were made in 12.9% of cases, because of misread lesions and uncorrect evaluation of their location, usually at the cervicol-dorsal junction.No side-effects were observed. Myelography appears thus to be extremely useful for both the preoperative evaluation and the choice of surgery in newborn children with obstetric palsy of the brachial plexus

  17. Evaluation of brachial plexus injury by MRI

    International Nuclear Information System (INIS)

    Objective: To evaluate the diagnostic value of MRI in brachial plexus injury. Methods: Total 98 patients with brachial plexus injury were examined by MRI before operation. Fifty-four of 98 patients MR imaging were obtained by 0.5 Tesla scanner and other 44 patients were obtained by 1.5 Tesla scanner. The scanning sequences include: SE T1WI, T2WI, FFE T2WI and T2WI SPIR. Exploration of the supraclavicular plexus was carried out and the MR imaging were compared with the operative finding in 63 patients. Thirty-five patients who had not surgery, were followed-up. Results: MR imaging found pre-ganglionic injuries in 45 patients and post- ganglionic injuries in 56 patients. Pre- and post- ganglionic injuries simultaneously in 16 patients among them. MR imaging can not find injury, sings in 13 patients. The positive rate was 86.73%. MR imaging finding of pre-ganglionic injuries include: (1) Spinal cord edema and hemorrhage, 2 patients (4.44%). (2) Displacement of spinal cord, 17 patients (37.78%). (3) Traumatic meningoceles, 37 patients( 82.22% ). (4) Absence of roots in spinal canal, 25 patients (55.56%). (5) Scarring in the spinal cnanl,24 patients (53.33%). (6) Denervation of erector spine, 13 patients (28.89%). MR imaging finding of post-ganglionic injuries include: (1) Trunk thickening with hypointensities in T2WI, 23 patients (41.07%). (2) Nerve trunk complete loss of continuity with disappeared of nerve structure, 16 patien disappeared of nerve structure, 16 patients (28.57%). (3) Continuity of nerve trunk was well with disappearance of nerve structure, 14 patients (25.00%). (4) Traumatic neurofibroma, 3 patients (5.36%). Conclusion: MR imaging can reveal Pre- and post- ganglionic injuries of brachial plexus simultaneously. MR imaging is able to determine the location (pre- or post- ganglionic) and extent of brachial plexus injury, provided important information for treatment method selection. (authors)

  18. Brachial plexopathy after prone positioning

    OpenAIRE

    Goettler, Claudia E.; Pryor, John P.; Reilly, Patrick M.

    2002-01-01

    Two cases of brachial plexus injury after prone position in the intensive care unit are described. Mechanisms of brachial plexus injury are described, as are methods for prevention of this unusual complication.

  19. 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.

  20. 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.

  1. Hand Function in Children with an Upper Brachial Plexus Birth Injury: Results of the Nine-Hole Peg Test

    Science.gov (United States)

    Immerman, Igor; Alfonso, Daniel T.; Ramos, Lorna E.; Grossman, Leslie A.; Alfonso, Israel; Ditaranto, Patricia; Grossman, John A. I.

    2012-01-01

    Aim: The aim of this study was to evaluate hand function in children with Erb upper brachial plexus palsy. Method: Hand function was evaluated in 25 children (eight males; 17 females) with a diagnosed upper (C5/C6) brachial plexus birth injury. Of these children, 22 had undergone primary nerve reconstruction and 13 of the 25 had undergone…

  2. 3 T MR tomography of the brachial plexus: Structural and microstructural evaluation

    International Nuclear Information System (INIS)

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus

  3. Changes in Spinal Cord Architecture after Brachial Plexus Injury in the Newborn

    Science.gov (United States)

    Korak, Klaus J.; Tam, Siu Lin; Gordon, Tessa; Frey, Manfred; Aszmann, Oskar C.

    2004-01-01

    Obstetric brachial plexus palsy is a devastating birth injury. While many children recover spontaneously, 20-25% are left with a permanent impairment of the affected limb. So far, concepts of pathology and recovery have focused on the injury of the peripheral nerve. Proximal nerve injury at birth, however, leads to massive injury-induced…

  4. Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report.

    Science.gov (United States)

    Restrepo, Carlos E; Spinner, Robert J; Howe, B Matthew; Jentoft, Mark E; Markovic, Svetomir N; Lachance, Daniel H

    2015-04-01

    Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in the literature. To their knowledge, the authors report the first known case of perineural spread of malignant melanoma to the brachial plexus. Clinicoradiological and anatomopathological correlation is presented, highlighting the importance of peripheral nerve communications in perineural spread. PMID:25614946

  5. Color Doppler Ultrasound-guided Supraclavicular Brachial Plexus Block to Prevent Vascular Injection

    OpenAIRE

    Christopher Hahn; Arun Nagdev

    2014-01-01

    Ultrasound-guided nerve blocks are quickly becoming integrated into emergency medicine practice for pain control and as an alternative to procedural sedation. Common, but potentially catastophic errors have not been reported outside of the anesthesiology literature. Evaluation of the brachial plexus with color Doppler should be standard for clinicians performing a supraclavicular brachial plexus block to determine ideal block location and prevention of inadvertant intravascular in...

  6. Schwannoma of the brachial plexus: cross-sectional imaging diagnosis using CT, sonography, and MR imaging

    International Nuclear Information System (INIS)

    Primary brachial plexus tumors are rare, usually benign, and in general have a good prognosis after surgical excision. We present a case of a schwannoma in which sonography enabled the correct diagnosis of a probably benign brachial plexus tumor. Key to the diagnosis was the demonstration of a smooth-bordered, longish, and well-defined nodule along a brachial plexus nerve root. Cross-sectional imaging modalities that provide a high degree of soft tissue contrast and spatial resolution, such as sonography and MR imaging, were suitable methods to establish the correct preoperative diagnosis. Findings at CT, sonography, MR imaging, and surgery are discussed. (orig.)

  7. Brachial artery pseudoaneurysm.

    Science.gov (United States)

    Kemp, Katie; Radwan, Rami; Shingler, Guy; Davies, Chris

    2014-01-01

    We describe a case of an elderly man who presented with an upper arm swelling that had developed following a humeral fracture 8?months previously. The swelling was painless but associated with significantly diminished motor function of his right hand and concurrent paraesthaesia. On examination, a large pulsatile mass was identified and CT angiography confirmed the presence of an 11×7?cm brachial artery pseudoaneurysm. The patient underwent surgical repair in which a fragment of the humerus was found to have punctured the brachial artery resulting in a pseudoaneurysm. The patient had an uncomplicated postoperative period and was discharged 2?days later having regained some motor function in his right hand. PMID:24859555

  8. Neurolymphomatosis of Brachial Plexus in Patients with Non-Hodgkin's Lymphoma

    OpenAIRE

    Yong Jun Choi; Shin, Jung A.; Yong Hoon Kim; Soon Joo Cha; Joong-Yang Cho; Seung Hee Kang; Seong Yoon Yi; Hye Ran Lee

    2013-01-01

    Neurolymphomatosis (NL) is a rare clinical disease where neoplastic cells invade the cranial nerves and peripheral nerve roots, plexus, or other nerves in patients with hematologic malignancy. Most NL cases are caused by B-cell non-Hodgkin's lymphoma (NHL). Diagnosis can be made by imaging with positron emission tomography (PET) and magnetic resonance imaging (MRI). We experienced two cases of NL involving the brachial plexus in patients with NHL. One patient, who had NHL with central nervous...

  9. Anatomy of Axillary Nerve and Its Clinical Importance: A Cadaveric Study

    Science.gov (United States)

    Kuppasad, Saniya

    2015-01-01

    Introduction: Axillary nerve is one of the terminal branches of posterior cord of brachial plexus, which is most commonly injured during numerous orthopaedic surgeries, during shoulder dislocation & rotator cuff tear. All these possible iatrogenic injuries are because of lack of awareness of anatomical variations of the nerve. Therefore, it is very much necessary to explore its possible variations and guide the surgeons to enhance the better clinical outcome by reducing the risk and complications. Materials and Methods: Twenty five cadavers (20 Males & 05 Females) making 50 specimens including both right and left sides were dissected as per standard dissection methods to find the origin, course, branches, distribution & exact location of the nerve beneath the deltoid muscle from important landmarks like: posterolateral aspect of acromion process, anteromedial aspect of tip of coracoid process, midpoint of deltoid muscle insertion (deltoid tuberosity of humerus) and from the midpoint of vertical length of deltoid muscle. The measurements were recorded and tabulated. Statistical Analysis: The measurements were entered in Microsoft excel and mean, proportion, standard deviation were calculated by using SPSS 16th version. Results: The axillary nerve was found to take origin from the posterior cord of brachial plexus (100%) dividing into anterior & posterior branches in Quadrangular space (88%) and supply deltoid muscle mainly. It also gave branches to teres minor muscle, shoulder joint capsule & superolateral brachial cutaneous nerve (100%). This study concluded that the mean distance of axillary nerve from the – anteromedial aspect of tip of coracoid process, posterolateral aspect of acromion process, midpoint of deltoid insertion & from the midpoint of vertical length of deltoid muscle measured to be (in cm) as 3.56±0.51, 7.4±0.99, 6.7±0.47 & 2.45±0.48 respectively. The mean vertical distance of entering point of axillary nerve from the anterior upper, mid middle upper & posterior upper deltoid border found to be (in cm): 4.94±0.86, 5.14±0.90 & 5.44±0.95 respectively and the horizontal anterior & horizontal posterior mean distance being 4.54±0.65 & 3.22±0.53 respectively. The mean height, mean width & mean depth of Quadrangular space measured to be (in cm): 2.23±0.40, 2.19±0.22 & 1.25±0.14 respectively. Conclusion: The findings were found to be highly significant when males were compared with females but not significant when sides (right & left) were compared. PMID:25954611

  10. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    International Nuclear Information System (INIS)

    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injuingocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction. (orig.)

  11. Características anatômicas do plexo braquial de tamanduá-mirim (Tamandua tetradactyla Linnaeus, 1758) / Anatomical characteristics of the brachial plexus of lesser anteater ("Tamandua tetradactyla" Linnaeus, 1758)

    Scientific Electronic Library Online (English)

    Géssica Ariane de Melo, Cruz; Marta, Adami; Ana Elisa Fernandes de Souza, Almeida; Érica Augusta dos Anjos Cerqueira da, Silva; Márcia Maria Magalhães Dantas de, Faria; Maria das Graças Farias, Pinto; Ricardo Diniz Guerra e, Silva.

    2012-09-01

    Full Text Available Objetivou-se com este trabalho identificar a origem, composição e os nervos do plexo braquial de tamanduá-mirim. Dois cadáveres foram cedidos pelo Centro de Triagem de Animais Silvestres (CETAS) Chico Mendes, Salvador, Bahia e a execução do projeto foi autorizada pelo Sistema de Autorização e Inform [...] ação em Biodiversidade (SISBIO - IBAMA) n°20268-1 (29/05/2009). Os resultados foram descritos, esquematizados e fotografados, e os termos anatômicos adotados foram os preconizados pelo International Committee on Veterinary Gross Anatomical Nomenclature. O plexo braquial recebeu contribuição dos segmentos medulares C5; C6; C7; C8 e T1, com a formação de três troncos: cranial (C5 e C6), médio (C7) e caudal (C8 e T1) que originaram os nervos derivados do plexo, com exceção do nervo cutâneo medial do antebraço que teve origem unissegmentar (T1). O plexo braquial de tamanduá-mirim apresentou origem, composição e formação dos nervos periféricos semelhantes ao observado em grande parte de outros mamíferos domésticos e silvestres. Abstract in english The aim of this study was to identify the origin, composition and the nerves from the brachial plexus of the lesser anteater. Two cadavers were given by the Wild Animals Screening Center (CETAS Chico Mendes), Salvador city, Brazil and the execution of the project was authorized by the System of Auth [...] orization and Information in Biodiversity (SISBIO - IBAMA) n°20268-1 (29/05/2009). The results were described, schematized and photographed, and the anatomic terms adopted were the ones recommended by the International Committee on Veterinary Gross Anatomical Nomenclature. The brachial plexus received contribution from the spinal cord segments C5; C6; C7; C8 and T1 with the formation of three trunks: cranial (C5 and C6), median (C7) and caudal (C8 and T1) which originated the nerves derived from the plexus, except the antebrachial medial cutaneous nerve that was of a monosegmental origin. The brachial plexus of the lesser anteater presented origin, composition and formation of peripheral nerves similar to the observed in several other domestic and wild mammals.

  12. Cervical myelographic findings of brachial plexus injury by trauma

    International Nuclear Information System (INIS)

    Authors reviewed 50 cases of cervical myelography during 4 years and 5 months, from February, 1985 to July, 1989 at Department of Radiography, Wonkwang University Hospital to analyse myelographic findings of traumatic brachial plexus injury with symptoms and signs and to discuss literature. The results were as follows: 1. Brachial plexus injury was predominant in male and the incidence was 50% in 3rd decade of the males. 2. Among the 50 patients, 11 were the peripheral type, which had symptoms but normal findings in cervical myelography and 39 were the central type, which were definitely abnormal findings in cervical myelography. 3. Cervical myelographic findings in the central type were divided into 5 groups. (all 39 cases) a. Obliteration of nerve root filling defect 39(cases) b. Pseudomeningocele. 32(cases) c. Narrowing of ipsilateral subarachnoid space 31(cases) d. Diverticulum. 4 (cases) e. Tracking of dye down the axillary sheath 1 (cases) 4. The most large numbers of pseudomeningoceles in cervical myelography were shown for two and in each case, the most multiple developing numbers of pseudomeningoceles were identified for four, that happened in one case. 5. In brachial plexus injury, there were two the most large involving numbers among the nerve roots, and in each involving nerve root, C7 was most common

  13. Sep diagnosing neurophaty of the lateral cutaneous branch of the iliohypogastric nerve: case report / Neuropatia do ramo cutâneo lateral do nervo ílio-hipogástrico diagnosticada por PES: relato de caso

    Scientific Electronic Library Online (English)

    Rafael José Soares, Dias; Lancaster de, Souza; Wanderley Freitas de, Morais; Armando Pereira, Carneiro.

    2004-09-01

    Full Text Available O presente artigo relata caso clínico incomum de neuropatia proximal de membro inferior, demonstra eletrofisiologicamente o comprometimento neural e revisa a literatura médica sobre o assunto. O teste neurofisiológico que demonstrou a patologia foi o potencial evocado somato-sensitivo (PES) segmenta [...] r do ramo cutâneo lateral do nervo ílio-hipogástrico. Ele revelou potenciais corticais bem definidos e replicáveis à estimulação do membro inferior assintomático, mas falhou em produzir respostas corticais do membro inferior sintomático. Na revisão da literatura não foi encontrado nenhum relato anterior de diagnóstico dessa patologia por PES segmentar. Conclui-se que é importante ter em mente ao avaliar pacientes com queixas de dor e disestesia na base dos membros inferiores que o acometimento de pequenos ramos cutâneos, como o cutâneo lateral do ílio-hipogástrico, pode ter confirmação eletrofisiológica da patologia por testes neurofisiológicos como o potencial evocado somato-sensitivo segmentar. Abstract in english The article pertains to the uncommon clinical case of a patient with a proximal neuropathy of the lower extremity. It outlines the electrophysiological evaluation and reviews the medical literature. The electrophysiologic test that most accurately revealed the neuropathy was the segmental somatosens [...] ory evoked potential (SEP) of the lateral cutaneous branch of the iliohypogastric nerve. It showed well-defined and replicable cortical waveforms following the excitation of the lateral cutaneous branch of the iliohypogastric nerve in the asymptomatic lower extremity, but failed to present somatosensory evoked potentials arising from the excitation of the contralateral nerve in the symptomatic lower extremity. We did not find any previous reports diagnosing that particular pathology by the use of segmental SEP. In conclusion, it is important to remember that the accurate diagnosis of patients complaining of pain and dysesthesia in the proximal part of the lower extremities can possibly be achieved through the use of electrophysiologic tests such as the segmental SEP.

  14. Sep diagnosing neurophaty of the lateral cutaneous branch of the iliohypogastric nerve: case report Neuropatia do ramo cutâneo lateral do nervo ílio-hipogástrico diagnosticada por PES: relato de caso

    Directory of Open Access Journals (Sweden)

    Rafael José Soares Dias

    2004-09-01

    Full Text Available The article pertains to the uncommon clinical case of a patient with a proximal neuropathy of the lower extremity. It outlines the electrophysiological evaluation and reviews the medical literature. The electrophysiologic test that most accurately revealed the neuropathy was the segmental somatosensory evoked potential (SEP of the lateral cutaneous branch of the iliohypogastric nerve. It showed well-defined and replicable cortical waveforms following the excitation of the lateral cutaneous branch of the iliohypogastric nerve in the asymptomatic lower extremity, but failed to present somatosensory evoked potentials arising from the excitation of the contralateral nerve in the symptomatic lower extremity. We did not find any previous reports diagnosing that particular pathology by the use of segmental SEP. In conclusion, it is important to remember that the accurate diagnosis of patients complaining of pain and dysesthesia in the proximal part of the lower extremities can possibly be achieved through the use of electrophysiologic tests such as the segmental SEP.O presente artigo relata caso clínico incomum de neuropatia proximal de membro inferior, demonstra eletrofisiologicamente o comprometimento neural e revisa a literatura médica sobre o assunto. O teste neurofisiológico que demonstrou a patologia foi o potencial evocado somato-sensitivo (PES segmentar do ramo cutâneo lateral do nervo ílio-hipogástrico. Ele revelou potenciais corticais bem definidos e replicáveis à estimulação do membro inferior assintomático, mas falhou em produzir respostas corticais do membro inferior sintomático. Na revisão da literatura não foi encontrado nenhum relato anterior de diagnóstico dessa patologia por PES segmentar. Conclui-se que é importante ter em mente ao avaliar pacientes com queixas de dor e disestesia na base dos membros inferiores que o acometimento de pequenos ramos cutâneos, como o cutâneo lateral do ílio-hipogástrico, pode ter confirmação eletrofisiológica da patologia por testes neurofisiológicos como o potencial evocado somato-sensitivo segmentar.

  15. Adult traumatic brachial plexus injury

    International Nuclear Information System (INIS)

    Injury to the brachial plexus in the adult is usually a closed injury and the result of considerable traction to the shoulder. Brachial plexus injury in the adult is an increasingly common clinical problem. Recent advances in neurosurgical techniques have improved the outlook for patients with brachial plexus injuries. The choice of surgical procedure depends on the level of the injury and the radiologist has an important role in guiding the surgeon to the site of injury. This article will describe the anatomy and pathophysiology of traction brachial plexus injury in the adult. The neurosurgical options available will be described with emphasis on the information that the surgeon wants from imaging studies of the brachial plexus. The relative merits of MRI and CT myelography are discussed

  16. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    Energy Technology Data Exchange (ETDEWEB)

    Medina, L.S. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Miami Children' s Hospital, Department of Radiology, Miami, FL (United States); Yaylali, Ilker [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); Zurakowski, David [Harvard Medical School, Boston Children' s Hospital, Boston, MA (United States); Ruiz, Jennifer; Altman, Nolan R. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Grossman, John A.I. [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); New York University, Hospital for Joint Disease, New York, NY (United States)

    2006-12-15

    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction. (orig.)

  17. 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.)

  18. Superficial course of brachial and ulnar arteries and high origin of common interosseous artery

    Directory of Open Access Journals (Sweden)

    Cherian SB

    2009-01-01

    Full Text Available Knowledge of variations in the course and branching pattern of the arteries of upper limb is important for clinicians. We report the variations of the branches of brachial artery. The brachial artery was superficial throughout its course. It divided into radial and ulnar arteries in the cubital fossa. The ulnar artery passed superficial to the flexor muscles of the forearm as it leaved the cubital fossa. The common interosseous artery was large in size and it was a direct branch of brachial artery. It took its origin from brachial artery approximately 5 cm below the lower border of teres major muscle and followed the median nerve till the cubital fossa and divided into anterior and posterior interosseous branches.

  19. 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.

  20. 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

    Directory of Open Access Journals (Sweden)

    Niladri Kumar Mahato

    2010-12-01

    Full Text Available 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 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.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 causantes 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.

  1. 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.

  2. 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.

  3. 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.

  4. Cutaneous Melanoma

    Science.gov (United States)

    Home Cancers Selected for Study Cutaneous Melanoma Cutaneous Melanoma Last Updated: February 22, 2012 What is melanoma? Melanoma is a cancer in the type of skin cells called melanocytes.  Melanocyes are the cells that produce melanin, which colors

  5. Management of desmoid-type fibromatosis involving peripheral nerves / Tratamento da fibromatose tipo desmoide envolvendo nervos periféricos

    Scientific Electronic Library Online (English)

    Mario G., Siqueira; Paulo L., Tavares; Roberto S., Martins; Carlos O., Heise; Luciano H.L., Foroni; Marcelo, Bordalo; Roberto, Falzoni.

    2012-07-01

    Full Text Available A fibromatose do tipo desmoide é uma lesão tumoral agressiva e rara, associada a alto índice de recorrência. É caracterizada pela fibroblástica infiltrativa, porém benigna, que ocorre no interior de tecidos moles profundos. Não existe consenso com relação ao tratamento desses tumores. Apresentamos u [...] ma série cirúrgica de quatro casos comprometendo o plexo braquial (dois casos), o nervo mediano e o nervo cutâneo medial do braço. Com exceção do último caso, todos foram submetidos a múltiplos procedimentos cirúrgicos e apresentaram recorrências repetidas. São discutidos o diagnóstico, as diferentes formas de tratamento e o prognóstico dessas lesões tumorais. Nossos resultados apoiam o conceito de que cirurgia radical seguida por radioterapia é uma das melhores formas de se tratar essas controvertidas lesões. Abstract in english Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a s [...] urgical series of four cases, involving the brachial plexus (two cases), the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.

  6. Management of desmoid-type fibromatosis involving peripheral nerves Tratamento da fibromatose tipo desmoide envolvendo nervos periféricos

    Directory of Open Access Journals (Sweden)

    Mario G. Siqueira

    2012-07-01

    Full Text Available Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a surgical series of four cases, involving the brachial plexus (two cases, the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.A fibromatose do tipo desmoide é uma lesão tumoral agressiva e rara, associada a alto índice de recorrência. É caracterizada pela fibroblástica infiltrativa, porém benigna, que ocorre no interior de tecidos moles profundos. Não existe consenso com relação ao tratamento desses tumores. Apresentamos uma série cirúrgica de quatro casos comprometendo o plexo braquial (dois casos, o nervo mediano e o nervo cutâneo medial do braço. Com exceção do último caso, todos foram submetidos a múltiplos procedimentos cirúrgicos e apresentaram recorrências repetidas. São discutidos o diagnóstico, as diferentes formas de tratamento e o prognóstico dessas lesões tumorais. Nossos resultados apoiam o conceito de que cirurgia radical seguida por radioterapia é uma das melhores formas de se tratar essas controvertidas lesões.

  7. 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.

  8. 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.)

  9. Brachial plexus variation involving the formation and branches of the cords

    OpenAIRE

    Fabian-Taylor FM; Varma KS

    2010-01-01

    This case report is aimed at reporting a rare variation of brachial plexus involving the cords and its branches in the right upper limb. The musculocutaneous nerve was missing. The whole medial cord continued as a medial root of median nerve. The lateral cord gave off the lateral root of median nerve and an additional root joined with posterior cord to form a short common trunk. The short common trunk divided into two roots: one joined the median nerve; and the second one continued down as ul...

  10. 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...

  11. Magnetic resonance neurography in children with birth-related brachial plexus injury

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Alice B. [University of California, San Francisco, Department of Neuroradiology, San Francisco, CA (United States); University of California, San Francisco, Department of Radiology, Box 0628, San Francisco, CA (United States); Gupta, Nalin [University of California, San Francisco, Department of Neurosurgery, San Francisco, CA (United States); Strober, Jonathan [University of California, San Francisco, Department of Pediatric Neurology, San Francisco, CA (United States); Chin, Cynthia [University of California, San Francisco, Department of Neuroradiology, San Francisco, CA (United States)

    2008-02-15

    Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury. We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings. The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained. All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012). MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and might be a useful adjunct in treatment planning. (orig.)

  12. Magnetic resonance neurography in children with birth-related brachial plexus injury

    International Nuclear Information System (INIS)

    Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury. We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings. The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained. All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012). MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and migical examination and EMG findings, and might be a useful adjunct in treatment planning. (orig.)

  13. 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.

  14. 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)

    João G Franca

    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.

  15. 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

    Science.gov (United States)

    Oliveira, Julia T.; Bittencourt-Navarrete, Ruben Ernesto; de Almeida, Fernanda M.; Tonda-Turo, Chiara; Martinez, Ana Maria B.; Franca, João G.

    2014-01-01

    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 three 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 five 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. PMID:25360086

  16. 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.

  17. Bilateral Obstetric Palsy of Brachial Plexus

    OpenAIRE

    Özlem Alt?nda?; Sava? Gürsoy; Ahmet Mete

    2009-01-01

    Obstetric Brachial Plexus Palsy (OBPP) is one of the devastating complications of difficult or assisted deliveries. Brachial plexus palsy with upper root involvement most commonly affects the external rotators and abductors. Twenty percent of obstetrical brachial plexus palsies are bilateral and they represent a more severe condition. An eight-year-old girl patient with bilateral brachial plexus palsy was described and discussed in this report. Turk J Phys Med Rehab 2009;55:126-7.

  18. Trifurcation of superficial brachial artery: a rare case with its clinico-embryological implications.

    Science.gov (United States)

    Gupta, N; Anshu, A; Dada, R

    2014-01-01

    Literatures on vasculature of upper limbs are crammed with reports of distinctly deviant version of normally prevalent vessels having modified origins, altered branching and odd courses. A unique anatomical variation in vascular pattern was observed during routine dissection of right upper limb in gross anatomy laboratory, AIIMS, New Delhi, India. The brachial artery was placed superficial to median nerve in the arm and therefore it was called superficial brachial artery. In the cubital fossa, 2.8 cm distal to intercondylar line of elbow joint, this superficial brachial artery terminated by trifurcation into radial, common interosseous and ulnar branches. Strikingly the ulnar branch, after its origin ran superficially over the median nerve and epitrochlear superficial flexor group of muscles of forearm in succession for the initial third of its course in the forearm, consequently it was addressed as superficial ulnar artery. The existence of superficial brachial artery in place of normal brachial artery, its termination by trifurcation into radial, common interosseous and superficial ulnar arteries with remarkably different courses, leads to confusing disposition of structures in the arm, cubital fossa and in the forearm and collectively makes this myriad of anatomical variations even rarer. The clinico-embryological revelations for combination of these unconventional observations, apprises and guides the specialized medical personnel attempting blind and invasive procedures in brachium and ante-brachium. This case report depicts the anatomical perspective and clinical implications on confronting a rare variant vasculature architecture pattern of upper limb. PMID:25366943

  19. 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.

  20. Our experience on brachial plexus blockade in upper extremity surgery

    Directory of Open Access Journals (Sweden)

    Ömer Uslukaya

    2012-03-01

    Full Text Available Objective: Peripheral nerve blocks are usually used either alone or along with general anesthesia for postoperative analgesia. We also aimed to present the results and experiences.Materials and methods: This retrospective study was conducted to scan the files of patients who underwent orthopedic upper extremity surgery with peripheral nerve block between September 2009 and October 2010. After ethics committee approval was obtained, 114 patients who were ASA physical status I-III, aged 18-70, performed upper extremity surgery in the Orthopedics and Traumatology Clinic were included to study. Patients’ demographic data, clinical diagnoses, premedication status, peripheral block type, local anesthetic dose, stimuplex needle types, hemodynamic parameters at the during surgery, the first postoperative analgesic requirements, complications and patient satisfaction were recorded.Results: Demographic data were similar to each other. Brachial plexus block was commonly performed for the forearm surgery. Infraclavicular block was performed the most frequently to patients. As the classical methods in the supine position were preferred in 98.2% of patients, Stimuplex A needle (B. Braun, Melsungen AG, Germany have been used for blockage in 80.7% of patients. Also, in 54.4% of patients, 30 ml of local anesthetic solution composed of bupivacaine + prilocaine was used for blockade. Blocks applied to patients had provided adequate anesthesia.Conclusion: Since the brachial plexus blockade guided peripheral nerve stimulator for upper extremity surgery provide adequate depth of anesthesia and analgesia, it may be a good alternative to general anesthesia because of unwanted side effects

  1. Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations.

