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MEDIAL BRACHIAL CUTANEOUS NERVE CONDUCTION VELOCITY: A DIAGNOSTIC METHOD FOR MEDIAL CORD LESIONS  

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Full Text Available Introduction. Regarding to the absence of doccumented studies concerning medial brachial coetaneous nerve conduction, the present study was conducted to evaluate this parameter as a diagnostic method for injuries to medial cord and lower trunk of brachial plexus. Methods. The sensory nerve action potential of median, ulnar and medial antebrachial cutaneous nerves were recorded to show these roots (Cs-TV are intact. Then, the medial brachial cutaneous nerve was stimulated on the line that connects axilla to medial epicondyle (parallel with mid axillary line at the junction site of coracobrachialis muscle to humerus recording was done 2 cm above the medial epicondyle (10 cm under stimulating site. Results. In all cases the wave was biphasic with primary negative phase. The latency was 2±0.3 ms-1 (range 1.4-2.6 ms-1 and the amplitude of SNAP was 30±10 mv (range 10-50 mV. The nerve conduction velocity was 61±4 ms-1 (range 53-69 ms-1. Discussion. With regard to the intensity and site of stimulation and recording area, this wave is not due to compound nerve action potential of median or ulnar nerve. This study may be useful in evaluation of T1 root and in differential diagnosis of medial cord and lower trunk lesions with ulnar and medial part of median nerve injuries.

B TAVANA

2000-06-01

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Medial antebrachial cutaneous nerve injury after brachial plexus block: two case reports.  

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Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block. PMID:24466530

Jung, Mi Jin; Byun, Ha Young; Lee, Chang Hee; Moon, Seung Won; Oh, Min-Kyun; Shin, Heesuk

2013-12-01

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Nerve transfer in brachial plexus traction injuries.  

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Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. This technique was analyzed in 37 patients with 64 reinnervation procedures of the musculocutaneous and/or axillary nerve using upper intercostal, spinal accessory, and regional nerves as donors. The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair. PMID:1730947

Samardzic, M; Grujicic, D; Antunovic, V

1992-02-01

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Reinnervation of avulsed brachial plexus using the spinal accessory nerve.  

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The use of the accessory nerve as a donor is one of the possibilities for the reinnervation of the brachial plexus in cases of paralysis due to root avulsion. In this paper, an analysis of the reinnervation of the musculocutaneous or axillary nerve using the spinal accessory nerve is made on 13 cases, 8 of total and 5 of upper partial avulsion. In all cases, Allieu's technique was used, but in seven cases reinnervation was supplemented by upper intercostal nerves when there was total avulsion and/or by the medial pectoral nerve when there was partial avulsion. The methods are discussed and compared with the intercostobrachial anastomosis. PMID:2154041

Samardzic, M; Grujicic, D; Antunovic, V; Joksimovic, M

1990-01-01

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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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

2014-06-01

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Surgical outcomes following nerve transfers in upper brachial plexus injuries  

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Full Text Available Background: Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury. Materials and Methods: We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations, surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients, and phrenic nerve to suprascapular nerve (1 patient. In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients, intercostal nerves (2 patients, and phrenic nerve with nerve graft (2 patients. Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients, both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients, spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient, intercostal nerves (3rd, 4th and 5th to musculocutaneous nerve (4 patients and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient. Results: Motor and sensory recovery was assessed according to Medical Research Council (MRC Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170 degrees. Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+ were obtained in seven patients. Five patients had fair results (M2+ to M3.

Bhandari P

2009-01-01

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Median nerve neuropraxia by a large false brachial artery aneurysm.  

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Peripheral nerve compression is a rare complication of an iatrogenic false brachial artery aneurysm. We present a 72-year-old patient with median nerve compression due to a false brachial artery aneurysm after removal of an arterial catheter. Surgical exclusion of the false aneurysm was performed in order to release traction of the median nerve. At 3-month assessment, moderate hand recovery in function and sensibility was noted. In the case of neuropraxia of the upper extremity, following a history of hospital stay and arterial lining or catheterization, compression due to pseudoaneurysm should be considered a probable cause directly at presentation. Early recognition and treatment is essential to avoid permanent neurological deficit. PMID:24347134

Lijftogt, Niki; Cancrinus, Ernst; Hoogervorst, Erwin Lj; Mortel, Rob Hw van de; Vries, Jean-Paul Pm de

2014-10-01

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Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries.  

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Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5-T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5-T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. PMID:22434572

Jerome, J Terrence Jose; Rajmohan, Bennet

2012-09-01

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Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation.  

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Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial plexus block. Ten residents with no previous experience with using ultrasound received ultrasound training and another ten residents with no previous experience with using nerve stimulation received nerve stimulation training. The novices' learning curves were generated by retrospective data analysis out of our electronic anaesthesia database. Individual success rates were pooled, and the institutional learning curve was calculated using a bootstrapping technique in combination with a Monte Carlo simulation procedure. The skills required to perform successful ultrasound-guided axillary brachial plexus block can be learnt faster and lead to a higher final success rate compared to nerve stimulator-guided axillary brachial plexus block. PMID:21318138

Luyet, C; Schüpfer, G; Wipfli, M; Greif, R; Luginbühl, M; Eichenberger, U

2010-01-01

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Primary nerve repair in associated lesions of the axillary artery and brachial plexus  

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Diagnosis becomes more complex when there is an association of a brachial plexus injury with an arterial lesion. The principal clinical picture in most cases is acute ischemia that requires initial treatment in the emergency room, and the final results of nerve repair are generally poorer. Although delayed brachial plexus reconstruction is preferred by some authors, our experience leads us to the opinion that a combined repair presents several advantages. Immediately after trauma, the surgica...

Bertoldo, Ugo; Tos, Pierluigi

2006-01-01

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Dorsal ulnar cutaneous nerve conduction: reference values  

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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.

Garibaldi Solange G.

2002-01-01

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Sensory nerves and nitric oxide contribute to reflex cutaneous vasodilation in humans.  

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We tested the hypothesis that inhibition of cutaneous sensory nerves would attenuate reflex cutaneous vasodilation in response to an increase in core temperature. Nine subjects were equipped with four microdialysis fibers on the forearm. Two sites were treated with topical anesthetic EMLA cream for 120 min. Sensory nerve inhibition was verified by lack of sensation to a pinprick. Microdialysis fibers were randomly assigned as 1) lactated Ringer (control); 2) 10 mM nitro-L-arginine methyl ester (L-NAME) to inhibit nitric oxide synthase; 3) EMLA + lactated Ringer; and 4) EMLA + L-NAME. Laser-Doppler flowmetry was used as an index of skin blood flow, and blood pressure was measured via brachial auscultation. Subjects wore a water-perfused suit, and oral temperature was monitored as an index of core temperature. The suit was perfused with 50°C water to initiate whole body heat stress to raise oral temperature 0.8°C above baseline. Cutaneous vascular conductance (CVC) was calculated and normalized to maximal vasodilation (%CVC(max)). There was no difference in CVC between control and EMLA sites (67 ± 5 vs. 69 ± 6% CVC(max)), but the onset of vasodilation was delayed at EMLA compared with control sites. The L-NAME site was significantly attenuated compared with control and EMLA sites (45 ± 5% CVC(max); P EMLA + L-NAME site (25 ± 6% CVC(max)) was attenuated compared with control and EMLA (P < 0.001) and L-NAME only (P < 0.01). These data suggest cutaneous sensory nerves contribute to reflex cutaneous vasodilation during the early, but not latter, stages of heat stress, and full expression of reflex cutaneous vasodilation requires functional sensory nerves and NOS. PMID:23408029

Wong, Brett J

2013-04-15

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Nerve transfer in brachial plexus injuries: Comparative analysis of surgical procedures  

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Full Text Available Nerve transfer is the only possibility for nerve repair in cases of the brachial plexus traction injuries with spinal roots avulsion. From 1980. until 2000. in Institute of Neurosurgery, Clinical Center of Serbia, nerve transfer has been performed in 127(79% of 159 patients with traction injuries of brachial plexus, i.e., 204 reinnervation procedures has been performed using different donor nerves. We achieved good or satisfactory arm abduction and full range or satisfactory elbow flexion through reinnervation of the axillary and musculocutaneous nerve using different donor nerves in 143 of 204 reinnervations, which presents general rate of useful functional recovery in 70,1% of cases. Mean values of the rate of useful functional recovery in individual modalities of nerve transfer in our series are 50,1% for intercostal and/or spinal accessory nerve transfer, 64,5% for plexo-plexal nerve transfer, 81,7% for regional nerve transfer, and 87,1% for combine nerve transfer.

Baš?arevi? Vladimir Lj.

2003-01-01

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

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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)

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Brachial plexopathy  

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... plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy . It occurs when there is damage to the brachial plexus , an area on each side of the neck where nerve roots from the spinal cord split into each ...

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Brachial Neuritis Presenting with Isolated Long Thoracic Nerve Involvement  

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

Hatice Rana Erdem

2009-06-01

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

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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

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

2014-01-01

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

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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

Desroches, Jean; Grabs, Ursula; Grabs, Detlev

2013-01-01

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Regional donor nerves in the reinnervation of brachial plexus palsy due to upper spinal roots avulsion.  

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The prognosis for surgical treatment in cases of upper brachial plexus palsy due to spinal roots avulsion is somewhat better than in cases of total palsy. The main reasons are better possibilities for surgical reinnervation using regional donors i.e. the medial pectoral and the thoracodorsal nerves, and a shorter time span for nerve regeneration. Regional donor nerves, alone or in combination with upper intercostals and/or the spinal accessory nerve, were used in 13 cases for the reinnervation of the musculocutaneous and/or the axillary nerves. The value of the regional donors is analysed and compared with that of the spinal accessory and intercostal nerves. The value is documented throughout the results of surgical treatment with a follow-up period of at least 18 months after surgery. PMID:2573856

Samardzic, M; Joksimovic, M; Antunovic, V; Grujicic, D

1989-09-01

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Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note  

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Full Text Available Abstract Background To determine whether monitoring end- tidal Carbon Dioxide (capnography can be used to reliably identify the phrenic nerve during the supraclavicular exploration for brachial plexus injury. Methods Three consecutive patients with traction pan-brachial plexus injuries scheduled for neurotization were evaluated under an anesthetic protocol to allow intraoperative electrophysiology. Muscle relaxants were avoided, anaesthesia was induced with propofol and fentanyl and the airway was secured with an appropriate sized laryngeal mask airway. Routine monitoring included heart rate, noninvasive blood pressure, pulse oximetry and time capnography. The phrenic nerve was identified after blind bipolar electrical stimulation using a handheld bipolar nerve stimulator set at 2–4 mA. The capnographic wave form was observed by the neuroanesthetist and simultaneous diaphragmatic contraction was assessed by the surgical assistant. Both observers were blinded as to when the bipolar stimulating electrode was actually in use. Results In all patients, the capnographic wave form revealed a notch at a stimulating amplitude of about 2–4 mA. This became progressively jagged with increasing current till diaphragmatic contraction could be palpated by the blinded surgical assistant at about 6–7 mA. Conclusion Capnography is a sensitive intraoperative test for localizing the phrenic nerve during the supraclavicular approach to the brachial plexus.

Agarwal Anil

2008-05-01

 
 
 
 
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Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series.  

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Object Axillary nerve palsy, isolated or as part of a more complex brachial plexus injury, can have profound effects on upper-extremity function. Radial to axillary nerve neurotization is a useful technique for regaining shoulder abduction with little compromise of other neurological function. A combined experience of this procedure used in children is reviewed. Methods A retrospective review of the authors' experience across 3 tertiary care centers with brachial plexus and peripheral nerve injury in children (younger than 18 years) revealed 7 cases involving patients with axillary nerve injury as part of an overall brachial plexus injury with persistent shoulder abduction deficits. Two surgical approaches to the region were used. Results Four infants (ages 0.6, 0.8, 0.8, and 0.6 years) and 3 older children (ages 8, 15, and 17 years) underwent surgical intervention. No patient had significant shoulder abduction past 15° preoperatively. In 3 cases, additional neurotization was performed in conjunction with the procedure of interest. Two surgical approaches were used: posterior and transaxillary. All patients displayed improvement in shoulder abduction. All were able to activate their deltoid muscle to raise their arm against gravity and 4 of 7 were able to abduct against resistance. The median duration of follow-up was 15 months (range 8 months to 5.9 years). Conclusions Radial to axillary nerve neurotization improved shoulder abduction in this series of patients treated at 3 institutions. While rarely used in children, this neurotization procedure is an excellent option to restore deltoid function in children with brachial plexus injury due to birth or accidental trauma. PMID:25192235

Zuckerman, Scott L; Eli, Ilyas M; Shah, Manish N; Bradley, Nadine; Stutz, Christopher M; Park, Tae Sung; Wellons, John C

2014-11-01

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Median nerve injury: an underrecognised complication of brachial artery cardiac catheterisation?  

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OBJECTIVE—To describe the local neurological complications associated with cardiac catheterisation via the right brachial artery.?METHODS—A follow up study to determine the mechanism of injury and outcome of patients who sustained a high median nerve palsy after this procedure. Five right handed patients were identified in a 24 month period. Each was assessed clinically and electrophysiologically at presentation. All were followed up initally (range six to 22months)...

Kennedy, A.; Grocott, M.; Schwartz, M.; Modarres, H.; Scott, M.; Schon, F.

1997-01-01

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Median palmar cutaneous nerve injury in a volleyball player.  

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A 14-yr-old female patient, a competitive high school volleyball player, was seen for an evaluation of right-hand numbness and tingling. Her symptoms began insidiously, midway through her second season of competitive play. Numbness and tingling improved with rest but returned immediately after resuming competition. Plain radiographs and magnetic resonance imaging were within normal limits. Meticulous sensory examination revealed a decrease in sensation to light touch over an area consistent with the distribution of the palmar cutaneous branch of the median nerve. It is postulated that the patient's complaints were due to right median palmar cutaneous nerve damage secondary to repetitive trauma to the right forearm and wrist as a result of her competitive volleyball play. To our knowledge, this is the first reported case of median palmar cutaneous nerve damage as a result of participation in competitive volleyball. PMID:19077672

Gitkind, Andrew I; Zhao, Peng; Oh-Park, Moo Yeon; Fast, Avital

2009-04-01

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PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK  

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Full Text Available A 67 year old male patient was scheduled for implant removal from right upper limb under supraclavicular block. During procedure patient develops right phrenic nerve palsy & complains of dyspnea which was managed conservatively and no intervention done except chest x-ray for confirming the diagnosis. Surgeons completed the implant removal without any invasive intervention or interruption.

Gupta A K

2009-09-01

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NERVE GROWTH FACTOR, NEUROPEPTIDES AND CUTANEOUS NERVES IN ATOPIC DERMATITIS  

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Introduction: Neurogenic components, as neurotrophic factors and neuropeptides, are probably involved in the pathogenesis of atopic dermatitis (AD) with the neuroimmunocutaneous system as they modify the functions of immunoactive cells in the skin. Nerve growth factor (NGF) is the best-characterized member of the neurotrophin family. Both NGF and neuropeptides (NPs) may be associated with the disease pathogenesis. Aim: This study aims to evaluate the plasma level of NGF and N...

Hodeib Abeer; Hanafy Hesham

2010-01-01

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

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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

Krutika B Rupera

2013-06-01

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Intercostal nerve transfer to neurotize the musculocutaneous nerve after traumatic brachial plexus avulsion: a comparison of two, three, and four nerve transfers.  

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The purpose of this study was to compare the outcomes of different numbers of intercostal nerve (ICN) transfers for elbow flexion and to determine whether age, body mass index (BMI), type of injury, and preoperative delay influence the outcomes. From 2004 to 2010, 32 (30 included) consecutive patients underwent ICN transfer to the musculocutaneous nerve following brachial plexus injury. Elbow flexion strength was evaluated according to the British Medical Research Council (BMRC) grading system. Of nine patients who received two ICN transfers, six (66.7%) recovered with useful elbow flexion compared with 14 of 17 (82.4%) patients who received three ICN transfers. Of the four patients with four ICN transfers, three (75%) achieved useful recovery. Statistical analysis showed no significant difference. There is no significant difference among the outcomes of two, three, and four ICN transfers to the musculocutaneous nerve. Two ICN transfers are sufficient for useful recovery of elbow flexion. Younger patients achieve better results. PMID:24683138

Xiao, Chengwei; Lao, Jie; Wang, Tao; Zhao, Xin; Liu, Jingbo; Gu, Yudong

2014-06-01

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Nerve growth factor, neuropeptides and cutaneous nerves in atopic dermatitis  

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

Hodeib Abeer

2010-01-01

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Surgical treatment of brachial plexus posterior cord lesion: a combination of nerve and tendon transfers, about nine patients.  

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Lesions of the posterior cord of the brachial plexus are rare. The symptoms are usually described as palsy of the deltoid and triceps brachii muscles and of the extensor muscles of the wrist, thumb and fingers. If there is no recovery, our strategy is to operate on these patients 6 months after the injury using a combination of nerve and tendon transfers. We present a series of nine patients, two with a partial palsy and seven with a complete palsy of the posterior cord. We performed five nerve transfers to the axillary nerve, four using intercostal nerves and one using the ulnar nerve. Six patients benefited from a transfer to one of the nerves to the triceps brachii (medial or lateral head), five using the ulnar nerve and one using two intercostal nerves. We performed eight tendon transfers for radial palsy. The results demonstrated significant restoration of the deltoid muscle (grade 4 strength, mean active abduction of 120°). Active elbow extension was restored in all patients with an average strength measured at 5.6kg and 48% of the contralateral strength. All tendon transfers were successful with recovery of active wrist extension (40°), long fingers extension and thumb abduction and extension (12.5cm between the tips of index and thumb). With this method, we were able to restore function to the upper limb of patients who presented with debilitating palsy of the posterior cord of the brachial plexus. PMID:23759287

Oberlin, C; Chino, J; Belkheyar, Z

2013-06-01

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A Need for Logical and Consistent Anatomical Nomenclature for Cutaneous Nerves of the Limbs  

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The system of anatomical nomenclature needs to be logical and consistent. However, variations in translation to English of the Latin and Greek terminology used in Nomina Anatomica and Terminologia Anatomica have led to some inconsistency in the nomenclature of cutaneous nerves in the limbs. An historical review of cutaneous nerve nomenclature…

Gest, Thomas R.; Burkel, William E.; Cortright, Gerald W.

2009-01-01

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Origin, distribution, and insertion of the brachial plexus nerves in Blue-and-yellow Macaws (Ara ararauna, Linnaeus, 1758  

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Full Text Available Brazil has about 80 species of parrots cataloged, and five of them are identified as Macaws. As the vast majority of birds, Macaws use flight as their primary means of locomotion. However, the strength and power generated during the cycle of beating wings require a mechanism of active neuromuscular control and specialized adaptations of muscles responsible for flight, which are innervated by the brachial plexus. This study aims to describe the origin and distribution of peripheral nerves that make up the brachial plexus in Blue-and-yellow Macaw (Ara ararauna, Linnaeus, 1758, in order to aid the veterinarian to recognize and locate neuromuscular lesions in this species. We used five dead bodies, obtained from the Screening Center for Wild Animals in Paraíba, Brazil, in which the nerves were identified by direct dissection. Four nerve roots were viewed, originating three nerve trunks, which stem from the intervertebral spaces between the tenth cervical vertebra and the second thoracic vertebra. Nerves from the dorsal cord innervated extensor muscles, while ventral cord nerves innervated flexor muscles of the wing, in addition to the pectoral branches, responsible to innervate the superficial thoracic and shoulder muscles.

Kamal Achôa Filho

2014-09-01

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

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

Radi Shahien

2011-02-01

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Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report  

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Full Text Available Abstract Background Brachial Plexus innervates the upper limb. As it is the point of formation of many nerves, variations are common. Knowledge of these is important to anatomists, radiologists, anesthesiologists and surgeons. The presence of anatomical variations of the peripheral nervous system is often used to explain unexpected clinical signs and symptoms. Case Presentation On routine dissection of an embalmed 57 year old male cadaver, variations were found in the formation of divisions and cords of the Brachial Plexus of the right side. Some previously unreported findings observed were; direct branches to the muscles Pectoralis Minor and Latissimus dorsi from C6, innervation of deltoid by C6 and C7 roots and the origin of lateral pectoral nerve from the posterior division of upper trunk. The median nerve was present lateral to axillary artery. The left side brachial plexus was also inspected and found to have normal anatomy. Conclusion The probable cause for such variations and their embryological basis is discussed in the paper. It is also concluded that although these variations may not have affected the functioning of upper limb in this individual, knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to the upper limb.

Rao Vani

2007-10-01

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Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block: A Comparative Study with Nerve Stimulator-Guided Method  

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Full Text Available Background: The aim of this study was to compare the efficacy of axillary brachial plexusblock using an ultrasound-guided method with the nerve stimulator-guidedmethod. We also compared the efficacy of ultrasound-guided single-injectionwith those of double-injection for the quality of the block.Methods: Ninety patients scheduled for surgery of the forearm or hand were randomlyallocated into three groups (n = 30 per group, i.e., nerve stimulator-guidedand double-injection (ND group, ultrasound-guided and double-injection(UD group, and ultrasound-guided and single-injection (US group. Eachpatient received 0.5 ml kg-1 of 1.5% lidocaine with 5 ?g kg-1 epinephrine.Patients in the ND group received half the volume of lidocaine injected nearthe median and radial nerves after identification using a nerve stimulator.Patients in the UD group received half the volume of lidocaine injectedaround the lateral and medial aspects of the axillary artery, while those in theUS group were given the entire volume near the lateral aspect of the axillaryartery. The extent of the sensory blockade of the seven nerves and motorblockades of the four nerves were assessed 40 min after the performance ofaxillary brachial plexus block.Results: Seventy percent of the patients in the ND and US groups as well as 73% ofthe patients in the UD group obtained satisfactory sensory and motor blockades.The success rate of performing the block was 90% in patients in theND and UD groups and 70% in the US group. The incidence of adverseevents was significantly higher in the ND group (20% compared with that inthe US group and the UD group (0%; p = 0.03.Conclusions: Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockadeswith fewer adverse events.

Fu-Chao Liu

2005-06-01

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Avulsão do plexo braquial em cães - 2: biópsia fascicular e histologia dos nervos radial, mediano, ulnar e musculocutâneo Brachial plexus avulsion in dogs - 2: fascicular biopsy and histology of the radial, median, ulnar and musculocutaneous nerves  

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Full Text Available O objetivo deste trabalho foi demonstrar os aspectos clínicos e neurológicos relevantes para o diagnóstico da avulsão do plexo braquial em cães, relacionando estes achados com os resultados da histologia dos nervos radiais, medianos, ulnar e músculo cutânea. A biópsia fascicular destes nervos foi realizada após abordagem cirúrgica às faces lateral e medial do braço afetado. Todos os fascículos submetidos ao exame histológico apresentaram alterações como tumefação axonal, degeneração walleriana e infiltrado inflamatório em graus variados, havendo principalmente nos nervos radial, mediano e ulnar a proliferação de colagem endoneural. A associação destes resultados com as alterações neurológicas e da eletroneuroestimulação (relatados na parte 1 e 3 deste trabalho respectivamente sugeriu envolvimento quase que total das raízes do plexo braquial em todos os casos.The main purposes of this work were the neurological evaluation of dogs with brachial plexus avulsion and correlation of these findings with the results of histology of the radial, median, and ulnar and muscle cutaneous nerves. Fascicular nerve biopsy was performed after surgical approach of medial and lateral aspect of the arm. Ali the submitted fascicles presented histologic alterations compatible with wallerian degeneration, axonal swelling, and inflammatory infiltrate ranging from mild to pronounced, with endoneural collagen proliferation mainly in radial, median and ulnar nerves. The association of these results with neurological and electroneurostimulation exams (respectively described in part 1 and 3 of this work suggested in all cases an almost total involvement of brachial plexus roots.

