WorldWideScience
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Avoiding the Medial Brachial Cutaneous Nerve in Brachioplasty: An Anatomical Study  

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Objective: With more patients undergoing bariatric surgery procedures, there has been an increased demand on plastic surgeons to manage excess skin around the body from massive weight loss. The upper arm is one of the areas that require surgical attention. One of the complications of brachioplasty is injury to cutaneous nerves of the arm. We report our findings of the location of the medial brachial cutaneous nerve on the basis of anatomical landmarks to aid the reconstructive surgeon in plan...

Chowdhry, Saeed; Elston, Joshua B.; Lefkowitz, Todd; Wilhelmi, Bradon J.

2010-01-01

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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 ...

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

2013-01-01

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The cutaneous branch of some human suprascapular nerves.  

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A cutaneous branch of the suprascapular nerve was observed in 6 arms from 5 (4 male and 1 female) out of 61 Japanese cadavers. The suprascapular nerves with a cutaneous branch arose from essentially normal brachial plexuses. Every suprascapular nerve with a cutaneous branch had a normal course, and gave rise to the cutaneous branch either from the upper of its two muscular branches to the supraspinatus or from its stem under the superior transverse scapular ligament. After passing between the...

Horiguchi, M.

1980-01-01

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Nerve Transfers for Traumatic Brachial Plexus Injury: Advantages and Problems  

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In recent years nerve transfers have been increasingly used to broaden reconstructive options for brachial plexus reconstruction. Nerve transfer is a procedure where an expendable nerve is connected to a more important nerve in order to reinnervate that nerve. This article outlines the experience of the Scottish National Brachial Plexus Injury Service as our use of nerve transfers has increased. Outcomes have improved for reconstruction of the paralysed shoulder using transfer of the accessor...

Hems, Tim

2011-01-01

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Nerve Transfers in Severe Obstetrical Brachial Plexus Palsy  

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Nerve transfers are increasingly utilized for repair of servere brachial plexus injuries and, indeed, are the only option when the proximal spine nerve roots have been avulsed from the spinal cord. The procedure essentially involves the coaption of a proximal foreign nerve to the distal denervated nerve, so that the latter will be reinnervated by the donated axons. The primary goal of surgery in the severe obstetrical brachial plexus palsy case is to return proximal arm function, particularly...

Midha, Rajiv; Drake, James M.

2005-01-01

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Nerve transfer helps repair brachial plexus injury by increasing cerebral cortical plasticity.  

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In the treatment of brachial plexus injury, nerves that are functionally less important are transferred onto the distal ends of damaged crucial nerves to help recover neuromuscular function in the target region. For example, intercostal nerves are transferred onto axillary nerves, and accessory nerves are transferred onto suprascapular nerves, the phrenic nerve is transferred onto the musculocutaneous nerves, and the contralateral C7 nerve is transferred onto the median or radial nerves. Nerve transfer has become a major method for reconstructing the brachial plexus after avulsion injury. Many experiments have shown that nerve transfers for treatment of brachial plexus injury can help reconstruct cerebral cortical function and increase cortical plasticity. In this review article, we summarize the recent progress in the use of diverse nerve transfer methods for the repair of brachial plexus injury, and we discuss the impact of nerve transfer on cerebral cortical plasticity after brachial plexus injury. PMID:25657729

Sun, Guixin; Wu, Zuopei; Wang, Xinhong; Tan, Xiaoxiao; Gu, Yudong

2014-12-01

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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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Posterior Approach for Double Nerve Transfer for Restoration of Shoulder Function in Upper Brachial Plexus Palsy  

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Restoration of shoulder function is one of the most critical goals of treatment of brachial plexus injuries. Primary repair or nerve grafting of avulsion injuries of the upper brachial plexus in adults often leads to poor recovery. Nerve transfers have provided an alternative treatment with great potential for improved return of function. Many different nerves have been utilized as donor nerves for transfer to the suprascapular nerve and axillary nerve for return of shoulder function with var...