    Science.gov (United States)

    Mian, Asma; Chaudhry, Irfan; Huang, Richard; Rizk, Elias; Tubbs, R Shane; Loukas, Marios

    2014-03-01

    The trend towards regional anesthesia began in the late 1800s when William Halsted and Richard Hall experimented with cocaine as a local anesthetic for upper and lower limb procedures. Regional anesthesia of the upper limb can be achieved by blocking the brachial plexus at varying stages along the course of the trunks, divisions, cords and terminal branches. The four most common techniques used in the clinical setting are the interscalene block, the supraclavicular block, the infraclavicular block, and the axillary block. Each approach has its own unique set of advantages and indications for use. The supraclavicular block is most effective for anesthesia of the mid-humerus and below. Infraclavicular blocks are useful for procedures requiring continuous anesthesia. Axillary blocks provide effective anesthesia distal to the elbow, and interscalene blocks are best suited for the shoulder and proximal upper limb. The two most common methods for localizing the appropriate nerves for brachial plexus blocks are nerve stimulation and ultrasound guidance. Recent literature on brachial plexus blocks has largely focused on these two techniques to determine which method has greater efficacy. Ultrasound guidance has allowed the operator to visualize the needle position within the musculature and has proven especially useful in patients with anatomical variations. The aim of this study is to provide a review of the literature on the different approaches to brachial plexus blocks, including the indications, techniques, and relevant anatomical variations associated with the nerves involved. PMID:23959836

  2. OCT/PS-OCT imaging of brachial plexus neurovascular structures

    Science.gov (United States)

    Raphael, David T.; Zhang, Jun; Zhang, Yaoping; Chen, Zhongping; Miller, Carol; Zhou, Li

    2004-07-01

    Introduction: Optical coherence tomography (OCT) allows high-resolution imaging (less than 10 microns) of tissue structures. A pilot study with OCT and polarization-sensitive OCT (PS-OCT) was undertaken to image ex-vivo neurovascular structures (vessels, nerves) of the canine brachial plexus. Methods: OCT is an interferometry-based optical analog of B-mode ultrasound, which can image through non-transparent biological tissues. With approval of the USC Animal Care and Use Committee, segments of the supra- and infraclavicular brachial plexus were excised from euthanized adult dogs, and the ex-vivo specimens were placed in cold pH-buffered physiologic solution. An OCT beam, in micrometer translational steps, scanned the fixed-position bisected specimens in transverse and longitudinal views. Two-dimensional images were obtained from identified arteries and nerves, with specific sections of interest stained with hematoxylin-eosin for later imaging through a surgical microscope. Results: with the beam scan direction transverse to arteries, the resulting OCT images showed an identifiable arterial lumen and arterial wall tissue layers. By comparison, transverse beam OCT images of nerves revealed a multitude of smaller nerve bundles contained within larger circular-shaped fascicles. PS-OCT imaging was helpful in showing the characteristic birefringence exhibited by arrayed neural structures. Discussion: High-resolution OCT imaging may be useful in the optical identification of neurovascular structures during attempted regional nerve blockade. If incorporated into a needle-shaped catheter endoscope, such a technology could prevent intraneural and intravascular injections immediately prior to local anesthetic injection. The major limitation of OCT is that it can form a coherent image of tissue structures only to a depth of 1.5 - 2 mm.

  3. 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.

  4. Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients

    International Nuclear Information System (INIS)

    The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients, treated according to the Danish Breast Cancer Cooperative Group protocols. One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months (13-99 months). After total mastectomy and axillary node sampling, high-risk patients were randomized to adjuvant therapy. One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks. In addition, 82 of these patients received cytotoxic therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and 46 received tamoxifen. Five percent and 9% of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy, respectively. Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy (p = 0.04) and in younger patients (p = 0.04). The clinical manifestations were paraesthesia (100%), hypaesthesia (74%), weakness (58%), decreased muscle stretch reflexes (47%), and pain (47%). The brachial plexus is more vulnerable to large fraction size. Fractions of 2 Gy or less are advisable. Cytotoxic therapy adds to the damaging effect of radiotherapy. Peripheral nerves in younger patients seems more vulnerable. Radiation-induced brachial plexopathy occurs mainly as diffuse damage toxopathy occurs mainly as diffuse damage to the brachial plexus. 24 refs., 9 tabs

  5. 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.

  6. A new rat model of neuropathic pain: complete brachial plexus avulsion.

    Science.gov (United States)

    Wang, Le; Yuzhou, Liu; Yingjie, Zhou; Jie, Lao; Xin, Zhao

    2015-03-01

    Brachial plexus avulsion (BPA) is one of the major injuries in motor vehicle accidents and may result in neuropathic pain. Accumulating evidence suggests that 30-80% of BPA developed neuropathic pain in human. In our study, complete brachial plexus avulsion (C5-T1) rats model leads to the results that 37.5% of rats had long-lasting (up to 6 months) mechanical allodynia and cold allodynia. We observed the activation of astrocyte and microglial in cervical spinal cord after BPA. Complete brachial plexus avulsion mimics human nerve root traction injury following traffic accidents. The complete BPA rat model approach human injuries and can be used for further investigations. PMID:25596440

  7. MR imaging of the brachial plexus

    International Nuclear Information System (INIS)

    Determining the cause of brachial plexopathy is often difficult. MR imaging allows for direct visualization of this region in multiple planes with high soft-tissue contrast. This paper defines the normal anatomy of the brachial plexus and demonstrates the ability of MR imaging to evaluate varied pathology in this region. Fifty-five patients with brachial plexopathy were evaluated with either a 1.5-T (General Electric, Milwaukee) or a 0.35-T (Diasonics, South San Francisco) superconducting MR system. Multiplanar, multiecho spin-echo images were obtained with either dual-coil imaging or a body coil. Individual fascicles to the brachial plexus were clearly separated from the subclavian artery and vein, clavicle, and surrounding musculature. Abnormalities well seen with MR imaging included primary tumors in the region of the brachial plexus, tumors metastatic to the brachial plexus, direct extension of pancoast tumors, postradiation fibrosis, and posttraumatic lesions, including fracture and edema

  8. 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 ...

  9. A Case of Schwannoma Arising From Brachial Plexus in an Operated Patient With the Diagnosis of Cubital Tunnel Syndrome

    OpenAIRE

    Su?rer, Levent; Koc?ak, Mu?ge; I?merci?, Ahmet; Haghari?, Sema; Gu?ney, Erkan

    2013-01-01

    Schwannomas are the frequently encountered neurogenic tumors of the thorax, especially in the posterior mediastinum, whereas in the peripheral nervous system, they are relatively uncommon and usually arise from one of the main nerves of the limbs. Schwannomas originating from the brachial plexus are rare and most of them are benign (1).Cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. The main complaints are numbness in ulnar nerve distribution a...

  10. COMMUNICATION BETWEEN RADIAL AND ULNAR NERVE AT A HIGH HUMERAL LEVEL

    Directory of Open Access Journals (Sweden)

    Monika Lalit

    2014-06-01

    Full Text Available Various communications between the different branches of brachial plexus have been reported by many authors but the communication between the radial and ulnar nerve; the branches of posterior and medial cords of brachial plexus in the arm is very rare. It features the communicating ramus travelling from proximal radial nerve and distal ulnar nerve at a high humeral level in the right arm of a 56 year old male cadaver. Knowledge of such variations may be of importance in the evaluation of certain entrapment phenomenon of ulnar nerve or unexplained sensory loss after trauma or surgical interventions in that particular area is also of clinical significance in anaesthetic blocks.

  11. 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

    Directory of Open Access Journals (Sweden)

    Martín Inzunza A

    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.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 degree 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.

  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. Absence of musculocutaneous nerve and accessory head of biceps brachii: a case report

    OpenAIRE

    Arora L; Dhingra R

    2005-01-01

    During dissection of a 55-year-old female cadaver, we observed that three nerve roots contributed to the formation of Median nerve in her right upper limb. Along with this variation, absence of Musculocutaneous nerve was noticed. The muscles of front of arm i.e. Biceps Brachii, Brachialis and Coracobrachialis received their nerve supply from Median nerve. The Lateral cutaneous nerve of forearm was derived from Median nerve. Also an accessory head of Biceps Brachii muscle was present in the ri...

  14. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome.

    Science.gov (United States)

    Fritz, Jan; Chhabra, Avneesh; Wang, Kenneth C; Carrino, John A

    2014-02-01

    Magnetic resonance (MR) neurography - guided nerve blocks and injections describe a techniques for selective percutaneous drug delivery, in which limited MR neurography and interventional MR imaging are used jointly to map and target specific pelvic nerves or muscles, navigate needles to the target, visualize the injected drug and detect spread to confounding structures. The procedures described, specifically include nerve blocks of the obturator nerve, lateral femoral cutaneous nerve, pudendal nerve, posterior femoral cutaneous nerve, sciatic nerve, ganglion impar, sacral spinal nerve, and injection into the piriformis muscle. PMID:24210321

  15. 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.

  16. Nerve Transfers in the Upper Extremity: A Practical User's Guide.

    Science.gov (United States)

    Rinker, Brian

    2015-06-01

    Nerve injuries above the elbow are associated with a poor prognosis, even with prompt repair and appropriate rehabilitation. The past 2 decades have seen the development of numerous nerve transfer techniques, by which a denervated peripheral target is reinnervated by a healthy donor nerve. Nerve transfers are indicated in proximal brachial plexus injuries where grafting is not possible or in proximal injuries of peripheral nerves with long reinnervation distances. Nerve transfers represent a revolution in peripheral nerve surgery and offer the potential for superior functional recovery in severe nerve injuries. However, the techniques have not been universally adopted due in part to a misconception that nerve transfers can only be understood and performed by superspecialists. Nerve transfer procedures are not technically difficult and require no specialized equipment. Numerous transfers have been described, but there are a handful of transfers for which there is strong clinical evidence. To restore shoulder abduction and external rotation in upper trunk brachial plexus injury, the key transfers are the spinal accessory to suprascapular nerve and the medial triceps branch to axillary nerve. For elbow flexion, the flexor carpi ulnaris branch of ulnar nerve to the biceps and brachialis branches of the musculocutaneous nerve is the key transfer. For ulnar intrinsic function, the distal anterior interosseous nerve to ulnar motor branch transfer has yielded excellent functional results. Nerve transfers form a therapeutic triad with traditional tendon transfers and functional motor unit rehabilitation which, when applied appropriately, can yield excellent functional results in complex nerve injuries. Nerve transfers are a powerful yet underused tool for proximal nerve injuries, which offer hope for traditionally discouraging injuries. PMID:25978554

  17. Neuromuscular hamartoma arising in the brachial plexus.

    Science.gov (United States)

    Lai, P H; Ho, J T; Lin, S L; Hsu, S S; Chen, C; Yeh, L R; Pan, H B

    2004-03-01

    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. PMID:14991257

  18. 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.)

  19. 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.

  20. 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

  1. Absence of upper trunk of the brachial plexus

    OpenAIRE

    Adam, Ali H.; Mohammed, Ammar M. A.; Grebballa, Abbas; Rizig, Sahar

    2011-01-01

    The brachial plexus is a complicated plexus supplying the upper limb. The brachial plexus is of great practical importance to the surgeon. It is encountered during operations upon the root of the neck, and hence it is in danger. Variations in the formation of the brachial plexus are common; and knowledge of the variation of the brachial plexus may be useful for surgeons, for improved guidance during supraclavicular block procedures, and for surgical approaches for brachial plexus. Here we rep...

  2. Traumatic injuries of brachial plexus

    International Nuclear Information System (INIS)

    The authors report their experience in 144 patients with traumatic brachial plexus injury who underwent Direct Cervical Myelography (DCM). Sometimes the diagnostic investigation was completed by CT. Various myelographic patterns are described: pseudomeningocele, missing sheet of the root, scarring lesions. In 9 cases only, myelography was not sufficient to provide a complete diagnosis. The examination showed all plexus roots lacerated in 14 patients, a monoradicular lesion in 75 cases, and no lesion in 26 cases. Twenty-one out of the 26 negative cases were confirmed during surgery, while in 2 patients an intracanalar injury was found, which had not been detected due to the presence of scars. Scars often compress healty roots, and may mask intracanalar injuries. In such cases, and when the spinal cord stretches towards the side of the lesion, Myelo-CT can be useful. DCM proved to be an extremely sensitive and specific method, which can be used as a first-choice radiological procedure in the study of traumatic injuries of the brachial plexus

  3. A giant plexiform schwannoma of the brachial plexus: case report

    Directory of Open Access Journals (Sweden)

    Kohyama Sho

    2011-11-01

    Full Text Available Abstract We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed.

  4. MORPHOLOGY OF ULNAR NERVE IN AXILLA & ARM & ITS VARIATIONS

    Directory of Open Access Journals (Sweden)

    Vijay Kumar S

    2014-11-01

    Full Text Available The ulnar nerve arises from the medial cord (C8, T1; medial cord also receives fibres from the ventral ramus of C7. Lesions of the ulnar nerve occur behind the medial epicondyle & in the cubital tunnel. When muscles are affected due to ulnar nerve dysfunction, there is ulnar neuropathy at the shoulder, arm & elbow. The study was done on 50 embalmed human cadavers (25 right & 25 left of both sexes of South Indian adult population obtained from the Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore. Variations in the ulnar nerve in its presence, origin, relations, distribution & communications were observed. Ulnar nerve was present in all 50 upper limb specimens (100%. Ulnar nerve originated from the medial cord of the brachial plexus in 49 cases (98%. In 1 case (2%, the ulnar nerve received C7 fibers from lateral cord i.e. the lateral root of the median nerve and then later fused with the median root of the median nerve. In 49 specimens (98% ulnar nerve took origin from the tip of the acromion processes. In 1 case (2% it took origin from distal to the tip of the acromion process. 49 specimens (98% showed the normal course, i.e. medial to axillary & brachial artery. 1 case (2% showed ulnar nerve present anterior to the third part of the axillary artery and brachial artery. In the midarm it passed medially as a normal course, then runs distally through the cubital tunnel. The awareness of these variations along the normal pattern are helpful for the interventional radiologists, orthopaedicians and neurologists in preventing untoward iatrogenic injury to the ulnar nerve during radiological procedures or operating on fractured patients or diagnostic therapy.

  5. Misdiagnosis of Brachial Plexus Schwannoma as Cervical Radiculopathy

    Directory of Open Access Journals (Sweden)

    Mahnaz Khajepour

    2013-01-01

    Full Text Available Schwannomas are relatively rare but benign nerve sheath tumors deriving from Schwann cells with low tendency of transformation to malignancy. Extracranial shwannomas usually present insidiously and thus are often diagnosed incorrectly or after lengthy delays. We present the case of a 51 years old female patient with chronic cervical pain radiating in left upper limb who was treated as cervical radiculopathy for 5 years. By aggrevation of pain and paresthesia, imaging and electrodiagnostic study revealed schwannoma of brachial plexus. In case of radiating pain and paresthesia in upper limb (such as this case symptoms can be misleading for cervical radiculopathy but careful examination especialy in persistence of symptoms with negative imaging results for radiculopathies are important and electrodiagnostic study can be helpful.

  6. Cervical spinal cord stimulation treatment of deafferentation pain from brachial plexus avulsion injury complicated by complex regional pain syndrome.

    Science.gov (United States)

    Chang Chien, George C; Candido, Kenneth D; Saeed, Kashif; Knezevic, Nebojsa Nick

    2014-08-01

    Brachial plexus avulsion is a rare and debilitating condition frequently associated with severe, intractable neuropathic pain. Interventional treatment modalities include dorsal root entry zone lesioning, stellate ganglion blockade, and neuromodulation such as spinal cord stimulation. We present a case of a 42-year-old woman with a traumatic left upper extremity brachial plexus avulsion injury after a motor vehicle accident and treatment of deafferentation pain complicated by complex regional pain syndrome type II. Previous unsuccessful interventions included repeated stellate ganglion blocks, transcutaneous electrical nerve stimulation, and opioid medication. After a successful trial of cervical spinal cord stimulator lead placement, she went on to an uneventful permanent implantation procedure. Spinal cord stimulation is an effective treatment for deafferentation pain and complex regional pain syndrome type II secondary to brachial plexopathy refractory to pharmacotherapy and conventional interventional attempts to modulate pain. PMID:25611136

  7. Radiation-induced brachial plexus neuropathy in breast cancer patients

    International Nuclear Information System (INIS)

    The incidence and latency period of radiation-induced brachial plexopathy (RBP) were assessed in 79 breast cancer patients by a neurological follow-up examination at least 60 months (range 67-130 months) after the primary treatment. All patients were treated primarily with simple mastectomy, axillary nodal sampling and radiotherapy (RT). Postoperatively, pre- and postmenopausal patients were randomly allocated chemotherapy for antiestrogen treatment. All patients were recurrence-free at time of examination. Clinically, 35% (25-47%) of the patients had RBP; 19% (11-29%) had definite RBP, i.e. were physically disabled, and 16% (9-26%) had probable RBP. Fifty percent (31-69%) had affection of the entire plexus, 18% (7-35%) of the upper trunk only, and 4% (1-18%) of the lower trunk. In 28% (14-48%) of cases assessment of a definite level was not possible. RBP was more common after radiotherapy and chemotherapy (42%) than after radiotherapy alone (26%) but the difference was not statistically significant (p = 0.10). The incidence of definite RBP was significantly higher in the younger age group (p = 0.02). This could be due to more extensive axillary surgery but also to the fact that chemotherapy was given to most premenopausal patients. In most patients with RBP the symptoms began during or immediately after radiotherapy, and were thus without significant latency. Chemotherapy might enhance the radiation-induced effect on nerve tissue, thus diminishing the latency period.ssue, thus diminishing the latency period. Lymphedema was present in 22% (14-32%), especially in the older patients, and not associated with the development of RBP. In conclusion, the damaging effect of RT on peripheral nerve tissue was documented. Since no successful treatment is available, restricted use of RT to the brachial plexus is warranted, especially when administered concomitantly with cytotoxic therapy. (orig.)

  8. Cutaneous angiomyolipoma

    OpenAIRE

    Singh Kulwant; Pai Radha; Kini Hema; Kini Ullal

    2009-01-01

    We report a case of cutaneous angiomyolipoma (AML) found on the anterior abdominal wall of a 3-year-old female child. Histologic examination showed a well-circumscribed nodule in the dermis composed of an intimate mixture of convoluted thick-walled blood vessels, smooth muscle, and mature fat. This lesion differs from renal AML in terms of a lack of association with tuberous sclerosis, circumscription, absence of epithelioid cells, and male predominance. We concluded that the unique features ...

  9. Cutaneous angiomyolipoma

    OpenAIRE

    Singh Kulwant; Pai Radha; Kini Hema; Kini Ullal

    2009-01-01

    Cutaneous angiomyolipomas are rare. We report a case in a 45-year-old male with a well circumscribed lesion located on the chin. This lesion, probably hamartomatous in nature, differs from renal angiomyolipoma in terms of nonassociation with tuberous sclerosis, circumscription, and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes angiolipoma, angioleiomyoma, hemangioma, and myolipoma. It is distinguished from the abovementi...

  10. Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia

    Directory of Open Access Journals (Sweden)

    Stoši? Mila M.

    2003-01-01

    Full Text Available Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transpher; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.; for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgens and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.

  11. Variant course and branching of right brachial artery: a case study

    Directory of Open Access Journals (Sweden)

    Preeti Goswami

    2013-04-01

    Full Text Available A variant course and branching pattern of the right brachial artery was recorded in a 54-year-old male cadaver during the practical sessions of University College of Medical Sciences, Delhi, India. The right brachial artery divided in the middle third of arm into a medial superficial and lateral deep branch. The superficial medial branch descended anterior to the median nerve and ended by dividing in the cubital fossa into ulnar and radial arteries, whereas the lateral branch descended postero-medial to the median nerve, ending deep to pronator teres as the common interosseous artery. The left brachial artery showed a normal branching pattern by dividing into radial and ulnar arteries in the cubital fossa. The probable origin of such a variation is embryological and familiarity with such variations is imperative as they might affect dynamics of limb function or alter the course of interventional procedures. [Int J Res Med Sci 2013; 1(2.000: 62-65

  12. Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication

    Science.gov (United States)

    Rastogi, Rakhi; Budhiraja, Virendra; Bansal, Kshitij

    2013-01-01

    Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.

  13. Radiodiagnosis of closed fractures of brachial plexus

    International Nuclear Information System (INIS)

    To clarify localization of brachial plexus (BP) root abruption, contrasting of spinal cord subarachnoidal space using X ray contrast preparation (myeloradiculography) is applied. Analysis of results of X-ray investigation in 91 patients is given. Typical symptoms of root abruption from the spinal cord on myelograms are described. it is shown that X ray contrast investigation is the main method in the diagnosis of brachial plexus injuries and selection of surgical treatment tactics

  14. What has changed in brachial plexus surgery?

    OpenAIRE

    Marcelo Rosa de Rezende; Gustavo Bersani Silva; Emygdio Jose Leomil de Paula; Rames Mattar Junior; Olavo Pires de Camargo

    2013-01-01

    Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others ...

  15. 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

  16. 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

  17. 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.

  18. Cutaneous angiomyolipoma

    Directory of Open Access Journals (Sweden)

    Singh Kulwant

    2009-04-01

    Full Text Available Cutaneous angiomyolipomas are rare. We report a case in a 45-year-old male with a well circumscribed lesion located on the chin. This lesion, probably hamartomatous in nature, differs from renal angiomyolipoma in terms of nonassociation with tuberous sclerosis, circumscription, and male predominance. Another characteristic feature is the absence of epithelioid cells. Differential diagnosis includes angiolipoma, angioleiomyoma, hemangioma, and myolipoma. It is distinguished from the abovementioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle, and fat.

  19. Cutaneous Vasculitis

    Directory of Open Access Journals (Sweden)

    Nilsel ?lter

    2010-06-01

    Full Text Available Vasculitis is defined as inflammation directed at vessels, which compromises or destroys the vessel wall leading to haemorrhagic and/or ischaemic events. Although the most common clinical finding of vasculitis is palpable purpura, patients may also present with other lesions including urticaria, infiltrative erythema, petechiae, purpura, purpuric papules, haemorrhagic vesicles and bullae, nodules, livedo reticularis, deep ulcers and digital gangrene. Classification systems have been important in the study of vasculitic diseases, and the most widely accepted one is based on the size of the vessel involved. This article will focus on the most common forms of cutaneous vasculitis.

  20. Phenotyping sensory nerve endings in vitro in the mouse

    OpenAIRE

    Zimmermann, Katharina; Hein, Alexander; Hager, Ulrich; Kaczmarek, Jan Stefan; Turnquist, Brian P.; Clapham, David E.; Reeh, Peter W.

    2009-01-01

    This protocol details methods to identify and record from cutaneous primary afferent axons in an isolated mammalian skin–saphenous nerve preparation. The method is based on extracellular recordings of propagated action potentials from single-fiber receptive fields. Cutaneous nerve endings show graded sensitivities to various stimulus modalities that are quantified by adequate and controlled stimulation of the superfused skin with heat, cold, touch, constant punctate pressure or chemicals. R...

  1. 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.)

  2. Neuromuscular hamartoma (benign "triton" tumor) of the brachial plexus. Case report.

    Science.gov (United States)

    Awasthi, D; Kline, D G; Beckman, E N

    1991-11-01

    Neuromuscular hamartoma (choristoma) or benign "triton" tumor is a very rare peripheral-nerve tumor composed of mature nerve fibers and well-differentiated striated muscle fibers. Only seven cases have been reported in the literature. A new case of this rare entity is described in a 36-year-old white woman with a recurrent left supraclavicular mass in the brachial plexus area. Unlike the previous cases, this patient had continued to have proliferation of her tumor since childhood, requiring total resection in adulthood. It is concluded that total resection of these tumors should be attempted at initial diagnosis. The histogenesis of these tumors remains unclear. They may represent proliferation of neuroectodermal-derived or limb mesodermal tissue in the elements of a peripheral nerve. PMID:1919706

  3. Diagnostic value of combined magnetic resonance imaging examination of brachial plexus and electrophysiological studies in multifocal motor neuropathy

    Directory of Open Access Journals (Sweden)

    Basta Ivana

    2014-01-01

    Full Text Available Background/Aim. Multifocal motor neuropathy (MMN is an immune-mediated disorder characterized by slowly progressive asymetrical weakness of limbs without sensory loss. The objective of this study was to investigate the involvement of brachial plexus using combined cervical magnetic stimulation and magnetic resonance imaging (MRI of plexus brachialis in patients with MMN. We payed special attention to the nerve roots forming nerves inervating weak muscles, but without detectable conduction block (CB using conventional nerve conduction studies. Methods. Nine patients with proven MMN were included in the study. In all of them MRI of the cervical spine and brachial plexus was performed using a Siemens Avanto 1.5 T unit, applying T1 and turbo spinecho T1 sequence, axial turbo spin-echo T2 sequence and a coronal fat-saturated turbo spin-echo T2 sequence. Results. In all the patients severe asymmetric distal weakness of muscles inervated by radial, ulnar, median and peroneal nerves was observed and the most striking presentation was bilateral wrist and finger drop. Three of them had additional proximal weakness of muscles inervated by axillar and femoral nerves. The majority of the patients had slightly increased cerebrospinal fluid (CSF protein content. Six of the patients had positive serum polyclonal IgM anti-GM1 antibodies. Electromyoneurography (EMG showed neurogenic changes, the most severe in distal muscles inervated by radial nerves. All the patients had persistent partial CBs outside the usual sites of nerve compression in radial, ulnar, median and peroneal nerves. In three of the patients cervical magnetic stimulation suggested proximal CBs between cervical root emergence and Erb’s point (prolonged motor root conduction time. In all the patients T2-weighted MRI revealed increased signal intensity in at least one cervical root, truncus or fasciculus of brachial plexus. Conclusion. We found clinical correlation between muscle weakness, prolonged motor root conduction time and MRI abnormalities of the brachial plexus, which was of the greatest importance in the nerves without CB inervating weak muscles.

  4. Case report 388: Transient paralysis of the left hemidiaphragm secondary to blocking anesthesia of the intrascalene brachial plexus

    International Nuclear Information System (INIS)

    Radiologists and clinicians should be aware of the phenomenon of transient, unilateral paralysis of the phrenic nerve, secondary to anesthesia performed in a block of the brachial plexus used in surgical procedures of the upper extremity and in manipulation of fractures and dislocations. The disorder is self-limited and requires no further investigation or treatment. This entity is well-illustrated and fully described in this case report. (orig.)

  5. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience

    International Nuclear Information System (INIS)

    To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus. Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively. SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols. High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibiliients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging. (orig.)

  6. Cutaneous tactile allodynia associated with microvascular dysfunction in muscle

    OpenAIRE

    de Mos Marissa; Siau Chiang; Xiao Wen; Xanthos Dimitris N; Millecamps Magali; Laferrière Andre; Sachot Christelle; Vaigunda, Ragavendran J.; Jpm, Huygen Frank; Bennett Gary J; Coderre Terence J

    2008-01-01

    Abstract Background Cutaneous tactile allodynia, or painful hypersensitivity to mechanical stimulation of the skin, is typically associated with neuropathic pain, although also present in chronic pain patients who do not have evidence of nerve injury. We examine whether deep tissue microvascular dysfunction, a feature common in chronic non-neuropathic pain, contributes to allodynia. Results Persistent cutaneous allodynia is produced in rats following a hind paw ischemia-reperfusion injury tha...

  7. TRPA1 modulates mechanotransduction in cutaneous sensory neurons

    OpenAIRE

    Kwan, Kelvin Y; Glazer, Joshua M.; Corey, David P; Rice, Frank L; Cheryl L. Stucky

    2009-01-01

    TRPA1 is expressed by nociceptive neurons of the dorsal root ganglia (DRG) and trigeminal ganglia, but its roles in cold and mechanotransduction are controversial. To determine the contribution of TRPA1 to cold and mechanotransduction in cutaneous primary afferent terminals, we used the ex-vivo skin-nerve preparation from Trpa1+/+, Trpa1+/? or Trpa1?/? adult mouse littermates. Cutaneous fibers from TRPA1-deficient mice showed no deficits in acute cold sensitivity, but they displayed str...