Mônica Vicky Bahr Arias

1997-03-01

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Avulsão do plexo braquial em cães - 2: biópsia fascicular e histologia dos nervos radial, mediano, ulnar e musculocutâneo / Brachial plexus avulsion in dogs - 2: fascicular biopsy and histology of the radial, median, ulnar and musculocutaneous nerves  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O objetivo deste trabalho foi demonstrar os aspectos clínicos e neurológicos relevantes para o diagnóstico da avulsão do plexo braquial em cães, relacionando estes achados com os resultados da histologia dos nervos radiais, medianos, ulnar e músculo cutânea. A biópsia fascicular destes nervos foi re [...] alizada após abordagem cirúrgica às faces lateral e medial do braço afetado. Todos os fascículos submetidos ao exame histológico apresentaram alterações como tumefação axonal, degeneração walleriana e infiltrado inflamatório em graus variados, havendo principalmente nos nervos radial, mediano e ulnar a proliferação de colagem endoneural. A associação destes resultados com as alterações neurológicas e da eletroneuroestimulação (relatados na parte 1 e 3 deste trabalho respectivamente) sugeriu envolvimento quase que total das raízes do plexo braquial em todos os casos. Abstract in english The main purposes of this work were the neurological evaluation of dogs with brachial plexus avulsion and correlation of these findings with the results of histology of the radial, median, and ulnar and muscle cutaneous nerves. Fascicular nerve biopsy was performed after surgical approach of medial [...] and lateral aspect of the arm. Ali the submitted fascicles presented histologic alterations compatible with wallerian degeneration, axonal swelling, and inflammatory infiltrate ranging from mild to pronounced, with endoneural collagen proliferation mainly in radial, median and ulnar nerves. The association of these results with neurological and electroneurostimulation exams (respectively described in part 1 and 3 of this work) suggested in all cases an almost total involvement of brachial plexus roots.

Mônica Vicky Bahr, Arias; Ana Paula Frederico Loureiro, Bracarense; Ângelo João, Stopiglia.

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Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation.  

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The aim of the study was to evaluate the effect on pain relief in patients with peripheral neuropathic pain after brachial plexus injuries using an implanted peripheral nerve stimulator applied directly to the nerve branch involved into the axillary cavity. Seven patients with post-traumatic brachial plexus lesions or distal peripheral nerve complaining of severe intractable chronic pain were enrolled in a single-centre, open-label trial. Conventional drugs and traditional surgical treatment were not effective. Patients underwent careful neurological evaluation, pain questionnaires and quantitative sensory testing (QST). Surgical treatment consists of a new surgical technique: a quadripolar electrode lead was placed directly on the sensory peripheral branch of the main nerve involved, proximally to the site of lesion, into the axillary cavity. To assess the effect, we performed a complete neuroalgological evaluation and QST battery after 1 week and again after 1, 6 and 12 weeks. All patients at baseline experienced severe pain with severe positive phenomena in the median (5) and/or radial (2) territory. After turning on the neuro-stimulator system, all patients experienced pain relief within a few minutes (>75 % and >95 % in most), with long-lasting pain relief with a reduction in mean Numerical Rating Scale (NRS) of 76.2 % after 6 months and of 71.5 % after 12 months. No significant adverse events occurred. We recommend and encourage this surgical technique for safety reasons; complications such as dislocation of electrocatheters are avoided. The peripheral nerve stimulation is effective and in severe neuropathic pain after post-traumatic nerve injuries of the upper limbs. PMID:24558032

Stevanato, Giorgio; Devigili, Grazia; Eleopra, Roberto; Fontana, Pietro; Lettieri, Christian; Baracco, Chiara; Guida, Franco; Rinaldo, Sara; Bevilacqua, Marzio

2014-07-01

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Computerized tomography myelography with coronal and oblique coronal view for diagnosis of nerve root avulsion in brachial plexus injury  

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Full Text Available Abstract Background The authors describe a new computerized tomography (CT myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view. Methods CT myelography was performed with penetration of the cervical subarachnoid space by the contrast medium. Then the coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyl transferase activity measurement in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy was compared with that of CT myelography with axial view, correlated with surgical findings or a natural course in 57 cervical roots in 28 patients. Results Coronal and oblique coronal views were superior to axial views in visualization of the rootlets and orientation of the exact level of the root. Sensitivity and specificity for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were 100% and 96%, respectively. There was no statistically significant difference between coronal and oblique coronal views and axial views. Conclusion The information by the coronal and oblique coronal slice CT myelography enabled the authors to assess the rootlets of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction.

Hattori Yasunori

2007-07-01

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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  

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Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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 arti

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

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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  

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Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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 arti

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

2011-12-01

 
 
 
 
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A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator  

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Full Text Available Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.

Lahori Vikram

2011-01-01

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Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients  

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Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

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Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients  

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Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

2012-12-01

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Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients  

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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.

Ximena Illarramendi

2012-12-01

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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)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish 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 l

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

46

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

LENUS (Irish Health Repository)

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.

Seoighe, D M

2010-09-01

47

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

Science.gov (United States)

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. PMID:20554261

Seoighe, D M; Baker, J F; Mulhall, K J

2010-09-01

48

Sudden severe postoperative dyspnea following shoulder surgery: Remember inadvertent phrenic nerve block due to interscalene brachial plexus block.  

Science.gov (United States)

Advanced imaging techniques, improved operative techniques, and instrumentation combined with better patient awareness and expectations have resulted in an exponential increase in upper limb surgical procedures during recent times. Surgical teams expect superior analgesia and regional blocks have matched these expectations quite often resulting in improved patient satisfaction and early rehabilitation to achieve best results. Ultrasound-guided interscalene brachial plexus block (ISB) is commonly used to provide analgesia for procedures involving shoulder girdle. We report a case of symptomatic hemi-diaphragmatic paresis (HDP) due to the phrenic nerve block following ISB for arthroscopic sub-acromial decompression of the shoulder presenting as severe postoperative dyspnea. There is strong evidence of HDP following ISB in anesthetic literature, but not reported in related surgical specialties such as orthopedics. We wish to inform upper-limb surgeons and educate junior doctors and other ancillary staff working in upper-limb units to be aware of this serious but reversible complication. PMID:25114416

Jariwala, Arpit; Kumar, B C Raju Pavan; Coventry, David M

2014-04-01

49

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)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

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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)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

2014-06-01

51

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

Directory of Open Access Journals (Sweden)

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.

K.E. Joubert

2012-07-01

52

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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....

Joubert, K. E.

2012-01-01

53

Nerve fibres in isolated segments of dog ulnar nerves after complete brachial plexotomy and periaxilar artery sympathectomy  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Prosseguindo estudos anteriores que demonstraram a existência de fibras íntegras no segmento distal de nervos com mais de seis meses de secção completa, novas experiências foram efetuadas em cães, desta feita sendo utilizado o nervo ulnar, por causa de suas características morfo-funcionais e topográ [...] ficas que se enquadravam perfeitamente aos nossos propósitos. A experimentação foi desenvolvida obedecendo a esquematização representada na fig. 1. Os resultados obtidos confirmaram nossos achados anteriores, visto que, mesmo após plexotomia braquial total e simpatectomia periarterial da artéria axilar, continuaram evidentes numerosas fibras nervosas de aspecto normal nos segmentos intermédios e distal do nervo ulnar mantidos em seus leitos conetivos naturais, mas completamente separados entre si e do côto proximal. Essas fibras nervosas, em face da experimentação efetuada, parecem não ser provenientes do côto proximal do nervo ulnar, nem de interco-municações com nervos vizinhos, nem tãopouco de "nervi-vasorum". Há indícios, no entanto, que possivelmente tenham se originado à custa de elementos constituintes de fibras "degeneradas", sob regência conjugada das células de Schwann e do meio ambiente natural. Os trabalhos prosseguem nesse sentido em busca de dados mais concretos. Todavia, desejamos ressaltar que os resultados práticos obtidos até o momento em mais de cento e cinqüenta pacientes, segundo informações de vários colegas que têm dado crédito às nossas pesquisas, vêm demonstrar que muito se poderá fazer em prol da reabilitação de inválidos, através de reconstruções e recuperação funcional de nervos com lesões antigas que infelizmente vinham sendo considerados como irreversíveis e irreparáveis. Abstract in english Experiments were performed in adult dogs in order to study our reported observation of normal nerve fibres in the intermediate and distal segments of nerves completely separated from the proximal stump for more than six months. The results obtained confirmed once more our previous observation: there [...] are normal nerve fibres and nerve bundles repopulating the pattern fascicles of the completely separated intermediate and distal segments of the ulnar nerve, although all other nerves of the operated limb, including the proximal stump of the ulnar, show a typical Wallerian degeneration. It seems, therefore, that these fibres of normal appearance must have arisen from a source other than the proximal ulnar nerve stump, neighbour nerves or "Nervi-vasorum". More concrete data about these findings are naturally necessary and our experiments are going on. Even so, as stated before, the practical results obtained up to now in more than one hundred and fifty patients allows us to go on recommending strongly, based on our observations, that proper nerve suture or neurolisys of long-time severed nerves by accident are worth while even after delays of many years.

Eros Abrantes, Erhart; Cecil J., Rezze.

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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

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A triple-masked, randomized controlled trial comparing ultrasound-guided brachial plexus and distal peripheral nerve block anesthesia for outpatient hand surgery.  

Science.gov (United States)

Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15?mL of 1.5% mepivacaine at the assigned location with 15?mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block. PMID:24839439

Lam, Nicholas C K; Charles, Matthew; Mercer, Deana; Soneru, Codruta; Dillow, Jennifer; Jaime, Francisco; Petersen, Timothy R; Mariano, Edward R

2014-01-01

56

Anomalous cutaneous branch of median nerve in arm: a report of anatomical variation with clinical implications  

Science.gov (United States)

The objective of the study was to observe and document the variation on the subject of branches of the median nerve. This report will assist clinicians and surgeons by considering anatomical variation associated with the median nerve in interpreting atypical clinical presentations. The arm and forearm region of a 55 year embalmed male cadaver during educational gross anatomy dissection. We found that an anomalous cutaneous branch arising from the median nerve in the right arm which was passing deep to the tendon of the biceps brachii. Later it enters the cubital fossa and then it is accompanied by the superficial vein of the forearm. The other limb of the cadaver did not show any such variation. No other neural, arterial or muscular variation was observed in either of the limbs. A rare anatomical variation in which the anomalous cutaneous branch arising from the median nerve in the right arm which is later accompanied by a superficial vein in the forearm. Such knowledge is advantageous in nerve grafting and neurophysiological evaluation for diagnosing peripheral neuropathies. PMID:24987552

Rani, Neerja; Kaushal, Parul; Kumar, Hitesh; Sharrif, A.; Roy, T. S.

2014-01-01

57

Role of sensory nerves in the cutaneous vasoconstrictor response to local cooling in humans.  

Science.gov (United States)

Local cooling (LC) causes a cutaneous vasoconstriction (VC). In this study, we tested whether there is a mechanism that links LC to VC nerve function via sensory nerves. Six subjects participated. Local skin and body temperatures were controlled with Peltier probe holders and water-perfused suits, respectively. Skin blood flow at four forearm sites was monitored by laser-Doppler flowmetry with the following treatments: untreated control, pretreatment with local anesthesia (LA) blocking sensory nerve function, pretreatment with bretylium tosylate (BT) blocking VC nerve function, and pretreatment with both LA and BT. Local skin temperature was slowly reduced from 34 to 29 degrees C at all four sites. Both sites treated with LA produced an increase in cutaneous vascular conductance (CVC) early in the LC process (64 +/- 55%, LA only; 42 +/- 14% LA plus BT; P 0.05). As cooling continued, there were significant reductions in CVC at all sites (P < 0.05). At control and LA-only sites, CVC decreased by 39 +/- 4 and 46 +/- 8% of the original baseline values, which were significantly (P < 0.05) more than the reductions in CVC at the sites treated with BT and BT plus LA (-26 +/- 8 and -22 +/- 6%). Because LA affected only the short-term response to LC, either alone or in the presence of BT, we conclude that sensory nerves are involved early in the VC response to LC, but not for either adrenergic or nonadrenergic VC with longer term LC. PMID:17468334

Hodges, Gary J; Traeger, J Andrew; Tang, Tri; Kosiba, Wojciech A; Zhao, Kun; Johnson, John M

2007-07-01

58

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)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

Enrique, Vergara Amador.

59

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)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

Enrique, Vergara Amador.

2012-12-01

60

Nerve-derived transmitters including peptides influence cutaneous immunology.  

Science.gov (United States)

Clinical observations suggest that the nervous and immune systems are closely related. For example, inflammatory skin disorders; such as psoriasis, atopic dermatitis, rosacea and acne; are widely believed to be exacerbated by stress. A growing body of research now suggests that neuropeptides and neurotransmitters serve as a link between these two systems. Neuropeptides and neurotransmitters are released by nerves innervating the skin to influence important actors of the immune system, such as Langerhans cells and mast cells, which are located within close anatomic proximity. Catecholamines and other sympathetic transmitters that are released in response to activation of the sympathetic nervous system are also able to reach the skin and affect immune cells. Neuropeptides appear to direct the outcome of Langerhans cell antigen presentation with regard to the subtypes of Th cells generated and neuropeptides induce the degranulation of mast cells, among other effects. Additionally, endothelial cells, which release many inflammatory mediators and express cell surface molecules that allow leukocytes to exit the bloodstream, appear to be regulated by certain neuropeptides and transmitters. This review focuses on the evidence that products of nerves have important regulatory activities on antigen presentation, mast cell function and endothelial cell biology. These activities are highly likely to have clinical and therapeutic relevance. PMID:23517710

Madva, Elizabeth N; Granstein, Richard D

2013-11-01

 
 
 
 
61

Selective bilateral activation of leg muscles after cutaneous nerve stimulation during backward walking.  

Science.gov (United States)

During human locomotion, cutaneous reflexes have been suggested to function to preserve balance. Specifically, cutaneous reflexes in the contralateral leg's muscles (with respect to the stimulus) were suggested to play an important role in maintaining stability during locomotor tasks where stability is threatened. We used backward walking (BW) as a paradigm to induce unstable gait and analyzed the cutaneous reflex activity in both ipsilateral and contralateral lower limb muscles after stimulation of the sural nerve at different phases of the gait cycle. In BW, the tibialis anterior (TA) reflex activity in the contralateral leg was markedly higher than TA background EMG activity during its stance phase. In addition, in BW a substantial reflex suppression was observed in the ipsilateral biceps femoris during the stance-swing transition in some participants, while for medial gastrocnemius the reflex activity was equal to background activity in both legs. To test whether the pronounced crossed responses in TA could be related to instability, the responses were correlated with measures of stability (short-term maximum Lyapunov exponents and step width). These measures were higher for BW compared with forward walking, indicating that BW is less stable. However, there was no significant correlation between these measures and the amplitude of the crossed TA responses in BW. It is therefore proposed that these crossed responses are related to an attempt to briefly slow down (TA decelerates the center of mass in the single-stance period) in the light of unexpected perturbations, such as provided by the sural nerve stimulation. PMID:22773779

Hoogkamer, Wouter; Massaad, Firas; Jansen, Karen; Bruijn, Sjoerd M; Duysens, Jacques

2012-10-01

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Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries  

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Full Text Available Abstract Background There have been several reports that partial ulnar transfer (PUNT is preferable for reconstructing elbow flexion in patients with upper brachial plexus injuries (BPIs compared with intercostal nerve transfer (ICNT. The purpose of this study was to compare the recovery of elbow flexion between patients subjected to PUNT and patients subjected to ICNT. Methods Sixteen patients (13 men and three women with BPIs for whom PUNT (eight patients or ICNT (eight patients had been performed to restore elbow flexion function were studied. The time required in obtaining M1, M3 (Medical Research Council scale grades recovery for elbow flexion and a full range of elbow joint movement against gravity with the wrist and fingers extended maximally and the outcomes of a manual muscle test (MMT for elbow flexion were examined in both groups. Results There were no significant differences between the PUNT and ICNT groups in terms of the age of patients at the time of surgery or the interval between injury and surgery. There were significantly more injured nerve roots in the ICNT group (mean 3.6 than in the PUNT group (mean 2.1 (P = 0.0006. The times required to obtain grades M1 and M3 in elbow flexion were significantly shorter in the PUNT group than in the ICNT group (P = 0.04 for M1 and P = 0.002 for M3. However, there was no significant difference between the two groups in the time required to obtain full flexion of the elbow joint with maximally extended fingers and wrist or in the final MMT scores for elbow flexion. Conclusions PUNT is technically easy, not associated with significant complications, and provides rapid recovery of the elbow flexion. However, separation of elbow flexion from finger and wrist motions needed more time in the PUNT group than in the ICNT group. Although the final mean MMT score for elbow flexion in the PUNT group was greater than in the ICNT group, no statistically significant difference was found between the two groups.

Matsumoto Taiichi

2010-01-01

63

Lateral antebrachial cutaneous neuropathy in a windsurfer.  

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Lateral antebrachial cutaneous neuropathy (LACN) was diagnosed in a young woman who developed pain and paresthesias in the right forearm after a long day of windsurfing (board sailing). The symptoms resolved with conservative treatment, including cessation of windsurfing and a brief course of oral corticosteroids. There was a permanent residual cutaneous sensory deficit in the distribution of the LACN. LACN is important to recognize because the symptomatology may mimic pathology of a cervical root, the brachial plexus, and the radial and median nerves at the level of the elbow. PMID:10398216

Jablecki, C K

1999-07-01

64

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

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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.

Ayse Tokcaer

2007-01-01

65

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

International Nuclear Information System (INIS)

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

66

Brachial plexopathy  

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

Khadilkar, Satish V.; Khade, Snehaldatta S.

2013-01-01

67

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

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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

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

2014-08-15

68

MRI of the Brachial Plexus  

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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.

Seyed Hassan Mostafavi

2010-05-01

69

Augmentation of partially regenerated nerves by end-to-side side-to-side grafting neurotization: experience based on eight late obstetric brachial plexus cases  

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Full Text Available Abstract Objective The effect of end-to-side neurotization of partially regenerated recipient nerves on improving motor power in late obstetric brachial plexus lesions, so-called nerve augmentation, was investigated. Methods Eight cases aged 3 – 7 years were operated upon and followed up for 4 years (C5,6 rupture C7,8T1 avulsion: 5; C5,6,7,8 rupture T1 avulsion:1; C5,6,8T1 rupture C7 avulsion:1; C5,6,7 ruptureC8 T1 compression: one 3 year presentation after former neurotization at 3 months. Grade 1–3 muscles were neurotized. Grade0 muscles were neurotized, if the electromyogram showed scattered motor unit action potentials on voluntary contraction without interference pattern. Donor nerves included: the phrenic, accessory, descending and ascending loops of the ansa cervicalis, 3rd and 4th intercostals and contralateral C7. Results Superior proximal to distal regeneration was observed firstly. Differential regeneration of muscles supplied by the same nerve was observed secondly (superior supraspinatus to infraspinatus regeneration. Differential regeneration of antagonistic muscles was observed thirdly (superior biceps to triceps and pronator teres to supinator recovery. Differential regeneration of fibres within the same muscle was observed fourthly (superior anterior and middle to posterior deltoid regeneration. Differential regeneration of muscles having different preoperative motor powers was noted fifthly; improvement to Grade 3 or more occurred more in Grade2 than in Grade0 or Grade1 muscles. Improvements of cocontractions and of shoulder, forearm and wrist deformities were noted sixthly. The shoulder, elbow and hand scores improved in 4 cases. Limitations The sample size is small. Controls are necessary to rule out any natural improvement of the lesion. There is intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Nerve augmentation improves cocontractions and muscle power in the biceps, pectoral muscles, supraspinatus, anterior and lateral deltoids, triceps and in Grade2 or more forearm muscles. As it is less expected to improve infraspinatus power, it should be associated with a humeral derotation osteotomy and tendon transfer. Function to non improving Grade 0 or 1 forearm muscles should be restored by muscle transplantation. Level of evidence Level IV, prospective case series.

Moharram Ashraf N

2006-12-01

70

Selective regulation of nerve growth factor expression in developing cutaneous tissue by early sensory innervation  

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Full Text Available Abstract Background In the developing vertebrate peripheral nervous system, the survival of sympathetic neurons and the majority of sensory neurons depends on a supply of nerve growth factor (NGF from tissues they innervate. Although neurotrophic theory presupposes, and the available evidence suggests, that the level of NGF expression is completely independent of innervation, the possibility that innervation may regulate the timing or level of NGF expression has not been rigorously investigated in a sufficiently well-characterized developing system. Results To address this important question, we studied the influence of innervation on the regulation of NGF mRNA expression in the embryonic mouse maxillary process in vitro and in vivo. The maxillary process receives its innervation from predominantly NGF-dependent sensory neurons of the trigeminal ganglion and is the most densely innervated cutaneous territory with the highest levels of NGF in the embryo. When early, uninnervated maxillary processes were cultured alone, the level of NGF mRNA rose more slowly than in maxillary processes cultured with attached trigeminal ganglia. In contrast to the positive influence of early innervation on NGF mRNA expression, the levels of brain-derived neurotrophic factor (BDNF mRNA and neurotrophin-3 (NT3 mRNA rose to the same extent in early maxillary processes grown with and without trigeminal ganglia. The level of NGF mRNA, but not BDNF mRNA or NT3 mRNA, was also significantly lower in the maxillary processes of erbB3-/- mice, which have substantially fewer trigeminal neurons than wild-type mice. Conclusions This selective effect of initial innervation on target field NGF mRNA expression provokes a re-evaluation of a key assertion of neurotrophic theory that the level of NGF expression is independent of innervation.

Vizard Tom N

2011-04-01

71

Never fear, a perforator will always appear: the use of a perforator flap based on the vasa nervosum of the anterior branch of the femoral cutaneous nerve.  

Science.gov (United States)

A 30 year old tree surgeon presented to our services with a Gustilo IIIB fracture to his right lower leg. An anterolateral thigh flap was planned for the reconstruction. Intraoperatively, there were no suitable perforators seen and a neurocutaneous perforator flap based on the vessels associated with the anterior branch of the femoral cutaneous nerve was used. The nerve was preserved in the flap harvest. He was discharged and later followed up in clinic with no complications. PMID:23490984

Manaf Khatib, M K; Matthew Ives, M I; Matthew Griffiths, M G

2013-11-01

72

Early social isolation provokes electrophysiological and structural changes in cutaneous sensory nerves of adult male rats.  

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Sensory and social deprivation from the mother and littermates during early life disturbs the development of the central nervous system, but little is known about its effect on the development of the peripheral nervous system. To assess peripheral effects of early isolation, male rat pups were reared artificially in complete social isolation (AR); reared artificially with two same-age conspecifics (AR-Social); or reared by their mothers and with littermates (MR). As adults, the electrophysiological properties of the sensory sural (SU) nerve were recorded. We found that the amplitude and normalized area (with respect to body weight) of the compound action potential (CAP) response provoked by single electrical pulses of graded intensity in the SU nerves of AR animals were shorter than the CAP recorded in SU nerves from MR and AR-Social animals. The slope of the stimulus-response curve of AR SU nerves was smaller than that of the other nerves. The histological characterization of axons in the SU nerves was made and showed that the myelin thickness of axons in AR SU nerves was significant lower (2-7µm) than that of the axons in the other nerves. Furthermore, the area and axon diameter of SU nerves of both AR and AR-Social animals were significant lower than in MR animals. This is the first report to show that maternal and littermate deprivation by AR disturbs the development of the myelination and electrophysiological properties of axons in the SU nerve; the replacement of social cues prevents most of the effects. © 2014 Wiley Periodicals, Inc. Develop Neurobiol 74: 1184-1193, 2014. PMID:24897933

Segura, Bertha; Melo, Angel I; Fleming, Alison S; Mendoza-Garrido, Maria Eugenia; González Del Pliego, Margarita; Aguirre-Benitez, Elsa L; Hernández-Falcón, Jesús; Jiménez-Estrada, Ismael

2014-12-01

73

A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report  

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Full Text Available Abstract Introduction Medial antebrachial cutaneous nerve (MACN neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

Ardic Füsun

2008-04-01

74

Malignant brachial plexopathy: A pictorial essay of MRI findings  

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

Iyer Veena

2010-01-01

75

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  

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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.

Mônica Duarte Pimentel

2007-06-01

76

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)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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.

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

2011-06-01

77

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  

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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.

E Olave

2011-06-01

78

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)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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.

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

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MRI of the brachial plexus: A pictorial review  

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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.

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Metastatic brachial plexopathy in breast cancer  

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Full Text Available We report the case of a 29-year-old woman previously treated for breast cancer who presented 3 years later with pain weakness and burning sensation in the left upper limb of one month duration. Electroneuromyography showed reduced sensory nerve action potential (SNAP amplitude and reduced conduction velocity in left median nerve sensory conduction, Magnetic resonance imaging (MRI of brachial plexus revealed nodular thickening of trunks and cords of left brachial plexus, suggesting metastasis. Ultrasonography guided fine needle aspiration cytology confirmed the presence of metastatic ductal cell carcinomatous deposits. Brachial plexopathy due to metastases from breast cancer is a rare entity, and should be kept in mind while evaluating patients with breast cancer.