Colbert, Stephen H.; Mackinnon, Susan

2006-01-01

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

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Abstract Background The lack of recovery of active external rotation of the shoulder is an important problem in children suffering from brachial plexus lesions involving the suprascapular nerve. The accessory nerve neurotization to the suprascapular nerve is a standard procedure, performed to improve shoulder motion in patients with brachial plexus palsy. Methods We operated on 65 patients with obstetric brachial plexus palsy (OBPP), aged 5-35 months (average: 19 months). We assessed the reco...

Sellhaus Bernd; Bahm Jörg; Schaakxs Dominique; Weis Joachim

2009-01-01

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

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

Bhanu SP

2010-02-01

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The cutaneous branch of the human suprascapular nerve.  

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The cutaneous branch of the suprascapular nerve was studied bilaterally in 34 adult cadavers. In 5 the suprascapular nerve derived its fibres from the ventral rami of the 4th, 5th and 6th cervical nerves. The cutaneous branch was observed in 14.7% of the 68 limbs examined. In 3 cadavers the cutaneous branch arose from the upper branch to the supraspinatus muscle and in 1 case from the stem of the suprascapular nerve just above the transverse scapular ligament. In 1 case the cutaneous branch a...

Ajmani, M. L.

1994-01-01

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Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?  

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Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and sal...

Chaudhuri, Souvik; Gopalkrishna, Md; Paul, Cherish; Kundu, Ratul

2012-01-01

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Outcome Following Spinal Accessory to Suprascapular (Spinoscapular) Nerve Transfer in Infants with Brachial Plexus Birth Injuries  

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The purpose of this study is to evaluate the value of distal spinal accessory nerve (SAN) transfer to the suprascapular nerve (SSN) in children with brachial plexus birth injuries in order to better define the application and outcome of this transfer in these infants. Over a 3-year period, 34 infants with brachial plexus injuries underwent transfer of the SAN to the SSN as part of the primary surgical reconstruction. Twenty-five patients (direct repair, n?=?20; interposition graft, n?=?...

Ruchelsman, David E.; Ramos, Lorna E.; Alfonso, Israel; Price, Andrew E.; Grossman, Agatha; Grossman, John A. I.

2009-01-01

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The rabbit brachial plexus as a model for nerve repair surgery--histomorphometric analysis.  

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One of the most devastating injuries to the upper limb is trauma caused by the avulsion. The anatomical structure of the rabbit's brachial plexus is similar to the human brachial plexus. The aim of our study was to analyze the microanatomy and provide a detailed investigation of the rabbit's brachial plexus. The purpose of our research project was to evaluate the possibility of utilizing rabbit's plexus as a research model in studying brachial plexus injury. Studies included histomorphometric analysis of sampled ventral branches of spinal nerves C5, C6, C7, C8, and Th1, the cranial trunk, the medial part of the caudal trunk, the lateral part of the caudal trunk and peripheral nerve. Horizontal and vertical analysis was done considering following features: the axon diameter, fiber diameter and myelin sheath. The number of axons, nerve area, myelin fiber density and minimal diameter of myelin fiber, minimal axon diameter and myelin area was marked for each element. The changes between ventral branches of spinal nerves C5-Th1, trunks and peripheral nerve in which the myelin sheath, axon diameter and fiber diameter was assessed were statistically significant. It was found that the g-ratio has close value in the brachial plexus as in the peripheral nerve. The peak of these parameters was found in nerve trunks, and then decreased coherently with the nerves travelling peripherally. PMID:25284580

Reichert, Pawe?; Kie?bowicz, Zdzis?aw; Dzi?giel, Piotr; Pu?a, Bartosz; Kuryszko, Jan; Gosk, Jerzy; Boche?ska, Aneta

2015-02-01

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The Use of the Phrenic Nerve Communicating Branch to the Fifth Cervical Root for Nerve Transfer to the Suprascapular Nerve in Infants with Obstetric Brachial Plexus Palsy  

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Traditionally, suprascapular nerve reconstruction in obstetric brachial plexus palsy is done using either the proximal C5 root stump or the spinal accessory nerve. This paper introduces another potential donor nerve for neurotizing the suprascapular nerve: the phrenic nerve communicating branch to the C5 root. The prevalence of this communicating branch ranges from 23% to 62% in various anatomical dissections. Over the last two decades, the phrenic communicating branch was used to reconstruct...