  8. Radiation-induced brachial plexus paralysis

    International Nuclear Information System (INIS)

    Fifteen patients with radiation-induced brachial plexus paralysis were studied. Thirteen women had been treated for breast cancer. Two men developed symptoms and signs following radiation therapy for lung cancer. The brachial plexus paralysis initially was not static and progressed, but spontaneous arrest with permanent residual paralysis was seen in three patients. Three were noted to have intractable pain, but the major complaint of the remaining 12 was the inability to use their hands. The ten patients on whom an earlier operation directed at the brachial plexus had been performed were not relieved. Two of these were later considered excellent candidates for a tendon transfer in the hand. One did not desire surgery. The other underwent operation and showed marked improvement of her grasp and general hand function

  9. Comparative analysis of MR myelography and conventional myelography in diagnosing traumatic brachial plexus lesions

    International Nuclear Information System (INIS)

    Nerve root avulsion is the most serious type of traumatic brachial plexus injury. The main radiological sign of this lesion is traumatic meningocele. Until recently the imaging method of choice in these cases was X-ray myelography, which in some patients was supplemented by computed tomography myelography (CT myelography). Recently, non-invasive magnetic resonance myelography (MR myelography) has an increasing significance. The aim of the study was to assess the value of MR myelography in diagnosing nerve root avulsions in patients with traumatic brachial plexus injuries by comparing it with X-ray myelography and to establish if MR myelography could replace X-ray myelography. Material consisted of 30 patients with traumatic brachial plexus injury, in whom MR myelography and X-ray myelography (in 4 cases also CT myelography) were performed. In 16 patients MR myelography was performed using open low-field MR unit (FSE 2D sequence) and in the remaining 14 patients middle-field closed MR unit was used (PSIF 3D sequence). MR myelography revealed traumatic meningoceles in 18 patients, while in 12 patients it showed normal appearance. MR myelography was compatible with X-ray myelography in 25 cases (83.3%). Among the not compatible or partially compatible results of the studies mentioned above, 4 patients were operated on. In 3 of them surgery confirmed the result of MR myelography and in 1 - of X-ray myelography. Among all 20 patients who were operated on, MR myelography wats who were operated on, MR myelography was confirmed by surgery in 18 cases (90%), while X-ray myelography - in 17 patients (85%). MR myelography is not inferior and in some cases even superior to conventional invasive X-ray myelography in diagnosing nerve root avulsion injuries, therefore it could replace it in most cases. X-ray myelography and CT myelography remain the methods of choice in patients with contraindications to MR study. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Radiation-included brachial plexus injury

    International Nuclear Information System (INIS)

    All 449 breast cancer patients treated with post-operative radiotherapy to the breast and lymph nodes between 1982 and 1984 have been followed for 3-5.5 years. In this group two different fractionation schedules were used, one five times a fortnight and one daily, both over 6 weeks. The calculated dose to the brachial plexus was 45 Gy in 15 fractions or 5e Gy in 30 fractions. These schedules are equivalent doses using the standard NSD formula. The diagnosis of a brachial plexus injury was made clinically and computed tomography from recurrent disease. The actuarial incidence of a radiation-induced brachial plexus injury for the whole group was 4.9% at 5.5 years. No cases were seen in the first 10 months following radiotherapy. The incidence rises between 1 and 4 years and then starts to plateau. When the large fraction size group is compared with the small fraction size group the incidence at 5.5 years is 5.9% and 1.0%, respectively (p 0.09). Two different treatment techniques were used in this group but were not found to contribute to the probability of developing a brachial plexud injury. It is suggested that radiation using large doses per fraction are less well tolerated by the brachial plexus than small doses per fraction; a commonly used fractionation schedule such as 45 Gy in 15 fractions may give unacceptably high brachial plexus morbidity; and the of small doses per fraction or avoiding lymphatic irradiation is advocated. (author). 13 refs.; 6 figs.; 1 tabted. (author). 13 refs.; 6 figs.; 1 tab

  12. Diffusion weighted MR imaging of brachial plexus diseases

    International Nuclear Information System (INIS)

    Diffusion weighted image (DWI) can specifically give running of nerve fibers as they have diffusion anisotropic property and DW whole body imaging with background body signal suppression (DWIBS) procedure, which being capable of imaging cervical and lumber nerve roots, is thus suggested to be useful for diagnosis of diseases related to brachial plexus (BP). The purpose of the present study is to confirm the usefulness of DWIBS by comparison of its images of the normal and sick plexuses. Subjects are 5 normal healthy males (27-36 y), 29 patients (19 M/10 F, 7-73 y) with BP diseases (10 cases of external injury, 6 of obstetric palsy, 2 of paralysis by dysfunctional position, 6 by Schwannoma, 2 by metastasis of breast cancer and 3 by radiation) and, to see the diagnostic specificity, 9 patients (M 7/F 2, 15-64 y) with severely reduced hand force by nervous causes other than BP ones. MRI with Philips Gyroscan INTERA 1.5T machine is conducted for DWIBS by DWI with single shot EPI (echo planar imaging) with the coil of either sensitivity encoding (SENSE) Cardiac, Flex-M or -S. Images are reconstructed 3D by a radiological technician possessing no information concerning patient's conditions, with Philips software Soap-bubble tool on the workstation, and are then evaluated by a radiologist and an orthopedist separately. It is found that BP disorders by injury, obstetric palsy and tumors, of which diagnosis has been difficult hitherto, can be imaged either negatively or positi can be imaged either negatively or positively depending on their history. In radiation paralysis, only 1/3 cases give a reduced signal intensity in the whole BP. DWIBS will be a new diagnostic mean for systemic peripheral nerve diseases as well as BP ones. (T.T.)

  13. A rare variation of the branching pattern of radial nerve

    Directory of Open Access Journals (Sweden)

    Jamuna M

    2011-02-01

    Full Text Available Variation in the branching pattern of posterior cord of the brachial plexus is common but variation in the branching pattern of the radial nerve is rare. A rare and unreported variation in the branching pattern of the radial nerve was noted in the left sided axilla of an embalmed adult male cadaver during the regular gross anatomical dissection for undergraduate students. The radial nerve was having its origin from the posterior cord as a terminal branch and it split into anterior and posterior divisions. Branches of the radial nerve in the arm were given off from the posterior division and the anterior division continued as the main radial nerve with normal course and relations. These variations are important in evaluating post-traumatic injuries and repair of peripheral nerve injuries and during flap dissections.

  14. Multiple cutaneous neuromuscular choristomas. Report of a case and a review of the literature.

    Science.gov (United States)

    O'Connell, J X; Rosenberg, A E

    1990-01-01

    We report a case of two neuromuscular choristomas occurring in separate cutaneous locations in a healthy 3-month-old infant. Both lesions had an identical histologic appearance and were composed of mature skeletal muscle cells admixed with nerve fibers. In all previous reports, neuromuscular choristoma has arisen in association with a major nerve, and most lesions have been solitary. The two separate cutaneous choristomas in this case suggest that this lesion may arise from the neuroectodermal-derived Schwann cell. PMID:2403760

  15. Aberrant radial-ulnar nerve communication in the upper arm presenting as an unusual radial nerve palsy: a case report.

    Science.gov (United States)

    Lombardo, Daniel J; Buzas, David; Siegel, Geoffrey; Afsari, Alan

    2015-05-01

    An unusual communication between the radial and ulnar nerves was observed during repair of a fracture of the humerus in an adult patient who presented with unusual physical exam findings. The patient had loss of radial and ulnar nerve motor function, as well as decreased sensation in both nerve distributions. Radial nerve injury following fracture of the humerus is a common condition, and anatomic variations are therefore of importance to clinicians. Communications between branches of the brachial plexus are also not uncommon findings; however there is very little mention of communication between the radial and ulnar nerves in the literature. An appreciation of unusual nerve anatomy is important in explaining unusual finding in patients. PMID:25481257

  16. 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.

  17. Cutaneous cryosurgery.

    Science.gov (United States)

    Zimmerman, Ethan E; Crawford, Paul

    2012-12-15

    Cutaneous cryosurgery refers to localized application of freezing temperatures to achieve destruction of skin lesions. It can be used to treat a broad range of benign and premalignant skin conditions, and certain malignant skin conditions, with high cure rates. Cellular destruction is accomplished by delivery of the cryogen via dipstick, probe, or spray techniques. It is widely used in primary care because of its safety, effectiveness, low cost, ease of use, good cosmetic results, and lack of need for anesthesia. Cryosurgery is as effective as alternative therapies for most cases of molluscum contagiosum, dermatofibromas, keloids, and plantar or genital warts. It is a more effective cure for common warts than salicylic acid or observation. Cryosurgery is generally the treatment of choice for actinic keratosis. Contraindications to cryosurgery include cryofibrinogenemia, cryoglobulinemia, Raynaud disease, agammaglobulinemia, and multiple myeloma. Complications from cryosurgery include hypopigmentation and alopecia, and can be avoided by limiting freeze times to less than 30 seconds. Referral to a dermatologist should be considered in cases of diagnostic uncertainty or for treatment of skin cancer, which requires larger amounts of tissue destruction, resulting in higher complication rates. PMID:23316984

  18. Cutaneous mucormycosis.

    Science.gov (United States)

    Skiada, Anna; Petrikkos, George

    2013-01-01

    Mucormycosis is an invasive fungal infection caused by fungi of the order Mucorales, mainly affecting immunocompromised patients. Cutaneous mucormycosis is the third most common clinical form of the disease, after pulmonary and rhino-cerebral. The usual factors predisposing to this infection are hematological malignancies and diabetes mellitus, but a significant proportion of patients are immunocompetent. The agents of mucormycosis are ubiquitous in nature and are transmitted to the skin by direct inoculation, as a result of various types of trauma. These include needle sticks, stings and bites by animals, motor vehicle accidents, natural disasters, and burn injuries. The typical presentation of mucormycosis is the necrotic eschar, but it can present with various other signs. The infection can be locally invasive and penetrate into the adjacent fat, muscle, fascia, and bone, or become disseminated. Diagnosis is difficult because of the nonspecific findings of mucormycosis. Biopsy and culture should be performed. The treatment of mucormycosis is multimodal and consists of surgical debridement, use of antifungal drugs (amphotericin B and posaconazole), and reversal of underlying risk factors, when possible. Mortality rates, although lower than in other forms of the disease, are significant, ranging from 4% to 10% when the infection is localized. PMID:23930354

  19. 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.

  20. A Rare Pattern of Brachial Artery Variation: Case Report / Un Patrón de Variación Raro de la Arteria Braquial: Reporte de Caso

    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 A diferencia del sistema venoso, las variaciones en la anatomía arterial son menos frecuentes y la mayoría afecta a las arterias viscerales. En los miembros, las variaciones de la arteria braquial son las más informadas y por lo menos seis diferentes patrones han sido descritos. La variación más com [...] ún es de la arteria braquial superficial que está superficialmente al nervio mediano. Mucho menos frecuente es el origen alto de la arteria braquial radial (la arteria braquiorradial) o la existencia de una arteria braquial doble (arteria braquial accesoria). Presentamos un patrón de variación no descrito de la arteria braquial observado durante la disección del miembro superior derecho de un cadáver en un hombre de 60 años de edad. Encontramos la bifurcación de la arteria braquial en la porción medial del brazo, pasando posterior al nervio mediano. Luego, esta rama medial se redirecciona lateralmente y cruza nuevamente al nervio mediano, esta vez, anterior a él, hasta alcanzar la región lateral del brazo. A nivel de la flexura del codo, la rama medial origina la arteria radial. La rama lateral de la arteria braquial se mantiene lateral al nervio mediano y continúa como arteria ulnar y origina la arteria interósea común. Abstract in english Unlike the venous system, variations in arterial anatomy are less frequent and most of them affect visceral arteries. In limbs, variations of the brachial artery are the most reported and at least six different patterns have been described so far. The commonest is the superficial brachial artery whi [...] ch lies superficially to the median nerve. Much less prevalent are the high origin of the radial artery (brachioradial artery) or the existence of a doubled brachial artery (accessory brachial artery). We present a previously undescribed pattern of brachial artery variation. During dissection of the right upper limb of a 60 year-old male embalmed cadaver, we found the bifurcation of the brachial artery in the proximal portion of the middle third of the arm. Its medial branch reaches the medial aspect of the arm, posterior to the median nerve. Afterwards, this medial branch redirects laterally and crosses again the median nerve, this time lying anterior to the nerve until it reaches the lateral aspect of the arm. At the elbow level, the medial branch originates the radial artery. The lateral branch of the brachial artery remains lateral to the median nerve and continues as ulnar artery and originates the interosseus artery.

  1. 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.

  2. Diagnosis of brachial and lumbosacral plexus lesions.

    Science.gov (United States)

    van Alfen, Nens; Malessy, Martijn J A

    2013-01-01

    To most doctors, brachial and lumbosacral plexopathies are known as difficult disorders, because of their complicated anatomy and relatively rare occurrence. Both the brachial, lumbar, and sacral plexuses are extensive PNS structures stretching from the neck to axillary region and running in the paraspinal lumbar and pelvic region, containing 100000-200000 axons with 12-15 major terminal branches supplying almost 50 muscles in each limb. The most difficult part in diagnosing a plexopathy is probably that it requires an adequate amount of clinical suspicion combined with a thorough anatomical knowledge of the PNS and a meticulous clinical examination. Once a set of symptoms is recognized as a plexopathy the patients' history and course of the disorder will often greatly limit the differential diagnosis. The most common cause of brachial plexopathy is probably neuralgic amyotrophy and the most common cause of lumbosacral plexopathy is diabetic amyotrophy. Traumatic and malignant lesions are fortunately rarer but just as devastating. This chapter provides an overview of both common and rarer brachial and lumbosacral plexus disorders, focusing on clinical examination, the use of additional investigative techniques, prognosis, and treatment. PMID:23931788

  3. What has changed in brachial plexus surgery?

    Scientific Electronic Library Online (English)

    Marcelo Rosa de, Rezende; Gustavo Bersani, Silva; Emygdio Jose Leomil de, Paula; Rames, Mattar Junior; Olavo Pires de, Camargo.

    Full Text Available Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressive [...] ly. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes. In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury.

  4. Shoulder deformities from obstetrical brachial plexus paralysis

    International Nuclear Information System (INIS)

    Abnormalities are described in the shoulders of 11 patients up to 17 years of age who have chronic brachial plexus paralyses from birth injuries. These abnormalities include a poorly formed and hypoplastic humeral head, a short abnormally formed clavicle, and a hypoplastic elevated scapula with a shallow glenoid fossa, inferiorly directed coracoid process, and abnormally tapered acromion. Four also had subluxated shoulders. (orig.)

  5. Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications / Ausência do nervo musculocutâneo: uma rara variação anatômica com possíveis implicações clínico-cirúrgicas

    Scientific Electronic Library Online (English)

    José Humberto Tavares Guerreiro, Fregnani; Maria Inez Marcondes, Macéa; Celina Siqueira Barbosa, Pereira; Mirna Duarte, Barros; José Rafael, Macéa.

    2008-09-01

    Full Text Available CONTEXTO: O nervo musculocutâneo é um dos ramos terminais do fascículo lateral do plexo braquial, sendo responsável pela inervação da musculatura flexora do cotovelo e pela sensibilidade cutânea da face lateral do antebraço. Sua ausência já foi descrita previamente, mas a sua real prevalência é desc [...] onhecida. RELATO DE CASO: Este é um relato de caso da ausência do nervo musculocutâneo observada durante a dissecção do membro superior direito de um cadáver do sexo masculino, sendo o seu território de inervação suprido pelo nervo mediano. Deste emergiam três ramos, um para o músculo coracobraquial, outro para o músculo bíceps braquial e o terceiro para o músculo braquial. Este último ramo continuava-se como nervo cutâneo lateral do antebraço. Trata-se de variação anatômica que tem implicações clínico-cirúrgicas, já que a lesão do nervo mediano, neste caso, acarretaria inesperada paralisia da musculatura flexora do cotovelo e hipoestesia da face lateral do antebraço. Abstract in english CONTEXT: The musculocutaneous nerve is one of the terminal branches of the lateral fasciculus of the brachial plexus, and is responsible for innervation of the flexor musculature of the elbow and for skin sensitivity on the lateral surface of the forearm. Its absence has been described previously, b [...] ut its real prevalence is unknown. CASE REPORT: A case of absence of the musculocutaneous nerve that was observed during the dissection of the right arm of a male cadaver is described. The area of innervation was supplied by the median nerve. From this, three branches emerged: one to the coracobrachialis muscle, another to the biceps brachii muscle and the third to the brachialis muscle. This last branch continued as a lateral antebrachial cutaneous nerve. This is an anatomical variation that has clinical-surgical implications, considering that injury to the median nerve in this case would have caused unexpected paralysis of the flexor musculature of the elbow and hypoesthesia of the lateral surface of the forearm.

  6. Cutaneous horn malignant melanoma

    OpenAIRE

    Haruto Nishida; Tsutomu Daa; Kenji Kashima; Motoki Arakane; Hiromitsu Shimada; Mizuki Goto; Yoshitaka Kai; Yutaka Hatano; Osamu Okamoto; Shigeo Yokoyama

    2013-01-01

    A 73-year-old Japanese woman presented with cutaneous horn on the right cheek. The resected tumor was 9 mm in diameter, with 14 mm protrusion, and showed exophytic growth with marked papillomatosis. Histopathology showed proliferation of atypical melanocytes with melanin pigments in the epidermis and dermis under the cutaneous horn. These cells were confined to the base of the cutaneous horn, and did not spread to the surrounding epidermis. The final diagnosis was cutaneous horn malignant mel...

  7. GIANT CUTANEOUS HORN

    OpenAIRE

    Kumaresan M; Kumar Pramod; Pai Manohar

    2008-01-01

    A 53-year-old male presented with a giant cutaneous horn over the left leg. Cutaneous horn was excised and primary closure of the defect was done under spinal anesthesia. Histopathology showed underlying seborrheic keratosis. Cutaneous horn has been noticed on top of many clinical conditions of diverse etiology, such as actinic keratoses, wart, molluscum contagiosum, seborrheic keratoses, keratoacanthoma, basal cell and squamous cell carcinoma. We report a patient with giant cutaneous horn on...

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Pan-brachial plexus neuropraxia following lightning: A rare case report

    Science.gov (United States)

    Patnaik, Ashis; Mahapatra, Ashok Kumar; Jha, Menka

    2015-01-01

    Background: Neurological complications following lightning are rare and occur in form of temporary neurological deficits of central origin. Involvement of peripheral nervous system is extremely rare and only a few cases have been described in the literature. Isolated unilateral pan-brachial plexus neuropraxia has never been reported in the literature. Steroids have long been used for treatment of neuropraxia. However, their use in lightning neural injury is unique and requires special mention. Case Description: We report a rare case of lightning-induced unilateral complete flaccid paralysis along with sensory loss in a young patient. Lightning typically causes central nervous involvement in various types of motor and sensory deficit. Surprisingly, the nerve conduction study showed the involvement of peripheral nervous system involvement. Steroids were administered and there was significant improvement in neurological functions within a short span of days. Patients’ functions in the affected limb were normal in one month. Conclusion: Our case was interesting since it is the first such case in the literature where lightning has caused such a rare instance of unilateral pan-brachial plexus lesion. Such cases when seen, raises the possibility of more common central nervous system pathology rather than peripheral involvement. However, such lesions can be purely benign forms of peripheral nerve neuropraxia, which can be managed by steroid treatment without leaving any long-term neurological deficits. PMID:25883854

  10. Birth Weight and Incidence of Surgical Obstetric Brachial Plexus Injury

    Science.gov (United States)

    Nath, Rahul K.; Avila, Meera B.; Melcher, Sonya E.; Eichhorn, Mitchell G.; Somasundaram, Chandra

    2015-01-01

    Objectives: (1) To analyze the birth weight of obstetric brachial plexus injury (OBPI) patients requiring one or more reconstructive surgeries and (2) to analyze whether there is any difference in the severity of the injury, and the outcome of the surgery between the macrosomic and nonmacrosomic OBPI patients. Study Design: An observational cohort study was performed on 100 consecutive patients treated with surgery at the Texas Nerve and Paralysis Institute. Ninety of the 100 patients underwent the modified Quad surgery, which improves the shoulder abduction and overall shoulder function. All OBPI patients in our study were assessed preoperatively and postoperatively by evaluating video recordings of active shoulder abduction. Results: Using a 4000 g definition of macrosomia, 52% of patients would be considered macrosomic, and using a 4500 g definition of macrosomia, 18% of patients are considered macrosomic in our study. Permanent injury occurs also in average-birth-weight children. Conclusions: A significant percentage (48%-82% depending on definition of macrosomia) of OBPI patients requiring major reconstructive surgery had birth weights which would put them in the “normal” birth weight category. In addition, we found that there was no significant difference in the severity of the injury, and the outcome of the modified Quad surgical procedure between macrosomic and nonmacrosomic OBPI patients. However, there was a significant improvement in shoulder movement in both macrosomic and nonmacrosomic patients after modified Quad surgery. PMID:25987939

  11. Evaluation of the brachial plexus with MR imaging

    International Nuclear Information System (INIS)

    MR imaging allows excellent visualization of the brachial plexus, including its cervical, subscapular, and axillary course. The anatomy of the normal brachial plexus as it appears on 5-mm coronal (short TR) and axial (1st and 2nd spin-echo sequences) images obtained using a body coil at 1.5 T is presented. Normal findings are compared with examples of pathologic masses arising in or adjacent to each part of the brachial plexus. Selected surface coil views were useful in the evaluation of the proximal brachial plexus. The MR imaging demonstration of the morphology of mass lesions and their relationship to the brachial plexus is superior to CT demonstration and can be accomplished in little time and without the use of intravenous contrast media. Currently it is not possible to achieve sufficient detail to detect infiltrative, fibrotic, or atrophic processes unless these cause significant changes in the size, shape, or position of the brachial plexus

  12. An anatomical study of double brachial arteries – a case report

    Directory of Open Access Journals (Sweden)

    Krstonosic B

    2010-02-01

    Full Text Available Superficial brachial artery is one of the major variations of the arterial pattern in the upper limb. During routine anatomical dissection in our department, we observed a case of unilateral double brachial artery in a formalin-fixed female cadaver.Left axillary artery entered into the anterior region of the arm, where it branched into two brachial arteries – the superficial brachial artery (SBA, which was longer, tortuous and with a smaller caliber, and the brachial artery (BA, which was placed deep and medially. In the cubital fossa, covered with an aponeurosis of the biceps brachii muscle, both brachial arteries were connected with an anastomotic vessel. Under this anastomotic branch, in the forearm, SBA continued as the radial artery, whereas BA continued as the ulnar artery.Variations of the arterial pattern in the upper limb are undoubtedly of interest to the anatomists as well as to the clinicians.

  13. Brachial plexus injury after median sternotomy.

    OpenAIRE

    Graham, J. G.; Pye, I. F.; Mcqueen, I. N.

    1981-01-01

    Five patients are described with brachial plexus injuries complicating median sternotomy for cardiac surgery. The lower roots (medial cord) of the plexus were most affected and in some cases the lesions were bilateral. Pain was a prominent feature and although motor and sensory symptoms both occurred, motor signs were more prominent than objective sensory loss. Recovery was protracted and sometimes incomplete. Traction or compression of the plexus (or both) are the major possible mechanisms o...

  14. “Huge Axillary Mass - Neurofibroma Brachial Plexus”

    OpenAIRE

    Mehta, Dharmendra; Mehta, D. D.; Shaam, M. B.; Yadav, J. K.

    2011-01-01

    Axillary swelling arising from soft tissue is not uncommon. Lipoma, Lymphadenopathy due to Kochs or Lymphoma are commonest swellings seen but firm to hard non tender mass arising from maninges of Brachial plexus is not so common. Usually these masses are benign but one may come across malignant tumour. Twenty-three year male presented with mass in anterior chest wall & arm pit having no other specific complaints, was diagnosed as Spindle cell tumour on FNAC & excision biopsy turned out to be ...

  15. Treatment Options for Brachial Plexus Injuries

    OpenAIRE

    Sakellariou, Vasileios I.; Badilas, Nikolaos K.; Stavropoulos, Nikolaos A.; George Mazis; Kotoulas, Helias K.; Stamatios Kyriakopoulos; Ioannis Tagkalegkas; Sofianos, Ioannis P.

    2014-01-01

    The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed.

  16. Post-irradiation pareses of brachial plexus

    International Nuclear Information System (INIS)

    Damage of brachial plexus as a sequel of breast carcinoma radiotherapy in 5 patients of an average age of 48 years is described. Complaints first appeared on the average 17.4 months after irradiation. The condition is characterized by initial pain, motor disturbances, reflex alteration. Skin alterations, atrophies, depilations, pigmentations, telangiectases and fibrous changes, and also lymphedema have been recorded. The necessity is stressed of an early start of therapy; the prognosis, however, is not very optimistic. (M.D.). 8 refs

  17. Systematic Evaluation Of Brachial Plexus Injuries

    OpenAIRE

    Haynes, Scott

    1993-01-01

    Brachial plexus injuries offer a unique challenge to the athletic trainer because of their relatively high frequency rate in contact sports and because of the complexity of the neuroanatomy in the cervical area. During a game, athletic trainers must make a fast, accurate decision regarding a player's return to competition. It is imperative that the athletic trainer be able to quickly differentiate between minor injuries and more serious injuries warranting removal from the game and/or physici...

  18. Qualitative dermatoglyphic traits in brachial plexus palsy.

    Science.gov (United States)

    Polovina, Svetislav; Milici?, Jasna; Cvjeticanin, Miljenko; Prolosci?, Tajana Polovina

    2007-12-01

    It has been considered for many years that the cause of perinatal brachial plexus palsy (PBPP) is excessive lateral traction applied to the fetal head at delivery, in association with anterior shoulder dystocia, but this do not explain all cases of brachial plexus palsy. The incidence found in several family members could be suggestive for inheritance with variable expression. The aim of this study was to prove early found confirmations of genetic predisposition for PBPP In the previous studies, the quantitative dermatoglyphic analysis showed some differences in digito-palmar dermatoglyphs between patients with PBPP and healthy controls. Now this qualitative analysis will try to determine hereditary of those diseases. We analyzed digito-palmar dermatoglyphics from 140 subjects (70 males and 70 females) diagnosed with PBPP and 400 phenotypically healthy adults (200 males and 200 females) from Zagreb area as control group. The results of Chi-square test showed statistically significant differences for frequencies of patterns on fingers in females between the groups observed. Statistically significant differences were found on palms in III and IV interdigital areas in both males and females and in thenar and I interdigital area only in females. As it was found in previous researches on quantitative dermatoglyphic traits, more differences are found between females with PBPP and control group, than between males. The fact, that the main presumed cause of PBPP is obstetrical trauma, it could be associated with congenital variability in formation of brachial plexus. PMID:18217462

  19. A Case of Schwannoma Arising From Brachial Plexus in an Operated Patient With the Diagnosis of Cubital Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Levent SÜRER

    2013-05-01

    Full Text Available Schwannomas are the frequently encountered neurogenic tumors of the thorax, especially in the posterior mediastinum, whereas in the peripheral nervous system, they are relatively uncommon and usually arise from one of the main nerves of the limbs. Schwannomas originating from the brachial plexus are rare and most of them are benign (1.Cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. The main complaints are numbness in ulnar nerve distribution and hand weakness. Advanced or severe cubital tunnel syndrome causes irreversible muscle atrophy and hand contractures due to chronic denervation (2.A 23yearold female was referred to an orthopedics clinic with right hand weakness, pain and numbness five years ago. She had undergone surgery after an electrodiagnostic evaluation, which revealed right cubital tunnel syndrome. She presented to our clinic complaining that her symptoms did not get better even she had additional ones, such as hand and forearm muscle atrophy. Motor evaluation revealed right forearm dorsal and volar, and right hand interosseous muscle atrophy as well as atrophy of the thenar and hypothenar areas. Right wrist flexion and extension muscle strength was 4/5. Abduction, adduction and opposition strength of the digits were 1/5. She did not have any additional muscle motor deficit. Sensory evaluation revealed C58 and T1 dermatomal hypoesthesia. There was a palpable mass in the supraclavicular region. Electrophysiological evaluation revealed low motor and sensory amplitudes for median, ulnar and radial nerves.Chest radiograph showed a superior mediastinal mass. Cervical magnetic resonance imaging (MRI showed a 5x5x4 cm mass (Figure 1. A vascular surgeon was consulted and the patient underwent surgery for a brachial plexus tumor. With supraclavicular incision, a 5x5x4 cm smoothedged mass was found with larger base at the right thoracic apex. Pathologically it was diagnosed as schwannoma originating from the brachial plexus. The patient was followed up with postoperative rehabilitation program. She was given strengthening exercises and occupational therapy for advancing her hand skills.Schwannomas are mostly located at the parapharyngeal area and originate from vagus nerve. Schwannomas of this region are seen as middle neck masses while cervical and brachial plexusoriginatedschwannomas are seen as lateral neck masses (3. To establish a firm diagnosis of primary brachial plexus tumor in the supraclavicular region in the absence of a cervical mass is challenging (4. Pain radiating to the arm is seen in 44% of these patients (5. Our patient had a supraclavicularlocated painless mass.During the management of patients suspected of having upper extremity entrapment neuropathies, it should not be forgotten that brachial plexusoriginated tumors could mimic entrapment neuropathies at the beginning (3,6,7.Morbidity resulting from permanent nerve damage due to missed or delayed diagnosis should be prevented with a proper physical examination for nerve assessment. Since permanent damage is a devastating result for the patient, it has a potential risk for medicolegal problems for the physicians if the only evaluation made is physical examination and electrophysiological tests. Physicians should be educated for peripheral nerve tumor morbidities and patients should be managed with evidencebased medicine protocols including early and proper consultations in order to prevent undesirable outcomes.

  20. An unusual presentation of whiplash injury: long thoracic and spinal accessory nerve injury

    OpenAIRE

    N. Omar; Alvi, F.; Srinivasan, M. S.

    2007-01-01

    Whiplash injuries from motor vehicle accidents are very common. The usual presentation and course of this condition normally results in resolution of symptoms within a few weeks. Brachial plexus traction injuries without any bone or joint lesion of the cervical spine have been reported before. We report a case where a gentleman was involved in a rear end vehicle collision, sustained a whiplash injury and was later found to have a long thoracic nerve palsy and spinal accessory nerve palsy. Alt...

  1. 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.

  2. Ultrasound-guided block of the axillary nerve: a volunteer study of a new method

    DEFF Research Database (Denmark)

    Rothe, C; Asghar, S

    2011-01-01

    Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-guided specific axillary nerve block.

  3. Transient neonatal radial nerve palsy. A case series and review of the literature.

    Science.gov (United States)

    Carsi, M Belen; Clarke, Anna M; Clarke, Nicholas P

    2015-01-01

    Transient neonatal radial nerve palsy manifests at birth by wrist drop and intact elbow and shoulder function. Spontaneous resolution is universal. We present a case series, including two bilateral cases, and a review of the cases found in the English literature, hypothesizing how this condition is probably misdiagnosed as brachial plexus injury. PMID:25835250

  4. 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...

  5. Sarcomas cutâneos primários / Primary cutaneous sarcomas

    Scientific Electronic Library Online (English)

    Luiz Fernando Fróes, Fleury Jr; José Antonio, Sanches 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. Es [...] te 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. Abstract in english 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 pr [...] imary 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.