T. Kannan

2012-10-01

 
 
 
 
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Brachial plexus variations during the fetal period.  

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The brachial plexus is an important nervous system structure. It can be injured during the perinatal period and by postnatal damage. The goal of this study was to assess human fetal brachial plexus variability. A total of 220 brachial plexuses were surgically prepared from 110 human fetuses aged 14-32 weeks of fetal life (50 females and 60 males) ranging in CRL from 80 to 233 mm. The study incorporated the following methods: dissectional and anthropological, digital image acquisition, digital image processing using Image J and GIMP software, and statistical methods (Statistica 9.0). Symmetry and sexual dimorphism were examined. Anomalies of the brachial plexuses were observed in 117 (53.18 %) cases. No sexual dimorphism was found. It was observed that cord variations occurred more often on the left side. Division variants (33.64 %) occurred most often, but also cords (18.18 %) as well as root nerves and terminal ramifications (15.90 %) were found. Trunk anomalies were rare and occurred in only 5.45 % of plexuses. Three height types of median nerve roots in combination with the nerve were distinguished. In one-third of cases, median nerve root connections were found below the axillary fossa and even half in the proximal part of the humerus. In conclusion, the brachial plexus was characterized for anatomical structural variability. Most often division and cord variations were observed. Anomalies occurred regardless of sex or body side except for cord variants. Brachial plexus variation recognition is significant from the neurosurgical and traumatological point of view. PMID:22945314

Wo?niak, Jowita; K?dzia, Alicja; Dudek, Krzysztof

2012-12-01

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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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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

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

2007-06-01

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Transcutaneous electrical nerve stimulation (TENS) accelerates cutaneous wound healing and inhibits pro-inflammatory cytokines.  

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The purpose of this study was to evaluate transcutaneous electrical nerve stimulation (TENS) and other common treatment methods used in the process of wound healing in terms of the expression levels of pro-inflammatory cytokines. In the study, 24 female and 24 male adult Wistar-Albino rats were divided into five groups: (1) the non-wounded group having no incision wounds, (2) the control group having incision wounds, (3) the TENS (2 Hz, 15 min) group, (4) the physiological saline (PS) group and (5) the povidone iodine (PI) group. In the skin sections, interleukin-1 beta (IL-1?), interleukin-6 (IL-6), and tumor necrosis factor-? (TNF-?) were assessed with enzyme-linked immunosorbent assay and immunohistochemical methods. In the non-wounded group, the expression of IL-1?, IL-6, and TNF-? signaling molecules was weaker in the whole tissue; however, in the control group, significant inflammatory response occurred, and strong cytokine expression was observed in the dermis, granulation tissue, hair follicles, and sebaceous glands (P?

Gürgen, Seren Gül?en; Say?n, Oya; Cetin, Ferihan; Tuç Yücel, Ay?e

2014-06-01

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

International Nuclear Information System (INIS)

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

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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)

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

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

1351-13-01

87

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

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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.

Elenara B. Araújo

2012-12-01

88

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  

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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

Carla Gabrielli

2005-06-01

89

Morphological description of the brachial plexus in ocelot (Leopardus pardalis  

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Full Text Available The brachial plexus is formed by the ventral roots of the spinal nerves, which unite to form the nerve trunks. It is usually formed by contributions of the last three cervical nerves and the first two thoracic nerves. Due to the scarcity of information on neuroanatomy, this study aimed to determine the macroscopic morphology of the brachial plexus of the ocelot (Leopardus pardalis. In this work, we used two ocelot specimens from the area of the Paragominas Bauxite Mine, PA, Brazil/Empresa Terra LTDA, with permission from SEMA – BP Nos. 455/2009 and 522/2009. The animals were donated to the Research Laboratory of Animal Morphology (LaPMA, Federal Rural University of Amazonia (UFRA, after they were accidentally run over. They were fixed by intramuscular injection of 10% formaldehyde. After fixation, the animals were dissected, allowing visualization of the thoracic nerves, as well as the identification of the ventral rami of the cervical and thoracic spinal nerves forming the brachial plexus. The brachial plexus was found to be formed by four trunks, which originated the ventral branches of cervical spinal nerves C6, C7 and C8 and the first thoracic (T1. These trunks gave rise to the suprascapular, subscapular, musculocutaneous, axillary, radial, median, ulnar, thoracodorsal and lateral thoracic nerves.

Kylma Lorena Saldanha Chagas

2014-06-01

90

Variations in branching of the posterior cord of brachial plexus in a Kenyan population  

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Full Text Available Abstract Background Variations in the branching of posterior cord are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the African population is scarce. Objective To describe the branching pattern of the posterior cord in a Kenyan population. Materials and methods Seventy-five brachial plexuses from 68 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of the posterior cord was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels. Results Only 8 out of 75 (10.7% posterior cords showed the classical branching pattern. Forty three (57.3% lower subscapular, 8(10.3% thoracodorsal and 8(10.3% upper subscapular nerves came from the axillary nerve instead of directly from posterior cord. A new finding was that in 4(5.3% and in 3(4% the medial cutaneous nerves of the arm and forearm respectively originated from the posterior cord in contrast to their usual origin from the medial cord. Conclusions Majority of posterior cords in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury. A wider study of the branching pattern of infraclavicular brachial plexus is recommended.

Matakwa Ludia C

2011-06-01

91

Distribuição do nervo cutâneo lateral da coxa na área de injeção intramuscular / Distribution of the lateral cutaneous nerve of the thigh in the area of intramuscular injection  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A técnica de injeção intramuscular (IM) na região ântero-lateral da coxa é prática médica muito utilizada. Entretanto, apesar desta área ser apontada como segundo melhor local para esta prática, tanto em adultos como em crianças, a técnica ainda mostra-se muito dolorosa em ambos. OBJETIVO: Estudar a [...] localização, distribuição, trajeto e relação topográfica do nervo cutâneo lateral da coxa com a área recomendada para prática da injeção intramuscular, relacionando-os à dor decorrente de tal procedimento. MÉTODO: Através da exposição da região ântero-lateral por dissecção clássica, o nervo cutâneo lateral da coxa foi identificado e isolado em 20 cadáveres adultos masculinos fixados, dando-se ênfase à visualização de seus ramos nervosos sobre o tracto iliotibial. RESULTADOS: Após emergir medialmente em relação à espinha ilíaca ântero-superior, em 100% dos casos, o nervo cutâneo lateral da coxa emite três ramos calibrosos em 70% dos espécimes, sendo que em 30% emite apenas dois. No terço superior, e na porção superior do terço médio da coxa, observa-se uma rede de numerosos ramúsculos nervosos envoltos por quantidade variável de tecido adiposo. Todavia, na porção inferior do terço médio da coxa e no terço inferior, não se visualizam ramos nervosos importantes. CONCLUSÃO: Baseados em nossos dados, recomendamos a utilização da porção inferior do terço médio da coxa como local de escolha para prática de injeção IM na região ântero-lateral da coxa, por se tratar de uma região menos inervada, o que acarretará menos dor nesta área durante tal procedimento, trazendo maior conforto ao paciente. Abstract in english The technique of intramuscular injection (IM) into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To [...] study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of intramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.

ROGÉRIO PORTO DA, ROCHA; GERALDO JOSÉ MEDEIROS, FERNANDES; ALESSANDRO, VENGJER; MAURÍCIO LEAL DIAS, MONGON; FÁBIO PIZZO, RIBEIRO; RODRIGO BARBOSA LONGUINHO E, SILVA.

2002-12-01

92

Distribuição do nervo cutâneo lateral da coxa na área de injeção intramuscular Distribution of the lateral cutaneous nerve of the thigh in the area of intramuscular injection  

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Full Text Available A técnica de injeção intramuscular (IM na região ântero-lateral da coxa é prática médica muito utilizada. Entretanto, apesar desta área ser apontada como segundo melhor local para esta prática, tanto em adultos como em crianças, a técnica ainda mostra-se muito dolorosa em ambos. OBJETIVO: Estudar a localização, distribuição, trajeto e relação topográfica do nervo cutâneo lateral da coxa com a área recomendada para prática da injeção intramuscular, relacionando-os à dor decorrente de tal procedimento. MÉTODO: Através da exposição da região ântero-lateral por dissecção clássica, o nervo cutâneo lateral da coxa foi identificado e isolado em 20 cadáveres adultos masculinos fixados, dando-se ênfase à visualização de seus ramos nervosos sobre o tracto iliotibial. RESULTADOS: Após emergir medialmente em relação à espinha ilíaca ântero-superior, em 100% dos casos, o nervo cutâneo lateral da coxa emite três ramos calibrosos em 70% dos espécimes, sendo que em 30% emite apenas dois. No terço superior, e na porção superior do terço médio da coxa, observa-se uma rede de numerosos ramúsculos nervosos envoltos por quantidade variável de tecido adiposo. Todavia, na porção inferior do terço médio da coxa e no terço inferior, não se visualizam ramos nervosos importantes. CONCLUSÃO: Baseados em nossos dados, recomendamos a utilização da porção inferior do terço médio da coxa como local de escolha para prática de injeção IM na região ântero-lateral da coxa, por se tratar de uma região menos inervada, o que acarretará menos dor nesta área durante tal procedimento, trazendo maior conforto ao paciente.The technique of intramuscular injection (IM into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of intramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.

ROGÉRIO PORTO DA ROCHA

2002-12-01

93

Distribuição do nervo cutâneo lateral da coxa na área de injeção intramuscular / Distribution of the lateral cutaneous nerve of the thigh in the area of intramuscular injection  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A técnica de injeção intramuscular (IM) na região ântero-lateral da coxa é prática médica muito utilizada. Entretanto, apesar desta área ser apontada como segundo melhor local para esta prática, tanto em adultos como em crianças, a técnica ainda mostra-se muito dolorosa em ambos. OBJETIVO: Estudar a [...] localização, distribuição, trajeto e relação topográfica do nervo cutâneo lateral da coxa com a área recomendada para prática da injeção intramuscular, relacionando-os à dor decorrente de tal procedimento. MÉTODO: Através da exposição da região ântero-lateral por dissecção clássica, o nervo cutâneo lateral da coxa foi identificado e isolado em 20 cadáveres adultos masculinos fixados, dando-se ênfase à visualização de seus ramos nervosos sobre o tracto iliotibial. RESULTADOS: Após emergir medialmente em relação à espinha ilíaca ântero-superior, em 100% dos casos, o nervo cutâneo lateral da coxa emite três ramos calibrosos em 70% dos espécimes, sendo que em 30% emite apenas dois. No terço superior, e na porção superior do terço médio da coxa, observa-se uma rede de numerosos ramúsculos nervosos envoltos por quantidade variável de tecido adiposo. Todavia, na porção inferior do terço médio da coxa e no terço inferior, não se visualizam ramos nervosos importantes. CONCLUSÃO: Baseados em nossos dados, recomendamos a utilização da porção inferior do terço médio da coxa como local de escolha para prática de injeção IM na região ântero-lateral da coxa, por se tratar de uma região menos inervada, o que acarretará menos dor nesta área durante tal procedimento, trazendo maior conforto ao paciente. Abstract in english The technique of intramuscular injection (IM) into the antero-lateral region of the thigh is widely used. Nevertheless, despite this area being indicated as the second best location for this practice, the technique is still observed to be very painful for both adult and child patients. OBJECTIVE: To [...] study the localization, distribution and course of the lateral cutaneous nerve of the thigh, and its topographic relationship with the area recommended for the practice of intramuscular injection, relating these characteristics to the pain resulting from such procedures. METHOD: By means of exposing the antero-lateral region by classical dissection, the lateral cutaneous nerve of the thigh was identified and isolated in 20 fixed adult male cadavers, giving emphasis to the viewing of its nerve rami across the iliotibial tract. RESULTS: In 100% of the cases, the lateral cutaneous nerve emerged medially in relation to the upper anterior iliac spine. After this, it issued three wide-caliber rami in 70% of the specimens and only two in the remaining 30%. In the upper third and in the upper portion of the middle third of the thigh, a network of numerous small nerve rami was observed, enveloped in a variable quantity of adipose tissue. However, in the lower portion of the middle third of the thigh and in the lower third, no significant nerve rami were seen. CONCLUSION: Based on our data, we recommend whenever possible that the distal half of the region displayed by the classical technique be utilized as the location of choice for the practice of intramuscular injection into the antero-lateral region of the thigh. This is because this region is less innervated by the lateral cutaneous nerve of the thigh, which will cause less pain in this area during such procedures, thereby affording greater comfort to the patient.

ROGÉRIO PORTO DA, ROCHA; GERALDO JOSÉ MEDEIROS, FERNANDES; ALESSANDRO, VENGJER; MAURÍCIO LEAL DIAS, MONGON; FÁBIO PIZZO, RIBEIRO; RODRIGO BARBOSA LONGUINHO E, SILVA.

94

Estudo eletrofisiológico do nervo cutâneo dorsal lateral: aplicabilidade técnica e valores de referência / Electrophysiological study of the lateral dorsal cutaneous nerve: technical applicability and normal values  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O estudo da condução neural dos segmentos mais distais dos nervos mais longos pode ser capaz de reconhecer mais precocemente as alterações oriundas da maioria das polineuropatias. O objetivo deste estudo, foi verificar a aplicabilidade técnica do exame de condução ortodrômica do ramo cutâneo dorsal [...] do nervo sural (nervo cutâneo dorsal lateral) em pessoas saudáveis, padronizar os valores normais para serem utilizados como referência e comparar seus valores com os do nervo sural na perna. Quarenta e cinco pessoas com idade média de 41,56 anos (19-75) foram avaliadas, com registro de potenciais de ação de nervo sensitivo nos noventa pés. O eletrodo de captação foi colocado inferior e posteriormente ao maléolo lateral e a estimulação realizada 10 cm distalmente na face dorso-lateral dos pés. O valor médio para a velocidade de condução do nervo sural cutâneo dorsal encontrado foi 47,35 ± 4,8 m/s e para a amplitude, 4,19 ± 1,9 miV. A velocidade de condução do segmento distal foi 14% inferior à do proximal. A amplitude média dos potenciais de ação sensitivos do segmento distal foi 73% aquém daquela obtida no segmento proximal. Os resultados confirmam a possibilidade técnica de se estudar o ramo cutâneo dorsal do nervo sural e sugerem que o limite mínimo de normalidade para sua velocidade de condução, após correção para a temperatura de 34ºC, seja 38 m/s. Diferenças na amplitude e velocidade de condução devem ser consideradas entre grupos etários. Abstract in english The distal nerve conduction study of the long nerve in the leg is more efficient to work with so that it can stablish the early diagnosis of the majority of polyneuropathies. The main purpose of this study is the technical applicability of the orthodromic neural conduction examination of the dorsal [...] cutaneous branch of the sural nerve (lateral dorsal cutaneous nerve) on healthy people, and define the normal values used as references to compare with the proximal segment. Forty five persons mean age 41.56 years old (range 19-75) were examined, and the sensory nerve action potentials were registered from ninety feet. The active recording superficial electrode was placed below and behind the lateral malleolus and the estimulating electrode was placed 10 cm distal to the recording superficial electrode at the dorsal lateral aspect of the feet. The mean value for the lateral dorsal cutaneous nerve conduction velocity was 47.35 ± 4.8 m/s and for amplitudes 4.19 ± 1.9 muV. The sensory conduction velocity in the distal segment was 14% lower than the proximal one. The sensory nerve action potencial amplitude of the distal segment was 73% lower than the proximal one. The lower normal limit recomended for conduction velocity of this nerve plus correction for skin temperature of 34ºC is 38 m/s. Some diferences in amplitude and conduction velocity among group ages are to be considered.

RAFAEL JOSÉ SOARES, DIAS; ARMANDO PEREIRA, CARNEIRO.

95

Estudo eletrofisiológico do nervo cutâneo dorsal lateral: aplicabilidade técnica e valores de referência Electrophysiological study of the lateral dorsal cutaneous nerve: technical applicability and normal values  

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Full Text Available O estudo da condução neural dos segmentos mais distais dos nervos mais longos pode ser capaz de reconhecer mais precocemente as alterações oriundas da maioria das polineuropatias. O objetivo deste estudo, foi verificar a aplicabilidade técnica do exame de condução ortodrômica do ramo cutâneo dorsal do nervo sural (nervo cutâneo dorsal lateral em pessoas saudáveis, padronizar os valores normais para serem utilizados como referência e comparar seus valores com os do nervo sural na perna. Quarenta e cinco pessoas com idade média de 41,56 anos (19-75 foram avaliadas, com registro de potenciais de ação de nervo sensitivo nos noventa pés. O eletrodo de captação foi colocado inferior e posteriormente ao maléolo lateral e a estimulação realizada 10 cm distalmente na face dorso-lateral dos pés. O valor médio para a velocidade de condução do nervo sural cutâneo dorsal encontrado foi 47,35 ± 4,8 m/s e para a amplitude, 4,19 ± 1,9 miV. A velocidade de condução do segmento distal foi 14% inferior à do proximal. A amplitude média dos potenciais de ação sensitivos do segmento distal foi 73% aquém daquela obtida no segmento proximal. Os resultados confirmam a possibilidade técnica de se estudar o ramo cutâneo dorsal do nervo sural e sugerem que o limite mínimo de normalidade para sua velocidade de condução, após correção para a temperatura de 34ºC, seja 38 m/s. Diferenças na amplitude e velocidade de condução devem ser consideradas entre grupos etários.The distal nerve conduction study of the long nerve in the leg is more efficient to work with so that it can stablish the early diagnosis of the majority of polyneuropathies. The main purpose of this study is the technical applicability of the orthodromic neural conduction examination of the dorsal cutaneous branch of the sural nerve (lateral dorsal cutaneous nerve on healthy people, and define the normal values used as references to compare with the proximal segment. Forty five persons mean age 41.56 years old (range 19-75 were examined, and the sensory nerve action potentials were registered from ninety feet. The active recording superficial electrode was placed below and behind the lateral malleolus and the estimulating electrode was placed 10 cm distal to the recording superficial electrode at the dorsal lateral aspect of the feet. The mean value for the lateral dorsal cutaneous nerve conduction velocity was 47.35 ± 4.8 m/s and for amplitudes 4.19 ± 1.9 muV. The sensory conduction velocity in the distal segment was 14% lower than the proximal one. The sensory nerve action potencial amplitude of the distal segment was 73% lower than the proximal one. The lower normal limit recomended for conduction velocity of this nerve plus correction for skin temperature of 34ºC is 38 m/s. Some diferences in amplitude and conduction velocity among group ages are to be considered.

RAFAEL JOSÉ SOARES DIAS

2000-06-01

96

Sonographic evaluation of brachial plexus pathology  

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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 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.)

Graif, Moshe; Blank, Anat; Weiss, Judith; Kessler, Ada [Department of Radiology, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv (Israel); Martinoli, Carlo; Derchi, Lorenzo E. [Department of Radiology, University of Genoa, Genoa (Italy); Rochkind, Shimon [Department of Neurosurgery, Tel Aviv Sourasky Medical Center and the Sackler faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv (Israel); Trejo, Leonor [Department of Pathology, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv (Israel)

2004-02-01

97

Axillary brachial plexus blockade in moyamoya disease?  

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Full Text Available Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.

Yalcin Saban

2011-01-01

98

Ultrasonography for neonatal brachial plexus palsy.  

Science.gov (United States)

Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP). An infant boy was born at term, complicated by right-sided shoulder dystocia. Initial clinical evaluation revealed proximal arm weakness consistent with an upper trunk injury. Unlike MRI or CT myelography that focus on proximal nerve roots, ultrasonography of the brachial plexus in the supraclavicular fossa was able to demonstrate a small neuroma involving the upper trunk (C-5 and C-6) and no asymmetry in movement of the diaphragm or in the appearance of the rhomboid muscle when compared with the unaffected side. However, the supra- and infraspinatus muscles were significantly asymmetrical and atrophied on the affected side. Importantly, ultrasound examination of the shoulder revealed posterior glenohumeral laxity. Instead of pursuing the primary nerve reconstruction first, timely treatment of the shoulder subluxation prevented formation of joint dysplasia and formation of a false glenoid, which is a common sequela of this condition. Because the muscles innervated by proximal branches of the cervical nerve roots/trunks were radiographically normal, subsequent nerve transfers were performed and good functional results were achieved. The authors believe this to be the first report describing the utility of ultrasonography in the surgical treatment planning in a case of NBPP. Noninvasive imaging, in addition to thorough history and physical examination, reduces the intraoperative time required to determine the extent and severity of nerve injury by allowing improved preoperative planning of the surgical strategy. Inclusion of ultrasonography as a preoperative modality may yield improved outcomes for children with NBPP. PMID:25216291

Joseph, Jacob Rahul; DiPietro, Michael A; Somashekar, Deepak; Parmar, Hemant A; Yang, Lynda J S

2014-11-01

99

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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

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

100

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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

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

2005-06-01

 
 
 
 
101

Long-term follow-up results of a pediatric brachial plexus laceration.  

Science.gov (United States)

A rare case of pediatric brachial plexus laceration is presented. A five-year-old boy who sustained a sharp laceration on his right axillary region was immediately operated. The axillary artery, radial, ulnar and musculocutaneous nerve branches of the brachial plexus, and the lateral root of the median nerve were totally lacerated. The medial root of the median nerve was partially transected. All of the lacerated brachial plexus elements and axillary artery were immediately repaired. Significant functional recovery was determined even six months after the repair. Motor and sensory functions of the affected extremity were almost totally restored at the postoperative 21st month, except for the ulnar nerve motor functions. There was no cold intolerance or trophic change at the injured extremity. Primary repair of a brachial plexus laceration injury in the pediatric population can be expected to produce successful functional recovery results, even in a relatively short period after the repair. PMID:24214794

Öksüz, Sinan; Karagöz, Hüseyin; Külahç?, Yalç?n; Ülkür, Ersin; Uslu, As?m

2013-09-01

102

Brachial plexus neuropathy  

Science.gov (United States)

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. ImagesFigure 1Figure 2Figure 3

Hubka, Michael J; King, Laurie; Cassidy, J David; Donat, JR

1992-01-01

103

Reconstruction of large facial defects using a sensate superficial circumflex iliac perforator flap based on the lateral cutaneous branches of the intercostal nerves.  

Science.gov (United States)

Extensive composite facial defects present a surgical challenge because both functional and esthetic results must be considered simultaneously. Free flap transfer is a good option for extensive facial defects. However, the major concern regarding free flap reconstructions of facial defects is the bulkiness of the flaps. The use of a superficial circumflex iliac perforator (SCIP) flap, first reported in 2004, has many advantages including the availability of a thin, hairless skin paddle. In addition, the use of a sensate SCIP flap based on the lateral cutaneous branches of the intercostal nerves has recently been reported, which can potentially contribute to improved quality of life. We present 2 cases of free sensate SCIP flap reconstruction for extensive facial defects after cancer resection. The flaps were successfully transferred for coverage of the defects with acceptable functional and esthetic results. Sensate SCIP flaps provide a good option for the reconstruction of large facial defects because they are thin and hairless and offer an acceptable color match. These sensate flaps based on the branches of the intercostal nerves are easily obtainable, the donor site is in a concealed area, and primary closure is possible. PMID:23615338

Iida, Takuya; Yoshimatsu, Hidehiko; Hara, Hisako; Mihara, Makoto; Koshima, Isao

2014-03-01

104

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)

105

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

106

Electrodiagnostic Evaluation and Treatment of Root Avulsion in an Obstetric Brachial Plexus Injury-Case Report  

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Full Text Available Obstetrical brachial plexus palsy is a common peripheral nerve injury in childhood. Root avulsion is one of the poor prognostic factors. The role of nerve conduction study and electroneuromyography (ENMG is to differentiate root avulsion from plexus lesions. Despite the normal sensory nerve conduction study, the absence of motor nerve conduction is diagnostic of root avulsion. Because of the root avulsion, definitely establish surgical decision and time of surgery, in the presence of doubt electrodiagnostic studies should be made. In this case, to emphasize the role of electroneuromyography, we presented a 5-month old male patient who was referred to our electrophysiology laboratory with the prediagnosis of brachial plexus injury.

Evrim KARADA? SAYGI

2011-01-01

107

Evaluation of brachial plexus injury by CT myelography  

International Nuclear Information System (INIS)

. 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)

108

Evaluation of brachial plexus injury by MRI  

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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)

109

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

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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

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

2014-12-01

110

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

111

Sonographic evaluation of brachial plexus pathology  

International Nuclear Information System (INIS)

nted 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.)

112

The Importance of Needle Echogenity in Ultrasound Guided Axillary Brachial Plexus Block: A Randomized Controlled Clinical Study  

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Objective: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery.