Al-qattan, M. M.; El-sayed, A. A. F.

2014-01-01

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Nerve reconstruction: A cohort study of 93 cases of global brachial plexus palsy  

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Full Text Available Introduction: Brachial plexus injury leading to flail upper limb is one of the most disabling injuries. Neglect of the injury and delay in surgeries may preclude reinnervation of the paralysed muscles. Currently for such injuries nerve transfers are the preferred procedures. We here present a series of 93 cases of global brachial plexus palsy treated with nerve transfers. Materials and Methods: Ninety-three cases of global palsies out of 384 cases of brachial plexus injury operated by the senior surgeon (AB were selected. Age varied from 4 to 51 years with 63 patients in 20 to 40 age group and all patients having a minimum follow up of at least 1 year post surgery ranging up to 130 months. The delay before surgery ranged from 15 days to 16 months (mean 3.2 months. The aim of the surgery was to restore the elbow flexion, shoulder abduction, triceps function and wrist and finger flexion in that order of priority. The major nerve transfers used were spinal accessory to suprascapular nerve, intercostal to musculocutaneous nerve and pectoral nerves, contralateral C7 to median and radial nerves. Nerve stumps were used whenever available (30 patients. Results: Recovery of ? grade 3 power was noted in biceps in 73% (68/93 of patients, shoulder abduction in 89% (43/49, pectoralis major in 100% (8/8. Recovery of grade 2 triceps power was seen in 80% (12/16 patients with nerve transfer to radial nerve. Derotation osteotomies of humerus (n=13 and wrist fusion (n=14 were the most common secondary procedures performed to facilitate alignment and movements of the affected limb. Better results were noted in 59 cases where direct nerve transfers were done (without nerve graft. Conclusion: Acceptable function (restoration of biceps power ?3 can be obtained in more than two thirds (73% of these global brachial plexus injuries by using the principles of early exploration and nerve transfer with rehabilitation.

Bhatia Anil

2011-01-01

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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 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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Brachial plexus injury as a complication after nerve block or vessel puncture.  

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Brachial plexus injury is a potential complication of a brachial plexus block or vessel puncture. It results from direct needle trauma, neurotoxicity of injection agents and hematoma formation. The neurological presentation may range from minor transient pain to severe sensory disturbance or motor loss with poor recovery. The management includes conservative treatment and surgical exploration. Especially if a hematoma forms, it should be removed promptly. Comprehensive knowledge of anatomy and adept skills are crucial to avoid nerve injuries. Whenever possible, the patient should not be heavily sedated and should be encouraged to immediately inform the doctor of any experience of numbness/paresthesia during the nerve block or vessel puncture. PMID:25031806

Kim, Hyun Jung; Park, Sang Hyun; Shin, Hye Young; Choi, Yun Suk

2014-07-01

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

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

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

2015-02-01

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Brachial nerve injury caused by percutaneous radiofrequency ablation of apical lung cancer: a report of four cases.  

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The present report describes four cases of brachial nerve injury caused by percutaneous radiofrequency (RF) ablation of lung cancer. All the tumors were located in the lung apex. The patients developed symptoms indicative of a low brachial plexus injury during RF ablation or as long as 7 days afterward. These symptoms partially receded over time. The indications of RF ablation in patients with apical lung cancer should be carefully determined because of the risk of brachial nerve injury associated with the procedure. PMID:20537909

Hiraki, Takao; Gobara, Hideo; Mimura, Hidefumi; Sano, Yoshifumi; Toyooka, Shinichi; Shibamoto, Kentaro; Kishi, Ryotaro; Uka, Mayu; Kanazawa, Susumu

2010-07-01

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ANÁLISE DA ORIGEM E DISTRIBUIÇÃO DOS NERVOS PERIFÉRICOS DO PLEXO BRAQUIAL DA PACA (Agouti paca, LINNAEUS, 1766 ORIGIN AND DITRIBUTION ANALYSIS OF THE BRACHIAL PLEXUS PERIPHERAL NERVES OF PACA (Agouti paca, LINNAEUS, 1766  