  6. Sarcomas cutâneos primários Primary cutaneous sarcomas

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    Trehan Vikas

    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.

  8. Peripheral nerves, tumors, and hybrid PET-MRI.

    Science.gov (United States)

    Vargas, Maria Isabel; Garibotto, Valentina; Viallon, Magalie; Guignard, Renaud; Cuvinciuc, Victor; Lovblad, Karl; Ratib, Osman

    2013-01-01

    The study of peripheral nerves (PN) is a challenge because of the orientation, size, and also because of the fact that these pathologies are not well known. The diagnosis of PN damage was based exclusively on clinical examination and electrophysiologic testing until few years ago. MRI is the examination of choice for studying peripheral nerves; recently, magnetic resonance neurography has been added as a part of clinical routine. However, the analysis of PN after surgical treatment remains difficult. This clinical case of a sarcoma of the right brachial plexus illustrates how hybrid PET-MRI in postsurgical evaluation will clearly improve the exact delimitation of residual metabolically active tumor after surgery. PMID:23242064

  9. Subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI) for selective visualization of peripheral nerves

    Energy Technology Data Exchange (ETDEWEB)

    Takahara, Taro; Kwee, Thomas C.; Hendrikse, Jeroen; Niwa, Tetsu; Mali, Willem P.T.M.; Luijten, Peter R. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Van Cauteren, Marc [Philips Healthcare, Asia Pacific, Tokyo (Japan); Koh, Dow-Mu [Royal Marsden Hospital, Department of Radiology, Sutton (United Kingdom)

    2011-02-15

    The aim of this study was to introduce and assess a new magnetic resonance (MR) technique for selective peripheral nerve imaging, called ''subtraction of unidirectionally encoded images for suppression of heavily isotropic objects'' (SUSHI). Six volunteers underwent diffusion-weighted MR neurography (DW-MRN) of the brachial plexus, and seven volunteers underwent DW-MRN of the sciatic, common peroneal, and tibial nerves at the level of the knee, at 1.5 T. DW-MRN images with SUSHI (DW-MRN{sub SUSHI}) and conventional DW-MRN images (DW-MRN{sub AP}) were displayed using a coronal maximum intensity projection and evaluated by two independent observers regarding signal suppression of lymph nodes, bone marrow, veins, and articular fluids and regarding signal intensity of nerves and ganglia, using five-point grading scales. Scores of DW-MRN{sub SUSHI} were compared to those of DW-MRN{sub AP} using Wilcoxon tests. Suppression of lymph nodes around the brachial plexus and suppression of articular fluids at the level of the knee at DW-MRN{sub SUSHI} was significantly better than that at DW-MRN{sub AP} (P < 0.05). However, overall signal intensity of brachial plexus nerves and ganglia at DW-MRN{sub SUSHI} was significantly lower than that at DW-MRN{sub AP} (P < 0.05). On the other hand, signal intensity of the sciatic, common peroneal, and tibial nerves at the level of the knee at DW-MRN{sub SUSHI} was judged as significantly better than that at DW-MRN{sub AP} (P < 0.05). The SUSHI technique allows more selective visualization of the sciatic, common peroneal, and tibial nerves at the level of the knee but is less useful for brachial plexus imaging because signal intensity of the brachial plexus nerves and ganglia can considerably be decreased. (orig.)

  10. Three-dimensional MR imaging of the brachial plexus.

    Science.gov (United States)

    Vargas, Maria Isabel; Gariani, Joanna; Delattre, Benedicte A; Dietemann, Jean-Louis; Lovblad, Karl; Becker, Minerva

    2015-04-01

    Pathologic conditions of the brachial plexus often result in serious and disabling complications. With the increasing availability and use of new and powerful MRI sequences and coils, understanding and assessment of the complex anatomy and pathology of the brachial plexus have been greatly facilitated. These new technical developments have led to an improved assessment of brachial plexus lesions, thereby improving patient care. In this article we describe various MRI techniques for the evaluation of the brachial plexus obtained at 1.5 T and 3 T, and we explain differences and similarities between sequences and protocols performed on MRI equipment from different vendors. The main characteristics of pathologic conditions affecting the brachial plexus are discussed and illustrated, as well as their differential diagnoses, with an emphasis on key imaging findings and relevance for patient management. Pitfalls related to suboptimal technique and image interpretation are also addressed. PMID:25764238

  11. Cutaneous tactile allodynia associated with microvascular dysfunction in muscle

    Directory of Open Access Journals (Sweden)

    de Mos Marissa

    2008-10-01

    Full Text Available Abstract Background Cutaneous tactile allodynia, or painful hypersensitivity to mechanical stimulation of the skin, is typically associated with neuropathic pain, although also present in chronic pain patients who do not have evidence of nerve injury. We examine whether deep tissue microvascular dysfunction, a feature common in chronic non-neuropathic pain, contributes to allodynia. Results Persistent cutaneous allodynia is produced in rats following a hind paw ischemia-reperfusion injury that induces microvascular dysfunction, including arterial vasospasms and capillary slow flow/no-reflow, in muscle. Microvascular dysfunction leads to persistent muscle ischemia, a reduction of intraepidermal nerve fibers, and allodynia correlated with muscle ischemia, but not with skin nerve loss. The affected hind paw muscle shows lipid peroxidation, an upregulation of nuclear factor kappa B, and enhanced pro-inflammatory cytokines, while allodynia is relieved by agents that inhibit these alterations. Allodynia is increased, along with hind paw muscle lactate, when these rats exercise, and is reduced by an acid sensing ion channel antagonist. Conclusion Our results demonstrate how microvascular dysfunction and ischemia in muscle can play a critical role in the development of cutaneous allodynia, and encourage the study of how these mechanisms contribute to chronic pain. We anticipate that focus on the pain mechanisms associated with microvascular dysfunction in muscle will provide new effective treatments for chronic pain patients with cutaneous tactile allodynia.

  12. Cell population kinetics and dose-time relationships for post-irradiation injury of the brachial plexus in man

    International Nuclear Information System (INIS)

    Collected data on radiation-induced lesions of the brachial plexus were analyzed on the assuption that this reaction arises from depletion of some unidentified cell population in the irradiated tissues. A multi-probit search program was used to derive best-fitting cell kinetic parameters in a composite multi-target model for cellular radiation lethality and repopulation. From these parameters, a comprehensive iso-effect table, for a wide range of treatment schedules including daily treatment as well as fractionation at shorter and longer intervals, was constructed. The table provides a useful set of tolerance dosage limits for late effects in irradiation peripheral nerve. (Auth.)

  13. MR-myelography for the brachial plexus injury. Comparison of the MR-myelography, myelography and CT myelography

    International Nuclear Information System (INIS)

    The usefulness of MR-myelography was evaluated in 6 patients with brachial plexus injury. Pseudo-meningocele was confirmed clearly on MR-myelography in 4 patients with whole plexus injury. In 2 patients with upper plexus injury, damages of C6 nerve root were confirmed but pseudo-meningocele was not found on MR-myelography. MR-myelography is noninvasive and the accuracy is not inferior to myelography. Because MR-myelography needs no contrast media and the images can be observed in three-dimensional direction, it is expected in future application. (H.O.)

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Isolated axillary nerve involvement: a case report

    Directory of Open Access Journals (Sweden)

    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 MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T

    International Nuclear Information System (INIS)

    To estimate intrastudy, intraobserver and interobserver reproducibility of DTI-derived measurements and fibre tractography (FT) at 3.0 T MR imaging in subjects without known brachial plexus pathology. IRB approval and written informed consent were obtained. Forty healthy volunteers underwent bilateral 3.0-T DTI of the brachial plexus. Postprocessing included FT and analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Four authors performed postprocessing and analysis independently and in different sessions at baseline and after 4 weeks. Non-parametric tests and Bland-Altman statistics were used. Minimum and maximum percent variability were 6% and 20% for FA (85%-93% reproducibility). For ADC minimum and maximum percent variability were 6% and 18% (86%-97% reproducibility). Quality of fibre tract was rated equal in 80% and slightly different in 20% of subjects. Minimum detectable differences between limb were 37% for FA and 32% for ADC. Intra- and inter-observer agreement were good. Evaluating the combined influence of the observer and of the repeated measurements the reproducibility was 81-92%. DTI of brachial plexus nerves is reliable. The healthy contralateral side can be used as an internal control considering that changes in FA and ADC values of less that 37% and 32% will not be clinically detectable with confidence. (orig.)

  17. Estudo anatômico do trajeto do nervo musculocutâneo em relação ao processo coracoide / Anatomical study of the musculocutaneous nerve in relation to the coracoid process

    Scientific Electronic Library Online (English)

    Fabiano, Rebouças; Romulo, Brasil Filho; Cantidio, Filardis; Renato Rodrigues, Pereira; Alessandro Alvarenga, Cardoso.

    Full Text Available OBJETIVO: Os autores realizaram o estudo anatômico do trajeto do nervo musculocutâneo pela dissecção de 20 ombros em 10 cadáveres adultos frescos. MÉTODO: Mediu-se a distância da borda inferior do processo coracoide, ao ponto de penetração do ramo mais proximal do nervo musculocutâneo no músculo cor [...] acobraquial, denominada base. Partindo da borda inferomedial do processo coracoide, foi medida uma segunda distância até o ponto em que o fascículo lateral do plexo braquial cruza o músculo subclávio, sendo identificada como altura. A terceira mensuração foi da área triangular formada pelas duas primeiras medidas, denominada área. RESULTADOS: Observou-se que a média da base foi de 3,42cm, com variações de 2,38 a 4,30cm. A medida da altura foi em média 2,75cm, variando entre 1,03 a 3,80cm, e a média da área foi de 4,92cm², variando entre 1,22 a 7,99cm². CONCLUSÃO: Estas medidas são de grande importância, devido ao risco de lesão do nervo musculocutâneo nas abordagens cirúrgicas do ombro. Abstract in english OBJETIVE: The authors performed an anatomic study of the trajectory of the muscle cutaneous nerve, dissecting 20 shoulders in 10 fresh adult corpses. METHOD: The distance was measured from the inferior edge of the coracoid process to the point of penetration of the nearest branch of the cutaneous ne [...] rve muscle of the coracobrachialis muscle, called base. Starting at the inferior-medial edge of the coracoid process, a second measurement was made to the point at which the lateral fascicle of the brachial plexus crosses the subclavius muscle, denominated height. The third measurement was of the triangular area formed by the two first measurements, denominated area. RESULTS: The average base length was 3.42 cm, varying from 2.38 cm to 4.40 cm. The height measurement was 2.74 cm, on average, varying between 1.03 cm and 3.80 cm. And the average area was 4.92 cm², varying between 1.22 cm² and 7.99 cm². CONCLUSION: These measurements are very important due to the risk of injury in the cutaneous nerve muscle in surgeries performed on the shoulder.

  18. 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.

  19. Optic Nerve Drusen

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Drusen En Español Read in Chinese What are optic nerve drusen? Optic nerve drusen are abnormal globular ...

  20. 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 ...

  1. Development of a novel experimental rat model for brachial plexus avulsion injury.

    Science.gov (United States)

    Yang, Jiantao; Li, Xiangming; Hou, Yi; Yang, Yi; Qin, Bengang; Fu, Guo; Qi, Jian; Zhu, Qingtang; Liu, Xiaolin; Gu, Liqiang

    2015-06-17

    Brachial plexus injuries (BPI) are devastating events that frequently result in severe functional impairment of the upper extremity, and yet, present surgical reconstruction provides limited results. An animal model is an important tool to study peripheral nerve repair and regeneration. Here, a passive traction apparatus that allowed a multidirectional force exerted on a fixed forelimb was designed to produce a BPI rat model in a noninvasive manner. Behavioral and histological analyses were carried out to assess the suitability of the model. Using the apparatus, a reproducible upper BPI model was established with the forelimb abducted 30° and a test weight of 2?kg. Avulsion of the nerve roots resulted in almost a total loss of forelimb function and the average Terzis score was decreased significantly compared with the sham group. No obvious recovery of shoulder and elbow movements was noted during the test period. In addition, nerve roots avulsion injury led to severe retrograde degeneration of motoneurons in the C5-C7 spinal cord segments. Nissl staining results showed that motoneurons decreased significantly in number and appeared to have irregular morphologies. These results indicated that a novel noninvasive rat model for BPI that simulates the mechanism of a human lesion could be produced using our passive traction apparatus, and it is expected to produce reliable preclinical evidence in the assessment of new therapeutic strategies for this lesion. PMID:26011385

  2. 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)

  3. 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.

  4. 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. 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.)

  5. Disseminated Cutaneous Rhinosporidiosis

    OpenAIRE

    Nayak Surajit; Acharjya Basanti; Devi Basanti; Sahoo Antaryami; Singh Nilachal

    2010-01-01

    Rhinosporidiosis is a granulomatous disorder caused by Rhinosporidium seeberi. It frequently involves the nasopharynx and occasionally affects the skin. We hereby report a case of 46–year-old male who presented with multiple cutaneous plaque-like lesions with nasal obstruction. On examination, multiple cutaneous lesions were found to be present on malar aspect, infraorbital and supraorbital region, right shoulder and over the back near the tip of scapula. Oral cavity revealed a polypoidal l...

  6. Update on Cutaneous Calciphylaxis

    OpenAIRE

    Wollina, Uwe

    2013-01-01

    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...

  7. Isolated facial cutaneous sarcoidosis

    OpenAIRE

    Kumar, Sumir; Garg, Ravinder; Aggarwal, Simmi; Kaur, Jaskanwal

    2012-01-01

    Isolated cutaneous sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. Cutaneous lesions have been classified into specific and nonspecific depending on the presence of noncaseating granulomas on histopathologic studies. Macrophages most likely initiate the response of sarcoidosis by presenting unidentified antigens to CD4+ lymphocytes. A persistent poorly degradable antigen-driven CMI response leads to cytokine cascade, granulomaformation, and fibrosis. In the pre...

  8. Optic Nerve Atrophy

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Atrophy En Español Read in Chinese What is the optic nerve? The optic nerve contains over one million nerves ...

  9. 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

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

    DEFF Research Database (Denmark)

    Rothe, C; Steen-Hansen, Christian

    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.

  11. Interscalene brachial plexus blocks in the management of shoulder dislocations.

    OpenAIRE

    Underhill, T. J.; Wan, A.; Morrice, M.

    1989-01-01

    Interscalene brachial plexus block is a simple and effective alternative to intravenous benzodiazepines or general anaesthesia for manipulation of the dislocated shoulder. Thirty interscalene brachial plexus blocks were performed on 29 patients with dislocations of the shoulder to provide regional anaesthesia for reduction. Pain was abolished by 14 out of the 30 blocks performed, improved by 13 and unchanged by three. Muscle relaxation (MRC grade 3 or less) occurred in 21 patients. In 26 case...

  12. Concomitant Pseudoaneurysm and Arteriovenous Fistula Formation of Brachial

    OpenAIRE

    Akshara Gupta,; Achal Gupta,; Nitesh Agarwal

    2013-01-01

    Concomitant pseudoaneurysm and arteriovenous (AV) fistula formation of brachial artery after a penetratinginjury has been rarely reported. False aneurysms of peripheral arteries are very rare. It is usually of infectious, post-traumatic or of iatrogenic etiology. In most cases, these are the result of penetrating injuries such as gunshot or stabwounds and iatrogenic arterial injuries. Brachial artery is not a common site for peripheral artery aneurysms. Its associationwith fistula formation w...

  13. Management of Intrathoracic Benign Schwannomas of the Brachial Plexus

    OpenAIRE

    Alessandro Bandiera; Giampiero Negri; Giulio Melloni; Carlo Mandelli; Simonetta Gerevini; Angelo Carretta; Paola Ciriaco; Armando Puglisi; Piero Zannini

    2014-01-01

    Primary tumours of the brachial plexus are rare entities. They usually present as extrathoracic masses located in the supraclavicular region. This report describes two cases of benign schwannomas arising from the brachial plexus with an intrathoracic growth. In the first case the tumour was completely intrathoracic and it was hardly removed through a standard posterolateral thoracotomy. In the second case the tumour presented as a cervicomediastinal lesion and it was resected through a one-st...

  14. Impact of phrenic nerve paralysis on the surgical outcome of intercostal nerve transfer.

    Science.gov (United States)

    Kita, Yusuke; Tajiri, Yasuhito; Hoshikawa, Shinya; Hara, Yukinori; Iijima, Junichi

    2015-01-01

    Brachial plexus injuries (BPI) can be complicated by diaphragmatic paralysis (DP). This study determined the influence of DP on biceps brachii (BB) recovery after intercostal nerve transfer (ICNT) for BPI and investigated the respiratory complications of ICNT. The study included 100 patients, 84 showing no DP in preoperative and early postoperative chest radiographic images (non-DP group) and 16 with DP that persisted for over one year after surgery (DP group). The postoperative reinnervation time did not differ between groups. BB strength one year after surgery was lower in the DP group than non-DP group (p = 0.0007). No differences were observed 2-3 years after surgery. In the DP group, four patients had respiratory symptoms that affected daily activities and their outcomes deteriorated (p = 0.04). Phrenic nerve transfer should not be combined with ICNT in patients with poor respiratory function because of the high incidence of respiratory complications. PMID:25609274

  15. Perineal muco-cutaneous herpes zoster treated with brivudin.

    Science.gov (United States)

    Correia, Osvaldo; Pereira, Marta A; Pereira, Teresa; Santos, António

    2008-01-01

    Herpes zoster results from the reactivation of latent varicella-zoster virus (VZV) from the dorsal root ganglion of sensory nerves. It is rarely described in the pediatric population. We report the case of an 8-year-old immunocompetent boy with a painful lumbosacral herpes zoster that was treated with brivudin and achieved rapid and sustained improvement in the absence of muco-cutaneous or pharmacological side effects. PMID:18608718

  16. A comparative evaluation of skin and nerve histopathology in single skin lesion leprosy

    Directory of Open Access Journals (Sweden)

    Reddy Raghunatha

    2005-01-01

    Full Text Available Background: In spite of leprosy being a disease of nerves, ROM therapy for single skin lesion leprosy was based on clinical trials without much evidence-based studies of nerve pathology. The present study was undertaken to compare the histology of skin and nerve in single skin lesion leprosy, and to assess the scientific rationale and justification of single dose ROM therapy. Methods: Twenty-seven untreated patients with single skin lesion without significantly thickened peripheral nerves were selected. Skin and nearby pure cutaneous nerve biopsies were studied under both H&E and Fite?s stain. Results: All the skin biopsies were negative for AFB and clinico-pathological correlation was positive in 51.85% of skin biopsy specimens. Histopathological diagnosis of leprosy was evident in 55.5% of clinically normal looking nerves, with AFB positivity in 29.6% of nerve biopsy specimens. Correlation between clinical diagnosis and nerve histopathology was poor (26%. Conclusions: Single skin lesion without thickened peripheral nerves as criteria for single dose ROM therapy is not logical, since the histological diagnosis of leprosy in normal looking nerves with presence of AFB is revealed in this study. Pure cutaneous nerve biopsy is a simple outpatient procedure, without complications. This study emphasizes the need to consider nerve pathology as an important tool for further therapeutic recommendations, than just clinical trials and skin pathology alone. Though single dose ROM therapy has been withdrawn recently, the principle holds good for any future therapeutic recommendations.

  17. Nerve Blocks

    Science.gov (United States)

    ... as the sciatic nerve, your doctor will tell you to speak up if you get a sudden jolt of pain. This means ... covered by insurance and the possible charges that you will incur. Web ... from the American College of Radiology (ACR) and the Radiological Society ...

  18. Nerve growth factor, human skin ulcers and vascularization. Our experience.

    Science.gov (United States)

    Aloe, Luigi

    2004-01-01

    Cutaneous wound is known to elicit a series of typical cellular responses that include clotting, inflammatory infiltration, reepithelialization, the formation of granulation tissue, including new blood vessel, followed by tissue remodeling and wound contraction. The regulatory molecules implicated in these events are not well known. Neurotrophins and their receptors are trophic factors that are known to play important roles in cutaneous tissues, nerve development and reconstruction after injury. Among the neurotrophins, the nerve growth factor (NGF) was one of the earliest used for clinical studies. NGF has been tested for potential therapeutic application in neuropathies of the central and peripheral nervous system and more recently in human corneal and cutaneous ulcers. Here, I present and discuss data obtained in the last few years on the healing action of NGF in human and domestic animal skin ulcers. PMID:14699983

  19. Anomalous median nerve associated with persistent median artery.

    OpenAIRE

    San?udo, J. R.; Chikwe, J.; Evans, S. E.

    1994-01-01

    A right human forearm showed persistence of the median artery in combination with anomalies of the median nerve and of the palmar circulation. The median nerve formed a ring enclosing the median artery, gave off its 3rd palmar digital branch in the forearm, and had a high palmar cutaneous nerve origin and a double thenar supply. The superficial palmar arch was incomplete. The median artery extended into the hand, providing the 2nd common palmar digital artery and the artery to the radial side...

  20. The H-reflex of the flexor carpi radialis muscle; a study in controls and radiation-induced brachial plexus lesions

    International Nuclear Information System (INIS)

    H-reflexes of the flexor carpi radialis muscle were studied in 52 controls and 25 cancer patients with radiation-induced brachial plexopathy. It was found that H-reflex conduction velocity (H-RCV) decreased with increasing age. This was not true for H-reflex latency (H-RL) and inter-latency times. There were no H-RCV and latency differences between age-matched male and female subjects. In the affected arm the reflex was absent in nine patients and delayed in 16 patients in whom H-RCV was decreased in 13 patients. Three patients showed large H-RL differences which were also notable features in median nerve disease in the region of the brachial plexus. (author)

  1. Evaluation of Tookad-mediated photodynamic effect on peripheral nerve and pelvic nerve in a canine model

    Science.gov (United States)

    Hetzel, Fred W.; Chen, Qun; Dole, Kenneth C.; Blanc, Dominique; Whalen, Lawrence R.; Gould, Daniel H.; Huang, Zheng

    2006-02-01

    Photodynamic therapy (PDT) mediated with a novel vascular targeting photosensitizer pd-bacteriopheophorbide (Tookad) has been investigated as an alternative modality for the treatment of prostate cancer and other diseases. This study investigated, for the first time, the vascular photodynamic effects of Tookad-PDT on nerve tissues. We established an in situ canine model using the cutaneous branches of the saphenous nerve to evaluate the effect of Tookad-PDT secondary to vascular damage on compound-action potentials. With Tookad dose of 2 mg/kg, treatment with 50 J/cm2 induced little change in nerve conduction. However, treatment with 100 J/cm2 resulted in decreases in nerve conduction velocities, and treatment with 200 J/cm2 caused a total loss of nerve conduction. Vasculature surrounding the saphenous nerve appeared irritated. The nerve itself looked swollen and individual fibers were not as distinct as they were before PDT treatment. Epineurium had mild hemorrhage, leukocyte infiltration, fibroplasias and vascular hypertrophy. However, the nerve fascicles and nerve fibers were free of lesions. We also studied the effect of Tookad-PDT secondary to vascular damage on the pelvic nerve in the immediate vicinity of the prostate gland. The pelvic nerve and saphenous nerve showed different sensitivity and histopathological responses to Tookad-PDT. Degeneration nerve fibers and necrotic neurons were seen in the pelvic nerve at a dose level of 1 mg/kg and 50 J/cm2. Adjacent connective tissue showed areas of hemorrhage, fibrosis and inflammation. Our preliminary results suggest that possible side effects of interstitial PDT on prostate nerve tissues need to be further investigated.

  2. Cutaneous neuropathy in Parkinson’s disease: a window into brain pathology

    OpenAIRE

    Doppler, Kathrin; Ebert, Sönke; Üçeyler, Nurcan; Trenkwalder, Claudia; Ebentheuer, Jens; Volkmann, Jens; Sommer, Claudia

    2014-01-01

    The deposition of alpha-synuclein in the brain, the neuropathological hallmark of Parkinson’s disease (PD), follows a distinct anatomical and temporal sequence. This study aimed to characterize alpha-synuclein deposition in cutaneous nerves from patients with PD. We further strived to explore whether peripheral nerve involvement is intrinsic to PD and reflective of known features of brain pathology, which could render it a useful tool for pathogenetic studies and pre-mortem histological diagn...

  3. US imaging of the musculocutaneous nerve

    International Nuclear Information System (INIS)

    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 valuableof the nerve, US can be used as a valuable complement of clinical and electrophysiologic findings. (orig.)

  4. Absence of musculocutaneous nerve and accessory head of biceps brachii: a case report

    Directory of Open Access Journals (Sweden)

    Arora L

    2005-01-01

    Full Text Available During dissection of a 55-year-old female cadaver, we observed that three nerve roots contributed to the formation of Median nerve in her right upper limb. Along with this variation, absence of Musculocutaneous nerve was noticed. The muscles of front of arm i.e. Biceps Brachii, Brachialis and Coracobrachialis received their nerve supply from Median nerve. The Lateral cutaneous nerve of forearm was derived from Median nerve. Also an accessory head of Biceps Brachii muscle was present in the right arm of the same cadaver. It is extremely important to be aware of these variations while planning a surgery in the region of axilla or arm as these nerves are more liable to be injured during operations.

  5. The cutaneous porphyrias.

    Science.gov (United States)

    Schulenburg-Brand, Danja; Katugampola, Ruwani; Anstey, Alexander V; Badminton, Michael N

    2014-07-01

    The porphyrias are a group of mainly inherited disorders of heme biosynthesis where accumulation of porphyrins and/or porphyrin precursors gives rise to 2 types of clinical presentation: cutaneous photosensitivity and/or acute neurovisceral attacks. The cutaneous porphyrias present with either bullous skin fragility or nonbullous acute photosensitivity. This review discusses the epidemiology, pathogenesis, clinical presentation, laboratory diagnosis, complications, and current approach to porphyria management. Although focusing mainly on their dermatological aspects, the article also covers the management of acute porphyria, which by virtue of its association with variegate porphyria and hereditary coproporphyria, may become the responsibility of the clinical dermatologist. PMID:24891059

  6. 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.

  7. 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.

  8. 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.

  9. 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...

  10. 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.

  11. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome / Cirurgia do plexo braquial: o papel da técnica cirúrgica para a obtenção de melhores resultados funcionais

    Scientific Electronic Library Online (English)

    Leandro Pretto, Flores.

    2011-08-01

    Full Text Available OBJETIVO: Análise de resultados das técnicas que comprovadamente melhoraram o prognóstico funcional de pacientes com lesões traumáticas do plexo braquial. MÉTODO: Estudo retrospectivo de cem casos de lesões traumáticas do plexo braquial. Foi realizada comparação dos resultados pós-operatórios obtido [...] s com as diferentes técnicas utilizadas. RESULTADOS: A técnica de enxertia a partir de raízes proximais resultou em bons graus de reinervação em 70% dos casos. Bons resultados (p Abstract in english OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison betwe [...] en the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  12. Ectopic cutaneous Schistosomiasis*

    OpenAIRE

    Vargas, Thiago Jeunon Sousa; Lopes, Raquel; Moraes, Maria Lourdes Palermo F. N.; Azevedo, Karen Grace Pena; Sousa, Maria Auxiliadora Jeunon

    2013-01-01

    The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue.

  13. Ectopic cutaneous Schistosomiasis*

    Science.gov (United States)

    Vargas, Thiago Jeunon de Sousa; Lopes, Raquel; Moraes, Maria de Lourdes Palermo F. N.; de Azevedo, Karen Grace Pena; Sousa, Maria Auxiliadora Jeunon

    2013-01-01

    The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue. PMID:24173194

  14. Cutaneous protothecosis - Case report*

    OpenAIRE

    Da Silva, Pa?mela Craveiro Gomes; Silva, Sabrina Beira?o Da Costa E.; Lima, Ricardo Barbosa; D Acri, Antonio Macedo; Lupi, Omar; Martins, Carlos Jose?

    2013-01-01

    Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation ...

  15. 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.

  16. Reflections on the contributions of Harvey Cushing to the surgery of peripheral nerves.

    Science.gov (United States)

    Tubbs, R Shane; Patel, Neal; Nahed, Brian Vala; Cohen-Gadol, Aaron A; Spinner, Robert J

    2011-05-01

    By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor. PMID:21214330

  17. Optic Nerve Pit

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Optic Nerve Pit What is optic nerve pit? An optic nerve pit is a ... may be seen in both eyes. How is optic pit diagnosed? If the pit is not affecting ...

  18. Brachial Artery Access for Percutaneous Renal Artery Interventions

    International Nuclear Information System (INIS)

    Purpose: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. Methods: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41-76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. Results: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. Conclusion: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible

  19. 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.

  20. 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.