Duger, Cevdet; Isbir, Ahmet Cemil; Kaygusuz, Kenan; Kol, Iclal Ozdemir; Gursoy, Sinan; Ozturk, Hayati; Mimarog?lu, Caner

2013-01-01

113

Nerve grafting in peripheral nerve injuries  

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

Simi? Vesna D.

2003-01-01

114

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  

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Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

2014-06-01

115

Imaging tumours of the brachial plexus  

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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.)

Saifuddin, Asif [Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, HA7 4LP, Stanmore (United Kingdom)

2003-07-01

116

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

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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 injection. PMID:25247047

Hahn, Christopher; Nagdev, Arun

2014-01-01

117

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

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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.)

118

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)  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

119

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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.

120

[Ankle brachial index measurement].  

Science.gov (United States)

Ultrasound examinations are noninvasive diagnostic methods which, along with appropriate history and clinical examination, provide basic information on the etiology and spread of the disease, as well as on treatment options required in patients with chronic venous insufficiency and arterial flow impairment. Doppler flow meter offers useful data on venous blood return, primarily in great veins, while both deep and superficial veins as well as arteries can be visualized and data on venous and arterial hemodynamics obtained by duplex ultrasonography. In addition, Doppler flow meter provides data on the peripheral arterial system action through ankle brachial index measurement, which will guide the choice of compression therapy when deciding on the treatment of peripheral arterial disease and mixed arteriovenous leg ulcers. However, diagnosis of arterial insufficiency requires additional examinations. PMID:25327002

Rucigaj, Tanja Planinsek

2014-10-01

 
 
 
 
121

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.)

122

MRI of the brachial plexus  

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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.)

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

2001-02-01

123

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)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.

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

2004-09-01

124

Restoration and protection of brachial plexus injury: hot topics in the last decade.  

Science.gov (United States)

Brachial plexus injury is frequently induced by injuries, accidents or birth trauma. Upper limb function may be partially or totally lost after injury, or left permanently disabled. With the development of various medical technologies, different types of interventions are used, but their effectiveness is wide ranging. Many repair methods have phasic characteristics, i.e., repairs are done in different phases. This study explored research progress and hot topic methods for protection after brachial plexus injury, by analyzing 1,797 articles concerning the repair of brachial plexus injuries, published between 2004 and 2013 and indexed by the Science Citation Index database. Results revealed that there are many methods used to repair brachial plexus injury, and their effects are varied. Intervention methods include nerve transfer surgery, electrical stimulation, cell transplantation, neurotrophic factor therapy and drug treatment. Therapeutic methods in this field change according to the hot topic of research. PMID:25374596

Zhang, Kaizhi; Lv, Zheng; Liu, Jun; Zhu, He; Li, Rui

2014-09-15

125

Treatment of a radiation-induced brachial plexopathy  

International Nuclear Information System (INIS)

A radiation-induced brachial plexopathy after a mastectomy causes severe pain and numbness, as well as motor and sensory disorders. Severe pain is often resistant to analgesic blocks, and in most instances, the effect of neurolysis is only temporary. We have treated two such patients with microsurgical neurolysis and then have covered the nerve by transferred muscles. In one case, the exposed brachial plexus was covered with a pedicled latissimus dorsi muscle flap, and in the other, with a free rectus abdominis muscle flap. Pain and numbness were markedly improved in these two patients soon after the surgery, and the improvement in the sensory function also was relatively satisfactory. In one case, the motor function also improved. These patients have had no recurrence of pain or numbness for 4 years and 2 months and 4 years and 7 months after surgery, respectively. Further, their sensory and motor disorders did not advance. Surgical indications for a radiation-induced brachial plexopathy remain controversial, since the operation does not always ensure a marked improvement in the sensory and motor functions. Further, the operation is ineffective for patients with advanced nerve degeneration. Taking these factors into consideration, the preoperative predication of beneficial effects from this surgery is difficult. Despite our limited experience, however, our surgical method has been thought to be effective because it achieves a marked improvement in the numbness and pain experienced in the arms, which are usually the patients' chief complaints. (author)

126

Treatment of a radiation-induced brachial plexopathy  

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A radiation-induced brachial plexopathy after a mastectomy causes severe pain and numbness, as well as motor and sensory disorders. Severe pain is often resistant to analgesic blocks, and in most instances, the effect of neurolysis is only temporary. We have treated two such patients with microsurgical neurolysis and then have covered the nerve by transferred muscles. In one case, the exposed brachial plexus was covered with a pedicled latissimus dorsi muscle flap, and in the other, with a free rectus abdominis muscle flap. Pain and numbness were markedly improved in these two patients soon after the surgery, and the improvement in the sensory function also was relatively satisfactory. In one case, the motor function also improved. These patients have had no recurrence of pain or numbness for 4 years and 2 months and 4 years and 7 months after surgery, respectively. Further, their sensory and motor disorders did not advance. Surgical indications for a radiation-induced brachial plexopathy remain controversial, since the operation does not always ensure a marked improvement in the sensory and motor functions. Further, the operation is ineffective for patients with advanced nerve degeneration. Taking these factors into consideration, the preoperative predication of beneficial effects from this surgery is difficult. Despite our limited experience, however, our surgical method has been thought to be effective because it achieves a marked improvement in the numbness and pain experienced in the arms, which are usually the patients' chief complaints. (author).

Tanaka, Ichirou; Harashina, Takao; Inoue, Takeo; Ueda, Kouichi; Hatoko, Mituo; Shidara, Yukinobu (Saitama Medical School, Kawagoe (Japan). Saitama Medical Center); Ito, Yoshiyasu

1990-07-01

127

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

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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.

Jamuna M

2011-01-01

128

Cutaneous Anthrax  

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... this page: About CDC.gov . Anthrax Share Compartir Cutaneous Anthrax When anthrax spores get into the skin, ... a cut or scrape, a person can develop cutaneous anthrax. This can happen when a person handles ...

129

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

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

LENUS (Irish Health Repository)

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.

Frizelle, H P

2012-02-03

131

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.)

132

Bilateral Obstetric Palsy of Brachial Plexus  

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Full Text Available 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.

Özlem Alt?nda?

2009-09-01

133

Cutaneous mechanisms of isometric ankle force control  

DEFF Research Database (Denmark)

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.

Choi, Julia T; Jensen, Jesper Lundbye

2013-01-01

134

Cutaneous Lymphoma Foundation  

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About Cutaneous Lymphoma What is Cutaneous Lymphoma? Living with Cutaneous Lymphoma Treatment Stories of Help & Hope Cutaneous Lymphoma News Glossary Programs Programs Educational Opportunities Online Learning Center ...

135

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

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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.

Mario G. Siqueira

2012-07-01

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Our experience on brachial plexus blockade in upper extremity surgery  

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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

Ömer Uslukaya

2012-03-01

137

Traumatic pseudoaneurysm of axillary artery combined with brachial plexus injury.  

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Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus. PMID:25412426

Chen, Lin; Peng, Feng; Wang, Tao; Chen, Desong; Yang, Jianyun

2014-01-01

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Comunicación Masiva del Ramo Superficial del Nervio Radial con el Nervio Cutáneo Antebraquial Lateral, un Análisis Morfométrico. 1+1 ? 2 / Massive Communication Between the Superficial Branch of Radial Nerve and the Lateral Cutaneous Nerve of the Forearm, a Morphometric Study. 1+1 ? 2  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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 nuevas técnicas de diagnóstico, 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. Conocer el número de fibras que componen un ramo nervioso cutáneo de la región de la mano, ha adquirido mayor relevancia con el desarrollo de técnicas de microcirugía y de ultrasonografía, procedimientos que han demostrado la utilidad de este conocimiento en el diagnóstico y tratamiento de las lesiones nerviosas. Así, la arquitectura fascicular, el área adiposa y el área vascular de un ramo nervioso determinado constituyen datos que se ha demostrado se modifican con la edad y, en consecuencia, van condicionar la conducta terapéutica y el pronóstico de las lesiones nerviosas. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial y al nervio cutáneo lateral antebraquial; situación que aparece descrita en la literatura especializada sólo una vez y que modifica notablemente la inervación sensitiva del borde radial de la mano. Abstract in english The distribution of sensory nerve branches in the lateral and the back of the hand have been described more accurately in recent decades due to advances in new diagnostic techniques, which have identified that about 40% of the population examined have some degree of anatomical variation in the distr [...] ibution area of the sensitive nerves involved. The knowledge of the number of fibers forming a sensitive nerve of the hand has become more important with the development of microsurgical techniques and ultrasonography; procedures that have demonstrated the usefulness of this information in the diagnosis and treatment of nerve injuries. Thus, the fascicular architecture, adipose tissue area and the vascular area of a nerve branch, data that has been demonstrated that change with age, will determine the therapeutic and prognosis of nerve injuries. In this case we present an extremely rare and bilateral anatomical variation, involving the superficial branch of radial nerve and the lateral antebrachial cutaneous nerve, a situation that is described in the literature only once and which notably alter the sensory innervations of the radial edge of the hand.

Guillermo, Salgado A; Martin, Inzunza A; Claudio, Cruzat C; Oscar, Inzunza H.

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Comunicación Masiva del Ramo Superficial del Nervio Radial con el Nervio Cutáneo Antebraquial Lateral, un Análisis Morfométrico. 1+1 ? 2 Massive Communication Between the Superficial Branch of Radial Nerve and the Lateral Cutaneous Nerve of the Forearm, a Morphometric Study. 1+1 ? 2  

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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 nuevas técnicas de diagnóstico, 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. Conocer el número de fibras que componen un ramo nervioso cutáneo de la región de la mano, ha adquirido mayor relevancia con el desarrollo de técnicas de microcirugía y de ultrasonografía, procedimientos que han demostrado la utilidad de este conocimiento en el diagnóstico y tratamiento de las lesiones nerviosas. Así, la arquitectura fascicular, el área adiposa y el área vascular de un ramo nervioso determinado constituyen datos que se ha demostrado se modifican con la edad y, en consecuencia, van condicionar la conducta terapéutica y el pronóstico de las lesiones nerviosas. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial y al nervio cutáneo lateral antebraquial; situación que aparece descrita en la literatura especializada sólo una vez y que modifica notablemente la inervación sensitiva del borde radial de la mano.The distribution of sensory nerve branches in the lateral and the back of the hand have been described more accurately in recent decades due to advances in new diagnostic techniques, which have identified that about 40% of the population examined have some degree of anatomical variation in the distribution area of the sensitive nerves involved. The knowledge of the number of fibers forming a sensitive nerve of the hand has become more important with the development of microsurgical techniques and ultrasonography; procedures that have demonstrated the usefulness of this information in the diagnosis and treatment of nerve injuries. Thus, the fascicular architecture, adipose tissue area and the vascular area of a nerve branch, data that has been demonstrated that change with age, will determine the therapeutic and prognosis of nerve injuries. In this case we present an extremely rare and bilateral anatomical variation, involving the superficial branch of radial nerve and the lateral antebrachial cutaneous nerve, a situation that is described in the literature only once and which notably alter the sensory innervations of the radial edge of the hand.

Guillermo Salgado A

2012-09-01

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Comunicación Masiva del Ramo Superficial del Nervio Radial con el Nervio Cutáneo Antebraquial Lateral, un Análisis Morfométrico. 1+1 ? 2 / Massive Communication Between the Superficial Branch of Radial Nerve and the Lateral Cutaneous Nerve of the Forearm, a Morphometric Study. 1+1 ? 2  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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 nuevas técnicas de diagnóstico, 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. Conocer el número de fibras que componen un ramo nervioso cutáneo de la región de la mano, ha adquirido mayor relevancia con el desarrollo de técnicas de microcirugía y de ultrasonografía, procedimientos que han demostrado la utilidad de este conocimiento en el diagnóstico y tratamiento de las lesiones nerviosas. Así, la arquitectura fascicular, el área adiposa y el área vascular de un ramo nervioso determinado constituyen datos que se ha demostrado se modifican con la edad y, en consecuencia, van condicionar la conducta terapéutica y el pronóstico de las lesiones nerviosas. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial y al nervio cutáneo lateral antebraquial; situación que aparece descrita en la literatura especializada sólo una vez y que modifica notablemente la inervación sensitiva del borde radial de la mano. Abstract in english The distribution of sensory nerve branches in the lateral and the back of the hand have been described more accurately in recent decades due to advances in new diagnostic techniques, which have identified that about 40% of the population examined have some degree of anatomical variation in the distr [...] ibution area of the sensitive nerves involved. The knowledge of the number of fibers forming a sensitive nerve of the hand has become more important with the development of microsurgical techniques and ultrasonography; procedures that have demonstrated the usefulness of this information in the diagnosis and treatment of nerve injuries. Thus, the fascicular architecture, adipose tissue area and the vascular area of a nerve branch, data that has been demonstrated that change with age, will determine the therapeutic and prognosis of nerve injuries. In this case we present an extremely rare and bilateral anatomical variation, involving the superficial branch of radial nerve and the lateral antebrachial cutaneous nerve, a situation that is described in the literature only once and which notably alter the sensory innervations of the radial edge of the hand.

Guillermo, Salgado A; Martin, Inzunza A; Claudio, Cruzat C; Oscar, Inzunza H.

2012-09-01

 
 
 
 
141

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

2014-03-01

142

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

143

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.  

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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.

João G Franca

2014-10-01

144

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)

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

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

2014-01-01

145

Thoracic Outlet Syndrome Caused by Schwannoma of Brachial Plexus  

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Schwannomas are benign, usually slow-growing tumors that originate from Schwann cells surrounding peripheral, cranial, or autonomic nerves. The most common form of these tumors is acoustic neuroma. Schwannomas of the brachial plexus are quite rare, and symptomatic schwannomas of the brachial plexus are even rarer. A 47-year-old woman presented with a 1-year history of dysesthesia, neuropathic pain, and mild weakness of the right upper limb. Results of physical examination and electrodiagnostic studies supported a diagnosis as thoracic outlet syndrome. Conservative treatment did not relieve her symptoms. After 9 months, a soft mass was found at the upper margin of the right clavicle. Magnetic resonance imaging showed a 3.0×1.8×1.7 cm ovoid mass between the inferior trunk and the anterior division of the brachial plexus. Surgical mass excision and biopsy were performed. Pathological findings revealed the presence of schwannoma. After schwannoma removal, the right hand weakness did not progress any further and neuropathic pain gradually reduced. However, dysesthesia at the right C8 and T1 dermatome did not improve. PMID:24466527

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

2013-01-01

146

A rare variant formation of the median nerve  

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Brachial plexus, due to its complicated formation frequently shows variations. Many formative variations of median nerve are reported. A variant formation of median nerve was noted in the right axilla and arm of a male cadaver, in the form of three accessory communications between lateral and medial roots of median nerve. All the accessory communications passed from lateral to medial root. Different types of variations of median nerve formation are documented but the one found in present stud...

Ar, Nene; Ks, Gajendra; Mvr, Sarma

2010-01-01

147

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

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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.

Amiri HR

2009-05-01

148

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

149

A case of connected superior and middle trunks of the brachial plexus or with abnormal upper trunk.  

Science.gov (United States)

During treatment of tumors of nerve sheaths, such as schwannomas and neurofibromas, neurosurgeons should be aware of variations and aberrant formations of brachial plexus. Variations of the branches of brachial plexus are common, but its variations in the level of the roots and trunks are rare. Variations regarding lower trunk were founded more frequent in previous studies. An unusual variant of the brachial plexus was found unilaterally during routine dissection of a 75-year-old male cadaver. It was observed that middle trunk was connected to superior trunk. Deep cervical artery originating from subclavian artery passed between C6 and C7 roots. Similar variations in the brachial plexus were not observed on the contralateral side. In available literature, only two similar bilateral cases were reported. The details of this variation and its clinical significance were discussed. Knowledge about these rare variations in the trunks is very useful in surgical practice and anesthesia. PMID:22119842

Yildiz, Selda; Cömert, A; Ozan, H

2011-01-01

150

Description of the brachial plexus of the short-eared dog (Atelocynus microtis Sclater, 1882: case report  

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Full Text Available The short-eared dog (Atelocynus microtis is one of the rarest species of South American canids. Aiming to describe the morphology of this animal and enhance the study of comparative neuroanatomy, we studied the anatomical makeup of the brachial plexus of a female specimen from Paragominas (PA. The specimen was donated, after natural death, to the Institute of Animal Health and Production (ISPA at the Universidade Federal Rural da Amazônia (UFRA. The animal was fixed in 10% formalin and later dissected bilaterally to reveal the origin of the brachial plexus. In A. microtis, the brachial plexus is derived from the ventral rami of the last three cervical spinal nerves and the first thoracic spinal nerve (C6-T1. The brachial plexus derivatives with their respective origins were: suprascapular n. (C6 and C7, subscapular n. (C6, musculocutaneous n. (C6 and C7, axillary n. (C6 and C7, radial n. (C7 and C8, median n. (C7, C8 and T1, ulnar n. (C8 and T1, thoracodorsal n. (C8 and T1, cranial pectoral nn. (C7, C8 and T1 and caudal pectoral nn. (C8 and T1. The brachial plexus of A. microtis resembled what has been described for the domestic dog, in relation to the origin of the initial and final segment, but showed differences in the composition of some nerves.

Luane Lopes Pinheiro

2013-09-01

151

Finger movement at birth in brachial plexus birth palsy  

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Full Text Available AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury. METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head (PHHA, and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient’s parent or guardian during the initial evaluation. RESULTS: Among 87 patients, 9 (10.3% patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion < -12°, whereas only 1 patient (1.1% with finger movement had a PHHA > 40%, and retroversion < -8° in study 1. The improvement in glenohumeral deformity (PHHA, 31.8% ± 14.3%; and glenoid retroversion 22.0° ± 15.0° was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth (group 1, when compared to those patients, who had primary surgeries (nerve and muscle surgeries, and lacked finger movement at birth (group 2, (PHHA 10.7% ± 15.8%; Version -8.0° ± 8.4°, P = 0.005 and P = 0.030, respectively in study 2. No finger movement at birth was observed in 55% of the patients in this study group. CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.

Rahul K Nath

2013-01-01

152

A rare variant formation of the median nerve  

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Full Text Available Brachial plexus, due to its complicated formation frequently shows variations. Many formative variations of median nerve are reported. A variant formation of median nerve was noted in the right axilla and arm of a male cadaver, in the form of three accessory communications between lateral and medial roots of median nerve. All the accessory communications passed from lateral to medial root. Different types of variations of median nerve formation are documented but the one found in present study is rare. There may be compression of axillary artery due to the accessory communication passing around the artery. Also injury in this region may lead to unusual clinical picture. A well-informed clinician must know about the variations usually seen in the brachial plexus and its branches to correctly examine a clinical case and also to explain unusual clinical signs seen when one come across a lesion in a variant brachial plexus.

Nene AR

2010-08-01

153

Cutaneous deposits.  

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: The cutaneous deposition disorders are a group of unrelated conditions characterized by the accumulation of either endogenous or exogenous substances within the skin. These cutaneous deposits are substances that are not normal constituents of the skin and are laid down usually in the dermis, but also in the subcutis, in a variety of different circumstances. There are 5 broad categories of cutaneous deposits. The first group includes calcium salts, bone, and cartilage. The second category includes the hyaline deposits that may be seen in the dermis in several metabolic disorders, such as amyloidosis, gout, porphyria, and lipoid proteinosis. The third category includes various pigments, heavy metals, and complex drug pigments. The fourth category, cutaneous implants, includes substances that are inserted into the skin for cosmetic purposes. The fifth category includes miscellaneous substances, such as oxalate crystals and fiberglass. In this article, the authors review the clinicopathologic characteristics of cutaneous deposition diseases, classify the different types of cutaneous deposits, and identify all the histopathologic features that may assist in diagnosing the origin of a cutaneous deposit. PMID:23249837

Molina-Ruiz, Ana M; Cerroni, Lorenzo; Kutzner, Heinz; Requena, Luis

2014-01-01

154

Gross anatomy of the brachial plexus in the giant Anteater (Myrmecophaga tridactyla).  

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Ten forelimbs of five Myrmecophaga tridactyla were examined to study the anatomy of the brachial plexus. The brachial plexuses of the M. tridactyla observed in the present study were formed by the ventral rami of the last four cervical spinal nerves, C5 through C8, and the first thoracic spinal nerve, T1. These primary roots joined to form two trunks: a cranial trunk comprising ventral rami from C5-C7 and a caudal trunk receiving ventral rami from C8-T1. The nerves originated from these trunks and their most constant arrangement were as follows: suprascapular (C5-C7), subscapular (C5-C7), cranial pectoral (C5-C8), caudal pectoral (C8-T1), axillary (C5-C7), musculocutaneous (C5-C7), radial (C5-T1), median (C5-T1), ulnar (C5-T1), thoracodorsal (C5-C8), lateral thoracic (C7-T1) and long thoracic (C6-C7). In general, the brachial plexus in the M. tridactyla is similar to the plexuses in mammals, but the number of rami contributing to the formation of each nerve in the M. tridactyla was found to be larger than those of most mammals. This feature may be related to the very distinctive anatomical specializations of the forelimb of the anteaters. PMID:23952693

Souza, P R; Cardoso, J R; Araujo, L B M; Moreira, P C; Cruz, V S; Araujo, E G

2014-10-01

155

Brachial Plexus Injury Related To Carrying A Rucksack: Two Cases Report  

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Full Text Available Brachial plexus injuries are often associated with penetrated trauma and isolated brachial plexus injuries are rarely seen. Since it has a complex anatomical structure including cervical nerve roots, truncus and fascicule, the injury can be more complicated rather than just peripheral nerve damage. Two patients were presented in this paper, both of whom are 21 year-old soldiers, applied with the complaints of numbness and paralyze in their left upper extremity which occurred after carrying 40 kg rucksack for 10 hours (first patient and for 8 hours (second patient. In the electromyography (EMG, brachial plexus upper and middle truncus injury was determined. Following the application of active and passive physical rehabilitation to the cases, the first patient clinically recovered after 6 months and the second patient after 4 months. This paper aims to emphasize that rarely observed isolated brachial plexus injury may result from carrying a seemingly innocent rucksack commonly used by many people and that early physical rehabilitation can lead to positive outcomes for patients.

Mehmet SEÇER

2009-12-01

156

Modified pathological classification of brachial plexus root injury and its MR imaging characteristics.  

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The authors described a modified pathological classification (PC) of brachial plexus injury (BPI) and its magnetic resonance (MR) imaging characteristics. The reliability and diagnostic accuracy of MR imaging for detecting nerve injury was discussed. Between 2006 and 2010, 86 patients with BPI were managed surgically in our department. Their preoperative MR images and surgical findings were analyzed retrospectively. The PC of BPI was classified into five types: (I) nerve root injury in continuity (including Sunderland grade I-IV injury); (II) postganglionic spinal nerve rupture with or without proximal stump; (III) preganglionic root injury (visible); (IV) preganglionic nerve root injury and postganglionic spinal nerves injury; (V) preganglionic root injury (invisible). The main MR imaging characteristics of BPI included traumatic meningocele, displacement of spinal cord, the absence of nerve root, "Black line" sign, nerve root/trunk injury in continuity, and thickening and edema of nerve root. The accuracy of MR imaging for detecting C5, C6, C7, C8, and T1 nerve roots injury were 93.3, 95.2, 92.3, 84, and 74.4%, respectively. The modified PC provides a detailed description of nerve root injury in BPI, and MR imaging technique is a reliable method for detecting nerve root injury. PMID:24163228

Yang, Jiantao; Qin, Bengang; Fu, Guo; Li, Ping; Zhu, Qingtang; Liu, Xiaolin; Zhu, Jiakai; Gu, Liqiang

2014-03-01

157

Cutaneous Leishmaniasis.  

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The cutaneous leishmaniases include a spectrum of self healing and chronic disease forms caused by protozoan parasites of the genus Leishmania. Clinical presentations differ according to parasite burden and host immune response. Although there can be cons...

A. J. Magill, M. K. Klassen- Fischer, R. C. Neafie, W. M. Meyers

2011-01-01

158

The use of thoracodorsal nerve transfer in restoration of irreparable C5 and C6 spinal nerve lesions.  