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Full Text Available O plexo braquial é um conjunto de nervos que surge na região medular cervicotorácica e que se distribui pelos membros torácicos e porção interna do tórax. O plexo braquial de oito pacas foi dissecado para evidenciação da origem e distribuição de seus nervos. O nervo supraescapular distribuía-se para os músculos supra e infra-espinhal, e o subescapular para o músculo subescapular. O nervo axilar ramificava-se para os músculos redondo maior, subescapular, redondo menor e deltóide. Os nervos ulnar e mediano ramificavam-se para a musculatura do antebraço, e o musculocutâneo para os músculos coracobraquial, bíceps braquial e braquial. O nervo radial abrangia o músculo tríceps braquial, tensor da fáscia do antebraço e ancôneo. O nervo torácico longo e o toracodorsal emitiam ramos para o músculo grande dorsal, e o torácico lateral para o músculo cutâneo do tronco. Os nervos peitorais craniais ramificavam-se no músculo peitoral profundo, e os nervos peitorais caudais distribuíam-se para o músculo peitoral superficial. O plexo braquial da paca é formado por doze pares de nervos com origens distintas, os quais surgem do quinto par de nervos cervicais até o segundo par de nervos torácicos, não havendo troncos ou cordões na formação destes.

PALAVRAS-CHAVES: Agouti paca, distribuição, plexo braquial, sistema nervoso. The brachial plexus is a set of nerves originated in the cervicothoracic medular region and distributed in the thoracic limbs and inner thorax. The brachial plexus of eight pacas was dissected for study on the nerves origin and distribution. The suprascapular nerve went through the supra and infraspinal muscles and the subscapular gave off on the subscapular muscle. The axilar nerve was distributed on the teres major, subscapular, teres minor and deltoid muscles. The ulnar and the median nerves branched off on the forearm musculature, and the musculocutaneous branched on the coracobrachial, biceps brachial and brachial muscles. The radial nerve went through the triceps brachial, tensor fasciae latae and anconeus muscles. The long thoracic and the thoracodorsal nerves branched on the latissimus dorsi muscle, and the lateral thoracic gave off on the trunk cutaneous muscle. The cranial pectoral nerves branched on the deep pectoral muscle and the caudal pectoral nerves gave off on the superficial pectoral muscle. The brachial plexus of pacas is formed by 12 pairs of nerves presenting different origins, which arose from ventral roots from the fifth pair of cervical to the second pair of thoracic nerves, not occurring trunks or cords in those formation.
KEY  WORDS: Agouti paca, brachial plexus, distribution, nervous system.

Sílvia Helena Brendolan Gerbasi

2008-12-01

24

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

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

Sellhaus Bernd

2009-09-01

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The use of the phrenic nerve communicating branch to the fifth cervical root for nerve transfer to the suprascapular nerve in infants with obstetric brachial plexus palsy.  

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Traditionally, suprascapular nerve reconstruction in obstetric brachial plexus palsy is done using either the proximal C5 root stump or the spinal accessory nerve. This paper introduces another potential donor nerve for neurotizing the suprascapular nerve: the phrenic nerve communicating branch to the C5 root. The prevalence of this communicating branch ranges from 23% to 62% in various anatomical dissections. Over the last two decades, the phrenic communicating branch was used to reconstruct the suprascapular nerve in 15 infants. Another 15 infants in whom the accessory nerve was used to reconstruct the suprascapular nerve were selected to match the former 15 cases with regard to age at the time of surgery, type of palsy, and number of avulsed roots. The results showed that there is no significant difference between the two groups with regard to recovery of external rotation of the shoulder. It was concluded that the phrenic nerve communicating branch may be considered as another option to neurotize the suprascapular nerve. PMID:24800206

Al-Qattan, M M; El-Sayed, A A F

2014-01-01

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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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Juxtamalleolar lipoma with intermediate dorsal cutaneous nerve entrapment.  