  1. Comparison of two techniques for ultrasound-guided axillary brachial plexus blockade in cats.

    Science.gov (United States)

    Ansón, Agustina; Laredo, Francisco G; Gil, Francisco; Soler, Marta; Belda, Eliseo; Ayala, Maria D; Agut, Amalia

    2015-06-01

    Axillary blockade of the brachial plexus (BP) is advocated in humans and dogs for surgical procedures carried out on the foot, carpus and elbow as it provides complete analgesia distally from above the elbow joint. The aim of this study was to develop an ultrasound (US)-guided approach to block the BP in cats. Two groups of 12 feline cadavers each were used to compare two different techniques to block the BP at the axillary level. The reliability of the techniques was assessed by anatomical and computed tomography (CT) studies. Cadavers of the first group were positioned in dorsal recumbency with the forelimb to be blocked adducted (thoracic limbs flexed and orientated caudally) (FAD technique). The second group was positioned in dorsal recumbency with the forelimb abducted 90° (FAB technique). The accuracy of the techniques was determined by US after injecting 1 ml blue ink along the BP nerves, and by CT after injecting 1 ml of an iodinated contrast medium. The anatomical and CT studies confirmed the accuracy of the US location of the BP nerves. Staining of the axillaris, musculocutaneous, radialis, medianus and ulnaris nerves was observed in 100% of cats using the FAB technique and in 66% of the cats using the FAD technique. Rate of complications was higher in the FAD technique. In conclusion, a US-guided axillary approach to the BP by the use of a FAB technique is a safe and feasible procedure to block the BP in the cat. Further studies are needed to ascertain whether the technique can be applied in a clinical setting. PMID:25193280

  2. Concomitant Pseudoaneurysm and Arteriovenous Fistula Formation of Brachial

    Directory of Open Access Journals (Sweden)

    Akshara Gupta,

    2013-01-01

    Full Text Available Concomitant pseudoaneurysm and arteriovenous (AV fistula formation of brachial artery after a penetratinginjury has been rarely reported. False aneurysms of peripheral arteries are very rare. It is usually of infectious, post-traumatic or of iatrogenic etiology. In most cases, these are the result of penetrating injuries such as gunshot or stabwounds and iatrogenic arterial injuries. Brachial artery is not a common site for peripheral artery aneurysms. Its associationwith fistula formation with adjacent vein makes this a rare case. This case was diagnosed on colour duplex ultrasound andconfirmed on subtraction angiography.

  3. 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.

  4. 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.

  5. Cutaneous herpes simplex infections.

    OpenAIRE

    Mindel, A.; Carney, O.; Williams, P.

    1990-01-01

    OBJECTIVE: To review the clinical features and natural history of cutaneous herpes simplex infections associated with genital herpes. DESIGN: A retrospective case note study of all patients presenting to James Pringle House with this condition between 1983-1987. SUBJECTS: 123 patients were identified. RESULTS: The commonest sites involved were the buttocks 64/186 (34%), suprapubic area 28/186 (15%) and thigh 14/186 (7.5%). Thirty five of the 123 (28%) patients had more than one anatomical sit...

  6. 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. [...

  7. 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...

  8. Cutaneous Manifestations of ESRD

    OpenAIRE

    Galperin, Timur A.; Cronin, Antonia J.; Leslie, Kieron S.

    2013-01-01

    A broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pr...

  9. Origin and distribution of the thoracodorsal nerve in pig fetuses of the lineage Pen Ar Lan

    Directory of Open Access Journals (Sweden)

    Eleusa Marta Mendonça Tavares

    2012-03-01

    Full Text Available Considering the importance of the nerves that make up the brachial plexus, the aim was to study the origin and distribution of the thoracodorsal nerve. Thus, 30 pig fetuses from the lineage Pen Ar Lan obtained from natural abortions in breedings of the Triangulo Mineiro region were used. The specimens were prepared through the injection of 50% Neoprene Latex “450” and 10% formaldehyde solutions in the descending aorta artery, and immersion in the same solution for least 48 hours. The dissections were carried out bilaterally until reaching the brachial plexus, that emerged from the spinal ventral branches of the sixth (C6, seventh (C7 and eighth (C8 cervical nerves and from the first thoracic (T1. It was found that the thoracodorsal nerve was formed from C8 in two antimeres (3.33%; fromT1 in 17 antimeres (28.33%; and from C8 and T1 in 41 antimeres (68.33 and that there was symmetry with regard to its origin in 23 animals (76.66%. It was also found that the thoracodorsal nerve sent branches in 100% of cases for the latissimus dorsi muscle, and 36.66% for the teres major.

  10. Subtraction of unidirectionally encoded images for suppression of heavily isotropic objects (SUSHI) for selective visualization of peripheral nerves

    International Nuclear Information System (INIS)

    The aim of this study was to introduce and assess a new magnetic resonance (MR) technique for selective peripheral nerve imaging, called ''subtraction of unidirectionally encoded images for suppression of heavily isotropic objects'' (SUSHI). Six volunteers underwent diffusion-weighted MR neurography (DW-MRN) of the brachial plexus, and seven volunteers underwent DW-MRN of the sciatic, common peroneal, and tibial nerves at the level of the knee, at 1.5 T. DW-MRN images with SUSHI (DW-MRNSUSHI) and conventional DW-MRN images (DW-MRNAP) were displayed using a coronal maximum intensity projection and evaluated by two independent observers regarding signal suppression of lymph nodes, bone marrow, veins, and articular fluids and regarding signal intensity of nerves and ganglia, using five-point grading scales. Scores of DW-MRNSUSHI were compared to those of DW-MRNAP using Wilcoxon tests. Suppression of lymph nodes around the brachial plexus and suppression of articular fluids at the level of the knee at DW-MRNSUSHI was significantly better than that at DW-MRNAP (P SUSHI was significantly lower than that at DW-MRNAP (P SUSHI was judged as significantly better thsub> was judged as significantly better than that at DW-MRNAP (P < 0.05). The SUSHI technique allows more selective visualization of the sciatic, common peroneal, and tibial nerves at the level of the knee but is less useful for brachial plexus imaging because signal intensity of the brachial plexus nerves and ganglia can considerably be decreased. (orig.)

  11. Axillary Brachial Plexus Blockade for the Reflex Sympathetic Dystrophy Syndrome.

    Science.gov (United States)

    Ribbers, G. M.; Geurts, A. C. H.; Rijken, R. A. J.; Kerkkamp, H. E. M.

    1997-01-01

    Reflex sympathetic dystrophy syndrome (RSD) is a neurogenic pain syndrome characterized by pain, vasomotor and dystrophic changes, and often motor impairments. This study evaluated the effectiveness of brachial plexus blockade with local anaesthetic drugs as a treatment for this condition. Three patients responded well; three did not. (DB)

  12. Imaging diagnosis of neurogenic tumors of the brachial plexus

    International Nuclear Information System (INIS)

    To analyse the imaging characteristics of neurogenic tumors in the brachial plexus, six cases of neurogenic tumors of the brachial plexus were reported pathologically proved as schwannoma in 4 and neurofibroma in 2 cases. The plain films demonstrated the mass at the apex of lung in 3 cases, enlargement of cervical intervertebral foremen in 1. CT scan revealed that the average diameter of the masses was 4 cm, with spindle shape in 4, dumb-bell shape in 2 cases. The averaged CT value was similar to that of muscle on plain scan. The density of the tumor was higher than that of muscle and lower than that of vessels after contrast enhancement. On MRI T1W image, the masses were all hyperintense. Three schwannoma presented high signal intensity similar to CSF. The lesion demonstrated moderate enhancement after contrast administration in 1 case. Based on the location of the mass and its imaging features, diagnosis of neurogenic tumor of the brachial plexus could possibly be established before operation. MRI imaging is the imaging modality of choice in displaying the anatomy and the lesion of brachial plexus

  13. Serious axillary nerve injury caused by subscapular artery compression resulting from use of backpacks.

    Science.gov (United States)

    Haninec, Pavel; Mencl, Libor; Ba?inský, Peter; Kaiser, Radek

    2013-12-01

    A palsy of the brachial plexus elements caused by carrying a heavy backpack is a very rare injury usually occurring in soldiers or hikers, and recovery is usually spontaneous. We describe here the case of male civilian presenting with an isolated serious axillary nerve palsy associated with chronic backpack use. During the surgery, a dumbbell-shaped neuroma-in-continuity was found which was caused by direct pressure from the subscapular artery. After resection of the neuroma, a nerve graft from the sural nerve was used to reconstruct the nerve. Reinnervation was successful and the patient was able to abduct his arm to its full range, with full muscle strength, within 24 months. PMID:23696291

  14. 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.

  15. Cutaneous reactions to vaccinations.

    Science.gov (United States)

    Rosenblatt, Adena E; Stein, Sarah L

    2015-01-01

    Vaccinations are important for infectious disease prevention; however, there are adverse effects of vaccines, many of which are cutaneous. Some of these reactions are due to nonspecific inflammation and irritation at the injection site, whereas other reactions are directly related to the live attenuated virus. Rarely, vaccinations have been associated with generalized hypersensitivity reactions, such as erythema multiforme, Stevens-Johnson syndrome, urticaria, acute generalized exanthematous pustulosis, and drug hypersensitivity syndrome. The onset of certain inflammatory dermatologic conditions, such as lichen planus, granuloma annulare, and pemphigoid, were reported to occur shortly after vaccine administration. Allergic contact dermatitis can develop at the injection site, typically due to adjuvant ingredients in the vaccine, such as thimerosal and aluminum. Vaccinations are important to promote development of both individual and herd immunity. Although most vaccinations are considered relatively safe, there may be adverse effects associated with any vaccine. Cutaneous manifestations make up a large portion of the types of reactions associated with vaccines. There are many different reasons for the development of a cutaneous reaction to a vaccination. Some are directly related to the injection of a live attenuated virus, such as varicella or vaccinia (for immunity to smallpox), whereas others cause more nonspecific erythema and swelling at the injection site, as a result of local inflammation or irritation. Vaccinations have also been associated in rare reports with generalized hypersensitivity reactions, such as erythema multiforme, Stevens-Johnson syndrome, urticaria, acute generalized exanthematous pustulosis, and drug hypersensitivity syndrome. There have been case reports associating the administration of a vaccine with the new onset of a dermatologic condition, such as lichen planus, granuloma annulare, and Sweet syndrome. Finally, allergic contact dermatitis can develop at the injection site, typically due to adjuvant ingredients in the vaccine, such as thimerosal and aluminum. PMID:25889134

  16. Management of cutaneous erythrasma.

    Science.gov (United States)

    Holdiness, Mack R

    2002-01-01

    Corynebacterium minutissimum is the bacteria that leads to cutaneous eruptions of erythrasma and is the most common cause of interdigital foot infections. It is found mostly in occluded intertriginous areas such as the axillae, inframammary areas, interspaces of the toes, intergluteal and crural folds, and is more common in individuals with diabetes mellitus than other clinical patients. This organism can be isolated from a cutaneous site along with a concurrent dermatophyte or Candida albicans infection. The differential diagnosis of erythrasma includes psoriasis, dermatophytosis, candidiasis and intertrigo, and methods for differentiating include Wood's light examination and bacterial and mycological cultures. Erythromycin 250mg four times daily for 14 days is the treatment of choice and other antibacterials include tetracycline and chloramphenicol; however, the use of chloramphenicol is limited by bone marrow suppression potentially leading to neutropenia, agranulocytosis and aplastic anaemia. Further studies are needed but clarithromycin may be an additional drug for use in the future. Where there is therapeutic failure or intertriginous involvement, topical solutions such as clindamycin, Whitfield's ointment, sodium fusidate ointment and antibacterial soaps may be required for both treatment and prophylaxis. Limited studies on the efficacy of these medications exist, however, systemic erythromycin demonstrates cure rates as high as 100%. Compared with tetracyclines, systemic erythromycin has greater efficacy in patients with involvement of the axillae and groin, and similar efficacy for interdigital infections. Whitfield's ointment has equal efficacy to systemic erythromycin in the axillae and groin, but shows greater efficacy in the interdigital areas and is comparable with 2% sodium fusidate ointment for treatment of all areas. Adverse drug effects and potential drug interactions need to be considered. No cost-effectiveness data are available but there are limited data on cost-related treatment issues. A guideline is proposed for the detection, evaluation, treatment and prophylaxis of this cutaneous eruption. PMID:12010076

  17. 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.

  18. Cutaneous manifestations of ESRD.

    Science.gov (United States)

    Galperin, Timur A; Cronin, Antonia J; Leslie, Kieron S

    2014-01-01

    A broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options. PMID:24115194

  19. Indigenous cutaneous leishmaniasis

    Directory of Open Access Journals (Sweden)

    Muhammed K

    1990-01-01

    Full Text Available A 20 year old male from Nilambur of Malappuram district of Kerala developed an asymptomatic , single, well circumscribed erythomatous indurated plaque about 3x 2.5 cm in size with central crusting, on the left forearm just about the wrist on the lateral aspect, of six months duration. He had never gone out of his native place at any time in his life, Slit smear examination and staining with Giemsa stain showed plenty of extracelluar and intracellular Leishman, Donovan bodies, ,Histopathology of the lesion was consistent with diagnosis of cutaneous Leishmaniasis. He was treated with rifampicin?600 mg and the lesion showed signs of regression within one month.

  20. 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.

  1. Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain.

    OpenAIRE

    Knockaert, D. C.; D Heygere, F. G.; Bobbaers, H. J.

    1989-01-01

    The ilioinguinal nerve entrapment syndrome is an abdominal muscular pain syndrome, characterized by the clinical triad of muscular type iliac fossa pain with a characteristic radiation pattern, an altered sensory perception in the ilioinguinal nerve cutaneous innervation area, and a well-circumscribed trigger point medial and below the anterosuperior iliac spine. Relief of pain by infiltration of a local anaesthetic confirms the diagnosis. This report describes retrospectively the clinical pi...

  2. Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures

    OpenAIRE

    Christos, Steve C.; Chiampas, George; Offman, Ryan; Rifenburg, Robert

    2010-01-01

    Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular and respiratory complications from opiate administration. Ultrasound (US) guided three-in-one (3-in-1) femoral nerve block (FNB) is an option for pain management in patients with femur fractures, as it provides regional anesthesia to the femoral, obturator and lateral cutaneous nerves. Our ...

  3. Tendon transfers to restore elbow flexion after traumatic paralysis of the brachial plexus in adults.

    Science.gov (United States)

    Rostoucher, P; Alnot, J Y; Touam, C; Oberlin, C

    1998-01-01

    Loss of elbow flexion after traumatic brachial palsy produces significant functional and cosmetic problems. Although a direct approach to the neurological lesion with an attempt to reinnervate the biceps has given some encouraging results, these can be incomplete and for this reason tendon transfers still have an important role. We report the results of our series of 60 patients (54 men and 6 women) who have undergone tendon transfer between 1984 and 1994. The transfers were performed during or after nerve surgery, and we used the muscles arising from the medial epicondyle, the pectoralis minor and the triceps. Our results were judged on any improvement in shoulder stability and in the power of lateral rotation, together with the power and range of active and passive flexion of the elbow. Good results were achieved in 74% of the patients in our study, with more than 120 degrees of elbow flexion and an ability to support at least 1 kg with the elbow flexed to 90 degrees. PMID:9795815

  4. 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)

  5. Brachial plexopathy after chemoradiotherapy for head and neck squamous cell carcinoma

    International Nuclear Information System (INIS)

    Purpose: To evaluate late brachial plexopathy after primary chemoradiotherapy for locally advanced head and neck squamous cell carcinoma. Patients and Methods: Consecutive 43 disease-free patients were evaluated by a specifically developed 26-item questionnaire. Retrospectively, the brachial plexus was delineated and the dose-volume histograms were calculated. Results: After a median follow-up of 24 months, no radiation-induced brachial plexopathy was reported in these 43 patients. Conclusion: No radiation-induced brachial plexopathy was seen in the patient group, although 72.1% of the brachial plexuses received doses > 60 Gy. These findings should prompt further prospective studies and also stress the importance of trying to keep the doses to the brachial plexus as low as possible while covering the target volumes well. (orig.)

  6. The reliability of toe systolic pressure and the toe brachial index in patients with diabetes

    OpenAIRE

    Perrin Byron; Raspovic Anita; Romanos Mary

    2011-01-01

    Abstract Background The Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the...

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

    OpenAIRE

    Düppe Henrik; Backman Clas; Thornqvist Catharina; Andersson Charlotte; Erichs Kristina; Dahlin Lars B; Lindqvist Pelle; Forslund Marianne

    2007-01-01

    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?...

  8. Penile erectile dysfunction after brachial plexus root avulsion injury in rats

    OpenAIRE

    Fu, Guo; Qin, Bengang; Jiang, Li; Huang, Xijun; Lu, Qinsen; Zhang, Dechun; Liu, Xiaolin; Zhu, Jiakai; Zheng, Jianwen; Li, Xuejia; Gu, Liqiang

    2014-01-01

    Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine (via a subcutaneous injection...

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

    OpenAIRE

    Maa?roufi, 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

  10. MR evaluation of the brachial plexus: Optimal imaging technique

    International Nuclear Information System (INIS)

    The authors compared four different reception coils, different degrees of T1 and T2 weighting, and different imaging planes for ability to depict normal brachial plexus anatomy at 1.5 T in 67 subjects. The use of loop gap resonators (axial opposed and butterfly) resulted in better resolution but a more limited field of view than did use of a rectangular surface coil (placed transversely behind the base of the neck) and the body coil. T1 and spin-density coronal images showed normal anatomy of the roots, trunks, and cords in a high proportion of cases. Double-echo (spin-density and T2-weighted) coronal imaging performed with a transversely oriented rectangular coil may be the best technique for imaging all three portions of the brachial plexus in the neck, retroclavicular, and axillary regions

  11. Brachial plexus lesions in patients with cancer: 100 cases

    International Nuclear Information System (INIS)

    In patients with cancer, brachial plexus signs are usually caused by tumor infiltration or injury from radiation therapy (RT). We analyzed 100 cases of brachial plexopathy to determine which clinical criteria helped differentiate tumor from radiation injury. Seventy-eight patients had tumor and 22 had radiation injury. Severe pain occurred in 80% of tumor patients but in only 19% of patients with radiation injury. The lower trunk was involved in 72% of the tumors. Seventy-eight percent of the radiation injuries affected the upper plexus (C5-6). Horner syndrome was more common in tumor, and lymphedema in radiation injury. The time from RT to onset of plexus symptoms, and the dose of RT, also differed

  12. High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging

    International Nuclear Information System (INIS)

    This technical note demonstrates the relevance of the isotropic 3D T2 turbo-spin-echo (TSE) sequence with short-term inversion recovery (STIR) and variable flip angle RF excitations (SPACE: Sampling Perfection with Application optimized Contrasts using different flip angle Evolutions) for high-resolution brachial plexus imaging. The sequence was used in 11 patients in the diagnosis of brachial plexus pathologies involving primary and secondary tumors, and in six volunteers. We show that 3D STIR imaging is not only a reliable alternative to 2D STIR imaging, but it also better evaluates the anatomy, nerve site compression and pathology of the plexus, especially to depict space-occupying tumors along its course. Finally, due to its appropriate contrast we describe how 3D-STIR can be used as a high-resolution mask to be fused with fraction of anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) data of the plexus. (orig.)

  13. 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.

  14. Optic Nerve Imaging

    Science.gov (United States)

    Optic Nerve Imaging email Send this article to a friend by filling out the fields below: Your name: ... Your eye doctor may use one of these optic nerve computer imaging techniques as part of your glaucoma ...

  15. Microvascular Cranial Nerve Palsy

    Science.gov (United States)

    ... Cranial Nerve Palsy? Tweet Microvascular cranial nerve palsy (MCNP) is a neurological condition involving the small blood ... affects the muscles that move the eyes. With MCNP, there is a blockage of blood flow to ...

  16. 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 But it was not effective for intraneural damage by radiation therapy. (author)

  17. 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

  18. 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.

  19. 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.

  20. Cutaneous neuropathy in Parkinson's disease: a window into brain pathology.

    Science.gov (United States)

    Doppler, Kathrin; Ebert, Sönke; Uçeyler, Nurcan; Trenkwalder, Claudia; Ebentheuer, Jens; Volkmann, Jens; Sommer, Claudia

    2014-07-01

    The deposition of alpha-synuclein in the brain, the neuropathological hallmark of Parkinson's disease (PD), follows a distinct anatomical and temporal sequence. This study aimed to characterize alpha-synuclein deposition in cutaneous nerves from patients with PD. We further strived to explore whether peripheral nerve involvement is intrinsic to PD and reflective of known features of brain pathology, which could render it a useful tool for pathogenetic studies and pre-mortem histological diagnosis of PD. We obtained skin biopsies from the distal and proximal leg, back and finger of 31 PD patients and 35 controls and quantified the colocalization of phosphorylated alpha-synuclein in somatosensory and autonomic nerve fibers and the pattern of loss of different subtypes of dermal fibers. Deposits of phosphorylated alpha-synuclein were identified in 16/31 PD patients but in 0/35 controls (p Detection of phosphorylated alpha-synuclein in dermal nerve fibers might be a useful diagnostic test for PD with high specificity but low sensitivity. PMID:24788821

  1. [Cranioencephalic cutaneous angiofibromatosis].

    Science.gov (United States)

    Nieto, M; Ruiz del Portal, L; Garrido, E; Navarrete, M; Felipe, F

    1996-10-01

    A nine year old girl with no significant prenatal or perinatal history had presented, at the age of four months, with infantile spasms and later with partial crises with or without secondary generalization. On examination there was left hemiparesis and various skin lesions: a pink plaque in the frontal region with hair loss, fibrous plaques on the right side of the face and hypomelanic spots on the trunk and thighs and some cafe-au-lait spots on the thorax and abdomen. On neuroimaging by CT and MR right cerebral hemiatrophy, periventricular calcifications and lesions in the right hemisphere were seen. On AMR an angioma was seen on the anterior communicating artery. A skin biopsy of the frontal plaque showed perifollicular fibromatosis with marked vascular proliferation. We discuss whether the presentation of this case of encephalocraneo-cutaneous angiofibromatosis is a new phenotype of tuberose sclerosis or a new neurocutaneous syndrome. PMID:8983727

  2. Cutaneous leishmaniasis: an overview.

    Directory of Open Access Journals (Sweden)

    Hepburn N

    2003-01-01

    Full Text Available 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 caused by Leishmania braziliensis may evolve into the mucocutaneous form, ?espundia?, and should be treated with systemic antimony. Sodium stibogluconate 20mg/kg/day i.v. for 20 days is the appropriate first line treatment in these cases. Although it may cause transient bone marrow suppression, liver damage, a chemical pancreatitis, and disturbances in the electrocardiogram, it appears safe. The success of treatment should be assessed 6 weeks after it has been completed and patients should be followed up for 6 months.

  3. Comparison Of Infraclavicular Brachial Plexus Block With Supraclavicular Brachial Plexus Block In Upper Limb Surgeries. (A Study Of 100 Patients)

    OpenAIRE

    Sheetal Shah; kamla Mehta; Kirti Patel; Khyati Patel

    2013-01-01

    Comparative prospective study of two routes of Brachial plexus block – infraclavicular coracoid approach with conventional supraclavicular approach was carried out in 100 patients of ASA RISK I to III, undergoing elective or emergency surgeries on upper limb, at the level of elbow and below elbow. Patients were divided into 2 equal groups, Group I (Infraclavicular) and Group S (Supraclavicular), which were compared for block performance time, onset, quality and duration of block. The applie...

  4. 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 stnative 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)

  5. Loxoscelismo cutáneo / Cutaneous Loxoscelism

    Scientific Electronic Library Online (English)

    Natacha, Hernández Pérez; José Mª, Alonso Gordo; Ángela, Fuentes López.

    2012-02-01

    Full Text Available Las picaduras por artrópodos son muy frecuentes en nuestro medio. Las más habituales son producidas por insectos, miriápodos y arácnidos (arañas y escorpiones). El veneno de la araña Loxosceles tiene propiedades necrotizantes, hemolíticas, vasculíticas y coagulantes, y el cuadro puede presentarse ba [...] jo dos formas bien definidas: Loxoscelismo cutáneo y Loxoscelismo cutáneo-visceral o sistémico, menos frecuente. En la piel puede provocar graves alteraciones vasculares, con áreas de vasoconstricción y otras de hemorragias que conllevan de inmediato a la isquemia local y a veces a la placa gangrenosa. Presentamos el caso de una mujer de 36 años que acude con una lesión en el miembro inferior izquierdo, refiriendo que le ha picado una araña en su domicilio. A los pocos días le aparece una placa necrótica de color violáceo, con una ulceración de evolución tórpida. Durante el seguimiento de la lesión aparecen en dos ocasiones lesiones similares, refiriendo nuevas picaduras de araña. Abstract in english Arthropod bites are very common in our surroundings; they are most often caused by insects, millipedes and arachnids (spiders and scorpions). The venom of the Loxosceles genus of spiders has necrotizing, hemolytic, vasculitic and coagulant properties. The clinical picture may present itself in two d [...] istinct forms: cutaneous Loxoscelism or, less frequently, cutaneous-visceral or systemic Loxoscelism. In the skin, the venom can cause severe vascular changes, with areas of vasoconstriction and other areas of bleeding that rapidly lead to local ischemia and sometimes to a gangrenous plaque. We present the case of a 36-year-old woman with a left lower limb lesion, who reported having been bitten by a spider in her home. A few days later, she developed a purplish necrotic plaque with slow growing ulceration. While monitoring the lesion, the patient received two new spider bites, similar in appearance to the first one.

  6. Differential Effects of NGF and BDNF on Axotomy-Induced Changes in GABAA-Receptor-Mediated Conductance and Sodium Currents in Cutaneous Afferent Neurons

    OpenAIRE

    OYELESE, ADETOKUNBO A.; RIZZO, MARCO A.; Waxman, Stephen G.; KOCSIS, JEFFERY D.

    1997-01-01

    Differential effects of NGF and BDNF on axotomy-induced changes in GABAA-receptor-mediated conductance and sodium currents in cutaneous afferent neurons. J. Neurophysiol. 78: 31–42, 1997. The effects of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) on injury-induced changes in the electrophysiological properties of adult rat cutaneous afferent dorsal root ganglion (DRG) neurons were examined. Whole cell patch-clamp techniques were used to study ?-aminobutyric acid-A (...

  7. Cutaneous lymphoma mimicking seborrhoeic dermatitis

    Directory of Open Access Journals (Sweden)

    Venkateswaran Sri

    1995-01-01

    Full Text Available A case of non Hodgkins lymphoma presenting with cutaneous lesions mimicking seborrhoeic dermatitis is reported. Clinician should have a high index of suspicion to diagnose lymphoma in its early stage, since it can mimic many benign dermatoses.

  8. Orbital metastasis from cutaneous melanoma

    Directory of Open Access Journals (Sweden)

    Samer Elsherbiny

    2012-01-01

    Full Text Available We report a case of a metastatic cutaneous melanoma to the orbit. A 60-year-old Caucasian male presented with a 2-day history of left-sided ocular pain, lid swelling and chemosis. Initially, this was treated as conjunctivitis with no signs of improvement. Four days later, the patient developed left proptosis, mechanical ptosis, left esotropia and diplopia. Computed tomography scan of the orbit demonstrated marked thickening of the lateral rectus muscle. The patient was treated as pseudotumor. Subsequent biopsy revealed malignant cutaneous melanoma. The patient had a history of cutaneous melanoma excised 15 years previously. Further imaging showed advanced metastatic disease in the brain, the lung and the liver. The patient passed away five months after initial presentation. Cutaneous melanoma metastasizing to the orbit has poor prognosis. Patients often have advanced disease at the time of presentation and orbital metastases may be the initial sign. A detailed history is paramount in making timely diagnosis.

  9. Prurigo Nodularis With Cutaneous Horn

    Directory of Open Access Journals (Sweden)

    Thadeus Joseph

    1997-01-01

    Full Text Available Cutaneous horns are rare horny excrescences which occur in various dermatoses. We report a girl with prurigo nodularis who developed a horn on one of the nodules. This unique association has not been reported so far.

  10. Cutaneous Lymphangioma circumscriptum - dermoscopic features**

    Science.gov (United States)

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

    2015-01-01

    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. PMID:25831002

  11. 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.

  12. Cutaneous lesions in new born

    OpenAIRE

    Sachdeva Meenakshi; Kaur Surjeet; Nagpal Madhu; Dewan S

    2002-01-01

    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%), su...

  13. 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...

  14. Disturbed function of the brachial plexus after irradiation for a malignant disease

    International Nuclear Information System (INIS)

    In reference to the case history of a woman aged 26 years in whom approx. 7 years after irradiation for Hodgkin's disease, lesions of the upper roots of the brachial plexus (Erb-Duchenne type) developed, the differential diagnosis is discussed of brachial plexus lesions in the presence of a recurrent malignant disease or as the consequence of irradiation. (Auth.)

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

    OpenAIRE

    Lawande, Malini; Patkar, Deepak P.; Pungavkar, Sona

    2012-01-01

    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.

  16. On the cause of brachial plexus neuropathy after radiation therapy of patients with mamma carcinoma

    International Nuclear Information System (INIS)

    Radiation therapy is often considered as cause of brachial plexus neuropathy in patients with mamma carcinoma. One case (in which metastases could be established as specific cause) is used as specific example for the possible differential diagnosis of brachial plexus neuropathy. (orig.)

  17. Oral clopidogrel improves cutaneous microvascular function through EDHF-dependent mechanisms in middle-aged humans

    OpenAIRE

    Dahmus, Jessica D.; Bruning, Rebecca S.; Larry Kenney, W.; Alexander, Lacy M.

    2013-01-01

    Platelet P2Y12-ADP and COX-1 receptor inhibition with oral clopidogrel (CLO) and low-dose aspirin (ASA), respectively, attenuates reflex-mediated cutaneous vasodilation, but little is known about how these medications affect local vasodilatory signaling. Reactive hyperemia (RH) results in vasodilation that is mediated by sensory nerves and endothelium-derived hyperpolarization factors (EDHF) through large-conductance calcium-activated potassium channels, whereas slow local heating (LH) elicit...