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There are only a few reports on the use of thoracodorsal nerve (TDN) transfer to the musculocutaneous or axillary nerves in cases of directly irreparable brachial plexus injuries. In this study, we analysed outcome and time-course of recovery in correlation with recipient nerves and type of nerve transfer (isolated or in combination with other collateral branches) for 27 patients with transfer to the musculocutaneous or axillary nerves. Using this nerve as donor, we obtained useful functional recovery in all 12 cases for the musculocutaneous nerve, and in 14 (93.3%) of 15 nerve transfers for the axillary nerve. Although, we found no significant statistical difference between analysed patients according to the percentage of recoveries and mean values, we established a better quality and shorter time of recovery for the musculocutaneous nerve. According to obtained results, we consider that transfer may be a valuable method in reconstruction after directly irreparable C5 and C6 spinal nerve lesions. PMID:15897040

Samardzic, M M; Grujicic, D M; Rasulic, L G; Milicic, B R

2005-06-01

159

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

LENUS (Irish Health Repository)

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.

O'Sullivan, Owen

2012-07-13

160

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

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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.

Duz Bulent

2009-07-01

 
 
 
 
161

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

162

Bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5% Bloqueo del plexo braquial por la vía posterior con el uso de neuroestimulador y ropivacaína a 0,5% Posterior brachial plexus block with nerve stimulator and 0.5% ropivacaine  

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Full Text Available JUSTIFICATIVA E OBJETIVOS: Existem várias maneiras de abordar o plexo braquial dependendo da experiência do anestesiologista e da região a ser operada. O bloqueio do plexo braquial pela via posterior pode representar uma alternativa para cirurgias de ombro, clavícula e úmero proximal. O objetivo deste estudo foi mostrar os resultados observados em pacientes submetidos a bloqueio do plexo braquial pela via posterior com uso de neuroestimulador e ropivacaína a 0,5%. MÉTODO: Vinte e dois pacientes com idade entre 17 e 76 anos, estado físico ASA I e II, submetidos a cirurgias ortopédicas envolvendo o ombro, clavícula e úmero proximal foram anestesiados com bloqueio de plexo braquial pela via posterior utilizando neuroestimulador a partir de 1 mA. Obtida a contração desejada, a corrente foi diminuída para 0,5 mA e, permanecendo a resposta contrátil, foram injetados 40 mL de ropivacaína a 0,5%. Foram avaliados os seguintes parâmetros: latência, analgesia, duração da cirurgia, duração da analgesia e do bloqueio motor, complicações e efeitos colaterais. RESULTADOS: O bloqueio foi efetivo em 20 dos 22 pacientes; a latência média foi de 15,52 min; a duração média da cirurgia foi de 1,61 hora. A média de duração da analgesia foi de 15,85 horas e do bloqueio motor 11,16 horas. Não foram observados sinais e sintomas clínicos de toxicidade do anestésico local e nenhum paciente apresentou efeitos adversos do bloqueio. CONCLUSÕES: Nas condições deste estudo o bloqueio de plexo braquial pela via posterior com o uso do neuroestimulador e ropivacaína a 0,5% demonstrou ser uma técnica efetiva, confortável para o paciente e de fácil realização.JUSTIFICATIVA Y OBJETIVOS: Existen varios modos de abordar el plexo braquial dependiendo de la experiencia del anestesiologista y de la región que será operada. El bloqueo del plexo braquial por la vía posterior puede representar una alternativa para cirugías de hombro, clavícula y húmero proximal. El objetivo de este estudio fue mostrar los resultados observados en pacientes sometidos a bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5%. MÉTODO: Veintidós pacientes con edad entre 17 y 76 años, estado físico ASA I y II, sometidos a cirugías ortopédicas envolviendo el hombro, clavícula y húmero proximal fueron anestesiados con bloqueo de plexo braquial por la vía posterior utilizando neuroestimulador desde 1 mA. Lograda la contracción deseada, la corriente fue disminuida para 0,5 MA y, permaneciendo la respuesta contráctil, fueron inyectados 40 mL de ropivacaína a 0,5%. Fueron evaluados los siguientes parámetros: latencia, analgesia, duración de la cirugía, duración de la analgesia y del bloqueo motor, complicaciones y efectos colaterales. RESULTADOS: El bloqueo fue efectivo en 20 de los 22 pacientes; la latencia media fue de 15,52 min; la duración media de la cirugía fue de 1,61 hora. La media de duración de la analgesia fue de 15,85 horas y del bloqueo motor 11,16 horas. No fueron observados señales y síntomas clínicos de toxicidad del anestésico local y ningún paciente presentó efectos adversos del bloqueo. CONCLUSIONES: En las condiciones de este estudio el bloqueo del plexo braquial por la vía posterior con el uso del neuroestimulador y ropivacaína a 0,5% demostró que es una técnica efectiva, confortable para el paciente y de fácil realización.BACKGROUND AND OBJECTIVES: There are several approaches to the brachial plexus depending on the experience of the anesthesiologist and the site of the surgery. Posterior brachial plexus block may be an alternative for shoulder, clavicle and proximal humerus surgery. This study aims at presenting the results of patients submitted to posterior brachial plexus block with 0.5% ropivacaine and the aid of nerve stimulator. METHODS: Participated in this study 22 patients aged 17 to 76 years, physical status ASA I and II, scheduled for shoulder, clavicle and proximal humerus surgery, who were submitted to posterior b

Lúcia Beato

2005-08-01

163

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)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish 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.

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

2011-09-01

164

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  

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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

Luis Henrique Cangiani

2008-04-01

165

Results and current approach for Brachial Plexus reconstruction  

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Full Text Available Abstract We review our experience treating 335 adult patients with supraclavicular brachial plexus injuries over a 7-year period at the University of Southern Santa Catarina, in Brazil. Patients were categorized into 8 groups, according to functional deficits and roots injured: C5-C6, C5-C7, C5-C8 (T1 Hand, C5-T1 (T2 Hand, C8-T1, C7-T1, C6-T1, and total palsy. To restore function, nerve grafts, nerve transfers, and tendon and muscle transfers were employed. Patients with either upper- or lower-type partial injuries experienced considerable functional return. In total palsies, if a root was available for grafting, 90% of patients had elbow flexion restored, whereas this rate dropped to 50% if no roots were grafted and only nerve transfers performed. Pain resolution should be the first priority, and root exploration and grafting helped to decrease or eliminate pain complaints within a short time of surgery.

Ghizoni Marcos F

2011-06-01

166

Iliac compartment block following ilioinguinal iliohypogastric nerve block.  

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Transient femoral nerve palsy is a known complication associated with percutaneous ilioinguinal iliohypogastric nerve block. Excess volume and higher concentrations of local anesthetic have been implicated for transient femoral nerve palsy. We encountered partial iliac compartment block involving lateral cutaneous nerve of the thigh and femoral nerve with a lower concentration (0.25%) of bupivacaine administered in the smallest indicated volume of 0.25 ml.kg-1 using a double-shot technique. PMID:16972842

Shivashanmugam, Thiayagarajan; Kundra, Pankaj; Sudhakar, Subramani

2006-10-01

167

Radiation-induced brachial plexus neuropathy in breast cancer patients  

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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.)

168

Radiation-induced brachial plexus neuropathy in breast cancer patients  

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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. 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.).

Olsen, N.K.; Pfeiffer, P.; Mondrup, K.; Rose, C. (Odense Univ. Hospital (Denmark). Dept. of Neurology Odense Univ. Hospital (Denmark). Dept. of Clinical Neurophysiology Odense Univ. Hospital (Denmark). Dept. of Oncology R)

1990-01-01

169

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

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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

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

2014-02-01

170

Nerve entrapments associated with postmastectomy lymphedema  

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Ninety females underwent mastectomy for breast cancer and were thereafter investigated to determine whether nerve entrapments were responsible for some of the disabling symptoms in their arms. The majority of these patients suffered from fullness (edema), numbness, paraesthesia, weakness and pain of the arm on the mastectomized side. Lymphedema of varying degrees found in 50% of these patients was associated with brachial plexus entrapment and carpal tunnel syndrome (CTS). 28% of the patients has CTS, and 28% suffered from brachial plexus entrapment of the arm on the mastectomized side, as compared with 8% and 5%, respectively, on the nonoperated side. 12% of the patients suffered from both types of entrapment. Thus we consider that brachial plexus entrapment and carpal tunnel syndrome should be added to the list of complications following mastectomy, with lymphedema playing an active part in their development

171

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

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.

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

172

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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 re

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

2008-04-01

173

Fibrolipoma of multiple nerves in the wrist.  

Science.gov (United States)

We report fibrolipoma involving the median nerve, its palmar cutaneous branch as well as the ulnar nerve in the same hand of a 25-year-old woman. The patient presented with a lump in the wrist with signs of carpal tunnel syndrome. Multiple nerve involvement was detected on magnetic resonance imaging and further confirmed at surgical exploration and decompression. Imaging is recommended in the management of an unusual lump in the wrist. PMID:19710960

Pang, H N; Puhaindran, M; Yong, F C

2009-08-01

174

Schwannomatosis of the sciatic nerve  

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A 52-year-old woman with schwannomatosis in the left sciatic nerve is presented. The patient had no stigmata of neurofibromatosis (NF) type 1 or 2. Cutaneous or spinal schwannomas were not detected. Magnetic resonance (MR) imaging of the sciatic nerve revealed more than 15 tumors along the course of the nerve. Histological examination revealed schwannomas consisting of Antoni A and B areas. Immunohistochemical study showed most cells reacting intensely for S-100 protein. The patient underwent conservative follow-up treatment due to the minimal symptoms. The relationship of the disease with NF-2 and plexiform schwannoma is discussed. (orig.)

Yamamoto, Tetsuji; Maruyama, Shigeki; Mizuno, Kosaku [Dept. of Orthopaedic Surgery, Kobe University School of Medicine (Japan)

2001-02-01

175

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

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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.

Cevdet Düger

2013-06-01

176

Management of traumatic brachial artery injuries: A report on 49 patients  

International Nuclear Information System (INIS)

The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability. The purpose of our study was to review our experience with brachial artery injuries over a 9-year period, describing the type of injury, surgical procedures, complications, and associated injuries. Forty-nine patients with brachial artery injury underwent surgical repair procedures at our hospital, from the beginning of May 1999 to the end of June 2008. The brachial artery injuries were diagnosed by physical examination and Doppler ultrasonography. Depending on the mode of presentation, patients were either taken immediately to the operating room for bleeding control and vascular repair or were assessed by preoperative duplex ultrasonography. This study group consisted of 43 males and 6 females, ranging in age from 6 to 65 years with a mean (SD) age of 27.9 (6.7) years. The mechanism of trauma was penetrating in 45 patients and blunt in the remaining 4 patients. Stab injury was the most frequent form of penetrating trauma (24 of 45). Treatment included primary arterial repair in 5 cases, end-to-end anastomosis in 28 cases, interposition vein graft in 15 cases, and interposition-ringed polytetrafluoroethylene graft in 1 case. Associated injuries were common and included venous injury (14), bone fracture (5), and peripheral nerve injury (11). Fifteen patients developed postoperative complications. One patient underwent an above-elbow amputation. Prompt and appropribove-elbow amputation. Prompt and appropriate management of the brachial artery injuries, attention to associated injuries, and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. (author)

177

Management of traumatic brachial artery injuries : A report on 49 patients.  

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Full Text Available Background and Objective: The brachial artery is the most frequently injured artery in the upper extrem--ity due to its vulnerability. The purpose of our study was to review our experience with brachial artery injuries over a 9-year period, describing the type of injury, surgical procedures, complications, and associated injuries. Patients and Methods: Forty-nine patients with brachial artery injury underwent surgical repair procedures at our hospital, from the beginning of May 1999 to the end of June 2008. The brachial artery injuries were diag--nosed by physical examination and Doppler ultrasonography. Depending on the mode of presentation, patients were either taken immediately to the operating room for bleeding control and vascular repair or were assessed by preoperative duplex ultrasonography. Results: This study group consisted of 43 males and 6 females, ranging in age from 6 to 65 years with a mean (SD age of 27.9 (6.7 years. The mechanism of trauma was penetrating in 45 patients and blunt in the remain--ing 4 patients. Stab injury was the most frequent form of penetrating trauma (24 of 45. Treatment included primary arterial repair in 5 cases, end-to-end anastomosis in 28 cases, interposition vein graft in 15 cases, and interposition-ringed polytetrafluoroethylene graft in 1 case. Associated injuries were common and included venous injury (14, bone fracture (5, and peripheral nerve injury (11. Fifteen patients developed postoperative complications. One patient underwent an above-elbow amputation. Conclusions: Prompt and appropriate management of the brachial artery injuries, attention to associated injuries, and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage.

Ekim Hasan

2009-01-01

178

Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia  

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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.

Stoši? Mila M.

2003-01-01

179

Brachial plexus injury in Thailand: a report of 520 cases.  

Science.gov (United States)

Between October 1984 and October 1993, 520 patients with traumatic brachial plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male and 34 female patients. Eighty-two percent of the injuries were caused by motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot, stabbing, and other means. The initial physical examination revealed 332 (63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred twenty-seven patients were treated conservatively, 43 patients were observed before definitive treatment was given, and 350 patients were treated by operative means. Four hundred and twenty-one surgical procedures were performed, consisting of 314 neurotisations (250 spinal accessory, 14 plexo-plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic, and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle transfers combined with neurotisations, and 30 musculotendinous transfers. Motor functional recovery of patients followed up for more than 2 years was evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In patients with neurotisation, the spinal accessory (to suprascapular, axillary, and musculotaneous) intercostal (to musculotaneous), phrenic (to suprascapular, axillary, and musculocutaneous), and plexo- plexal methods gave a significant number of good results. PMID:7658965

Songcharoen, P

1995-01-01

180

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

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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.

Basta Ivana

2014-01-01

 
 
 
 
181

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.)

182

Nerve biopsy  

Science.gov (United States)

Biopsy - nerve ... A nerve biopsy is most often done on a nerve in the ankle, forearm, or along a rib. The health care ... feel a prick and a mild sting. The biopsy site will be sore for a few days ...

183

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 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.)

184

Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture  

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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.

Marco Rosati

2013-07-01

185

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.)

186

Application of magnetic motor stimulation for measuring conduction time across the lower part of the brachial plexus  

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Full Text Available Abstract Objective The objective of this study was to calculate central motor conduction time (CMCT of median and ulnar nerves in normal volunteers. Conduction time across the lower part of the brachial plexus was measured by using magnetic stimulation over the motor cortex and brachial plexus and recording the evoked response in hand muscles. Design This descriptive study was done on 112 upper limbs of healthy volunteers. Forty-six limbs belonging to men and sixty-six belonging to women were studied by magnetic stimulation of both motor cortex and brachial plexus and recording the evoked response in thenar and hypothenar muscles. Stimulation of the motor cortex gives rise to absolute latency of each nerve whereas stimulation of the brachial plexus results in peripheral conduction time. The difference between these two values was considered the central motor conduction time (CMCT. Results In summary the result are as follows; Cortex-thenar latency = 21.4 ms (SD = 1.7, CMCT-thenar = 9.6 ms (SD = 1.9, Cortex-hypothenar latency = 21.3 ms (SD = 1.8, CMCT-hypothenar = 9.4 ms (SD = 1.8. Conclusion These findings showed that there is no meaningful difference between two genders. CMCT calculated by this method is a little longer than that obtained by electrical stimulation that is due to the more distally placed second stimulation. We recommend magnetic stimulation as the method of choice to calculate CMCT and its use for lower brachial plexus conduction time. This method could serve as a diagnostic tool for diagnosis of lower plexus entrapment and injuries especially in early stages.

Hafezi Rahmatollah

2008-03-01

187

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.)

188

[Cutaneous calciphylaxis].  

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Calciphylaxis represents a dermatological emergency with a mortality of up to 80%. The disease is characterized by a triad of arteriolar medial calcification, thrombotic cutaneous ischemia and necrotic ulcerations. Recently several mechanisms of vascular calcification have been identified. This may led to preventive measures in the future. Early diagnosis is important to avoid complications such as sepsis. The dermatologist plays an important role in early diagnosis based on the recognition of clinical presentation and histopathology. Patients with end-stage renal disease are most commonly affected by calciphylaxis. The most frequent non-uremic predisposing conditions are primary hyperparathyroidism, malignancies, alcohol-induced liver disease, and autoimmune connective tissue diseases. Medical treatment aims to normalize mineral metabolism to reduce the serum concentration of sodium phosphate and thus to prevent precipitation and calcification. Newer compounds are bisphosphonates, non-sodium/non-aluminium phosphate binders, cinacalcet, paricalcitrol, and sodium thiosulfate. Among the surgical procedures parathyroidectomy did not result in a significant survival benefit. An aggressive surgical debridement of necrotic ulcerations, on the other hand, improved survival. Early diagnosis and a multidisciplinary treatment approach including re-vascularization by the vascular surgeon, repeated surgical debridement and split skin transplantation support wound healing and insure limb conservation. PMID:21103856

Wollina, U

2010-12-01

189

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

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Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

2014-06-01

190

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

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

2014-06-01

191

Long-term use of nerve block catheters in paediatric patients with cancer related pathologic fractures.  

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We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control. PMID:22813501

Burgoyne, L L; Pereiras, L A; Bertani, L A; Kaddoum, R N; Neel, M; Faughnan, L G; Anghelescu, D L

2012-07-01

192

Cutaneous skin tag  

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A cutaneous skin tag is a common skin growth. Most of the time, it is harmless ( benign ). ... A cutaneous tag usually occurs in older adults. They are more common in people who are overweight or who ...

193

An anatomical study of double brachial arteries – a case report  

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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.

Krstonosic B

2010-02-01

194

Functioning transferred free muscle innervated by part of the vascularized ulnar nerve connecting the contralateral cervical seventh root to themedian nerve: Case report  

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Full Text Available Abstract Background The limited nerve sources available for the reconstruction and restoration of upper extremity function is the biggest obstacle in the treatment of brachial plexus injury (BPI. We used part of a transplanted vascularized ulnar nerve as a motor source of a free muscle graft. Case presentation A 21-year-old man with a left total brachial plexus injury had received surgical intercostal nerve transfer to the musculocutaneous nerve and a spinal accessory nerve transfer to the suprascapular nerve in another hospital previously. He received transplantation of a free vascularized gracilis muscle, innervated by a part of the transplanted vascularized ulnar nerve connecting the contralateral healthy cervical seventh nerve root (CC7 to the median nerve, and recovered wrist motion and sensation in the palm. At the final examination, the affected wrist could be flexed dorsally by the transplanted muscle, and touch sensation had recovered up to the base of each finger. When his left index and middle fingers were touched or scrubbed, he felt just a mild tingling pain in his right middle fingertip. Conclusion Part of the transplanted vascularized ulnar nerve connected to the contralateral healthy cervical seventh nerve root can be used successfully as a motor source and may be available in the treatment of patients with BPI with scanty motor sources.

Nakayama Ken

2007-09-01

195

Etiological factors of traumatic peripheral nerve injuries  

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

Eser Filiz

2009-01-01

196

Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome.  

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The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome is defined by rapidly progressive oropharyngeal and cervicobrachial weakness associated with areflexia in the upper limbs. Serial nerve conduction studies suggest that PCB represents a localised subtype of Guillain-Barré syndrome characterised by axonal rather than demyelinating neuropathy. Many neurologists are unfamiliar with PCB, which is often misdiagnosed as brainstem stroke, myasthenia gravis or botulism. The presence of additional ophthalmoplegia and ataxia indicates overlap with Fisher syndrome. Half of patients with PCB carry IgG anti-GT1a antibodies which often cross-react with GQ1b, whereas most patients with Fisher syndrome carry IgG anti-GQ1b antibodies which always cross-react with GT1a. Significant overlap between the clinical and serological profiles of these patients supports the view that PCB and Fisher syndrome form a continuous spectrum. In this review, we highlight the clinical features of PCB and outline new diagnostic criteria. PMID:23804237

Wakerley, Benjamin R; Yuki, Nobuhiro

2014-03-01

197

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

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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.

Safoura Ghadirian

2013-09-01

198

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

199

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)

Full Text Available SciELO Chile | Language: English Abstract in spanish 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.

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

2014-06-01

200

Essential regional nerve blocks for the dermatologist: Part 2.  

Science.gov (United States)

Following on from Part 1 of the series (regional nerve blocks for the face and scalp), we guide the clinician through the anatomy and cutaneous innervation of the digits, wrist and ankle, providing a practical step-by-step guide to regional nerve blockade of these areas. PMID:25394292

Davies, T; Karanovic, S; Shergill, B

2014-12-01

 
 
 
 
201

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

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

E. M. Rickes

2012-04-01

202

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

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Full Text Available SciELO South Africa | Language: English Abstract in english 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.

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

203

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

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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.

Levent SÜRER

2013-05-01

204

Anatomical Variation: Median Nerve Formation – A Case Vignette  

Science.gov (United States)

Variations in the arrangement and distribution of brachial plexus and its branches in the infraclavicular part are common and have been reported by several investigators since the 19th century. These variations are significant for the neurologists, surgeons, anesthetists and the anatomists. During routine anatomical dissection of the right axilla and infraclavicular region of a 45-year-old male cadaver, the medial root of the median nerve was found to receive a supplementary branch from the medial aspect of the terminal portion of the lateral cord of brachial plexus and the branch was passing infront of the axillary artery from lateral to medial side. The median nerve was formed by joining of the lateral and medial roots from the lateral and medial cords of brachial plexus, infront of brachial artery, lower down, at the junction of upper one-third and lower two-third of the arm, instead in the axilla. This variation could be one of the cause of pressure symptom which occurs on the axillary artery and also the injury which occurs on the lateral cord or upstream to the lateral cord, which may sometimes lead to an unexpected presentation of weakness of forearm flexors and thenar muscles. PMID:25120965

Sinha, Pranoti; Tamang, Binod Kumar; Sarda, Rohit Kumar

2014-01-01

205

Nerve injuries about the elbow in the athlete.  

Science.gov (United States)

The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery. PMID:25077754

Harris, Joshua D; Lintner, David M

2014-09-01

206

Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia  

Science.gov (United States)

Background: Mixing of various adjuvants has been tried with local anesthetics in an attempt to prolong anesthesia from peripheral nerve blocks but have met with inconclusive success. More recent studies indicate that 8 mg dexamethasone added to perineural local anesthetic injections augment the duration of peripheral nerve block analgesia. Aims: Evaluating the hypothesis that adding dexamethasone to ropivacaine significantly prolongs the duration of analgesia in supraclavicular brachial plexus block compared with ropivacaine alone. Patients and Methods: It was a randomized, prospective, and double-blind clinical trial. Eighty patients of ASA I and II of either sex, aged 16-60 years, undergoing elective upper limb surgeries were equally divided into two groups and given supraclavicular nerve block. Group R patients (n = 40) received 30 ml of 0.5% ropivacaine with distilled water (2 ml)-control group whereas Group D patients (n = 40) received 30 ml of 0.5% ropivacaine with 8 mg dexamethasone (2 ml)-study group. The primary outcome was measured as duration of analgesia that was defined as the interval between the onset of sensory block and the first request for analgesia by the patient. The secondary outcome included maximum visual analogue scale (VAS), total analgesia consumption, surgeon satisfaction, and side effects. Results: Group R patients required first rescue analgesia earlier (557 ± 58.99 min) than those of Group D patients (1179.4 ± 108.60 min), which was found statistically significant in Group D (P compared to Group D, which was statistically significant (P < 0.00). Conclusion: Addition of dexamethasone (8 mg) to ropivacaine in supraclavicular brachial plexus approach significantly and safely prolongs motor blockade and postoperative analgesia (sensory) that lasted much longer than that produced by local anesthetic alone.

Kumar, Santosh; Palaria, Urmila; Sinha, Ajay K.; Punera, D. C.; Pandey, Vijita

2014-01-01

207

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

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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.

Trehan Vikas

2010-01-01

208

Terminal nerve: cranial nerve zero  

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

Jorge Eduardo Duque Parra

2006-12-01

209

Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings  

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)

Oguz, B.; Oguz, K.K.; Cila, A. [Dept. of Radiology, Hacettepe Univ. Faculty of Medicine, Ankara (Turkey); Tan, E. [Dept. of Neurology, Hacettepe Univ. Faculty of Medicine, Ankara (Turkey)

2003-12-01

210

Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings  

International Nuclear Information System (INIS)

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon demyelinating disorder with a relapsing and remitting or continuously progressive course. Hypertrophic nerve roots, sometimes associated with gadolinium enhancement, has been reported more commonly in lumbar spine and less commonly in the brachial plexus and cervical roots; however, diffuse involvement of intercostal nerves bilaterally has never been reported previously. We present MRI findings which include diffuse enlargement and mild enhancement of roots and extraforaminal segments of nerves in all segments except a short segment between T12-L2 as well as all the intercostal nerves in a case of CIPD with a 10-year history. (orig.)