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From a review of the literature, it would appear that lipomas of the foot are relatively rare and that, when they do exist, they are of little clinical significance other than cosmetic appearance. The authors presented a case in which the size, location, and character of the mass predisposed the patient to entrapment syndrome of the intermediate dorsal cutaneous nerve. It is important to emphasize, however, that in these cases symptoms are related to a pressure phenomenon and are not a direct result of tumor physiology. PMID:1774645

Nicklas, B J; Schwein, J

1991-10-01

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Ultrasound-Guided Lateral Femoral Cutaneous Nerve Conduction Study  

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

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

2015-01-01

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Ultrasound-guided lateral femoral cutaneous nerve block: comparison of two techniques.  

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The aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nerve-targeting technique). The time required to perform the block and the onset time of the block were similar for both techniques. However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably. PMID:21375093

Hara, K; Sakura, S; Shido, A

2011-01-01

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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

31

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

32

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

33

Repair of avulsed ventral nerve roots by direct ventral intraspinal implantation after brachial plexus injury.  

Science.gov (United States)

Currently, the authors' research confirms that,in humans, communication between the cord and effector muscles can be re-established after multi-ple nerve root avulsion by the implantation of peripheral nerve grafts. Outcomes are still modest,but the possibility of improvement exists. The technique of reimplantation makes it possible to envisage global repair with the possibility of repair of all avulsed regions. The most important factor that could maximize the extent of functional recovery is reducing the time between the injury and corrective surgery: the diagnosis of avulsion within 10 days and reparative surgery within 3 weeks is the objective. This goal will involve a global re-evaluation of how these patients are managed. The problem of the recovery of sensory function (tactile and fine perception and proprioception) warrants further work. It seems likely that methods combining medullary reimplantation with neurotization will be the best way of correcting these lesions of the brachial plexus. In this context, cross-disciplinary collaboration is probably more important than ever. The place that methods based on reimplantation will have in the final picture remains to be seen. The key question is in which patients should medullary reimplantation be attempted and which method should be used. Moreover, medullary reimplantation should be considered as an adjunct to all other surgical options and should not compromise the chance of the latter modalities to be effective.An important point remains: are physicians going to be able to map out all the boundaries of this question in the future? PMID:15668071

Fournier, Henri D; Mercier, Philippe; Menei, Philippe

2005-02-01

34

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  

Scientific Electronic Library Online (English)

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.

1997-03-01

35

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  

Directory of Open Access Journals (Sweden)

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

36

THE RESULTS OF USING A PART OF ULNAR NERVE FOR RESTORATION OF ELBOW FLEXION IN PATIENTS WITH UPPER BRACHIAL PLEXUS INJURY  

OpenAIRE

In upper brachial plexus (C5-C6 or C5-C6-C7 roots) injuries, restoration of elbow flexion is the first aim. Several methods have been used to achieve this goal. Among these procedures, Oberlin’s method (transfer of part of ulnar nerve to the nerve to biceps muscle) is the newest one. From April 2002 to March 2003 we used this method in 9 cases, 8 males and 1 female, of upper brachial plexus injury with impaired active elbow flexion and intact ulnar nerve. Patients’ age ranged from 9 to 53...

Shahriar-kamrani, R.; Guiti, S. M. Jafari M. R.

2005-01-01

37

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

Science.gov (United States)

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

38

Ultrasound-guided Lateral Femoral Cutaneous Nerve Block in Meralgia Paresthetica  

OpenAIRE

Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound ...

Kim, Jeong Eun; Lee, Sang Gon; Kim, Eun Ju; Min, Byung Woo; Ban, Jong Suk; Lee, Ji Hyang

2011-01-01

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

OpenAIRE

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

Ebenezer, Gigi J.; Laast, Victoria A.; Dearman, Brandon; Hauer, Peter; Tarwater, Patrick M.; Adams, Robert J.; Zink, M. Christine; Mcarthur, Justin C.; Mankowski, Joseph L.

2009-01-01

40

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

OpenAIRE

During routine dissection of the upper limbs of a Caucasian male cadaver, multiple variations of the branches of the brachial plexus were observed. On the left side, the musculocutaneous nerve was absent and the muscles of the anterior compartment of the arm were innervated by the median nerve. The median nerve was also formed from three roots viz; two from the lateral and one from the medial cord of the brachial plexus. On the right side, the musculocutaneous nerve contributed a long communi...