  18. Anomalous Branching Pattern of Lateral Cord of Brachial Plexus Padrón de Ramos Anómalos del Fascículo Lateral del Plexo Braquial

    Directory of Open Access Journals (Sweden)

    Srijit Das

    2005-01-01

    Full Text Available During routine dissection, an unusual formation of median nerve was detected in the right upper limb of a 55 year old male cadaver. The median nerve had an additional contribution from lateral cord. The two branches of the lateral cord designated as upper and the lower branches were observed at different levels. The upper branch was in close contact with the third part of the axillary artery and it crossed the vessel anteriorly to unite with a branch of the medial cord to form the median nerve. The median nerve thus formed was related medially to the axillary artery (instead of the normal position of being anterolateral. The median nerve descended below and was joined by an additional lower branch from the lateral cord. Interestingly, the ulnar nerve which arose from the medial cord, descended below and was joined within its fascial sheath by the medial cutaneous nerve of the forearm The presence of such an additional branch from the lateral cord contributing to the formation of median nerve and its unusual relation of being medial to the axillary artery may be of immense clinical interest to neurologists diagnosing nerve lesions and surgeons who are exposed to the topographical anatomy of the neural structures during radical neck dissection. The additional branch of the lateral cord may compress upon the axillary artery to cause vascular insufficiencyDurante una disección de rutina fue encontrada una formación inusual del nervio mediano en el miembro superior derecho, de un inividuo de sexo masculino, de 55 años de edad. El nervio mediano tenía una contribución adicional del facículo lateral. Los dos ramos del fascículo lateral, designados como ramos superior e inferior, fueron observados a diferentes niveles. El ramo superior tuvo un estrecho contacto con la tercera parte de la arteria axilar y cruzaba la vena axilar anteriormente para unirse con un ramo del fascículo medial y formar el nervio mediano. El nervio mediano así formado estaba relacionado medialmente con la arteria axilar (en vez de su posición normal de situación anterolateral. El nervio mediano se dirigía hacia bajo y se unía con un ramo inferior adicional del fascículo lateral. El nervio ulnar, que se originaba del fascículo medial, descendía posterior y se unía en la vaina fascial con el nervio cutáneo medial del antebrazo. La presencia de un ramo adicional del fascículo lateral contribuyendo a la formación del nervio mediano y su inusual relación con la arteria axilar, tiene un interés clínico para los neurólogos, quienes diagnostican lesiones nerviosas, y cirujanos que están expuestos a encontrar variaciones de estructuras nerviosas durante disecciones radicales de cuello. El ramo adicional del fascículo lateral puede comprimir la arteria axilar y causar insuficiencia vascular

  19. 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.

  20. Steindler flexorplasty to restore elbow flexion in C5-C6-C7 brachial plexus palsy type

    Directory of Open Access Journals (Sweden)

    Monreal Ricardo

    2007-07-01

    Full Text Available Abstract Background Loss of elbow flexion due to traumatic palsy of the brachial plexus represents a major functional handicap. Then, the first goal in the treatment of the flail arm is to restore the elbow flexion by primary direct nerve surgery or secondary reconstructive surgery. There are various methods to restore elbow flexion which are well documented in the medical literature but the most known and used is Steindler flexorplasty. This review is intended to detail the author's experience with Steindler flexorplasty to restore elbow flexion in patients with brachial plexus palsy C5-C6-C7 where wrist extensors are paralyzed or weakened. Methods We conducted a retrospective follow-up study of 12 patients with absent or extremely weak elbow flexion (motor grade 2 or less, wrist/finger extensor and triceps palsy associated; who had undergone surgical reconstruction of the flail upper limb by tendon transfer (Steindler flexorplasty and wrist arthrodesis to restore elbow flexion. The aetiology of elbow weakness was in all patients brachial plexus palsy (C5-C6-C7 deficit. Data were collected from medical records and from the information obtained during follow-up visits. Age, sex, preoperative strength (rated on a 0 to 5 scale for the flexors of the elbow, wrist flexors, pronator and triceps, previous surgery, length of follow-up, other associated operative procedures, results and complications were recorded. Results The results are the follows: Eleven patients were found to have very good or good function of the transferred muscles. One patient had mild active flexion of the elbow despite the reconstructive procedure. There were no major intraoperative complications. Two patients experienced transient, intermittent nocturnal ulnar paresthesias postoperatively. In both patients these symptoms subsided without further surgery. Conclusion Our study suggests that in patients with C5-C6-C7 palsy where the wrist and finger extensors are paralyzed or weaked, the flexor-pronators muscles of the forearm are strong but the triceps is not available for transfer; Steindler flexorplasty to restore elbow flexion should be complemented with wrist arthrodesis.

  1. 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.

  2. 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

  3. Postirradiation lesions of the brachial plexus. Results of surgical treatment

    International Nuclear Information System (INIS)

    In a series of 103 cases of postirradiation lesions of the brachial plexus operated on between 1978 and 1986--of which 60 patients have been reviewed with a follow up from 2 to 9 years--the surgical results are analyzed according to an anatomic classification, a clinical classification, and the surgical procedures. We conclude that the radiation plexitis should be treated surgically and at the earliest possible time after the onset of paresthesias. Also, the surgical procedure which gives the best results is neurolysis with pedicled omentoplasty

  4. 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

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

    International Nuclear Information System (INIS)

    This case highlights the importance of recognition of the pattern of metastatic brachialplexopathy in breast cancer patients undergoing 18F-fluorodeoxyglucose (18F-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 18F-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 18F-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 18F-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. 18F-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 18F-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 to the plexus), which is the commonest fin

  6. Cutaneous metastasis in esophageal squamous cell carcinoma

    OpenAIRE

    Baijal, Rajiv; Hassan, Praveenkumar; Jain, Mayank; Gupta, Deepak; Shah, Nimish

    2013-01-01

    Cutaneous metastasis from internal malignancies are common in breast cancer, pulmonary malignancies and melanomas. The primary site of metastases has been reported to the chest and abdomen. We are hereby reporting rare case of cutaneous metastasis in esophageal cancer.

  7. Estudio anatómico de la transferencia de los nervios accesorio y toracodorsal al nervio cubital en el gato Anatomic study of spinal accesory and thoracodorsal nerves transfer to ulnar nerve in cats

    Directory of Open Access Journals (Sweden)

    J.R. Martínez-Méndez

    2008-09-01

    Full Text Available Las lesiones del plexo braquial son una de las patologías más graves y con mayor número de secuelas del miembro superior. En el momento actual las transferencias nerviosas se encuentran en primera línea del armamento terapéutico para reconstruir funciones proximales del miembro superior. En el estudio que presentamos se realizaron 20 transferencias nerviosas al nervio cubital del gato común, tomando bien el nervio accesorio del espinal (10 casos o bien el nervio toracodorsal (10 casos. Como grupo control se utilizó el lado contralateral al intervenido. Durante el año siguiente, se evaluó la reinervación mediante estudios electromiográficos, histológicos de nervio y músculo, así como histoquímicos de médula espinal. Tras el análisis de los resultados encontramos que las motoneuronas de ambos nervios donantes son capaces de conseguir reinervaciones parciales del territorio cubital.A brachial plexus injury is one of the most severe pathologies of the upper limb, and also has severe sequels. In the actual state of the art, nerve transfers are being used as first line of therapeutic approach in the reconstruction of proximal functions of the upper limb. In this study 20 nerve transfers were made to the ulnar nerve of the cat, using the spinal accessory nerve (10 cases or the thoracodorsal nerve (10 cases. The opposite side was used as control. During next year, reinnervation was assessed by electromyography, nerve and muscle histology and histochemical evaluation of the spinal cord. We found that motoneurons of both donor nerves are able to make partial reinervation of the ulnar nerve territory.

  8. Facial Nerve Neuroma Management

    OpenAIRE

    Weber, Peter C.; Osguthorpe, J. David

    1998-01-01

    Three facial nerve neuromas were identified in the academic year 1994-1995. Each case illustrates different management dilemmas. One patient with a grade III facial nerve palsy had a small geniculate ganglion neuroma with the dilemma of decompression versus resection clear nerve section margins. The second patient underwent facial neuroma resection with cable graft reconstruction, but the permanent sections were positive. The last patient had a massive neuroma in which grafting versus other f...

  9. Engineering Peripheral Nerve Repair

    OpenAIRE

    Marquardt, Laura; Sakiyama-Elbert, Shelly E

    2013-01-01

    Current approaches for treating peripheral nerve injury have resulted in promising, yet insufficient functional recovery compared to the clinical standard of care, autologous nerve grafts. In order to design a construct that can match the regenerative potential of the autograft, all facets of nerve tissue must be incorporated in a combinatorial therapy. Engineered biomaterial scaffolds in the future will have to promote enhanced regeneration and appropriate reinnervation by targeting the high...

  10. Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study.

    Science.gov (United States)

    Franzblau, Lauren E; Maynard, Mallory; Chung, Kevin C; Yang, Lynda J-S

    2015-06-01

    OBJECT Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why patients elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these patients are satisfied with their treatment choices over time. METHODS Twelve patients with total avulsion BPIs were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions. RESULTS Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 patients), delayed diagnosis (3 patients), and insufficient information regarding treatment (4 patients) prevented patients from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices. CONCLUSIONS Patients with panplexus avulsion injuries are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of patients able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help patients meet critical points in care within the ideal timeframe and using a patient- and family-centered care approach combined with patient decision aids to foster shared decision making, increase access to information, and improve patient satisfaction with decisions. These measures could greatly benefit patients with BPI while reducing costs, improving efficiency, and generating better outcomes. PMID:25839930

  11. 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.

  12. Cutaneous plasmacytosis with perineural involvement.

    Science.gov (United States)

    Brezinski, Elizabeth A; Fung, Maxwell A; Fazel, Nasim

    2014-01-01

    Importance. Cutaneous and systemic plasmacytosis are rare conditions of unknown etiology with characteristic red-brown skin lesions and a mature polyclonal plasma cell infiltrate within the dermis. Perineural plasma cell infiltrates may be a histologic clue to the diagnosis of cutaneous plasmacytosis. Observations. Our patient had a five-year history of persistent reddish-brown plaques on the neck and trunk without systemic symptoms. Histologic examination showed dermal perivascular and perineural plasma cells with excess lambda light chain expression. Due to decreased quality of life caused by his skin lesions, he was placed on a chemotherapeutic regimen with bortezomib. Conclusions and Relevance. The patient was diagnosed with cutaneous plasmacytosis based on classic histopathology results with a recently characterized pattern of perineural involvement. Bortezomib therapy was initiated to manage his skin eruption, which has not been previously described as a treatment for this chronic condition. PMID:24839563

  13. The role of cutaneous sensation in the motor function of the hand.

    Science.gov (United States)

    Ebied, Ayman M; Kemp, Graham J; Frostick, Simon P

    2004-07-01

    We studied the effect of abolishing cutaneous sensation (by infiltrating local anaesthetic around the median nerve at the wrist) on the ability of 10 healthy volunteers (a) to maintain a submaximal isometric pinch-grip force for 30 s without visual feedback, and (b) to perform a fine finger-manipulation 'handwriting' task. Blocking cutaneous sensation had no effect on ability to maintain pinch force, suggesting that muscle afferents have the major role in force-control feedback. However, a near-linear fall in force, present with or without block (mean slope=-1.3+/-0.2% s(-1)), which cannot be attributed to motor fatigue, reveals a shortcoming of the afferent feedback system. Blocking cutaneous sensation did impair ability to perform the more demanding writing task, as judged by an 18+/-6% increase in the length of the path between target points, a 22+/-9% increase in the duration of the movement and a 63+/-24% in 'normalised averaged rectified jerk', an averaged time-derivative of acceleration (all significantly nonzero, P < 0.04). These experiments demonstrate the relative importance of muscular and cutaneous afferent feedback on two aspects of hand performance, and provide a way to quantify the deficit resulting from the lack of cutaneous sensation. PMID:15183446

  14. Perineural granulomas in cutaneous sarcoidosis may be associated with sarcoidosis small-fiber neuropathy.

    Science.gov (United States)

    Munday, William R; McNiff, Jennifer; Watsky, Kalman; DiCapua, Daniel; Galan, Anjela

    2015-07-01

    Perineural granulomas in cutaneous sarcoidosis have been rarely reported and their clinical significance has yet to be evaluated. Recently, a 27-year-old male presented with multiple pink papules on the flank and lower back, accompanied by a painful, burning sensation. Biopsies revealed well-defined granulomas, consistent with sarcoidosis, in the dermis and involving small cutaneous nerves. We hypothesized that perineural granulomas may be an under-recognized feature of cutaneous sarcoidosis and may be responsible for sensory disturbances. We reviewed cases from 29 consecutive patients with cutaneous sarcoidosis. Perineural granulomas were identified in 18/29 (62%) patients and in 22/40 (55%) biopsies. Perineural granulomas were identified in 7/9 biopsies from the proximal upper extremity, 1/3 from the distal upper extremity, 7/12 from the head and the neck, including 4/4 from the nose, 5/9 from the back, 1/2 from the flank and 1/1 from the proximal lower extremity and 0/4 from the distal lower extremity. The anatomical distribution is similar to sarcoidosis small-fiber neuropathy (SSFN), in which sarcoidosis patients without evident skin lesions experience sensory disturbances of unknown etiology involving the face, the proximal extremities and the trunk. Our results indicate perineural granulomas in cutaneous sarcoidosis are more common than previously appreciated, primarily involve the head, the proximal upper extremities and the back, and may be responsible for neurological manifestations. PMID:25757612

  15. Co-infusion of autologous adipose tissue derived neuronal differentiated mesenchymal stem cells and bone marrow derived hematopoietic stem cells, a viable therapy for post-traumatic brachial plexus injury: A case report

    Directory of Open Access Journals (Sweden)

    Umang G Thakkar

    2014-08-01

    Full Text Available Stem cell therapy is emerging as a viable approach in regenerative medicine. A 31-year-old male with brachial plexus injury had complete sensory-motor loss since 16 years with right pseudo-meningocele at C5-D1 levels and extra-spinal extension up to C7-D1, with avulsion on magnetic resonance imaging and irreversible damage. We generated adipose tissue derived neuronal differentiated mesenchymal stem cells (N-AD-MSC and bone marrow derived hematopoietic stem cells (HSC-BM. Neuronal stem cells expressed ?-3 tubulin and glial fibrillary acid protein which was confirmed on immunofluorescence. On day 14, 2.8 ml stem cell inoculum was infused under local anesthesia in right brachial plexus sheath by brachial block technique under ultrasonography guidance with a 1.5-inch-long 23 gauge needle. Nucleated cell count was 2 × 10 4 /?l, CD34+ was 0.06%, and CD45-/90+ and CD45-/73+ were 41.63% and 20.36%, respectively. No untoward effects were noted. He has sustained recovery with re-innervation over a follow-up of 4 years documented on electromyography-nerve conduction velocity study.

  16. 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

  17. Guillain-Barré syndrome after brachial plexus trauma: case report / Síndrome de Guillain-Barré após traumatismo de plexo braquial: relato de caso

    Scientific Electronic Library Online (English)

    Marcos R.G. de, Freitas; Osvaldo J.M., Nascimento; Maria Beatriz B.P., Harouche; Adolfo, Vasconcelos; Heloy, Darroz Jr; Tânia Maria, Escada.

    1039-10-01

    Full Text Available A síndrome de Guillain-Barré (SGB) é uma polineuropatia predominantemente desmielinizante, que ocorre na maioria das vezes após uma infecção, vacinação, cirurgia ou traumatismo. Embora tenham sido descritos alguns casos após traumatismo crânio encefálico, ainda não foi referido caso de SGB após trau [...] matismo do plexo braquial. Relatamos o caso de um homem de 51 anos que 15 dias após ter apresentado paralisia traumática do plexo braquial, desenvolveu SGB. Recuperou-se inteiramente em algumas semanas. Achamos que em nosso caso a SGB foi desencadeada pelo traumatismo, que provocou distúrbios imunológicos com conseqüente acometimento dos nervos periféricos. Abstract in english The Guilllain-Barré syndrome (GBS) is an acute predominantly demyelinating polyneuropathy. In many cases GBS is preceding by infection, immunization, surgery or trauma. Although there are a few reports of GBS after head trauma, there is no report of this syndrome after brachial plexus injury. We rep [...] ort on a 51 years-old man who presented GBS fifteen days after a brachial plexus trauma. The polineuropathy resolved completely in a few weeks. We believe that GBS was triggered by the trauma that evoked an immune mediated disorder producing inflammation and demyelination of the peripheral nerves.

  18. Nerve Disease and Bladder Control

    Science.gov (United States)

    ... Disease and Bladder Control Nerve Disease and Bladder Control On this page: What bladder control problems does ... bladder do not work properly. [ Top ] What bladder control problems does nerve damage cause? Nerves that work ...

  19. 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.

  20. Cutaneous lesions of the nose

    Directory of Open Access Journals (Sweden)

    Altmeyer Peter

    2010-06-01

    Full Text Available 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 surgery or laser therapy is considered a possible treatment option or that can be surgically evaluated.

  1. 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.)

  2. Isolated optic nerve pseudotumour

    International Nuclear Information System (INIS)

    Isolated optic nerve involvement by the idiopathic inflammatory process is a rare finding and very few reports are available. Here a case of an isolated optic nerve inflammatory pseudotumour presenting with gradually progressive unilateral loss of vision is described. It showed dramatic response to a trial of steroids and its differential diagnoses are discussed. Copyright (1999) Blackwell Science Pty Ltd

  3. 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.

  4. 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.

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

    International Nuclear Information System (INIS)

    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 cm3 of the brachial plexus (OR, 4.909; 95% CI, 0.966–24.952; p = 0.038), and the presence of ple.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.

  6. 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.

  7. Parálisis diafragmática secundaria a bloqueo de plexo braquial vía infraclavicular para cirugía de miembro superior / Diaphragmatic Paresis Secondary to Infraclavicular Brachial Plexus Block for Upper Limb Surgery

    Scientific Electronic Library Online (English)

    Antonio José, Bonilla Ramírez; Reinaldo, Grueso Angulo; Edwin Enrique, Peñate Suárez.

    2011-12-01

    Full Text Available En las últimas décadas, ha sido exponencial el incremento del uso de la anestesia regional, y es cada vez mayor el número de pacientes que se benefician de bloqueos de nervio periférico, ya sea anestésicos o analgésicos. El uso de la anestesia regional ha demostrado ser una herramienta útil en el ma [...] nejo analgésico post operatorio. La vía infraclavicular para bloqueo de plexo braquial es frecuentemente utilizada en la cirugía de miembro superior. Abstract in english Introduction. Regional anesthesia techniques have grown exponentially in the last decades, and there is a growing number of patients who can benefit from anesthetic or analgesic peripheral nerve blocks. The use of Regional Anesthesia has shown to be a helpful tool for postoperative analgesic managem [...] ent. The infraclavicular approach to the brachial plexus block is widely used in upper extremity surgery.

  8. Carpal tunnel syndrome: an unusual presentation of brachial hypertrophy.

    OpenAIRE

    Shenoy, K. T.; Saha, P K; M. Ravindran

    1980-01-01

    A patient with carpal tunnel syndrome in association with congenital hypertrophy of right upper limb is described. The median nerve also showed hypertrophy. The symptoms were relieved by decompression of the carpal tunnel.

  9. The involvement of cutaneous receptors in the biological effects of electromagnetic millimeter waves

    Directory of Open Access Journals (Sweden)

    Anton Emil

    2014-01-01

    Full Text Available The involvement of peripheral nerve terminations in the mechanisms of action of electromagnetic millimeter waves (mmW was assessed. It is currently thought that mmW could be used in noninvasive complementary therapy because of their analgesic effect. However, the mechanisms of their antinociceptive effect and non-ionizing radiation are the subjects of controversy. The mechanisms of interaction of mmW and the cutaneous tissue have not been elucidated. We observed mast cell degranulation at the place of mmW action, a decrease of chronaxie and Turck reflex time, an increase in the number of afferent impulses after sciatic nerve at stimulation, as well as an increase electrocardiogram R-R interval of isolated frog heart after application of mmW. Based on these investigations, we propose that electromagnetic waves of millimeter length modify, through indirect mechanisms, the excitability and reactivity of peripheral nerve terminations.

  10. Cutaneous Manifestation of Pediatric AIDS

    OpenAIRE

    P Alizadeh Taheri; SM Rohani

    2002-01-01

    Cutaneous disorders are the most common manifestation of HIV infection in both children and adults. The spectrum of these manifestations includes infections, neoplasm, drug reactions, nonspecific exanthemas and skin changes associated with nutritional deficits. Mucocutaneous candidiasis, herpetic gingivostomatitis and severe bacteriemia.

  11. 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.

  12. 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.

  13. 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.)

  14. 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.

  15. Vitiligo associated with cutaneous amyloidosis

    Directory of Open Access Journals (Sweden)

    Rajkumar V

    2001-09-01

    Full Text Available 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.

  16. Vitiligo associated with cutaneous amyloidosis.

    Science.gov (United States)

    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. PMID:17664769

  17. 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.

  18. Cutaneous, mucocutaneous and neurocutaneous cysticercosis

    Directory of Open Access Journals (Sweden)

    Arora P

    1990-01-01

    Full Text Available Cutaneous cysticerci are often a pointer to the involvement of internal organs. A series of 33 patients including 5 vegetarians, between 10 to 48 years age, were investigated. Almost half the patients presented with cutaneous cysts of less than one month duration or were unaware of it. In the, other the duration varied upto 10 years. Cutaneous cysts were present in the case&Mental retardation, diminished vision and flashes of lights were, recorded in one case each, raised intracranial tension in 11 and seizures in 29 patients. Four, of the 6 patients with solitary cysts had no involvement of the internal- organs, whereas all the 27 patients with multiple had in nt of brain. Trunk was the commonest site in 16 patients. The other sites involved were scalp, eyelids, face, tongue neck, breast and limbs. Stool examination -for tapeworm segments/ eggs was positive in 2,calcification was seen on X-ray examination of skull in one and of soft tissues in 3, CT scan of skull was suggestive of cysticerci in 27 and skin biopsy for cysticercosis was confirmatory in all the 33 patients. Four patients with a solitary cutaneous cyst were treated by excision. One patients with neurocutaneous cysts was treated with albendazole without response. Out of 16patients with mucocutaneous and neurocutaneous cysticercosis treated with praziquantel, one did not respond. 7 responded partially and 8 had complete relief.

  19. Primary cutaneous B cell lymphoma

    Directory of Open Access Journals (Sweden)

    Bhat I

    2003-07-01

    Full Text Available A 54-year-old man, a road layer by occupation, presented with a 'leonine facies' and multiple tumors that were more commonly present over the exposed parts of the body. On investigation, he turned out to be a case of primary cutaneous B cell lymphoma with a distinctive histopathology. Chemotherapy was given with a good therapeutic response.

  20. Biology of Human Cutaneous Melanoma

    OpenAIRE

    Sharma, Bhuvnesh K.; Hasskamp, Joanne H.; Elias, Elias G.

    2010-01-01

    A review of the natural behavior of cutaneous melanoma, clinical and pathological factors, prognostic indicators, some basic research and the present and possible futuristic strategies in the management of this disease are presented. While surgery remains to be the most effective therapeutic approach in the management of early primary lesions, there is no standard adjuvant therapy after surgical resection, or for metastatic disease.

  1. Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients.

    Science.gov (United States)

    Li, Wenjun; Wang, Shufeng; Zhao, Jianyong; Rahman, M Fazlur; Li, Yucheng; Li, Pengcheng; Xue, Yunhao

    2015-06-01

    OBJECT In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy. METHODS A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period. RESULTS The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%). CONCLUSIONS The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results. PMID:25495742

  2. Cutaneous HPV and skin cancer.

    Science.gov (United States)

    Accardi, Rosita; Gheit, Tarik

    2014-10-22

    Papillomaviruses (HPVs) are small non-enveloped icosahedral viruses that infect the keratinocytes of skin and mucosa. The cutaneous HPV types are represented mainly by the beta and gamma genera, which are widely present in the skin of normal individuals. More than 40 beta-HPV types and 50 gamma-HPV types have been isolated, and these numbers are continuously growing. The main cause of non-melanoma skin cancer is exposure to ultraviolet radiation (UVR). However, cutaneous HPVs that belong to the beta genus may act as a co-carcinogen with UVR. The association between beta-HPVs and skin cancer was first reported in patients with epidermodysplasia verruciformis (EV), who frequently develop cutaneous squamous cell carcinoma (SCC) on sun-exposed areas. Isolation of HPVs from the lesions suggested that HPVs might act as a co-carcinogen with UVR in EV patients. Beta-HPVs may also play a role in cutaneous SCC in immunocompromised non-EV and in immunocompetent individuals. Several studies have reported an association of viral DNA and/or antibodies to beta HPV types with SCC. Interestingly, HPV prevalence and viral load decrease during skin carcinogenesis, being significantly higher in actinic keratosis than in SCC, suggesting that the virus may play a role in the early stages of tumour development (the "hit-and-run" hypothesis). Concordantly, in vivo and in vitro studies have shown that E6 and E7 from certain cutaneous HPV types display transforming activities, further confirming their potential role in carcinogenesis. PMID:25451638

  3. 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.

  4. 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

  5. Combination of Interscalene Brachial and Superficial Cervical Plexus Block for Fracture Clavicle Surgery

    OpenAIRE

    Anirban Pal; Nidhi Dawar; Rajarsree Biswas; Chaitali Biswas

    2011-01-01

    We report a case of interscalene brachial plexus block supplemented with superficial cervical plexus block in a patient with dilated cardiomyopathy with ejection fraction of 24% scheduled for surgery of fracture mid-shaft of clavicle.

  6. A Human Brachial Artery System Prototype Controller Calibration (Static Model

    Directory of Open Access Journals (Sweden)

    Shahariar Kabir

    2011-12-01

    Full Text Available In this paper, controller for a human brachial artery system prototype has been devised with respect to a static model. Operational procedure of the designed prototype has been pointed out. A linear model has been taken in the consideration. Major structural components (pump and shaker have been treated autonomously during preliminary analysis. Ziegler - Nichols tuning methods and pole placement technique have been utilized to determine the suitable controller parameters. At the concluding stage of analysis, the computed parameter values for both pump and shaker are combined to denote the overall response of the complete system. System has been tested with three typical test inputs: step, ramp and sine functions. Simulation results have been presented to verify the correctness of the utilized techniques. It has been concluded from obtained results that the determined controller parameter values for both pump and shaker are more than satisfactory for all typical test inputs.

  7. Suprascapular nerve entrapment.

    Science.gov (United States)

    Corò, L; Azuelos, A; Alexandre, A

    2005-01-01

    It is important to be aware of neuropathy involving the suprascapular nerve. While direct trauma to the suprascapular nerve is the usual cause (direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture), the problem may result from overuse injuries (such as repetitive tennis serving or spiking of a volley ball), excessive horizontal adduction, weight lifting, backpacking or no apparent reason. These last three years we have operated 8 cases of suprascapular nerve neurolysis at the level of suprascapular incision, and section of the transverse scapular ligament through the back supraspinal approach. PMID:15830964

  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. Acute Brachial Artery Thrombosis in a Neonate Caused by a Peripheral Venous Catheter

    OpenAIRE

    Berzel, Simon; Stegemann, Emilia; Hertfelder, Hans-Joerg; Schneider, Katja; Hepping, Nico

    2014-01-01

    This case describes the diagnostic testing and management of an acute thrombosis of the brachial artery in a female neonate. On day seven of life, clinical signs of acutely decreased peripheral perfusion indicated an occlusion of the brachial artery, which was confirmed by high-resolution Doppler ultrasound. Imaging also showed early stages of collateralization so that surgical treatment options could be avoided. Unfractionated heparin was used initially and then replaced by low-molecular-wei...

  10. A case of elbow hyperextension leading to complete brachial artery rupture

    OpenAIRE

    David Huw G; Butler Michael; Jeyaretna Deva S; Walker Alasdair J

    2007-01-01

    Abstract Background To our knowledge there are no cases in the literature of traumatic vascular injury of the brachial artery by elbow hyperextension without elbow dislocation based on either clinical or radiological evidence. Case presentation We present the first case of complete brachial artery rupture resulting from a hyperextension injury to an elbow, without dislocation. The history, early assessment and operative treatment with figures are presented. Conclusion We advocate prompt clini...

  11. Utility of Toe-brachial Index for Diagnosis of Peripheral Artery Disease

    OpenAIRE

    Seong Chul Park; Chang Yong Choi; Young In Ha; Hyung Eun Yang

    2012-01-01

    Background The ankle brachial pressure index (ABI) is a simple, useful method for diagnosingperipheral artery disease (PAD). Although the ABI is an objective diagnostic method, it haslimited reliability in certain scenarios. The aim of the present study was to determine theaccuracy and reliability of the toe brachial index (TBI) as a diagnostic tool for detectingstenosis in PAD, associated with normal or low ABI values.Methods ABI and TBI values were measured in 15 patients with diabetic gang...