211

Visualization of Cervical Nerve Roots and Their Distal Nerve Fibers by Diffusion-Weighted Scanning Using Parallel Imaging  

International Nuclear Information System (INIS)

Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging. Material and Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s/mm2 in a preliminary series of 13 subjects. Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves. Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising

212

Visualization of Cervical Nerve Roots and Their Distal Nerve Fibers by Diffusion-Weighted Scanning Using Parallel Imaging  

Energy Technology Data Exchange (ETDEWEB)

Purpose: To report a technique developed for visualizing cervical nerve roots and distal nerve fibers using diffusion-weighted magnetic resonance imaging employing parallel imaging. Material and Methods: We performed maximum intensity projection for a stack of isotropic axial diffusion-weighted images obtained with parallel imaging applying a motion-probing gradient in six directions with a b-value of 500 s/mm{sup 2} in a preliminary series of 13 subjects. Results: This method worked well for visualizing the spinal cord and most of the nerve roots, the dorsal root ganglia, and proximal peripheral nerves. Conclusion: Although the technique remains limited in depicting the brachial plexus and distal nerves, the ability to visualize the proximal peripheral nervous system at the cervical level is promising.

Tsuchiya, K.; Fujikawa, A.; Tateishi, H.; Nitatori, T. [Kyorin Univ. School of Medicine, Tokyo (Japan). Dept. of Radiology

2006-07-15

213

Lateral approach for supraclavicular brachial plexus block  

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Full Text Available A lateral approach described by Volker Hempel and Dr. Dilip Kotharihas been further studied, evaluated and described in detail in the present study. The aim of this study was to evaluate lateral approach of supraclavicular brachial plexus block, mainly in terms of successes rate and complication rate. The study was conducted in secondary level hospital and tertiary level hospital from 2004 to 2008. It was a prospective nonrandomized open-level study. Eighty-two patients of both sexes, aged between 18 and 65 years with ASA Grade I and II scheduled to undergo elective major surgery of the upper limb below the midarm, were selected for this new lateral approach of brachial plexus block. The onset and duration of sensory and motor block, any complications and need for supplement anaesthesia were observed. Success and complication rate were calculated in percentage. Average onset and duration of sensory and motor block was calculated as mean ± SD and percentage. Out of 82 patients, 75 (92% have got successful block with no significant complication in any case.

Sahu D

2010-01-01

214

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

DEFF Research Database (Denmark)

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.

Rothe, C; Asghar, S

2011-01-01

215

Iatrogenic Injury to the Long Thoracic Nerve: An Underestimated Cause of Morbidity after Cardiac Surgery  

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After heart surgery, complications affecting the brachial plexus have been reported in 2% to 38% of cases. The long thoracic nerve is vulnerable to damage at various levels, due to its long and superficial course. This nerve supplies the serratus anterior muscle, which has an important role in the abduction and elevation of the superior limb; paralysis of the serratus anterior causes “winged scapula,” a condition in which the arm cannot be lifted higher than 90° from the side. Unfortunat...

Bizzarri, Federico; Davoli, Giuseppe; Bouklas, Dimitri; Oricchio, Luca; Frati, Giacomo; Neri, Eugenio

2001-01-01

216

A novel chondroitin sulfate hydrogel for nerve repair  

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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 scaffo...

Conovaloff, Aaron William

2011-01-01

217

Sarcomas cutâneos primários / Primary cutaneous sarcomas  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

Luiz Fernando Fróes, Fleury Jr; José Antonio, Sanches Jr.

218

Sarcomas cutâneos primários Primary cutaneous sarcomas  

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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.

Luiz Fernando Fróes Fleury Jr

2006-06-01

219

Electroacupuncture attenuates neuropathic pain after brachial plexus injury.  

Science.gov (United States)

Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root (associated with upper-limb chronic neuropathic pain) were given electroacupuncture stimulation at bilateral Quchi (LI11), Hegu (LI04), Zusanli (ST36) and Yanglingquan (GB34). After electroacupuncture therapy, chronic neuropathic pain in the rats' upper limbs was significantly attenuated. Immunofluorescence staining showed that the expression of ?-endorphins in the arcuate nucleus was significantly increased after therapy. Thus, experimental findings indicate that electroacupuncture can attenuate neuropathic pain after brachial plexus injury through upregulating ?-endorphin expression. PMID:25221593

Zhang, Shenyu; Tang, Hailiang; Zhou, Junming; Gu, Yudong

2014-07-15

220

[Meningoencephalo-myeloradiculitis due to Flavivirus: bi-brachial paralysis and respiratory insufficiency].  

Science.gov (United States)

3 patients developed rapid onset of fever and nuchal stiffness. Paresis of brachial muscles occurred within 4 days and all patients had respiratory failure that needed mechanical ventilation. At the peak of the disease there were bilateral asymmetrical severe atrophy of brachial, shoulder and neck muscles, cranial nerve pareses and absent or weak deep reflexes in the upper extremities. CSF analyses showed sterile lymphocytic pleocytosis. In 2 cases the patients suffered a tick bite in Switzerland and the third was probably bitten by an insect while opening a package received from Indonesia. Patients had rapid defervescence and serological tests were found to be highly positive for IgM and then IgG ELISA FSME (Frühsommer-Meningoenzephalitis). The patients were ventilated for 2 to 5 weeks before a progressive improvement was seen. However, on follow-up at 12, 18 and 30 months respectively, proximal muscles were still atrophied and quite weak. Our cases underline that: (1) FSME-ELISA results may cross-react with the Japanese and Central European encephalitis virus species; (2) Flaviviruses do induce unusual and preferential long-term paralysis of the upper extremities simulating poliomyelitis; (3) in the 2 patients studied electrophysiologically, there were signs of axonal reinnervation not seen in lower motor neuron syndrome which were important for reinnervation to permit progressive, but late, motor improvement; (4) there is no evidence of extension of the endemic foci of tick-borne encephalitis in Switzerland. PMID:7709179

Kuntzer, T; de Marval, F; Ochsner, F; de Torrenté, A; Kuhn, M; Fitting, J W

1995-04-01

 
 
 
 
221

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

LENUS (Irish Health Repository)

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.

Mullins, G M

2012-02-03

222

Ultrasound-guided supraclavicular brachial plexus block in upper limb surgery: outcomes and patient satisfaction.  

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We examined the outcomes and levels of patient satisfaction in 202 consecutive cases of ultrasound-guided supraclavicular brachial plexus block (SBPB) in upper limb surgery performed between September 2007 and March 2010. All blocks were performed by orthopaedic surgeons using ultrasound visualisation with a high-frequency linear probe. The probe was placed in the coronal-oblique plane in the supraclavicular fossa, and the puncture was 'in-plane' from lateral to medial. Most of the blocks were performed with 0.75% ropivacaine/1% lidocaine (1:1), with or without adrenaline in 1:200 000 dilution. In 201 patients (99.5%) the brachial plexus block permitted surgery without conversion to general anaesthesia. The mean procedure time for block was 3.9 min (2 to 12), the mean waiting time for surgery was 34.1 min (10 to 64), the mean surgical time was 75.2 min (6 to 232), and the mean duration of post-anaesthetic analgesia was 437 min (171 to 992). A total of 20 patients (10%) developed a transient Horner's syndrome. No nerve injury, pneumothorax, arterial puncture or systemic anaesthetic toxicity were recorded. Most patients (96.7%) were satisfied with ultrasound-guided SBPB. This study demonstrates the efficacy and safety of ultrasound-guided SBPB for orthopaedic surgery on the upper limb. PMID:24891581

Gamo, K; Kuriyama, K; Higuchi, H; Uesugi, A; Nakase, T; Hamada, M; Kawai, H

2014-06-01

223

Peripheral nerves, tumors, and hybrid PET-MRI.  

Science.gov (United States)

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

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

2013-01-01

224

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

Energy Technology Data Exchange (ETDEWEB)

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.)

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

225

Electrodiagnosis in traumatic brachial plexus injury.  

Science.gov (United States)

Electrodiagnosis (EDX) is a useful test to accurately localize the site, determine the extent, identify the predominant pathophysiology, and objectively quantify the severity of brachial plexopathies. It can also be used to examine muscles not easily assessed clinically and recognize minimal defects. Post-operatively and on follow up studies, it is important for early detection of re-innervation. It can be used intra-operatively to assess conduction across a neuroma, which would help the surgeon to decide further course of action. Localization of the site of the lesion can be very challenging as there may be multiple sites of involvement and hence the electroneuromyographic evaluation must be adequate. The unaffected limb also needs to be examined for comparison. The final impression must be co-related with the type and severity of injury. PMID:23661958

Mansukhani, K A

2013-01-01

226

Ankle-brachial index in HIV infection.  

Science.gov (United States)

Prognosis for patients with the human immunodeficiency virus (HIV) has improved with the introduction of highly active antiretroviral therapy (HAART). Evidence over recent years suggests that the incidence of cardiovascular disease is increasing in HIV patients. The ankle-brachial index (ABI) is a cheap and easy test that has been validated in the general population. Abnormal ABI values are associated with increased cardiovascular mortality. To date, six series of ABI values in persons with HIV have been published, but none was a prospective study. No agreement exists concerning the risk factors for an abnormal ABI, though its prevalence is clearly higher in these patients than in the general population. Whether this higher prevalence of an abnormal ABI is associated with a higher incidence of vascular events remains to be determined. PMID:19397788

Olalla, Julián; Salas, Daniel; de la Torre, Javier; Del Arco, Alfonso; Prada, José Luis; Martos, Francisco; Perea-Milla, Emilio; García-Alegría, Javier

2009-01-01

227

Ankle-brachial index in HIV infection  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Prognosis for patients with the human immunodeficiency virus (HIV has improved with the introduction of highly active antiretroviral therapy (HAART. Evidence over recent years suggests that the incidence of cardiovascular disease is increasing in HIV patients. The ankle-brachial index (ABI is a cheap and easy test that has been validated in the general population. Abnormal ABI values are associated with increased cardiovascular mortality. To date, six series of ABI values in persons with HIV have been published, but none was a prospective study. No agreement exists concerning the risk factors for an abnormal ABI, though its prevalence is clearly higher in these patients than in the general population. Whether this higher prevalence of an abnormal ABI is associated with a higher incidence of vascular events remains to be determined.

Martos Francisco

2009-04-01

228

Resection of Primary Brachial Plexus Tumor via a Modified Supraclavicular Approach.  

Science.gov (United States)

Benign peripheral nerve sheath tumors are generally considered curable lesions, and surgical resection is recommended as the primary line of treatment. When these tumors occur in the brachial plexus, they are most frequently accessed via the supraclavicular approach. Traditional descriptions of this approach have included either transection of sternocleidomastoid (SCM) muscle fibers or disarticulation of the clavicular head of the SCM muscle. This report presents a simple and easy-to-adapt modification of the supraclavicular approach that offers greater preservation of the SCM muscle. The modification primarily consists of the creation of an intramuscular window between the sternal and clavicular heads of the SCM via the splitting and dilation SCM muscle fibers. This technique minimizes the disruption of SCM muscle tissue compared with previous descriptions and may be associated with improved postoperative pain and return to function. PMID:25083372

Tschoe, Christine; Holsapple, James W; Binello, Emanuela

2014-08-01

229

Management of Intrathoracic Benign Schwannomas of the Brachial Plexus  

Science.gov (United States)

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-stage combined supraclavicular incision followed by left video-assisted thoracoscopic surgery. A brachial plexus tumour should be suspected not only in patients with a supraclavicular or cervicomediastinal mass but also in those with intrathoracic apical lesions. A preoperative magnetic resonance imaging study of brachial plexus should be performed in such cases in order to plan the correct surgical approach. PMID:25143855

Negri, Giampiero; Melloni, Giulio; Carretta, Angelo; Ciriaco, Paola; Puglisi, Armando; Zannini, Piero

2014-01-01

230

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

Kátia Torres, Batista; Hugo José de, Araújo.

231

Sensory disturbances and pain complaints after brachial plexus root injury: a prospective study involving 150 adult patients.  

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After injury of the brachial plexus, sensory disturbance in the affected limb varies according to the extent of root involvement. The goal of this study was to match sensory assessments and pain complaints with findings on CT myelo scans and surgical observations. One hundred fifty patients with supraclavicular stretch injury of the brachial plexus were operated upon within an average of 5.4 months of trauma. Preoperatively, upper limb sensation was evaluated using Semmes-Weinstein monofilaments. Pain complaints were recorded for each patient. With lesions affecting the upper roots of the brachial plexus, hand sensation was largerly preserved. Sensory disturbances were identified over a longitudinal bundle on the lateral arm and forearm. In C8-T1 root injuries, diminished protective sensation was observed on the ulnar aspect of the hand. If the C7 root also was injured, sensation in the long finger was impaired. Eighty-four percent of our 64 patients with total palsy reported pain, versus just 47% of our 72 patients with upper type palsies. This rate dropped to 29% in the 14 patients with a lower-type palsy. C8 and T1, when injured, always were avulsed from the cord; when avulsion of these roots was the only nerve injury, pain was absent. Hand sensation was largely preserved in patients with partial injuries of the brachial plexus, particularly on the radial side. Even when T1 was the only preserved root, hand sensation was mostly spared. This indicates that overlapping of the dermatomal zones seems much more widespread than previously reported. PMID:20939002

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio; Loure Iro Chaves, Daniel Preissler

2011-02-01

232

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

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

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

2011-01-15

233

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.)

234

Endovascular stenting of brachial artery occlusion in critical hand ischemia.  

Science.gov (United States)

Critical upper limb ischemia caused by atherosclerosis is uncommon. Endovascular treatment, with angioplasty or stenting, has been successfully performed for subclavian and below the elbow diseases; however, there's a lack of report regarding the treatment of brachial artery disease causing critical hand ischemia. In this article, we describe the treatment of a brachial artery occlusion with endovascular stenting in a patient with chronic upper limb ischemia. PMID:24517984

Nasser, Felipe; Cavalcante, Rafael Noronha; Galastri, Francisco Leonardo; de Amorim, Jorge Eduardo; Telles, Marcus Alexandre Politzer; Travassos, Fabiellen Berzoini; De Fina, Bruna; Affonso, Breno Boueri

2014-08-01

235

Acute brachial neuropathy--electrophysiological study and clinical profile.  

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Acute brachial neuropathy (ABN) is a rare disease, characterized by an acute or subacute onset of pain followed by weakness of shoulder or arm muscles without trauma or traction injury. So the diagnosis of this clinical entity is not easy. The purpose of this study was to analyze retrospectively the ABN in 14 cases focusing on the clinical profile and to evaluate the effectiveness of electrophysiologic study in diagnosis of ABN with a new result helpful in localizing a brachial plexus disorde...

Kim, K. K.

1996-01-01

236

Disseminated cutaneous sporotrichosis.  

Science.gov (United States)

The dimorphic fungus Sporothrix schenckii commonly causes localized cutaneous disease with lymphocutaneous distribution. However, disseminated sporotrichosis occurs predominantly in immunocompromised patients. We report a case of disseminated cutaneous sporotrichosis in a patient with newly diagnosed HIV with a CD4 count of 208. The patient presented with multiple cutaneous and subcutaneous nodules as well as fever and malaise. Tissue culture and skin biopsy confirmed the diagnosis of sporotrichosis. He was started on itraconazole 200mg twice a day with rapid resolution of fever along with cessation of the development of new lesions. PMID:24314777

Chang, Shurong; Hersh, Andrew M; Naughton, Greg; Mullins, Kevin; Fung, Maxwell A; Sharon, Victoria R

2013-11-01

237

Nerve conduction  

Science.gov (United States)

... individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The dendrites are the tree- ... genetic information in the form of DNA. The axon transmits signals away from the cell body to ...

238

Isolated axillary nerve involvement: a case report  

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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.

betul tekin guveli

2013-01-01

239

Rare communication between the musculocutaneous and median nerves in the forearm: its clinical significance.  

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Morphologic classifications of communication between musculocutaneous and median nerves are not based on the distribution and the function of the communicating branch. The authors report a rare case of such a communication with passage of the median nerve through the pronator teres muscle and discuss its clinical significance. The musculocutaneous nerve was divided into a lateral branch that continued to the lateral antebrachial cutaneous nerve and a medial branch that joined the median nerve in the forearm. The authors separated the nerve bundles and noted that the communicating branch derived from the sixth to seventh cervical nerves and supplied nerve fibers to the pronator teres muscle and the proper palmar digital nerve of the thumb. In addition, the median nerve penetrated the humeral head of the pronator teres muscle. Isolated musculocutaneous neuropathy with such a communication may cause unexpected symptoms such as sensory deficit in the palm and muscular weakness of the forearm and the thumb. PMID:25122101

Liu, Hong-Fu; Won, Hyung-Sun; Chung, In-Hyuk; Kim, Seung-Min; Kim, In-Beom

2014-10-01

240

[Perioperative brachial plexus injury caused by hyperabduction of the upper extremity in a patient with Ehlers-Danlos syndrome in the prone position].  

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A 26-year-old woman with Ehlers-Danlos syndrome (EDS) underwent posterior spinal fusion with instrumentation for scoliosis. General anesthesia was maintained using propofol and remifentanil. The procedure was performed examining the motor evoked potential (MEP) and somatosensory evoked potential (SSEP) of the lower extremities with the patient placed in the prone position. The procedure was completed successfully without major cardiovascular or respiratory complications. The duration of anesthesia was 821 min. When drapes were removed, we noticed that the right shoulder was in a hyperabduction position. After emergence from anesthesia, it was observed that the right upper extremity was paralyzed. Thereafter, brachial plexus injury, which may have been due to intraoperative malpositioning, was diagnosed. Brachial plexus injury is the most common among the nerve injuries resulting from intraoperative malpositioning. Patients with EDS are thought to be at high risk for the complications and it has also been reported that patients with joint hypermobility, such as that in EDS or Marfan syndrome, are highly susceptible to nerve injury. Intraoperative monitoring of the MEP and SSEP in the upper extremities should be considered for early detection and prevention of brachial plexus injury in patients with EDS who are thought to be at high risk. PMID:22746029

Ohashi, Nobuko; Furutani, Kenta; Ishii, Hideaki; Baba, Hiroshi

2012-06-01

 
 
 
 
241

Secondary cutaneous carcinomatosis  

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Full Text Available Secondary cutaneous carcinomatosis may be the primary menifestation of malignancies. Due to the help of modern investigative techniques primary malignant sites can be detected. But in many circumstances the primary site can not be detected in spite of available investigation. The cases presented here clearly show that the secondary cutaneous menifestation may be the first clue for detecting a hidden primary maligmancy.

Kotokey R

1996-01-01

242

Posterior branch of the axillary nerve transfer to the lateral triceps branch for restoration of elbow extension: case report.  

Science.gov (United States)

We report a nerve transfer to the triceps using the posterior branch of the axillary nerve to restore elbow extension in an 18-year-old woman with a C7-T1 injury. Elbow extension strength improved from M0 to M4, whereas deltoid strength was minimally affected. Her Disabilities of the Arm, Shoulder and Hand score improved 14 points. This method may be considered for restoring triceps function in lower pattern brachial plexus injury. PMID:23707014

Klika, Brian J; Spinner, Robert J; Bishop, Allen T; Kircher, Michelle F; Shin, Alexander Y

2013-06-01

243

A Soldier with Lateral Antebrachial Cutaneous Neuropathy: Malingering or Fact?  

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Introduction: Compression of the lateral antebrachial cutaneous nerve (LACN) is a rarely recognized but clearly definable syndrome. It should be taken into account in the differential diagnosis in the context of soldiers who are suspected of avoiding military duties by assuming the sick role. In this report, we describe a 23-year-old soldier who presented with avoidance of elbow extension due to a burning pain in the right forearm induced by extension. LACN neuropathy, which occurred after ph...

Necmettin Y?ld?z; Bar?? K?l?nç; Füsun Ard?ç

2010-01-01

244

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

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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.

Beyaz?t Zencirci

2007-08-01

245

Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery.  

Science.gov (United States)

In a prospective controlled trial to compare conventional interscalene brachial plexus block (ISBPB) using anatomic landmarks and electro-stimulation with a combined technique of ultrasound guidance followed by nerve stimulation, 60 patients were randomized into 2 matched equal groups: Group A using nerve stimulation (NS) alone and Group B using the combination of ultrasound and NS. The time to detect the plexus (3.9 ± 4 min in Group A and 3.3 ± 1.4 min in Group B) was not significantly different. We needed to reposition the needle once (n = 13) or twice (n = 4) in Group B. First-shot motor response was achieved in all but one patient in Group A; here we were only able to locate the plexus by use of ultrasound. None of the patients needed general anaesthesia. There were no significant differences between postoperative pain, motor power, or patient's satisfaction. ISBPB seems similarly effective using electro-stimulation and ultrasound if performed by experienced anesthesiologists. PMID:22391670

Salem, Mohamed H; Winckelmann, Jörg; Geiger, Peter; Mehrkens, Hans-Hinrich; Salem, Khaled H

2012-08-01

246

Reversible brachial plexopathy following primary radiation therapy for breast cancer  

International Nuclear Information System (INIS)

Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen

247

Reversible brachial plexopathy following primary radiation therapy for breast cancer  

Energy Technology Data Exchange (ETDEWEB)

Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen.

Salner, A.L.; Botnick, L.E.; Herzog, A.G.; Goldstein, M.A.; Harris, J.R.; Levene, M.B.; Hellman, S.

248

Distribution of Intercostal Nerves in Musculis Rectus Abdominis  

Directory of Open Access Journals (Sweden)

Full Text Available This study was conducted on 48 specimens of Rectus abdominis muscles for recognition and definition of passage and ramification of lower intercostal nerves. The main results of this study are as follows: 1- The seventh and eight intercostal nerves penetrated to posterior layer of the Rectus sheath while other intercostal nerves perforated to dorsal layer of internal oblique abdominis aponeurosis. 2- Distance between lateral border of the Rectus abdominis muscle till penetrate point for all nerves were 18±1 mm, but the subcostal nerve was 16±1 mm. 3- Each intercostal nerve was ramified in thickness of muscle and formed many branches that maximum of this was middle longitudinal region and minimum of that was lateral longitudinal region. In addition we did not observe the nerve anastomosis between intercostal nerves. 4- The lower primary branch of the intercostal nerve after piercing of anterior layer of the Rectus sheath was named anterior cutaneous branch and terminated to abdominal skin. 5- All of intercostal nerves at first was placed right angle to muscle fibers but immediately decrease its and was placed parallel to muscle fibers. 6- The entrance, passage and ramification of intercostal nerves in both male and female cadavers were similar.

A Abdolvahhabi

2001-06-01

249

Cutaneous manifestations of dysproteinemias.  

Science.gov (United States)

A number of cutaneous lesions may represent signs of underlying dysproteinemia. The lesions may result from direct infiltration by plasmacytes and immunoblasts--such as plasmacytomas seen with multiple myeloma--or they may result from indirect effects of the immunoglobulins by a number of different mechanisms. Because the spectrum of cutaneous lesions is so large and at times nonspecific, it is important to keep dysproteinemia in one's differential diagnosis at all times. Careful monitoring of these patients is important since the latency period for the actual development of a plasma cell malignancy may be years. PMID:2502337

Dominey, A M; Tschen, J A

1989-07-01

250

The cutaneous porphyrias.  

Science.gov (United States)

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

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

2014-07-01

251

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

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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.

Reddy Raghunatha

2005-01-01

252

ORIGEN AXILAR DE LA ARTERIA PROFUNDA DEL BRAZO / AXILAR ORIGIN OF THE DEEP BRACHIAL ARTERY  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish RESUMEN: Lesiones de la arteria axilar se debe principalmente a traumatismos penetrantes, aunque puede ocurrir también como consecuencia de traumatismos crónicos debido el uso inadecuado de muletas o por caídas sobre el miembro superior estirado, entre otras causas. La presencia de variaciones arter [...] iales a nivel axilar adquiere importancia ya que hematomas axilares podrían comprimir al plexo braquial y, por ende, producir un déficit neurológico, incluso permanente aún con la descompresión quirúrgica inmediata. Describimos el origen axilar de la arteria profunda del brazo encontrada en un cadáver formolizado, de sexo masculino, adulto disecado en la Disciplina de Anatomía Humana de la Facultad de Medicina, Universidad de La Frontera, Chile. La arteria axilar del miembro superior izquierdo dio origen, distal al nacimiento de la arteria circunfleja humeral posterior, a la arteria profunda del brazo, la cual seguía en dirección al brazo, por delante del tendón del músculo gran dorsal para, posteriormente, emitir la arteria colateral ulnar superior, penetrando en el brazo y siguiendo un trayecto normal junto al nervio radial Abstract in english SUMMARY: Injuries of the axillar artery are mainly due to penetrating traumatisms, although they may also occur as a consequence of chronic traumatisms because of inadequate use of crutches or falls on the stretched upper limb, among other causes. The presence of artery variations at the axillar lev [...] el becomes important since axillar ha ematomas might compress the brachial plexus, thus producing a neurological deficit, even permanent with the immediate surgical decompression. We described the axillar origin of the deep brachial artery found in a formolized adult cadaver of male sex, dissected in the Human Anatomy Discipline of the Faculty of Medicine, Universidad de la Frontera, Chile. The axillar artery of the left upper left limb gave off (distal to the origin of the posterior circumflex humeral artery) to the deep brachial artery. The course of this artery was anterior to the tendon of the Latissimus dorsi muscle where it emitted the later superior collateral ulnar artery, penetrating in the arm and following a normal course together with to the radial nerve

Mariano, del Sol; Enrique, Olave.