  12. The reliability of toe systolic pressure and the toe brachial index in patients with diabetes

    Directory of Open Access Journals (Sweden)

    Perrin Byron M

    2010-12-01

    Full Text Available Abstract Background The Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system. Methods This was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45 and a standardised measurement protocol. Results The mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 (95% LOA: -25.97 to 26.06 mmHg and the mean intra-class correlation for Toe Brachial Indices was 0.75 (95% LOA: -0.22 to 0.28. The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures (95% LOA: -22.91 to 29.17.mmHg and 0.77 for Toe Brachial Indices (95% LOA: -0.21 to 0.22. Conclusion Despite the reasonable intra-class correlation results, the range of error (95% LOA was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.

  13. Brachial plexus injury as an unusual complication of coronary artery bypass graft surgery

    OpenAIRE

    Chong, A.; Clarke, C.; Dimitri, W.; Lip, G.

    2003-01-01

    Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history.

  14. Fracture–dislocation of the shoulder and brachial plexus palsy: a terrible association

    OpenAIRE

    Chillemi, Claudio; Marinelli, Mario; Galizia, Pierluigi

    2008-01-01

    Primary post-traumatic anterior dislocation of the shoulder with associated fracture of the greater tuberosity and brachial plexus injury is rare and, to our knowledge, has never previously been reported in the literature. We present a case of this unhappy triad in which a brachial plexus injury was diagnosed and treated 3 weeks later. The characteristics of this rare condition are discussed on the basis of our case and the published literature in order to improve early diagnosis and treatme...

  15. Axillary brachial plexus block--an underused technique in the accident and emergency department.

    OpenAIRE

    Mackay, C. A.; Bowden, D. F.

    1997-01-01

    OBJECTIVE: To compare axillary brachial plexus block and Bier's block as methods of providing upper limb anaesthesia. METHODS: Axillary brachial plexus or Bier's blocks were performed on all patients requiring upper limb anaesthesia in a three month period. For Bier's block, a single cuff tourniquet and 3 mg/kg 0.5% prilocaine were used. For axillary plexus block, 40 ml 1% lignocaine with adrenaline (1:200,000) were used, given by perivascular or transarterial technique. Prospective analysis ...

  16. Radiation dose to the brachial plexus in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: An increased risk of an excessive dose to the brachial plexus adjacent to gross nodal disease

    OpenAIRE

    Feng, Guosheng; Lu, Heming; Liang, Yuan; Chen, Huasheng; Shu, Liuyang; Lu, Shui; Zhu, Jianfang; Gao, Weiwei

    2012-01-01

    This retrospective study aimed to evaluate the dose to the brachial plexus in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Twenty-eight patients were selected and the brachial plexus was delineated retrospectively. Brachial plexus adjacent/not adjacent to nodes were defined and abbreviated as BPAN and BPNAN, respectively. Dose distribution was recalculated and a dose-volume histogram was generated based on the original treatment plan....

  17. 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.

  18. 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.

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

    Science.gov (United States)

    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 mamba (Dendroaspis angusticeps) venom and toxin I from black mamba (D. polylepis) venom increased the amplitude of e.p.ps by increasing quantal content, and also induced repetitive e.p.ps. 3. Perineural recordings revealed that dendrotoxins could decrease the component of the waveform associated with K+ currents at the nerve terminals, and induce repetitive activation of nerve terminals. 4. In frog motor nerves, dendrotoxins are known to block the fast f1 component of the K+ current at nodes of Ranvier. Blockade of a similar component of the K+ current at motor nerve terminals may be responsible for the effects of these toxins on neuromuscular transmission. 5. Similar conclusions can be drawn from the results obtained from mouse neuromuscular junctions. PMID:2450611

  20. Study of sensory and motor fascicles in brachial plexus and establishment of a digital three-dimensional graphic model.

    Science.gov (United States)

    Chen, Zenggan; Zhang, Jian; Chen, Tongyi; Chen, Zhongwei; Li, Hua; Zhang, Elizabeth W; Lineaweaver, William C; Zhang, Feng

    2011-12-01

    To investigate a 3-dimensional (3D) model of human brachial plexus including its topography of sensory and motor fascicles with the assistance of the computer technology, 2 brachial plexus were serially horizontally sliced. Each slice was stained by Karnovsky-Roots acetylcholinesterase histochemical method. The stained sections were scanned, and the image was put into the computer serially. At last, the 3D diagram of brachial plexus was made. The internal structure of the brachial plexus was found to be very complicated. The fascicles bifurcated and recombined with one another with no fixed rules. All fascicles were mixed sensory and motor fibers. Acetylcholinesterase histochemical staining from a serial tissue section is a useful technique to distinguish sensory fibers from motor ones. The 3D visualization of the brachial plexus may help to develop a computerized database of the fascicle topography to provide an anatomical reference in fascicular repair of brachial plexus. PMID:22123540

  1. 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.

  2. Facial nerve pathology

    International Nuclear Information System (INIS)

    This paper reports MR imaging and CT used in 13 cases of facial neuromas and eight simulating lesions. On MR imaging, facial neuromas has long T1 and long T2 characteristics. In a 4-year-old girl with congenital facial palsy, CT and MR imaging demonstrated a facial neuroma involving the entire intratemporal segment of the facial nerve, including massive involvement of the greater superficial petrosal nerve extending into the vidian canal. A primary chemodectoma of the facial nerve (enhanced after administration of gadolinium) was identical to the facial neuroma on CT scans and MR images. Perineural metastatic lesions could not be differentiated from facial neuromas. Isolated granulomas of the facial nerve had CT findings similar to those of a facial neuroma

  3. 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.

  4. Sacral nerve stimulation

    Directory of Open Access Journals (Sweden)

    Besendörfer M.

    2004-01-01

    Full Text Available The current concept of recruiting residual function of an inadequate pelvic organ by electrostimulation involves stimulation of the sacral spinal nerves at the level of the sacral canal. The rationale for applying SNS to fecal incontinence was based on clinical observations of its effect on bowel habits and anorectal continence function in urologic patients (increased anorectal angulation and anal canal closure pressure and on anatomic considerations: dissection demonstrated a dual peripheral nerve supply of the striated pelvic floor muscles that govern these functions. Because the sacral spinal nerve site is the most distal common location of this dual nerve supply, stimulating here can elicit both functions. Since the first application of SNS in fecal incontinence in 1994, this technique has been improved, the patient selection process modified, and the spectrum of indications expanded. At present SNS has been applied in more than 1300 patients with fecal incontinence limited.

  5. Femoral nerve dysfunction

    Science.gov (United States)

    ... surgical removal of tumors or other growths that press on the nerve. Pain medication, if necessary. Various ... complication is repeated and unnoticed injury to the leg. When there is muscle weakness, falls and related ...

  6. Cervical Radiculopathy (Pinched Nerve)

    Science.gov (United States)

    ... takes advantage of the anti-in? ammatory e? ects similar to oral steroids. The injection may be ... the nerve to recover with more time. Surgical Treatment There are several surgical procedures for radiculopathy. The ...

  7. 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.

  8. MRI of the Brachial Plexus: Modified Imaging Technique Leading to a Better Characterization of Its Anatomy and Pathology

    OpenAIRE

    Torres, Carlos; Mailley, Kathleen; Del Carpio O’donovan, Raquel

    2013-01-01

    Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of the brachial plexus due to its superior soft tissue resolution and multiplanar capabilities. The evaluation of the brachial plexus however represents a diagnostic challenge for the clinician and the radiologist. The imaging assessment of the brachial plexus, in particular, has been traditionally challenging due to the complexity of its anatomy, its distribution in space and due to technical factors. Herei...

  9. Optic nerve aspergillosis.

    Science.gov (United States)

    Yuan, Lisi; Prayson, Richard A

    2015-07-01

    We report a 55-year-old woman with optic nerve Aspergillosis. Aspergillus is an ubiquitous airborne saprophytic fungus. Inhaled Aspergillus conidia are normally eliminated in the immunocompetent host by innate immune mechanisms; however, in immunosuppressed patients, they can cause disease. The woman had a past medical history of hypertension and migraines. She presented 1year prior to death with a new onset headache behind the left eye and later developed blurred vision and scotoma. A left temporal artery biopsy was negative for giant cell arteritis. One month prior to the current admission, she had an MRI showing optic nerve thickening with no other findings. Because of the visual loss and a positive antinuclear antibody test, she was given a trial of high dose steroids and while it significantly improved her headache, her vision did not improve. At autopsy, the left optic nerve at the level of the cavernous sinus and extending into the optic chiasm was enlarged in diameter and there was a 1.3cm firm nodule surrounding the left optic nerve. Histologically, an abscess surrounded and involved the left optic nerve. Acute angle branching, angioinvasive fungal hyphae were identified on Grocott's methenamine silver stained sections, consistent with Aspergillus spp. No gross or microscopic evidence of systemic vasculitis or infection was identified in the body. The literature on optic nerve Aspergillosis is reviewed. PMID:25861888

  10. Carcinoma in cutaneous Lichen Planus

    Directory of Open Access Journals (Sweden)

    Rahul Shetty

    2013-01-01

    Full Text Available 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 so that it can be treated in the initial stages. A high degree of suspicion should be present whenever we come across a non healing lesion in a patient with lichen planus. A few markers, which may give us a clue for increased chances of malignant transformation in these cases is presented.

  11. 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.

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

    Scientific Electronic Library Online (English)

    Jorge Roberto Marcante, Carlotto; Luciana Estacia, Ambros; Juarez Antônio, Dal Vesco; Paulo Roberto, Reichert.

    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 ne [...] rvio. 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. Abstract in english 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 originate [...] d 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.

  13. Unusual presentation of cutaneous leiomyoma.

    Science.gov (United States)

    Bhaskar, Sapnashree; Jaiswal, Ashok K; Madhu, Sm; Santosh, Kv

    2014-11-01

    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. PMID:25484434

  14. Unusual Presentation of Cutaneous Leiomyoma

    OpenAIRE

    Bhaskar, Sapnashree; Jaiswal, Ashok K.; Madhu, SM; Santosh, KV

    2014-01-01

    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.

  15. 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.

  16. Cutaneous schwannomas in 22 horses.

    Science.gov (United States)

    Schöniger, S; Valentine, B A; Fernandez, C J; Summers, B A

    2011-03-01

    Schwannomas are uncommonly recognized in horses. This study describes cutaneous schwannomas in 22 horses aged 8 to 25 years: 12 male, 7 female, and 3 of unknown sex. The horses had solitary cutaneous masses: 9 on the head, 3 on the neck, and the others on the shoulder, hip, thorax, abdomen, rump, extremities, or tail. The location of 1 tumor was unknown. The dermal tumors were well demarcated and expansile. Twelve had a multinodular pattern, whereas 10 formed a single nodule. Antoni A areas were observed in all tumors, and 10 tumors contained Antoni B areas. In Antoni A areas, the densely packed spindle-shaped neoplastic cells were arranged in short fascicles with nuclear palisading. In the hypocellular Antoni B areas, neoplastic cells were separated by abundant myxomatous stroma. Tumors commonly had hyalinization of stroma and vessel walls and ancient change. Cellular vacuolation was observed in 18 tumors. In all 22 cases, neoplastic cells were immunopositive for S100 protein. Expression of laminin and glial fibrillary acidic protein was observed in all 6 tumors evaluated by immunohistochemistry for these markers. One tumor was examined ultrastructurally: Neoplastic cells had branched cytoplasmic processes and were surrounded by an external lamina. Follow-up information was available 8 months to 10 years postexcision for 9 horses, for which surgical excision of the tumor was curative. The equine cutaneous schwannomas in this study had microscopic features like those of human schwannoma and had benign clinical behavior. Correct classification of equine cutaneous schwannoma will facilitate accurate prognosis and appropriate treatment. PMID:20716761

  17. 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...

  18. A case of cutaneous plasmacytosis

    OpenAIRE

    Xia, Jian-xin; Li, Fu-qiu; Zhang, Ming; Mou, Yan; Wang, Jin-feng; Mei, Xiang-lin; Li, Xue; Zhu, Wen-jing

    2013-01-01

    The present study reports a case of cutaneous plasmacytosis in a 51-year-old patient suffering from infiltrated erythema of the right lower lateral femur for 4–5 years and perioral and abdominal erythema for 1 year. Histopathological examination showed that dense mature plasma cell-dominant inflammatory cell infiltration appeared in the deep dermis and between part of the subcutaneous tissues and that there were small numbers of lymphocytes and polykaryocytes. Immunopathogenetic analysis sh...

  19. 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.

  20. Cutaneous side effects of antiosteoporosis treatments

    OpenAIRE

    Musette, P.; Kaufman, J. -m; Rizzoli, Rene?; 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 ...

  1. Cutaneous manifestations in acute meningococcal meningitis

    Directory of Open Access Journals (Sweden)

    Chakrabarty N

    1991-01-01

    Full Text Available Twenty three army recruits with acute meningococcal meningitis were admitted to a military hospital during February-March 1986. Of the 23 patients 11 developed cutaneous lesions, 3 had associated herpes simplex, 6 had arthritis/artharalgia and 3 got conjunctivitis. Maculopapular lesions were the commonest cutaneous manifestation although pinkish macules, purpura and cutaneous vasculitis were also seen. All the patients were treated with intravenous pencillin and other supportive measures.

  2. Essential fatty acids prevent slowed nerve conduction in streptozotocin diabetic rats.

    Science.gov (United States)

    Julu, P O

    1988-01-01

    Rats were given streptozotocin to induce insulin-dependent diabetes or citrate buffer alone in two experiments. Initially, the effect of 5 wks of dietary gamma-linolenic acid (GLA) plus eicosapentaenoic acid (EPA) on cutaneous nerve conduction velocity (CV) was examined. CV was determined by direct stimulation and recording from saphenous nerve under urethane anesthesia. Secondly, a 5 weeks study of supplementing the diet with GLA, GLA and EPA, or hydrogenated coconut oil (HC) was done. In addition, motor nerve CV was determined by directly stimulating sciatic nerve and recording from gastrocnemius muscle. The acute diabetes led to weight loss, and elevated blood glucose and glycosylated hemoglobin levels. Essential fatty acid (EFA) supplementation had no effect on any of these measures of severity of diabetes. In diabetic rats without EFA supplementation, CV of the myelinated fibers fell by 19-21%, while those receiving both GLA and EPA had normal CV. In diabetic rats receiving GLA alone, CV fell by 5-7%, which was significantly less than those without EFA supplementation (p less than 0.01 for cutaneous, and p less than 0.001 for motor nerves). PMID:2853165

  3. Nerve in reversal reaction.

    Science.gov (United States)

    Job, C K

    1996-01-01

    1. Much of the nerve destruction in leprosy takes place during the reactive phase, both during ENL reaction and RR. 2. The high risk patients expected to develop RR are borderline patients with generalized lesions (more than 10 skin lesions) and those presenting with three or more thickened nerve trunks. 3. In RR there is a sudden enhancement of already existing DTH to M. leprae and its antigens resulting in the release of excessive quantities of TNF alpha, INF gamma, and IL-2. The triggering mechanisms of this phenomenon is poorly understood. 4. The already existing granulomas suddenly increase considerably in size due to oedema and rapid influx of lymphocytes, Langhan's and foreign body giant cells. Fragments of M. leprae are also present in the granuloma of some patients. 5. In RR, the acute granulomatous inflammation can produce destruction of nerves even to the extent of causing caseous necrosis of the nerve tissue and irreversible paralysis. The swelling of the nerves due to sudden increase in inflammatory cells and oedema within an unyielding perineurium produce ischaemia and transient paralysis. 6. With prompt administration of anti-inflammatory drugs, paralysis recovers quickly, if it is of ischaemic origin; but will not recover if the Schwann cells and other nerve tissues are destroyed as a result of the immune granuloma. 7. A course of corticosteroids for six months along with anti-leprosy therapy is suggested in high risk patients as a preventive measure. 8. Further the serious problem of continuing nerve damage after clinical cure should be urgently tackled. PMID:8727113

  4. Nova técnica de bloqueio do plexo braquial em cães / New technique of brachial plexus block in dogs

    Scientific Electronic Library Online (English)

    Fábio, Futema; Denise Tabacchi, Fantoni; José Otávio Costa, Auler Junior; Silvia Renata Gaido, Cortopassi; Andrea, Acaui; Angelo João, Stopiglia.

    1999-03-01

    Full Text Available O objetivo do presente estudo foi analisar a viabilidade e a eficácia de uma nova técnica para o bloqueio do plexo braquial em cães. Para tanto, foram utilizados 11 cães, machos e fêmeas, idade e peso variáveis e mestiços. Os animais foram pré-tratados com acepromazina e a indução da anestesia foi r [...] ealizada com propofol. Posteriormente, os animais foram submetidos ao bloqueio do plexo braquial que constou da associação da técnica de múltiplas injeções com o emprego do estimulador de nervos e a técnica da palpação arterial como ponto de referência para a localização dos nervos. Utilizou-se como anestésico local, a bupivacaína com vasoconstritor administrado na dose total de 4mg/kg a 0,375% . O volume total foi dividido em 4 partes iguais, administradas na velocidade de 30 segundos cada, com o objetivo de se atingir a maior quantidade de nervos. O tempo necessário para realização da técnica foi de 11,30 ± 4,54 minutos; o período de latência para o bloqueio motor foi de 9,70 ± 5,52 minutos e para o bloqueio sensitivo foi de 26,20 ± 8,86 min. , sendo a duração da analgesia de 11:00 ± 0:45 horas. Em 90% dos animais, o bloqueio foi efetivo, constatado através da anestesia de todo membro torácico distal à articulação escápulo-umeral. A única complicação observada foi a hipotensão arterial desenvolvida em um animal. Mediante os resultados obtidos, pode-se pressupor que as cirurgias envolvendo o membro torácico distal à articulação escápulo-umeral poderão ser utilizadas com auxílio desta nova técnica do bloqueio do plexo braquial, bem como na analgesia pós-operatória de longa duração. Abstract in english The aim of this study was to evaluate the viability and efficacy of a new technique of brachial plexus block in dogs. Eleven mongrel dogs of different ages and weight, both male and female were used. Animals were pre-medicated with acepromazine and induction of anesthesia was performed with propofol [...] . The brachial plexus block was achieved with the combination of the following techniques: multiple injections, nerve stimulator and the axilary artery pulse to locate the nerves. Bupivacaine was the local anesthetic employed at a total dose of 4mg/kg. This dose was divided in 4, that were administered in 30 seconds each, to achieve more nerves as possible. The time spent to perform the whole procedure was 11.30 ± 4.54 minutes; onset time for motor and sensitive block were 9.70 ± 5.52 and 26.20 ± 8.86 respectively. Duration of analgesia was 11.0 ± 0.45 hours. The block was effective in 90% of animals what was assessed through complete anesthesia of the front limb distally to the shoulder joint. Hypotension in one animal was the sole complication observed. With the results obtained we can suggest the use of this technique for front limb surgery performed distally to the shoulder joint as well as a pos-operative analgesic approach in dogs.

  5. 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

  6. Unusual Relation of the Median Nerve with the Accessory Head of the Biceps Brachii Muscle: An Original Case Report Una Rara Relación del Nervio Mediano con la Cabeza Accesoria del Músculo Bíceps Braquial: Reporte de Caso

    OpenAIRE

    Nuket Mas; Can Pelin; Ragiba Zagyapan; Hakan Bahar

    2006-01-01

    During the laboratory dissection of the brachial region and the arm, an abnormal relation of median nerve with the accessory head of biceps brachii muscle has been observed unilaterally on the right upper limb of a male cadaver. Whereas the short and long heads have their normal origin, additional-excess third head originated from the anteromedial surface of the superior part of the humerus. Some fibers of this accessory head on the medial side arise from the deep fascia surrounding the brach...

  7. Femoral nerve palsy as a complication of anterior iliac crest bone harvest: Report of two cases and review of the literature

    Science.gov (United States)

    Kargel, Jennifer; Dimas, Vanessa; Tanaka, Wayne; Robertson, O Bailey; Coy, J Michael M; Gotcher, Jack; Chang, Peter

    2006-01-01

    There are many documented neurological complications of anterior iliac crest bone harvest. Until now, these have included injuries to the iliohypogastric, subcostal and lateral femoral cutaneous nerves. Femoral nerve palsy as a direct surgical complication of anterior iliac crest bone harvest has never been cited in any surgical literature, although it has been reported in deep pelvic and abdominal surgeries in which improper retraction and/or prolonged hyperextension of the hip may have caused a nerve compression syndrome. In addition, surgical patients on antithrombolytic therapy have experienced hemorrhage within the iliacus and iliopsoas muscles, resulting in hematoma and secondary femoral nerve compression. The classic motor and sensory deficits reported in femoral nerve palsies are reduced or absent patellar reflex, weak hip flexion, quadriceps muscle weakness, and anesthesia of the anterior thigh and medial aspect of the leg. Two cases of femoral nerve palsy with different etiologies are presented. PMID:19554143

  8. Monkey median nerve repaired by nerve graft or collagen nerve guide tube.

    Science.gov (United States)

    Archibald, S J; Shefner, J; Krarup, C; Madison, R D

    1995-05-01

    Nerve regeneration was followed in 15 median and 1 ulnar nerve of eight Macaca fascicularis monkeys by serial electrophysiological assessments over a period of three and a half years. Nerve gaps of 5 mm at the wrist were bridged by collagen-based nerve guides, nerve autografts, or direct suture repairs. Thenar muscle reinnervation occurred between 50 and 70 d for all groups, indicating axonal elongation rates of approximately 1 mm/d. The recovery rates of the compound muscle action potential (CMAP) and the compound sensory action potential (CSAP) amplitudes were significantly slower after direct suture repair compared to the other two procedures, although the final levels of recovery were all comparable. Similar results were achieved in one median and one ulnar nerve following nerve guide repair of a 15 mm nerve gap. The functional reinnervation of Pacinian corpuscles was detected in all cases following either nerve graft or nerve guide repair, with similar amplitudes and latencies of the tactile evoked CSAP for both types of repair. Histological analysis demonstrated a significant increase in the number of myelinated axons in the median nerve distal to the nerve lesions following both nerve graft and nerve guide repairs compared to proximal and normal controls, with significant reductions of fiber diameter and corresponding increases in g-ratio. The return of a bimodal frequency distribution of myelinated axon fiber diameter was confirmed by three-dimensional surface plots which illustrate the frequency distribution of the relationship between fiber diameter and g-ratio. These combined results demonstrate that nerve regeneration after repair of a 5 mm nerve gap with a collagen nerve guide in the nonhuman primate is similar to that after graft repair, and the final level of physiological recovery for both repair procedures is comparable to direct suture repair of the median nerve. PMID:7751969

  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. Conceptos actuales en la parálisis braquial perinatal: Parte 1: etapa temprana / Current concepts in perinatal brachial plexus palsy: Part 1: Early phase

    Scientific Electronic Library Online (English)

    Andrés Alejandro, Dogliotti.

    2011-08-01

    Full Text Available La parálisis braquial perinatal tiene una incidencia similar a otras patologías frecuentes de la ortopedia infantil. Su tratamiento ha sido tradicionalmente conservador, con seguimiento pediátrico y consultas a los distintos especialistas para tratar las secuelas. Existen controversias respecto de l [...] a historia natural y el tratamiento. Las secuelas comienzan cada vez más tempranamente, por lo que debe ser pesquisada en las revisaciones y ser considerada en la táctica terapéutica al mismo tiempo que la reparación de los nervios. Se analiza la clasifcación clínica y los parámetros de recuperación nerviosa, fundamentales para decidir el momento de indicar una exploración del plexo. Abstract in english The incidence of perinatal brachial palsy is similar to that of other frequent conditions in children's orthopedics. The treatment has been traditionally conservative with pediatric follow-up and consultations with various specialists to deal with its sequelae. Its natural history and treatment are [...] controversial. Sequelaes tend to appear earlier each time, so that it should be attended to in checkups and taken into consideration in therapeutic tactics at the same time as nerve repair. This paper includes an analysis of its clinical classifcation and nerve recovery parameters, essential to decide whent to start an exploration of the plexus.

  11. Cutaneous Horn Following Injury to Pinna

    OpenAIRE

    Purohit, G. N.; Agarwal, Navneet; Agarwal, Ritu

    2011-01-01

    Cutaneous Horn of the pinna is a relatively uncommon entity. Most of the cases reported in literature have been caused due to prolonged exposure to sunlight but in this case the cutaneous horn has been caused due to injury to the pinna with wheat sheaf

  12. A STUDY ON THE RISK FACTORS FOR OBSTETRICAL BRACHIAL PLEXUS PALSY

    Directory of Open Access Journals (Sweden)

    Farah Ashrafzadeh MD

    2010-10-01

    Full Text Available ObjectiveConsiderable medical and legal debates have surrounded the prognosis and outcome of obstetrical brachial plexus injuries and obstetricians are oftenconsidered responsible for the injury. In this study, we assessed the factors related to the outcome of brachial plexus palsy.Material & MethodsDuring 24 months, 21 neonates with obstetrical brachial plexus injuries were enrolled.Electrophysiology studies were done at the age of three weeks. They received physiotherapy and occupational therapy. They were examined every 3 monthsfor one year and limbs function was assessed according to Mallet scores; also, maternal and neonatal factors were collected by a questionnaire.Results There were 10 boys and 11 girls.Of all, 76.2% had Erb's palsy, 19% had total brachial palsy and 4.8% hadklumpke paralysis.Risk factors including primiparity, high birth weight, shoulder dystocia, andprolonged second stage of labor were assessed.Electrophysiology studies showed neuropraxia in 52.4% and axonal injuries in42.9% of the patients.At the end of the first year, 81% of the patients had functioned recovery aroundgrade III or IV of Mallet scores.There were only significant relationships between functional improvement andneurophysiologic findings.ConclusionOutcome of obstetrical brachial injuries has a close relationship toneurophysiologic study results than other risk factors.

  13. 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.

  14. 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.

  15. Brachial artery with high up division with its embryological basis and clinical significance

    Directory of Open Access Journals (Sweden)

    Satyanarayana N

    2010-04-01

    Full Text Available Objectives: To document an unusually short segment brachial artery with its high up division into radial and ulnar arteries in the middle of the arm and to establish embryological and clinico-anatomical correlations of such variation.Methods: The finding was noted after thorough and meticulous dissection of the upper limbs of both sides (axilla, arm, cubital fossa, forearm and palm of a 40-year-old adult male cadaver in the Department of Anatomy, College of Medical Sciences, Bharatpur, Nepal. Photographic documentation of the variation was also made.Results: An unusually short segment brachial artery was noted in the right arm. This short segment brachial artery bifurcated more proximally at the level of insertion of coracobrachialis in the middle of the right arm into radial and ulnar arteries both of same caliber. Further distribution of these two arteries was normal. No other variation was found particularly in relation to the cords of the brachial plexus and their branches. Dissection of the left upper limb revealed no unusual observations.Conclusion: The short segment brachial artery with high up bifurcation as noted in the present study is fairly common. The variation 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.

  16. 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.

  17. 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.

  18. 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 ...

  19. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... nerve is. It lies right next to an artery and a vein, which makes it very easy ... The vagus nerve runs right between the carotid artery and the jugular vein, so that’s where we’ ...

  20. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... the area where the nerve is. It lies right next to an artery and a vein, which ... called the carotid sheath. The vagus nerve runs right between the carotid artery and the jugular vein, ...

  1. [Chronic lupus erythematosus, subacute cutaneous lupus].

    Science.gov (United States)

    Doutre, M S; Beylot, C

    1990-09-21

    The cutaneous manifestations of lupus erythematosus (LE) are extremely varied, and they predominate among the clinical signs of chronic LE and subacute cutaneous LE. In chronic LE, typical lesions are found in regions exposed to sunlight and consist of erythema, hyperkeratosis and skin atrophy. The skin of patients with subacute cutaneous LE is also highly sensitive to light; the lesions consist of an annular or polycyclic or sometimes psoriasiform erythemato-squamous eruption observed mainly in uncovered areas. These dermatological forms are part of the wide spectrum of "lupus". Cutaneous manifestations are often associated with systemic signs of varying type and severity and with immunological abnormalities, such as antibodies to Ro in subacute cutaneous LE, which act as markers of the disease. PMID:2237183

  2. 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.

  3. Systemic therapy for cutaneous melanoma.

    Science.gov (United States)

    Treisman, Jonathan; Garlie, Nina

    2010-01-01

    This article provides a review of the current medical management of patients with high-risk and metastatic cutaneous melanoma, including a review of the use of adjuvant interferon therapy and a discussion of adjuvant treatments under evaluation. The use of standard chemotherapeutic agents for metastatic disease is discussed, with an emphasis on developmental therapeutics using targeted agents. This discussion includes a review of the immune therapy for metastatic melanoma, including newer immunomodulatory agents and cellular therapeutics that are expected to significantly impact the care of these patients. PMID:19914464

  4. Optic nerve hypoplasia in children.

    OpenAIRE

    Zeki, S M; Dutton, G N

    1990-01-01

    Optic nerve hypoplasia (ONH) is characterised by a diminished number of optic nerve fibres in the optic nerve(s) and until recently was thought to be rare. It may be associated with a wide range of other congenital abnormalities. Its pathology, clinical features, and the conditions associated with it are reviewed. Neuroendocrine disorders should be actively sought in any infant or child with bilateral ONH. Early recognition of the disorder may in some cases be life saving.

  5. High division of sciatic nerve

    OpenAIRE

    Tripti Shrivastava; Lalit Garg; B.K.Mishra; Neeta Chhabra

    2014-01-01

    Background: The Sciatic nerve is the largest and thickest nerve in the human body with a long course in the inferior extremity. It divides into tibial and common peroneal nerves which can occur at any level from the sacral plexus to the inferior part of the popliteal space. Sciatic nerve variations are relatively common. These variations may contribute to clinical conditions ex sciatica, coccygodynia and piriformis syndrome and have important clinical implications in anaesthesiology, neurolog...