253

Cutaneous sympathetic neural responses to body cooling in type 2 diabetes mellitus  

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In humans, sympathetic vasoconstrictor nerves in the skin contribute to resting vascular tone and mediate reflex vasoconstrictor responses to body cooling. Although it is well recognized that type 2 diabetes mellitus (T2DM) is associated with peripheral neurovascular changes, it is unclear to what extent the thermal responsiveness of the cutaneous vasoconstrictor system is altered in individuals with relatively uncomplicated T2DM. We tested the hypothesis that skin sympathetic nerve activity ...

Strom, Nicholas A.; Meuchel, Lucas W.; Mundy, Daniel W.; Sawyer, Jessica R.; Roberts, Shelly K.; Kingsley-berg, Shirley M.; Charkoudian, Nisha

2011-01-01

254

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

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Full Text Available 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 applied anatomy, methodology, complications and limitations have been emphasized. The study concludes that infraclavicular brachial plexus block with coracoid approach is a useful block without complications if practiced with precautions.

Sheetal Shah

2013-01-01

255

The Cutaneous Rabbit Revisited  

Science.gov (United States)

In the cutaneous rabbit effect (CRE), a tactile event (so-called attractee tap) is mislocalized toward an adjacent attractor tap. The effect depends on the time interval between the taps. The authors delivered sequences of taps to the forearm and asked participants to report the location of one of the taps. The authors replicated the original CRE…

Flach, Rudiger; Haggard, Patrick

2006-01-01

256

Cutaneous anthrax (image)  

Science.gov (United States)

Cutaneous anthrax is an infection of the skin caused by the bacterium Bacillus anthracis. The bacteria causes disease when it comes into contact with non-intact skin. During an infection, an initial skin lesion forms then blisters. The blister breaks down ...

257

Cutaneous leishmaniasis in Assam  

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

Baishya B

1996-01-01

258

Cutaneous manifestations of lupus erythematosus.  

Science.gov (United States)

Cutaneous involvement in case of lupus erythematosus (LE) is very frequent and can present both specific or non-specific manifestations. LE specific lesions can be classified in acute, subacute and chronic cutaneous LE lesions. All of them can be localized and generalized. The LE non specific lesions are not exclusive to LE disease but are often seen in patients with active systemic LE. All the cutaneous lesions are often induced or aggravated by ultraviolet light, in fact they are usually localized in sun-exposed areas. Acute cutaneous LE is associated with systemic disease, subacute cutaneous LE has been considered a subset of its own since 1979 when it was first described, chronic cutaneous LE is the most common subtype of LE. Although less frequently also the chronic cutaneous lesions can be an aspect of systemic LE (25%). PMID:25077888

Parodi, A; Cozzani, E

2014-10-01

259

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

Science.gov (United States)

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.

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

2006-02-01

260

Dissection of intercostal nerves by means of assisted video thoracoscopy: experimental study.  

Science.gov (United States)

In total brachial plexus preganglionic lesions (C5-C6-C7-C8 and T1) different extraplexual neurotizations are indicated for partial motor function restitution. Mostly for the flexion of the elbow. Neurotization with intercostal nerves (ICN) to musculocutaneous nerve has been known and accepted during many years with different results 2 - 5. The customary technique as described by various authors is carried out by means of a large submammary incision to harvest three or four intercostal nerves (Figure 1). Then are connected by direct suture or grafts to the musculocutaneous nerve or its motor branches 6 - 7. In this article the authors described the possibility of dissection intercostal nerves by means of assisted video thoracoscopy. (VATS-videdo assisted thoracic surgery). PMID:23406448

Cáceres, Juan Pablo; Palazzi, Santos; Palazzi, Jose Luis; Llusá, Manuel; M, Sanz; S, Varci

2013-01-01

 
 
 
 
261

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.)

262

Reconstruction of brachial pressure from finger arterial pressure during orthostasis  

DEFF Research Database (Denmark)

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

Bogert, Lysander W J; Harms, Mark P M

2004-01-01

263

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

LENUS (Irish Health Repository)

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.

O'Donnell, Brian

2010-09-01

264

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

Science.gov (United States)

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

Mirilas, Petros; Skandalakis, John E

2010-03-01

265

Adult motor axons preferentially reinnervate predegenerated muscle nerve.  

Science.gov (United States)

Preferential motor reinnervation (PMR) is the tendency for motor axons regenerating after repair of mixed nerve to reinnervate muscle nerve and/or muscle rather than cutaneous nerve or skin. PMR may occur in response to the peripheral nerve pathway alone in juvenile rats (Brushart, 1993; Redett et al., 2005), yet the ability to identify and respond to specific pathway markers is reportedly lost in adults (Uschold et al., 2007). The experiments reported here evaluate the relative roles of pathway and end organ in the genesis of PMR in adult rats. Fresh and 2-week predegenerated femoral nerve grafts were transferred in correct or reversed alignment to replace the femoral nerves of previously unoperated Lewis rats. After 8 weeks of regeneration the motoneurons projecting through the grafts to recipient femoral cutaneous and muscle branches and their adjacent end organs were identified by retrograde labeling. Motoneuron counts were subjected to Poisson regression analysis to determine the relative roles of pathway and end organ identity in generating PMR. Transfer of fresh grafts did not result in PMR, whereas substantial PMR was observed when predegenerated grafts were used. Similarly, the pathway through which motoneurons reached the muscle had a significant impact on PMR when grafts were predegenerated, but not when they were fresh. Comparison of the relative roles of pathway and end organ in generating PMR revealed that neither could be shown to be more important than the other. These experiments demonstrate unequivocally that adult muscle nerve and cutaneous nerve differ in qualities that can be detected by regenerating adult motoneurons and that can modify their subsequent behavior. They also reveal that two weeks of Wallerian degeneration modify the environment in the graft from one that provides no modality-specific cues for motor neurons to one that actively promotes PMR. PMID:23933577

Abdullah, M; O'Daly, A; Vyas, A; Rohde, C; Brushart, T M

2013-11-01

266

Brachial plexopathy after postoperative radiotherapy of breast cancer patients--A long-term follow-up  

International Nuclear Information System (INIS)

In 1963-1965 a group of 71 patients operated on for breast cancer with total mastectomy and axillary clearance were given aggressive postoperative telecobalt therapy to the axillary, supraclavicular and parasternal lymph node regions. The prescribed dose to these lymph node regions was 44 Gy in 11 fractions. Only two of the three fields were treated per day. Retrospective dose calculations showed that the total dose in the brachial plexus from the axillary and supraclavicular fields was c. 57 Gy in 16-17 fractions over 3-4 weeks. After a few years, symptoms and signs of brachial plexus injury appeared in many patients, which was reported in some early papers. The cohort has now been followed-up to 34 years. As expected, there was progression of both prevalence and severity of the late effects between 5 and 34 years and 11 of 12 patients who are still alive have paralysis of their arms. The neuropathy seems to be closely linked to fibrosis around the nerve trunks. The use of large daily fractions, in some cases combined with hot spots from overlapping fields, was certainly the cause of the complication

267

Brachial plexopathy after postoperative radiotherapy of breast cancer patients--A long-term follow-up  

Energy Technology Data Exchange (ETDEWEB)

In 1963-1965 a group of 71 patients operated on for breast cancer with total mastectomy and axillary clearance were given aggressive postoperative telecobalt therapy to the axillary, supraclavicular and parasternal lymph node regions. The prescribed dose to these lymph node regions was 44 Gy in 11 fractions. Only two of the three fields were treated per day. Retrospective dose calculations showed that the total dose in the brachial plexus from the axillary and supraclavicular fields was c. 57 Gy in 16-17 fractions over 3-4 weeks. After a few years, symptoms and signs of brachial plexus injury appeared in many patients, which was reported in some early papers. The cohort has now been followed-up to 34 years. As expected, there was progression of both prevalence and severity of the late effects between 5 and 34 years and 11 of 12 patients who are still alive have paralysis of their arms. The neuropathy seems to be closely linked to fibrosis around the nerve trunks. The use of large daily fractions, in some cases combined with hot spots from overlapping fields, was certainly the cause of the complication.

Johansson, Silvia; Svensson, Hans; Larsson, Lars-Gunnar; Denekamp, J. [Umea Univ. (Sweden). Dept. of Oncology and Radiation Physics

2000-07-01

268

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

Science.gov (United States)

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 toxicity such as vitamin B12 deficiency. Our findings suggest that loss of peripheral nerve fibers is an intrinsic feature of PD and that peripheral nerve changes may reflect the two types of central alpha-synuclein-related PD pathology, namely neuronal death and axonal degeneration. 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

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

2014-07-01

269

Somatosensory evoked potentials following nerve and segmental stimulation do not confirm cervical radiculopathy with sensory deficit.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Twenty eight patients with unilateral cervical radiculopathy were studied by somatosensory evoked potentials (SEPs) from nerve stimulation at the wrist and from skin stimulation at the first, third or fifth finger depending on the root involved. In order to evaluate the reliability of various "radicular SEP patterns" as described in the literature, absolute latencies and side-to-side differences of the brachial plexus component from the supraclavicular fossa (N9), the medullary component (N13...

Schmid, U. D.; Hess, C. W.; Ludin, H. P.

1988-01-01

270

Update on cutaneous tuberculosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

271

Update on cutaneous tuberculosis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

272

Update on cutaneous tuberculosis*  

Science.gov (United States)

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, it 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. PMID:25387498

Dias, Maria Fernanda Reis Gavazzoni; Bernardes Filho, Fred; Quaresma, Maria Victoria; do Nascimento, Leninha Valerio; Nery, Jose Augusto da Costa; Azulay, David Rubem

2014-01-01

273

[Cutaneous tuberculosis: case report].  

Science.gov (United States)

Cutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It is not very frequent and particularly difficult to diagnose. It incidence ranges between 1.5 and 4% of all extrapulmonary tuberculosis, according to bibliography. The clinic presentations depend on the arrival via of the bacillus to the skin, the patient's immune state and the environment. We show a cutaneous tuberculosis on a child with chronic dermatologic lesions, with torpid evolution, without response to treatments; the skin biopsy showed caseous granulomas. The aim is to show a patient with an infrequent clinic presentation of this disease, to emphasize the importance of an early recognition and treatment, avoiding the appearance of complications and sequels. PMID:24862824

Bisero, Elsa; Luque, Graciela; Melillo, Karina; Favier, María Inés; Zapata, Alejandra; Cuello, María Soledad

2014-06-01

274

Optic Nerve Pit  

Science.gov (United States)

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

275

Nerve conduction velocity  

Science.gov (United States)

Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... normal body temperature. Being too cold slows nerve conduction. Tell your doctor if you have a cardiac ...

276

Cutaneous drug delivery: an update.  

Science.gov (United States)

Cutaneous delivery of therapeutics represents a proven and attractive option for treating a variety of dermatologic conditions with minimal systemic side effects. Although there have been many innovations in drug delivery systems, the number of effective cutaneous drugs remains small, primarily because of the stratum corneum permeability barrier. Overcoming this barrier safely and reversibly to deliver large hydrophilic drugs cutaneously is one of the major challenges in the field of dermatologic therapy. PMID:24326566

Tran, Thanh-Nga T

2013-12-01

277

US imaging of the musculocutaneous nerve  

Energy Technology Data Exchange (ETDEWEB)

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

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

2011-05-15

278

Nerve conduits for peripheral nerve surgery.  

Science.gov (United States)

Autologous nerve grafts are the current criterion standard for repair of peripheral nerve injuries when the transected nerve ends are not amenable to primary end-to-end tensionless neurorrhaphy. However, donor-site morbidities such as neuroma formation and permanent loss of function have led to tremendous interest in developing an alternative to this technique. Artificial nerve conduits have therefore emerged as an alternative to autologous nerve grafting for the repair of short peripheral nerve defects of less than 30 mm; however, they do not yet surpass autologous nerve grafts clinically. A thorough understanding of the complex biological reactions that take place during peripheral nerve regeneration will allow researchers to develop a nerve conduit with physical and biological properties similar to those of an autologous nerve graft that supports regeneration over long nerve gaps and in large-diameter nerves. In this article, the authors assess the currently available nerve conduits, summarize research in the field of developing these conduits, and establish areas within this field in which further research would prove most beneficial. PMID:24867724

Pabari, Amit; Lloyd-Hughes, Hawys; Seifalian, Alexander M; Mosahebi, Ash

2014-06-01

279

21 CFR 882.1320 - Cutaneous electrode.  

Science.gov (United States)

...2010-04-01 2010-04-01 false Cutaneous electrode. 882.1320 Section 882...Neurological Diagnostic Devices § 882.1320 Cutaneous electrode. (a) Identification. A cutaneous electrode is an electrode that is...

2010-04-01

280

Use of somatosensory evoked potentials to detect and prevent impending brachial plexus injury during surgical positioning for the treatment of supratentorial pathologies.  

Science.gov (United States)

Somatosensory evoked potentials (SSEPs) are widely utilized for the intraoperative detection and prevention of nerve conduction injuries. Their use in identifying position-related injuries to the brachial plexus in patients undergoing supine craniotomies for the treatment of supratentorial pathology is not well documented. This case series describes three instances of unilateral upper extremity SSEP changes in patients positioned for supine craniotomies. In all three cases SSEP responses improved after repositioning. None of the patients exhibited new neurological deficits post-operatively. This case series highlights the importance of vigilant monitoring in the period after final positioning and demonstrates the usefulness of SSEPs as a tool to aid in the early detection and prevention of impending position-related nerve injury. PMID:25351034

La Neve, Joseph E; Zitney, Gregory P

2014-09-01

 
 
 
 
281

Acromioclavicular joint dislocation with associated brachial plexus injury.  

Science.gov (United States)

We present the case of a 32-year-old female who sustained a left acromioclavicular (AC) joint type V injury and brachial plexus injury. The patient's AC joint injury was identified 6?days after she was involved in a motorbike accident where she sustained multiple other injuries. She required operative fixation of the AC joint using a locking compression medial proximal tibial plate. At 3?months post operatively, the patient was found to have a subluxed left shoulder as a result of an axonal injury to the upper trunk of the brachial plexus. In addition, the tibial plate had cut out. The plate was subsequently removed. At 8?months the glenohumeral articulation had been restored and the patient had clinically regained significant shoulder function. After 15?months the patient was pain free and could complete all her activities of daily living without impediment. She returned to playing competitive pool after 24?months. PMID:24855076

Gallagher, Charles Alexander; Blakeney, William; Zellweger, René

2014-01-01

282

Massive pneumorrhachis, pneumocephalus and pneumoopticus following thoracic trauma and avulsion of the brachial plexus: case report and review of the literature.  

Science.gov (United States)

A 41-year-old man with injury of right half of the thorax, fractures of the left crural bones and paralysis of the right upper limb was admitted to our hospital. A CT examination at admission revealed bilateral pulmonary contusion and bilateral fluid- and pneumothorax. In addition pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumorrhachis at the cervicothoracic transition was demonstrated. Abnormal findings in the skull and brain were not revealed. The fifth day after admission repeated CT examination demonstrated extensive frontal pneumocephalus on the right, presence of air in several cisterns and in the right optic nerve sheaths (pneumoopticus). Right frontal craniotomy was performed, dura mater was incised and air was evacuated. Rapid regression of pneomocephalus was evident postoperatively. The tenth day after admission MRI of the cervical spine and brachial plexus was performed. At the level of the C7 and C8, nerve roots pneumomenigocele and a nerve retracting ball indicating the presence of a nerve root injury were discernible. This case demonstrated that severe thoracic blunt trauma leads to acute increase of intrathoracic pressure with concomitant fluid- and pneumothorax, pneumomediastinum and pneumopericard. From the mediastinum air propagated subcutaneously. Disrupted cervical dural sheaths resulted in leakage of cerebrospinal fluid and entry of air from mediastinum to subdural and subarachnoid spinal and cranial space and to the subarachnoid space of the optic nerve. PMID:21470500

Derner, M; Drugová, B; Ho?ejší, L; Skvára, D; Druga, R

2011-01-01

283

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.)

284

Delayed presentation of a traumatic brachial artery pseudoaneurysm.  

LENUS (Irish Health Repository)

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.

Forde, James C

2009-09-01

285

Trapezius transfer to treat flail shoulder after brachial plexus palsy  

Directory of Open Access Journals (Sweden)

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

Diaz Humberto

2007-01-01

286

The Relationship between Multiple Health Behaviours and Brachial Artery Reactivity  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background. The effects of smoking, alcohol consumption, obesity, and a sedentary lifestyle on endothelial function (EF) have only been examined separately. The relative contributions of these behaviours on EF have therefore not been compared. Purpose. To compare the relative associations between these four risk factors and brachial artery reactivity in the same sample. Methods. 328 patients referred for single-photon emission computed tomography (SPECT) exercise stress tests completed a nucl...

Gordon, Jennifer L.; Lavoie, Kim L.; André Arsenault; Bernard Meloche; Blaine Ditto; Campbell, Tavis S.; Bacon, Simon L.

2012-01-01

287

Delivery factors for brachial plexus palsy by newborns  

Directory of Open Access Journals (Sweden)

Full Text Available Brachial plexus injuries represent a low percentage of delivery complications. Most newborns fully recover from the injury, very few retain a permanent neurological deficit whereas some remain unnoticed. An objective of this study was to establish delivery factors for brachial plexus palsy at the Clinic for Gynecology and Obstetrics and relation between the deficits with length of delivery, the length of delivery periods, induction of delivery and surgical interventions at delivery. The analysed group involved 90 newborn babies with an injury of brachial plexus made at the delivery in the period between 01.01.1996 and 31.12.2005. The controlled group included 90 newborns randomly selected. The comparison was made using an ?2 test. The incidence of injuries of plexus brachialis was 1.72 per 1,000 newborns. Analysing the length of delivery there was no difference found between the analysed and controlled group (p > 0.05. In the group of newborns with the injury of brachial plexus it was found that the second delivery period was significantly shorter (p < 0.01. In the analysed group 89 (98.8% newborn babies were delivered vaginally and one (1.2% was delivered by the cesarean section. 13 newborns (14.4% from the analysed group were delivered with application of vacuum extractor and in the controlled group it was the case with one (1.2% newborn baby (p < 0.01. The delivery of 98.8% newborns from the analysed group started spontaneously and two deliveries (1.2% were induced. Risk factors for injuries of plexus brachialis in newborns at the Clinic for Gynaecology and Obstetrics of the University Clinical Centre Tuzla include shortened second delivery period and completion of deliveries applying the vacuum extractor.

D. Bali?

2007-02-01

288

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

Science.gov (United States)

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 PMID:25360196

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

2014-01-01

289

Association Between Atherosclerosis in Carotid Artery and Elastic Modulus of Brachial Artery  

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Background: Common carotid arterial stiffness can be assessed during carotid arterial ultrasonography, but its association with brachial stiffness, a well-defined cardiovascular risk factor, has not been clarified. The aim of this study was to examine the relationship between common carotid artery and brachial artery stiffness. Methods: The static pressure-strain elastic modulus of the common carotid and brachial arteries were evaluated in 40 men with 15 healthy carotids, 15 mild carotid sten...

Manijhe Mokhtari-Dizaji; Tavvos Rahmani-Cherati; Masome Gity

2007-01-01

290

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.  

Science.gov (United States)

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. Moreover, neurogenic pain after amputation and its treatment with mirror therapy were shown to be followed by dramatic decrease in phantom limb pain. Finally clinical experiences on surgical techniques to repair avulsed spinal nerve root and the motoric as well as sensoric regain of function were presented. PMID:21629875

Sköld, Mattias K; Svensson, Mikael; Tsao, Jack; Hultgren, Thomas; Landegren, Thomas; Carlstedt, Thomas; Cullheim, Staffan

2011-01-01

291

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

Gessica Ariane M, Cruz; Marta, Adami.

2010-10-01

292

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

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

Gessica Ariane M Cruz

2010-10-01

293

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

Gessica Ariane M, Cruz; Marta, Adami.

294

Cutaneous sarcoidosis without systemic manifestations  

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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.

Mohanty Rajesh

2009-01-01

295

Cutaneous leishmaniasis in North Dakota.  

Science.gov (United States)

In the United States, autochthonous cutaneous leishmaniasis caused by infection with Leishmania mexicana has been reported from Texas and Oklahoma. Here, we describe a child with 2 new features: cutaneous infection acquired outside of the south-central United States (in North Dakota) and infection caused by Leishmania donovani species complex. PMID:24850800

Douvoyiannis, Miltiadis; Khromachou, Tamim; Byers, Norman; Hargreaves, James; Murray, Henry W

2014-09-01

296

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

International Nuclear Information System (INIS)

.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.

297

Cutaneous and mucocutaneous leishmaniasis.  

Science.gov (United States)

Tegumentary leishmaniases are caused by approximately 15 species of protozoa of the genus Leishmania. They prevail in tropical and subtropical areas of the Old and New World but human mobility also makes them a medical problem in nonendemic areas. Clinical manifestations may comprise cutaneous and mucocutaneous forms that may be localized, disseminated, or diffuse in distribution and may differ in Old and New World leishmaniases. Diagnosis and treatment vary according to the clinical manifestations, geographic area, and Leishmania species involved. This article highlights the diversity and complexity of tegumentary leishmaniases, which are worsened by human immunodeficiency virus/Leishmania coinfection. PMID:22632640

Goto, Hiro; Lauletta Lindoso, José Angelo

2012-06-01

298

Indigenous cutaneous leishmaniasis  

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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.

Muhammed K

1990-01-01

299

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

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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

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

2013-12-01

300

Normal tissue tolerance to external beam radiation therapy: Peripheral nerves  

International Nuclear Information System (INIS)

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

 
 
 
 
301

Adverse cutaneous drug reaction  

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Full Text Available In everyday clinical practice, almost all physicians come across many instances of suspected adverse cutaneous drug reactions (ACDR in different forms. Although such cutaneous reactions are common, comprehensive information regarding their incidence, severity and ultimate health effects are often not available as many cases go unreported. It is also a fact that in the present world, almost everyday a new drug enters market; therefore, a chance of a new drug reaction manifesting somewhere in some form in any corner of world is unknown or unreported. Although many a times, presentation is too trivial and benign, the early identification of the condition and identifying the culprit drug and omit it at earliest holds the keystone in management and prevention of a more severe drug rash. Therefore, not only the dermatologists, but all practicing physicians should be familiar with these conditions to diagnose them early and to be prepared to handle them adequately. However, we all know it is most challenging and practically difficult when patient is on multiple medicines because of myriad clinical symptoms, poorly understood multiple mechanisms of drug-host interaction, relative paucity of laboratory testing that is available for any definitive and confirmatory drug-specific testing. Therefore, in practice, the diagnosis of ACDR is purely based on clinical judgment. In this discussion, we will be primarily focusing on pathomechanism and approach to reach a diagnosis, which is the vital pillar to manage any case of ACDR.

Nayak Surajit

2008-01-01

302

The significance of diagnostic MRI for visualisation of trauma-induced cervical nerve root avulsion. Case report; Die Bedeutung der MRT-Diagnostik zur Darstellung traumatisch bedingter zervikaler Wurzelausrisse. Kasuistik  

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The article is intended to show the value of MRI for diagnostic visualisation and evaluation of posttraumatic nerve root avulsion as a brachial plexus injury. (orig./MG) [Deutsch] Das Ziel der Arbeit besteht in der Darstellung des Wertes der MRT-Diagnostik bei der Abklaerung traumatischer Wurzelausrisse im Bereich des Plexus brachialis. (orig./MG)

Muth, C.P. [Carl-Thiem-Klinikum, Cottbus (Germany). Inst. fuer Radiologie; Biemelt, F. [Carl-Thiem-Klinikum, Cottbus (Germany). Inst. fuer Radiologie; Kamenz, M. [Carl-Thiem-Klinikum, Cottbus (Germany). Inst. fuer Radiologie

1996-11-01

303

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)

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

MattiasK.Sköld

2011-05-01

304

Nerve fibers in lumbar spine structures and injured spinal roots express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2.  