  6. High division of sciatic nerve

    Directory of Open Access Journals (Sweden)

    Tripti Shrivastava

    2014-04-01

    Results: In all except two cadavers, the nerve divided at the apex of the popliteal fossa. In two cadavers the sciatic nerve divided bilaterally in the upper part of thigh. Conclusion: The high division presented in this study can make popliteal nerve blocks partially ineffective. The high division of sciatic nerve must always be borne in mind as they have important clinical implications. [Int J Res Med Sci 2014; 2(2.000: 686-688

  7. Constraint-Induced Movement Therapy for Children with Obstetric Brachial Plexus Palsy: Two Single-Case Series

    Science.gov (United States)

    Buesch, Francisca Eugster

    2010-01-01

    The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT…

  8. Vagus Nerve Stimulation (VNS Therapy)

    Medline Plus

    Full Text Available ... coming loose. STEPHANIE EINHAUS, M.D. In a moment here, he’s got the tiny electrodes, tiny wires wrapped around the nerve. The nerve itself, if you can see it, is only about 3 mm thick, so it’s fairly small. That nerve has a lot of different functions. It has to do with stomach function, mobility ...

  9. MR imaging findings of anterior interosseous nerve lesions

    International Nuclear Information System (INIS)

    To study and characterise the MR imaging findings of lesions of the anterior interosseous nerve (AIN). Magnetic resonance imaging (MRI) findings of the forearm of ten patients referred to our institution with suspected AIN lesions were retrospectively studied. Five healthy volunteers with normal forearm MRI findings formed a control group. Two musculoskeletal radiologists assessed the forearm musculature for oedema in the distribution of the AIN, median, posterior interosseous and radial nerves on T2-weighted (T2W) fat-saturated sequences. T1-weighted (T1W) images were assessed and graded for the presence of muscle atrophy and fatty involution. Six patients had undergone surgical exploration; five of these had surgically confirmed AIN compression. Four patients had diagnoses other than AIN compression made on imaging features. Of the cases of proven AIN compression, oedema within the pronator quadratus (PQ) muscle was identified in all cases. PQ atrophy and fatty involution were seen in three (43%) surgically confirmed cases. Cases 2 and 3 also demonstrated oedema in the flexor digitorum profundus (FDP)1 and FDP2 muscles. These cases also showed oedema in the flexor-carpi radialis (FCR) and FDP3/FDP4 muscles, respectively. The four cases of non-AIN compression demonstrated muscle oedema patterns that were atypical for the AIN distribution. They included a rupture of the flexor pollicis longus (FPL) tendon, brachial neuritis, amyotrophic lateral sclerosis and compressimyotrophic lateral sclerosis and compression of the proximal median nerve. MRI is a useful investigation in the diagnostic workup of AIN syndrome. AIN syndrome is likely when there is diffuse oedema of AIN innervated muscles on T2W fat-saturated images. The most reliable sign of an AIN lesion is oedema within the PQ. Oedema in the flexor carpi radialis, FDP3 and FDP4, although not in the classical distribution of the AIN, does not preclude the diagnosis of AIN syndrome. (orig.)

  10. Carcinomatous versus radiation-induced brachial plexus neuropathy in breast cancer

    International Nuclear Information System (INIS)

    A retrospective study was performed of 18 women in whom ipsilateral brachial plexus neuropathy developed after treatment for carcinoma of the breast. In the absence of metastatic tumor elsewhere, the only distinguishing feature between carcinomatous neuropathy and radiation-induced neuropathy was the symptom-free interval after mastectomy and radiation therapy. Women with an interval of less than a year have radiation-induced neuropathy. Brachial plexus exploration in difficult diagnostic situations will permit early treatment and avoid debilitating loss of function. Brachial plexus exploration for biopsy is safe and free of complications if performed carefully. Treatment of carcinomatous neuropathy is most likely to succeed if the tumor is hormonally sensitive, but radiotherapy may also be effective. Treatment of radiation-induced neuropathy remains largely ineffective

  11. Brachial plexus palsy following a training run with a heavy backpack.

    Science.gov (United States)

    McCulloch, Robert; Sheena, Y; Simpson, C; Power, D

    2014-12-01

    A 23-year-old male British soldier developed a progressive sensory loss and weakness in his right arm during a 12?km training run with a load of approximately 70?kg. There was no recovery of his symptoms within 3?months and both MRI and USS did not demonstrate a site of compression within the brachial plexus. An infraclavicular brachial plexus exploration was performed 11?months after injury that indicated an ischaemic neuropathy with post-injury fibrosis. Injuries of the brachial plexus secondary to carrying a heavy backpack during prolonged periods of exercise are rare, particularly in the infraclavicular region. Cases such as this highlight that training regimens within the military population should be appraised due to the risk of similar injuries occurring. PMID:24125801

  12. Arteria Braquial Superficial Bilateral: Una Variación Anatómica Infrecuente con Implicancias Clínicas y Quirúrgicas / Bilateral Superficial Brachial Artery: A Rare Anatomical Variation with Clinical and Surgical Implications

    Scientific Electronic Library Online (English)

    Guillermo, Salgado; Oscar, Inzunza; Javier, Rodríguez; Romina, Soza; Mario, Cantín.

    2014-03-01

    Full Text Available Las variaciones del sistema arterial en el miembro superior son relevantes debido a la gran cantidad de procedimientos diagnósticos, invasivos y terapéuticos realizados en la actualidad. Reportamos una variante poco frecuente de la arteria braquial superficial (ABS) encontrada bilateralmente en los [...] miembros superiores. En ambos miembros la ABS descendió superficial y lateral al nervio mediano y medial a la cabeza corta del músculo bíceps braquial. La ABS derecha terminó en la fosa cubital se unió a la arteria braquial en un tronco común, una variación anatómica rara de tipo isla, mientras que la ABS izquierda terminó en el antebrazo como arteria radial. La presencia unilateral de la ABS se ha informado con una frecuencia relativa, pero una variación bilateral es extremadamente rara. La relevancia de la embriología, incidencia y clínica de esta variación anatómica se discuten. Abstract in english Variations of the upper limb arterial system are an important consideration due to the large number of invasive, diagnostic and therapeutic procedures performed in this region. We report a rare variant of the superficial brachial artery (SBA) found bilaterally in the upper limbs. In both limbs the S [...] BA desending superficial and lateral of median nerve, and medial to the short head of bicep brachii muscle. Right SBA finished in the cubital fossa joined the deep brachial artery in a common trunk, a rare anatomical variation of island type, while the left SBA finished in the forearm and radial artery. The unilateral presence of the SBA reported with relative frequency, but a bilateral variation is extremely rare. The relevance of embryology, and clinical incidence of this anatomical variation are discussed.

  13. Cutaneous signs of classical dermatomyositis.

    Science.gov (United States)

    Auriemma, M; Capo, A; Meogrossi, G; Amerio, P

    2014-10-01

    Idiopathic immune myopathies (IIM) are an heterogeneous group of autoimmune muscle disorders characterized by progressive muscle involvement. Dermatomyositis (DM) is the most common form of IIM. It is a multisystem disorder characterized by symmetric proximal, extensor, inflammatory myopathy, vascular involvement and a characteristic cutaneous eruption. Six types of DM have been identified: idiopathic, juvenile (JDM), cancer-related other autoimmune diseases-related, iatrogenic DM and amyopathic DM. Cutaneous manifestations of DM are the most important aspect of this disease and can precede from several months to years muscle or systemic involvement. Three groups of signs have been described: pathognomonic, highly characteristic and compatible. Although differences exist among the different clinical presentation of skin lesions, they share common histological findings including the presence of interface dermatitis with epidermal atrophy, basement membrane degeneration, vacuolar alteration of basal keratinocytes, and dermal changes consisting of interstitial mucin deposition and a sparse lymphocytic infiltrate. DM is a serious disease; the correct evaluation of any skin lesion suggesting an early diagnosis is of utmost importance. Skin signs may, also, represent a marker of treatment efficacy even though systemic symptoms worsening may not always be followed by more severe skin lesions. PMID:25014587

  14. A cutaneous horn over seborrhoeic keratosis of pinna

    OpenAIRE

    Gupta, Abhay; Jain, A. K.

    1997-01-01

    Cutaneous horn is not rare. Many varieties of cutaneous horns have been described. Seborrhoeic keratosis of pinna is not very common especially with a cutaneous horn developing over it. We encountered a cutaneous horn, over seborrhoeic kerotosis involving pinna, an uncommon finding.

  15. 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).

  16. Cutaneous afferents provide a neuronal population vector that encodes the orientation of human ankle movements.

    Science.gov (United States)

    Aimonetti, Jean-Marc; Hospod, Valérie; Roll, Jean-Pierre; Ribot-Ciscar, Edith

    2007-04-15

    The aim of this study was to analyse the directional coding of two-dimensional limb movements by cutaneous afferents from skin areas covering a multidirectional joint, the ankle. The activity of 89 cutaneous afferents was recorded in the common peroneal nerve, and the mean discharge frequency of each unit was measured during the outward phase of ramp and hold movements imposed in 16 different directions. Forty-two afferents responded to the movements in the following decreasing order (SA2, n = 24/27; FA2, n = 13/17; FA1, n = 3/24; SA1, n = 2/21). All the units activated responded to a specific range of directions, defining their 'preferred sector', within which their response peaked in a given direction, their 'preferred direction'. Based on the distribution of the preferred directions, two populations of afferents, and hence two skin areas were defined: the anterior and the external lateral parts of the leg. As the directional tuning of each population was cosine shaped, the neuronal population vector model was applied and found to efficiently describe the movement direction encoded by cutaneous afferents, as it has been previously reported for muscle afferents. The responses of cutaneous afferents were then considered with respect to those of the afferents from the underlying muscles, which were previously investigated, and an almost perfect matching of directional sensitivity was observed. It is suggested that the common movement-encoding characteristics exhibited by cutaneous and muscle afferents, as early as the peripheral level, may facilitate the central co-processing of their feedbacks subserving kinaesthesia. PMID:17255169

  17. Biocompatibility of Different Nerve Tubes

    Directory of Open Access Journals (Sweden)

    Hisham Fansa

    2009-09-01

    Full Text Available 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 clinically, where biocompatibility is an inevitable prerequisite. This review gives an idea about artificial nerve tubes with special focus on their biocompatibility in animals and humans.

  18. [Tissue engineering of erectile nerves].

    Science.gov (United States)

    May, F; Weidner, N; Matiasek, K; Vroemen, M; Mrva, T; Caspers, C; Henke, J; Brill, T; Lehmer, A; Blesch, A; Erhardt, W; Gänsbacher, B; Hartung, R

    2004-10-01

    Dissection of the cavernous nerves eliminates spontaneous erections and may lead to irreversible erectile dysfunction due to degeneration of cavernous tissue. Novel procedures to reconstruct penile innervation include cavernous nerve interposition grafting and neurotrophic treatments to revitalize penile neural input, evaluated thus far in various preclinical models of cavernous nerve injury. Schwann cells crucially contribute to successful axonal regeneration by mechanical and paracrine mechanisms in the injured nerve, and Schwann cells seeded into guidance channels have been successfully employed to support regeneration in animal models of cavernous nerve injury. Gene therapy, tissue engineering, and reconstructive techniques have been combined to deliver neurotrophic factors and recover erectile function. PMID:15549162

  19. 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.)

  20. 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. MEDITIRM, 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.)

  1. 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.

  2. A Case of True Brachial Artery Aneurysm in an Elderly Male

    Directory of Open Access Journals (Sweden)

    M. Bassir A. Fakhree

    2012-02-01

    Full Text Available Brachial artery aneurysms are relatively rare and are mostly pseudoaneurysms rather than true aneurysms, as true aneurysms are even rarer entities. Patients can be asymptomatic, or present with pulsatile masses, or ischemia due to associated thromboembolic complica-tions. Distal embolism can occur with transient or minimal ischemic symptoms; however, aneurysm itself can thrombose entirely. The authors report a case of upper limb acute ischemia caused by true brachial artery aneurysm thrombosis in an elderly man, managed by reconstructive vascular surgery.

  3. CT scanning of the brachial plexus, normal anatomy, pathology, and radiation fibrosis

    International Nuclear Information System (INIS)

    The brachial plexus is a region difficult to examine clinically and by conventional radiology. CT is ideally suited to image this area, and detailed anatomy of the plexus can be visualized. Sixty patients with brachial plexus symptoms underwent CT of the root of the neck and axilla. Forty-two of these had previously been treated with radiation therapy for carcinoma of the breast. CT was a sensitive modality for demonstrating abnormalities in this region, and radiation fibrosis could be differentiated from recurrent axillary disease. A greater degree of fibrosis did not correlate with different treatment schedules but with a higher fraction size

  4. Does the Addition of Tramadol and Ketamine to Ropivacaine Prolong the Axillary Brachial Plexus Block?

    OpenAIRE

    Ahmet Can Senel; Ozlem Ukinc; Alper Timurkaynak

    2014-01-01

    Background and Objectives. A prospective, randomized, controlled, double-blind clinical trial to assess the effect of tramadol and ketamine, 50?mg, added to ropivacaine in brachial plexus anesthesia. Methods. Thirty-six ASA physical statuses I and II patients, between 18 and 60 years of age, scheduled for forearm and hand surgery under axillary brachial plexus block, were allocated to 3 groups. Group R received 0.375% ropivacaine in 40?mL, group RT received 0.375% ropivacaine in 40?mL w...

  5. Clinical Neuropathology practice guide 3-2014: Combined nerve and muscle biopsy in the diagnostic work-up of neuropathy – the Bordeaux experience

    Science.gov (United States)

    Vital, Anne; Vital, Claude

    2014-01-01

    Simultaneous combined superficial peroneal nerve and peroneous brevis muscle biopsy, via the same cutaneous incision, allows examination of several tissue specimens and significantly improves the diagnosis of systemic diseases with peripheral nerve involvement. Vasculitides are certainly the most frequently diagnosed on neuro-muscular biopsies, but this procedure is also well advised to asses a diagnosis of sarcoidosis or amyloidosis. More occasionally, combined nerve and muscle biopsy may reveal an unpredicted diagnosis of cholesterol embolism, intra-vascular lymphoma, or enables complementary diagnosis investigations on mitochondrial cytopathy or storage disease. PMID:24618073

  6. Clinical Neuropathology practice guide 3-2014: combined nerve and muscle biopsy in the diagnostic workup of neuropathy - the Bordeaux experience.

    Science.gov (United States)

    Vital, Anne; Vital, Claude

    2014-01-01

    Simultaneous combined superficial peroneal nerve and peroneous brevis muscle biopsy, via the same cutaneous incision, allows examination of several tissue specimens and significantly improves the diagnosis of systemic diseases with peripheral nerve involvement. Vasculitides are certainly the most frequently diagnosed on neuro-muscular biopsies, but this procedure is also well advised to asses a diagnosis of sarcoidosis or amyloidosis. More occasionally, combined nerve and muscle biopsy may reveal an unpredicted diagnosis of cholesterol embolism, intra-vascular lymphoma, or enables complementary diagnosis investigations on mitochondrial cytopathy or storage disease. PMID:24618073

  7. Bilateral eventration of sciatic nerve.

    Science.gov (United States)

    Sharma, T; Singla, R K; Lalit, M

    2010-01-01

    During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block. PMID:22049898

  8. Estudio anatómico de la transferencia de los nervios accesorio y toracodorsal al nervio cubital en el gato / Anatomic study of spinal accesory and thoracodorsal nerves transfer to ulnar nerve in cats

    Scientific Electronic Library Online (English)

    J.R., Martínez-Méndez; A., Isla Guerrero; C., Pérez Conde; C., Morales; C., Casado Pérez.

    2008-09-01

    Full Text Available Las lesiones del plexo braquial son una de las patologías más graves y con mayor número de secuelas del miembro superior. En el momento actual las transferencias nerviosas se encuentran en primera línea del armamento terapéutico para reconstruir funciones proximales del miembro superior. En el estud [...] io que presentamos se realizaron 20 transferencias nerviosas al nervio cubital del gato común, tomando bien el nervio accesorio del espinal (10 casos) o bien el nervio toracodorsal (10 casos). Como grupo control se utilizó el lado contralateral al intervenido. Durante el año siguiente, se evaluó la reinervación mediante estudios electromiográficos, histológicos de nervio y músculo, así como histoquímicos de médula espinal. Tras el análisis de los resultados encontramos que las motoneuronas de ambos nervios donantes son capaces de conseguir reinervaciones parciales del territorio cubital. Abstract in english A brachial plexus injury is one of the most severe pathologies of the upper limb, and also has severe sequels. In the actual state of the art, nerve transfers are being used as first line of therapeutic approach in the reconstruction of proximal functions of the upper limb. In this study 20 nerve tr [...] ansfers were made to the ulnar nerve of the cat, using the spinal accessory nerve (10 cases) or the thoracodorsal nerve (10 cases). The opposite side was used as control. During next year, reinnervation was assessed by electromyography, nerve and muscle histology and histochemical evaluation of the spinal cord. We found that motoneurons of both donor nerves are able to make partial reinervation of the ulnar nerve territory.

  9. Intraoperative radial nerve injury during coronary artery surgery – report of two cases

    Directory of Open Access Journals (Sweden)

    Tsivgoulis Georgios

    2006-12-01

    Full Text Available Abstract Background Peripheral nerve injury and brachial plexopathy are known, though rare complications of coronary artery surgery. The ulnar nerve is most frequently affected, whereas radial nerve lesions are much less common accounting for only 3% of such intraoperative injuries. Case presentations Two 52- and 50-year-old men underwent coronary artery surgery. On the first postoperative day they both complained of wrist drop on the left. Neurological examination revealed a paresis of the wrist and finger extensor muscles (0/5, and the brachioradialis (4/5 with hypoaesthesia on the radial aspect of the dorsum of the left hand. Both biceps and triceps reflexes were normoactive, whereas the brachioradialis reflex was diminished on the left. Muscles innervated from the median and ulnar nerve, as well as all muscles above the elbow were unaffected. Electrophysiological studies were performed 3 weeks later, when muscle power of the affected muscles had already begun to improve. Nerve conduction studies and needle electromyography revealed a partial conduction block of the radial nerve along the spiral groove, motor axonal loss distal to the site of the lesion and moderate impairment in recruitment with fibrillation potentials in radial innervated muscles below the elbow and normal findings in triceps and deltoid. Electrophysiology data pointed towards a radial nerve injury in the spiral groove. We assume external compression as the causative factor. The only apparatus attached to the patients' left upper arm was the sternal retractor, used for dissection of the internal mammary artery. Both patients were overweight and lying on the operating table for a considerable time might have caused the compression of their left upper arm on the self retractor's supporting column which was fixed to the table rail 5 cm above the left elbow joint, in the site where the radial nerve is directly apposed to the humerus. Conclusion Although very uncommon, external compression due to the use of a self retractor during coronary artery surgery can affect – especially in obese subjects – the radial nerve within the spiral groove leading to paresis and should therefore be included in the list of possible mechanisms of radial nerve injury.

  10. Cutaneous malignant lymphoma of the nasal tip.

    Science.gov (United States)

    Strauss, M; Kolkova, Z; Laurian, N; Zohar, Y

    1986-01-01

    Cutaneous lymphomas are relatively rare malignant lesions. Lymphomas limited to the skin are uncommon and most patients have a generalized disease. The head and neck are the most common sites of presentation. This lesion is diagnostically problematic since histologic distinction from several benign cutaneous lymphocytic infiltrates is occasionally difficult and thus its clinical behavior is unpredictable. The most common histopathologic subtype is diffuse histiocytic lymphoma and therapy is analogous to that for lymphomas arising elsewhere. The prognosis of lymphoma presenting in the skin is dependent upon the initial extent of the disease and probably upon histology. A case of cutaneous malignant lymphoma arising at the nasal tip, surgically treated, is presented. PMID:3963696

  11. Cutaneous findings in five cases of malaria

    Directory of Open Access Journals (Sweden)

    Vaishnani Jignesh

    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.

  12. 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.

    1060-10-01

    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.

  13. Effects of nerve growth factor on nerve regeneration after corneal nerve damage

    OpenAIRE

    Ma, Ke; Yan, Naihong; Huang, Yongzhi; Cao, Guiqun; Deng, Jie; Deng, Yingping

    2014-01-01

    The study aims to determine the relation between the effects of mouse nerve growth factor (mNGF) and nerve regeneration after corneal surgery nerve damage. Mechanical nerve injury animal model was established by LASIK (the excimer laser keratomileusis) surgery in 12 Belgian rabbits. mNGF and the balanced salt solution (BBS) were alternatively administered in the left and right eye two times every day for 8 weeks. The morphous and growth of the sub-basal nerve plexus and superficial stroma wer...

  14. An experimental study to determine and correlate choline acetyltransferase assay with functional muscle testing after nerve injury.

    Science.gov (United States)

    Vathana, Torpon; Nijhuis, Tim H J; Friedrich, Patricia F; Bishop, Allen T; Shin, Alexander Y

    2014-05-01

    OBJECT Choline acetyltransferase (ChAT) is an enzyme synthesized within the body of a motor neuron whose role is to form the neurotransmitter acetylcholine. Quantification of ChAT levels in motor or mixed nerves has been proposed to provide information regarding the viability of a proximal nerve stump for motor neurotization following brachial plexus injury. To do so requires information regarding normal ChAT levels and those in injured nerves, as well as the correlation of ChAT level determined at surgery with eventual motor recovery. The purpose of this study was to determine ChAT activity in the normal and injured sciatic/peroneal nerve in a rat model, evaluate the correlation between ChAT and motor recovery, find the relationship between ChAT activity and isometric muscle force, and elucidate the parallel between ChAT activity and acetylcholinesterase (AChE) activity. METHODS Sixty animals were divided into 3 groups. The sciatic nerves in Group 1 were transected without repair. Nerves in Group 2 were transected and repaired. Nerves in Group 3 sustained a crush injury followed by transection and reconstruction. All animals were allowed 12 weeks of recovery followed by evaluation of ChAT levels in the peroneal nerve, correlated with measures of maximal isometric tibialis anterior muscle force and muscle weight (the operated side normalized to the control side). Karnovsky AChE staining of peroneal nerve segments was also compared with radiochemical assay of ChAT activity in the same nerve. RESULTS A significant difference in the tibialis anterior isometric tetanic force and the tibialis anterior muscle weight index (TAMI) was noted between Group 1 and Groups 2 and 3 (p TAMI was 0.382. Both AChE measurement and ChAT activity demonstrated significantly fewer fibers in the operated nerve compared with the contralateral nerve. Intergroup variability could also be illustrated using these tests. The correlation coefficient between the isometric tetanic force measurement and the ChAT analysis in Groups 1 and 2 was 0.468. The correlation for the AChE staining and the isometric tetanic force measurement was 0.111. The correlation between the TAMI and the ChAT levels was 0.773. The correlation between the TAMI and the AChE-stained fibers was 0.640. Correlating AChE staining to the ChAT analysis produced a correlation of 0.712. CONCLUSIONS The great variability in all groups and weak correlations to the functional muscle assessments and the ChAT radiochemical assay made this technique an unreliable method of determining motor nerve viability. PMID:24559224

  15. Comparing the Surgical Outcomes of Modified Quad and Triangle Tilt Surgeries to other Procedures Performed in Obstetric Brachial Plexus Injury

    Directory of Open Access Journals (Sweden)

    Rahul K. Nath

    2013-08-01

    Full Text Available Purpose: To compare results from our surgical treatment experiences in children with obstetric brachial plexus injuries (OBPI, to those who have had other surgical treatments. Methods: We conducted a retrospective study in our medical records consisting of two groups of OBPI patients. Group 1: 26 OBPI children (16 girls and 10 boys, age range between 2.0 and 12.0 (mean age 6.9, who have undergone surgical treatments at other institutions between 2005 and 2010. Group 2: 45 OBPI children (20 boys and 25 girls, age between 0.7 and 12.9 (mean age 3.7, who have had modified Quad and triangle tilt surgical treatment between 2005 and 2010 at our institution. In both groups Mean modified Mallet scores and radiological scores were measured and compared. All measurements were made at least one year post surgery in both groups. Results: Post-operative mean modified Mallet score was 11.8 ± 2.4 in group 1 patients, whereas post-mean modified Mallet score was 20 ± 2.7 (P 0.0001 following modified Quad and triangle tilt surgeries in group 2 patients. Further, their radiological scores such as posterior subluxation, and glenoid version were 13.4 ± 21.3 and ?30.2 ± 19.1 in group 1, whereas 32.1 ±13.5 (P 0.0004, and ?16.3 ± 11.5 (P 0.008 in group 2 patients, when compared to normal values of 50, and 0 respectively. Conclusion: Patients who have had mod Quad and triangle tilt for OBPI obtained significantly better functional outcomes in modified total Mallet score as well as in radiological scores, when compared to those OBPI children, who underwent other procedures such as posterior glenohumeral capsulorrhaphy, biceps tendon lengthening, humeral osteotomy, anterior capsule release, nerve transfer/graft, botox and muscle/tendon transfer and release.

  16. Intraepidermal neuron-specific enolase (NSE)-immunoreactive nerve fibres: evidence for sprouting in uremic patients on maintenance hemodialysis.

    Science.gov (United States)

    Johansson, O; Hilliges, M; Ståhle-Bäckdahl, M

    1989-05-01

    The use of indirect immunohistochemistry in 12 patients on maintenance hemodialysis has shown weak or moderately strong neuron-specific enolase (NSE)-immunoreactive nerve terminals and fibres sprouting throughout the layers of the epidermis. No such terminals or fibres were found in any of 15 controls. There was no difference between uremic patients with pruritus and those without. Furthermore, NSE-positive nerve fibres with a normal appearance were seen in the dermis, at the epidermal-dermal junctional zone and sometimes entering the stratum basale in both patients and controls. The immunoreactive nerves were thin, smooth and, at their terminal fields, varicose. The immunoreactivity seemed to be associated chiefly with sensory nerves. Thus, our results suggest that uremic patients undergoing maintenance hemodialysis develop an abnormal pattern of cutaneous innervation. PMID:2657508

  17. [Niacin deficiency and cutaneous immunity].

    Science.gov (United States)

    Ikenouchi-Sugita, Atsuko; Sugita, Kazunari

    2015-01-01

    Niacin, also known as vitamin B3, is required for the synthesis of coenzymes, nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP). Niacin binds with G protein-coupled receptor (GPR) 109A on cutaneous Langerhans cells and causes vasodilation with flushing in head and neck area. Niacin deficiency due to excessive alcohol consumption, certain drugs or inadequate uptake in diet causes pellagra, a photosensitivity dermatitis. Recently several studies have revealed the mechanism of photosensitivity in niacin deficiency, which may pave a way for new therapeutic approaches. The expression level of prostaglandin E synthase (PTGES) is up-regulated in the skin of both pellagra patients and niacin deficient pellagra mouse models. In addition, pellagra is mediated through prostaglandin E?-EP4 (PGE?-EP4) signaling via reactive oxygen species (ROS) production in keratinocytes. In this article, we have reviewed the role of niacin in immunity and the mechanism of niacin deficiency-induced photosensitivity. PMID:25765687

  18. Treatment Approaches for Cutaneous Leishmaniasis

    Directory of Open Access Journals (Sweden)

    Sema Aytekin

    2009-06-01

    Full Text Available Cutaneous leishmaniasis (CL is a widespread tropical infection caused by numerous different species of Leishmania protozoa. In our country, CL is due frequently to L. major and L. tropica. Its clinical presentation is extremely diverse. Treatment of CL aims to prevent mucosal invasion, to accelerate the healing of skin lesions, and avoid disfiguring scar. Local and physical treatment modalities including topical paromomycin, cryotherapy, localized controlled heat, carbon dioxide laser therapy, or pentavalant antimonals can be effective against. Intralesional antimonals are still the drug of choice may patients. WHO recommends an injection of drug under edges of the lesions and the entire lesion until the surface has blanched. Parenteral antimonials are useful for large, persistent or recurrent lesions. Combinations with other drugs such as allopurinol, pentoxifylline must be used for antimony unresponsive lesions.

  19. Four-headed biceps brachii muscle with variant course of musculocutaneous nerve: anatomical and clinical insight

    Directory of Open Access Journals (Sweden)

    Aggarwal A

    2009-10-01

    Full Text Available A rare case of four-headed biceps brachii muscle with variation in the course of musculocutaneous nerve was observed in left arm of a 48-year-old embalmed male cadaver. One of the extra head (third was fleshy throughout, originated from anteromedial surface of shaft of humerus and merged with the deep surface of short head. Fourth thin tendinous head originated just below lesser tuberosity of humerus and joined with the third head. Both accessory heads were lying under cover of short head of biceps. Musculocutaneous nerve was coursing between two supernumerary heads and subsequently between third head and short head of biceps brachii muscle. Origin of third head from shaft of humerus led to passage of nerve between this head and short head, before acquiring normal position between biceps brachii and brachialis muscles, and emerging out as lateral cutaneous nerve of forearm. Intramuscular course of nerve may be a potential site for nerve compression by hypertrophied biceps associated with strenuous regular physical activity of biceps or weight lifting.

  20. 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...