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STUDY DESIGN: This prospective study examined the innervation of lumbar spine in tissues from patients with lower back pain and spine nerve roots from patients with traumatic brachial plexus injuries. OBJECTIVES: To demonstrate the presence of nerve fibers in lumbar spine structures and spine nerve roots, and to determine whether they express the sensory neuron-specific sodium channels SNS/PN3 and NaN/SNS2. SUMMARY OF BACKGROUND DATA: The anatomic and molecular basis of low back pain and scia...

Bucknill, At; Coward, K.; Plumpton, C.; Tate, S.; Bountra, C; Birch, R.; Sandison, A.; Hughes, Sp; Anand, P.

2002-01-01

305

Constituent ratio of motor fibers from the C5-C7 spinal nerves in the radial nerve is greater in pup rats than in adult rats.  

Science.gov (United States)

Clinically, injuries of C5-C7 of the brachial plexus cause falling of the wrist and fingers in infants but not in adults unless 4 consecutive spinal nerves are injured. The purpose of this study was to compare the constituent difference of spinal nerves in the radial nerve between pup and adult rats.A group of 16 pup rats and a group of 16 adult rats were each divided into 2 groups of 8 (P1 and A1 groups, C5-C6 were divided; P2 and A2 groups, C5-C7 were divided]). A nerve conduction study and histological examination were performed to evaluate radial nerve innervation to the extensor digitorum communis muscle after dividing the spinal nerves. Retrograde tracing with 5% cholera toxin B for anterior horn motoneurons of the spinal cord innervating the radial nerve was performed in 8 pup rats and 8 adult rats. Results showed that the division of C5-C7 caused more significant damage to radial nerve innervation to the extensor digitorum communis in pups than in adults, although the division of C5-C6 did not. In pups, the percentages (median with interquartile) of anterior horn motoneurons of the spinal cord innervating the radial nerve were 36.4 (28.3-38.5) in C5-C6, 28.1 (24.5-32.5) in C7, and 37.5 (36.5-39.3) in C8-T1. In adults, they were 24.2 (23.6-27.8) in C5-C6, 21.8 (19.5-26.3) in C7, and 50.7 (48.7-55.5) C8-T1.This study implies that C7 innervation in the radial nerve in humans may be more critical to the function of this nerve in infants than in adults. PMID:22691665

Nie, Mingbo; Chen, Liang; Gu, Yudong

2012-06-01

306

Cutaneous Leishmaniasis with HIV.  

Science.gov (United States)

Cutaneous Leishmaniasis (CL) is a vector borne disease caused by various species of the Leishmania parasite. CL is endemic in the province of Balochistan in Pakistan. In certain instances a Human Immunodeficiency Virus (HIV)-related immunocompromised is associated with atypical clinical presentation and occurrence of reactivated lesions of CL. Such presentations respond poorly to the standard treatment and frequent relapses are noted. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which responded to meglumine antimoniate. Due to the fact that CL is endemic in Balochistan, we did not consider HIV infection as a causative organism. It was their presentation with history of weight loss and fever that prompted Enzyme-linked Immunosorbent Assay (ELISA) tests for HIV, which turned out to be positive. CL is becoming visible as an opportunistic infection associated with HIV/AIDS and may even be the first symptom in HIV positive patients in an endemic area. PMID:24906285

Talat, Humaira; Attarwala, Sharmeen; Saleem, Mubasshir

2014-05-01

307

Cutaneous leishmaniasis: an overview.  

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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.

Hepburn N

2003-01-01

308

Cutaneous T cell lymphoma.  

Science.gov (United States)

Cutaneous T cell lymphoma, previously known as mycosis fungoides, presents as either an aggressive disease (tumeur d'emblee type and the Sézary syndrome type) or a prolonged disease which evolves through patch, plaque, and tumor stages. Erythroderma is present either from the start or develops later in the disease process. Its incidence in the United States more than doubled from 1973 to 1984 (from 0.19 to 0.42 cases per 100,000 population). Staging classifications are being refined to reflect increasing knowledge of important prognostic indicators, e.g., absence or presence of lymph node involvement, pattern of lymph node involvement, and absence or presence of visceral disease. A number of newer treatment modalities is being investigated including the retinoids and ultraviolet A photopheresis. PMID:2662058

Worobec-Victor, S M

1989-05-01

309

Common cutaneous parasites.  

Science.gov (United States)

This issue provides a clinical overview of Common Cutaneous Parasites focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic. PMID:25178582

Markova, Alina; Kam, Sarah A; Miller, Daniel D; Lichtman, Michael K

2014-09-01

310

Brachial neuritis with bilateral diaphragmatic paralysis following herpes zoster: a case report.  

Science.gov (United States)

We present a case of supine respiratory failure due to a bilateral diaphragmatic paralysis associated with brachial neuritis secondary to thoracic herpes zoster. Fluoroscopy in both the standing and supine positions revealed bilateral diaphragmatic paralysis accentuated in the supine position. To our knowledge, this is the first case of thoracic herpes zoster associated with brachial neuritis and bilateral diaphragmatic paralysis. PMID:18525424

Hoque, Romy; Schwendimann, Robert N; Liendo, Cesar; Chesson, Andrew L

2008-06-01

311

Brachial plexitis preceding encephalomyelitis in a patient with West Nile virus infection.  

Science.gov (United States)

We describe the case of a 54-year-old woman with West Nile virus infection presenting with painful brachial plexitis and radiculitis that preceded the more typically associated symptoms of meningoencephalitis. Physicians should be aware that West Nile virus infection can present with painful brachial plexitis. PMID:24311412

Scholz, Sonja; Kaas, Bonnie; Simpkins, Alexis; Lyons, Jennifer; Venkatesan, Arun; Probasco, John

2013-01-01

312

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.)

313

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)

314

Contralateral lower trapezius transfer for restoration of shoulder external rotation in traumatic brachial plexus palsy: a preliminary report and literature review.  

Science.gov (United States)

The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°-110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12-86). No donor site deficit was seen in any patient. PMID:24212416

Satbhai, N G; Doi, K; Hattori, Y; Sakamoto, S

2014-10-01

315

Schwann Cell Engraftment Into Injured Peripheral Nerve Prevents Changes in Action Potential Properties  

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Peripheral nerve injury results in changes in action potential waveform, ion channel organization, and firing properties of primary afferent neurons. It has been suggested that these changes are the result of reduction in basal trophic support from skin targets. Subcutaneous injections of Fluro-Gold (FG) in the hind limb of the rat were used to identify cutaneous primary afferent neurons. Five days after FG injection, sciatic nerves were ligated and encapsulated in a silicon tube allowing neu...

Yu, Kewei; Kocsis, Jeffery D.

2005-01-01

316

Potential axillary nerve stretching during RSA implantation: an anatomical study.  

Science.gov (United States)

Clinical and subclinical neurological injury after reverse shoulder arthroplasty (RSA) may jeopardize functional outcomes due to the risk of irreversible damage to the axillary nerve. We proposed a simple anatomical study in order to assess the macroscopic effects on the axillary nerve when lowering the humerus as performed during RSA implantation. We also measured the effect on the axillary nerve of a lateralization of the humerus. Between 2011 and 2012, cadaveric dissections of 16 shoulder specimens from nine fresh human cadavers were performed in order to assess the effects on the axillary nerve after the lowering and lateralization of the humerus. We assessed the extent of stretching of the axillary nerve in four positions in the sagittal plane [lowering of the humerus: great tuberosity in contact with the acromion (position 1), in contact with the upper (position 2), middle (position 3) and lower rim of the glenoid (position 4)] and three positions in the frontal plane [lateralization of the humerus: humerus in contact with the glenoid (position 1), humerus lateralized 1 cm (position 2) and 2 cm (position 3)]. When the humerus was lowered, clear macroscopical changes appeared below the middle of the glenoid (the highest level of tension). As regards the lateralization of the humerus, macroscopic study and measurements confirm the absence of stretching of the nerve in those positions. Lowering of the humerus below the equator of the glenoid changes the course and tension of the axillary nerve and may lead to stretching and irreversible damage, compromising the function of the deltoid. Improvements in the design of the implants and modification of the positioning of the glenosphere to avoid notching and to increase mobility must take into account the anatomical changes induced by the prosthesis and its impact on the brachial plexus. Level of Evidence and study type Level IV. PMID:24497198

Marion, Blandine; Leclère, Franck Marie; Casoli, Vincent; Paganini, Federico; Unglaub, Frank; Spies, Christian; Valenti, Philippe

2014-09-01

317

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

318

Orbital metastasis from cutaneous melanoma  

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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.

Samer Elsherbiny

2012-01-01

319

Prurigo Nodularis With Cutaneous Horn  

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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.

Thadeus Joseph

1997-01-01

320

Optic Nerve Imaging  

Science.gov (United States)

... Tomography (OCT) , which measures the reflection of laser light much like an ultrasound measures the reflection of sound, can directly measure the thickness of the nerve fiber layer and create a three dimensional representation of the optic nerve. ...

 
 
 
 
321

The clinical course of non-operated peripheral nerve tumor  

International Nuclear Information System (INIS)

Peripheral nerve tumors are routinely removed by operation, however, complete enucleation is not always possible with schwannomas. Even if such tumors were completely enucleated, neurological deficits may still appear. Recently, a few studies have described the clinical course of spinal cord tumors but, there has been no study showing the clinical course of non-operated peripheral nerve tumors. This study reviewed the clinical course of non-operated peripheral nerve tumors. Ten tumors diagnosed as peripheral nerve tumors by clinical findings and MR images (MRI) were studied semiannually. The patients included seven males and three females with a mean age of 59 (range 20 to 89) years at final follow-up. The involved nerves were the radial nerve in four cases, the brachial plexus in three cases, and the median nerve, the femoral nerve, the tibial nerve in one case each. The mean follow-up interval was 43 (range 24-81) months. One patient was followed for four years and three patients were followed over six years. The initial complaint was of a palpable mass in eight cases. The mean time from clinical presentation to the first examination was 16.1 (range 1-48) months. No tumors caused sensory deficit although two tumors caused objective muscle weakness by Medical Research Council (MRC) grading. All ten tumors demonstrated a positive Tinel's sign over the mass. The mean tumor size on MRI was 36.8 (range 20-85) mm. In this study, there was no significant change of the clinhere was no significant change of the clinical findings and the size on MRI in the peripheral nerve tumors in the follow-up of over two years. All ten tumors were static in size when examined by MRI. Only one of the ten patients experienced slightly increased pain. We conclude that the decision to operate on peripheral nerve tumors should be considered more carefully, since in patients with no or little symptoms, tumor size and symptoms did not increase. (author)

322

Characterization of a chondroitin sulfate hydrogel for nerve root regeneration  

Science.gov (United States)

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.

Conovaloff, Aaron; Panitch, Alyssa

2011-10-01

323

Damage to the superficial peroneal nerve in operative treatment of fibula fractures: straight to the bone? Case report and review of the literature.  

Science.gov (United States)

Ankle fractures are a significant part of the lower extremity trauma seen in the emergency department. Neurologic complications of ankle fracture surgery are infrequently described but account for significant morbidity. The risk of nerve injury is increased for the Blair and Botte type B pattern of the intermediate cutaneous dorsal nerve branch, crossing the distal fibula from posterior to anterior (at 5 to 7 cm from malleolar tip). This pattern is present in about 10% to 15% of patients. Injuries to the superficial peroneal nerve and its branches negatively influence the outcome. Early recognition and protection might reduce the incidence of superficial peroneal nerve injuries during open reduction and internal fixation of lateral malleolus fractures. We describe 2 surgically treated ankle fractures with superficial peroneal nerve branch (intermediate cutaneous dorsal nerve) involvement and review the current literature. PMID:22789487

Halm, Jens A; Schepers, Tim

2012-01-01

324

Cranial Nerves Model  

Science.gov (United States)

Lesson is designed to introduce students to cranial nerves through the use of an introductory lecture. Students will then create a three-dimensional model of the cranial nerves. An information sheet will accompany the model in order to help students learn crucial aspects of the cranial nerves.

Juliann Garza (University of Texas-Pan American Physician Assistant Studies)

2010-08-16

325

Axillary nerve dysfunction  

Science.gov (United States)

Axillary nerve dysfunction is a form of peripheral neuropathy . It occurs when there is damage to the axillary nerve. This is the nerve that helps control the deltoid muscles of the shoulder and the skin around it. A problem with just one ...

326

[Prevention of cutaneous melanoma].  

Science.gov (United States)

Cutaneous melanoma exhibited a rapidly increasing incidence during the 70 s and 80 s. As a consequence primary and secondary prevention campaigns were developed, starting in Australia, where the incidence was by far the highest, but later also in the Netherlands. Mortality from melanoma in the Netherlands is stable at a rate of 2.4 per 100,000 person years since 1980. The melanoma incidence has stabilized since 1989 at a level of about 11 per 100,000. In the development of the melanoma it is not so much the accumulated exposure to sun that is of importance, as in squamous carcinoma, but rather incidental serious sunburn. It is especially exposure at an early age that increases the risk of melanoma as well as that of basal cell carcinoma. Primary prevention must be focussed on avoiding sunburn in young people. Secondary prevention can be realised by frequent controls of risk groups and a raised awareness for changing moles in the general population but also in physicians who see patients' skins for whatever reason. PMID:10416492

van der Rhee, H J; Coebergh, J W

1999-06-26

327

Leishmaniasis cutánea / Cutaneous leishmaniasis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

Osvaldo, Miranda Gómez; Iván, González Barea.

328

Leishmaniasis cutánea Cutaneous leishmaniasis  

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

Osvaldo Miranda Gómez

2007-12-01

329

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

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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.

Shah Anand

2007-01-01

330

Comparative study of bupivacaine alone and bupivacaine along with buprenorphine in axillary brachial plexus block: a prospective, randomized, single blind study  

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Full Text Available Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomized single-blind study to compare Bupivacaine alone and Bupivacaine along with Buprenorphine for onset, quality, and duration of block as well as post-operative analgesia and any complication in axillary brachial- plexus block. Methods: Randomized controlled study was carried out among 60 patients of either sex, aged 20-60 years. ASA grade I or II undergoing elective hand, forearm, elbow surgery under axillary brachial plexus block. Patients were randomly divided into two groups. Group-l received 30 ml of 0.35% Bupivacaine alone in axillary block. Group-II received 30 ml of 0.35% Bupivacaine with 3µg/kg Buprenorphine in axillary block. Time taken for onset and completion of motor and sensory block as well as complete duration of block were noted in both groups. Any complication during procedure, during surgery as well as post-operatively were noted and treated. Results: Addition of Buprenorphine (3µg/kg to Bupivacaine mixture in peripheral nerve block did not affected the onset time for motor as well as sensory block. Mean duration of motor block was 284.33±78.94 mins. in group I and in group II 307.33±60.26 mins. Mean duration of sensory block 305.066±83.64 mins. in group I while 580.166±111.45 mins. in group II. It suggests duration of sensory block was prolonged in group II then group I. Conclusions: Addition of Buprenorphine to local anesthetic drug provides good post-operative analgesia. Buprenorphine significantly prolongs sensory block and lengthens duration of analgesia without prolonging duration of motor block. [Int J Basic Clin Pharmacol 2013; 2(5.000: 640-644

Kinjal S. Sanghvi

2013-10-01

331

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

International Nuclear Information System (INIS)

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

332

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

International Nuclear Information System (INIS)

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

333

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

Directory of Open Access Journals (Sweden)

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

A.S. Pagnussat

2012-08-01

334

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

Science.gov (United States)

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

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

2014-07-01

335

Bilateral optic nerve injury.  

Directory of Open Access Journals (Sweden)

Full Text Available Bilateral optic nerve injury is a rare condition and is reported in 5-6 percent of all optic nerve injuries. However, there is no published series on bilateral optic nerve injury. Analysis of 31 cases of bilateral optic nerve involvement seen amongst 275 patients with optic nerve injury (11.5 percent is discussed. Road traffic accident which is the most common cause of optic nerve injury, was recorded in 61 percent. Shotgun injury and blast in jury was the cause in 22.5 percent of cases. All the patients except 4 received steroids. Anterior cranial fossa fracture and opacity of paranasal sinuses were recorded in a third of the patients. Visual evoked potentials were recorded in 27 patients. Improvement in vision was noticed in 23 patients (74 percent. However, among the 62 eyes, 39 eyes showed improvement (62.8 percent. Possible reasons for better outcome in bilateral optic nerve injury are discussed.

Mahapatra A

1999-04-01

336

[Prolonged blocking of the brachial plexus by axillary approach in children].  

Science.gov (United States)

Surgical interventions were carried out under combined total anesthesia with prolonged blocking of the brachial plexus via axillary approach in 40 children aged 4-14 years with surgical diseases of the arms. Prolonged axillary blockade maintained adequate analgesia in the lower third of the brachial bone, ulnar joint, forearm, and hand for 24-48 h. The proposed protocols of lidocaine and bupivacaine infusion into the axillary space of the brachial plexus caused no toxic reactions in children of this age group. The method can be used in children during and after surgery. PMID:10584368

Leshkevich, A I; Razhev, S V; Lukin, G I; Sidorov, V A

1999-01-01

337

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

338

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

Jamuna M

2011-01-01

339

Enhancement of arm and leg locomotor coupling with augmented cutaneous feedback from the hand.  

Science.gov (United States)

Cutaneous feedback from the hand could assist with coordination between the arms and legs during locomotion. Previously we used a reduced walking model of combined arm and leg (ARM&LEG) cycling to examine the separate effects of rhythmic arm (ARM) and leg (LEG) movement. Here we use this same paradigm to test the modulation H-reflexes with and without interlimb cutaneous conditioning evoked by stimulating a nerve innervating the hand (superficial radial, SR). It was hypothesized that both ARM and LEG would contribute significantly to suppression of H-reflex amplitude during ARM&LEG. We also predicted a conservation of interlimb cutaneous conditioning during movement and an interaction between arm and leg rhythmic movement control. Subjects were seated in a recumbent ARM&LEG cycle ergometer and maintained a low-level soleus contraction for all tasks. H-reflex amplitude was facilitated by cutaneous conditioning evoked by stimulation of the SR nerve. H-reflex amplitudes were taken from recruitment curves and included modulation of 50% H max and H max. The suppressive effect of arm was less than that for LEG and ARM&LEG, while suppression during LEG and ARM&LEG were generally equivalent. For H-reflexes conditioned by cutaneous input, amplitudes during ARM&LEG instead were in between those for ARM and LEG modulation. Multiple regression analysis revealed a significant contribution for arm only in trials when SR stimulation was used to condition H-reflex amplitudes. We suggest that there is a measurable interaction between neural activity regulating arm and leg movement during locomotion that is specifically enhanced when cutaneous input from the hand is present. PMID:17615121

Zehr, E Paul; Klimstra, Marc; Dragert, Katie; Barzi, Yasaman; Bowden, Mark G; Javan, Bahar; Phadke, Chetan

2007-09-01

340

Localized cutaneous sporotrichosis lasting for 10 years  

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Full Text Available A case of localized cutaneous sporotrichosis lasting for 10 years is being reported. The fixed cutaneous variety creates diagnostic difficulty by mimicking other conditions, chiefly lupus vulgaris.

Rathi S

2003-05-01

 
 
 
 
341

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.  

Science.gov (United States)

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. PMID:25116721

Thakkar, Umang G; Vanikar, Aruna V; Trivedi, Hargovind L

2014-01-01

342

[Ultrasonography for traction injuries of the brachial plexus].  

Science.gov (United States)

Results of preoperative ultrasonography (US) were compared with the subsequently offered operative findings retrospectively on 35 ventral rami of the cervical nerves (11 C5, 11 C6 and 13 C7) in 12 patients injured in motorcycle accidents in order to examine the usefulness of US in the diagnosis of nerve injury. The findings of a US-scanned ramus consisted of shape, internal echo pattern, regularity of border, and ratio of the diameter of an injured nerve to that of the corresponding nerve on the intact side (I/C). An intact ventral ramus was shown as a hypoechoic tubular structure with many parallel fine linear internal echoes, a regular border, and I/C ranging from 1.0 to 1.2. Categories such as I/C and shape improved the accuracy of differential diagnosis of severe nerve injuries. Avulsion of the ganglion was observed as a winding or tadpole-shaped remarkably enlarged (2.3 < or = I/C < or = 5.0) mass lesion, intraforaminal lesion as a thick (1.5 < or = I/C < or = 3.2) structure with an irregular shape and border close to the transverse process, and pseudocontinuity as irregular internal echoes. It was difficult to discriminate a lesion with continuity and localized scar formation around the nerve from normal fasciculi. These results strongly suggest that the application of improved US diagnosis to cervical nerve injury should make it much easier to select the best treatment for the patient, in that we can detect preoperatively those injuries to which nerve transplantation is not applicable. PMID:8539106

Hayamizu, K; Naito, K; Ito, K

1995-10-01

343

Iatogenic pseudoaneurysm of the brachial artery in a child  

International Nuclear Information System (INIS)

Arterial aneurysms are rarely encountered in children. When they are, the existence of an underlying disease or a history of previous infection or trauma should be suspected since the majority them are acquired. Pseudo aneurysms or false aneurysms are a consequence of the rupture of the arterial wall after accidental injury or a iatrogenic lesion. We present a case of a pseudoaneurysm of the brachial artery secondary to repeated attempts at venipuncture in a 3-month-old infant. We show the plain radiography and duplex Doppler color Doppler ultrasound findings which, in the clinical context of the patient, were sufficient for diagnosis, making it unnecessary to perform arteriography prior to surgical treatment. (Author) 9 refs

344

Brachial artery waveforms for automatic blood pressure measurement.  

Science.gov (United States)

Theoretically the auscultatory method using Korotkoff sounds is more related to the maximum artery closure status, while the oscillometric method is more related to the overall artery closure status under the cuff. Therefore, the latter is less accurate than the former. This work introduces a new method, which is more accurate than the oscillometric method and suitable for automatic devices. To monitor the maximum artery closure status, a piezoelectric film sensor is attached to the skin just above the brachial artery and under the central section of the cuff where maximum cuff pressure is transferred to the arm. Using the waveform features obtained by this sensor, measurement errors of 0.7±2.5 and 1.27±4.53 mmHg were obtained for the systolic and diastolic pressure, respectively. These reflect small deviations from auscultatory clinical data. PMID:23149078

Al-Jumaily, A M; Lan, H; Stergiopulos, N

2013-02-01

345

Imaging the trigeminal nerve  

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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.

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

346

Ectopic cutaneous schistosomiasis - Case report  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

347

Ectopic cutaneous schistosomiasis - case report.  

Science.gov (United States)

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 located 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. PMID:25054754

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

2014-01-01

348

Ectopic cutaneous schistosomiasis - Case report*  

Science.gov (United States)

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 located 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. PMID:25054754

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

2014-01-01

349

Cutaneous lesions of the nose  

Directory of Open Access Journals (Sweden)

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.

Altmeyer Peter

2010-06-01

350

Ectopic cutaneous schistosomiasis - Case report  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

351

Cutaneous leishmaniasis with unusual presentation  

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Full Text Available Three cases of cutaneous leishmaniasis with unusual presentation seen at Central Hospital Tripoli, Libya are described. Case No. 1 and 2 had 102 and 109 noduloulcerative lesions with generalized almost bilaterally symmetrical distribution, suggestive of dissemination. Case No. 3 had large verrucous carcinoma but histopathology suggested lupoid (chronic cutaneous leishmaniasis. Patient No. 2 developed hypersensitivity reaction to sodium stibogluconate after 10 days but responded well to the treatment. Case No. 2 did not tolerate the above treatment and was treated successfully with combination of rifampicin and INH. Case No. 3 was treated successfully with liquid nitrogen cryotherapy by Cryosurg-Frigitonics, using special open probes.

Khatri M

1999-01-01

352

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)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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.

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

353

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  

Directory of Open Access Journals (Sweden)

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 manejo analgésico post operatorio. La vía infraclavicular para bloqueo de plexo braquial es frecuentemente utilizada en la cirugía de miembro superior.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 management. The infraclavicular approach to the brachial plexus block is widely used in upper extremity surgery.

Antonio José Bonilla Ramírez

2011-12-01

354

Arterial function of carotid and brachial arteries in postmenopausal vegetarians  

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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