Nasirudeen Oladipupo Ajayi; Lelika Lazarus; Kapil Sewsaran Satyapal

2012-01-01

41

The Brachial Plexus  

Science.gov (United States)

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

Mr. Samuel J Schwarzlose (Amarillo College Biology)

2010-08-20

42

Ultrasound-guided Lateral Femoral Cutaneous Nerve Block in Meralgia Paresthetica.  

Science.gov (United States)

Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound has developed into a powerful tool for the visualization of peripheral nerves including very small nerves such as accessory and sural nerves. The LFCN can be located successfully, and local anesthetic solution distribution around the nerve can be observed with ultrasound guidance. Our successfully performed ultrasound-guided blockade of the LFCN in meralgia paresthetica suggests that this technique is a safe way to increase the success rate. PMID:21716611

Kim, Jeong Eun; Lee, Sang Gon; Kim, Eun Ju; Min, Byung Woo; Ban, Jong Suk; Lee, Ji Hyang

2011-06-01

43

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

Scientific Electronic Library Online (English)

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

44

Cutaneous lesions sensory impairment recovery and nerve regeneration in leprosy patients  

Scientific Electronic Library Online (English)

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

2012-12-01

45

The growth of segmental nerves from the brachial myotomes into the proximal muscles of the chick forelimb during development.  

Science.gov (United States)

A study has been made of the growth of segmental nerves 13 to 16 (SN13 to SN16) into the chick limb bud, from the time when they have just reached the ends to the brachial myotomes (stage 21: Hamburger and Hamilton, '51), until they enter the newly formed ventral (stage 24) and dorsal (stage 25) pre-muscle cell masses in the limb bud. At stage 22 axon bundles of SN13 to SN16 have grown off the ends of their respective myotomes, and converge towards the most densely packed mesenchyme in the limb bud at segmental level 15. As a consequence, the first axon bundles of SN14 and SN16 have almost joined those of SN15, whereas the further removed SN13 axon bundles have not yet reached the level of SN15. By stage 23 the first axon bundles from SN14 to SN16 have joined at segmental level 15 to form a nerve which grows toward the ventral pre-muscle cell mass. At stage 24 axon bundles from SN13 have joined those from SN14 to SN16 to form the brachialis longus inferior nerve, which enters the densest region of the ventral pre-muscle. Other axons from SN13 to SN15 grow along the pathways provided by the early arriving axon bundles towards the ventral pre-muscle, but diverge from those at segmental level 14 to grow to the dorsal pre-muscle. By stage 25 axon bundles from SN13 to SN15 have joined to form the brachialis longus superior nerve which enters the densest region of the dorsal pre-muscle. At stage 26 a plexus has formed due to this pattern of growth of the segmental nerves between stages 22 and 25. It is suggested that pre-muscle cells synthesize a nerve growth factor which directs the growth of axons into the limb bud. PMID:7364968

Bennett, M R; Davey, D F; Uebel, K E

1980-01-15

46

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.

2011-12-01

47

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 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

48

Brachial Plexus (Erb's Palsy)  

Science.gov (United States)

... the crushing of the brachial plexus between the collarbone and first rib, which can happen during a ... Conditions Nerve Injuries Cubital Tunnel Syndrome Complex Regional Pain Syndrome - CRPS Carpal Tunnel Syndrome American Society for ...

49

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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Upregulation of ?1-adrenoceptors on cutaneous nerve fibres after partial sciatic nerve ligation and in complex regional pain syndrome type II.  

Science.gov (United States)

After peripheral nerve injury, nociceptive afferents acquire an abnormal excitability to adrenergic agents, possibly due to an enhanced expression of ?1-adrenoceptors (?1-ARs) on these nerve fibres. To investigate this in the present study, changes in ?1-AR expression on nerve fibres in the skin and sciatic nerve trunk were assessed using immunohistochemistry in an animal model of neuropathic pain involving partial ligation of the sciatic nerve. In addition, ?1-AR expression on nerve fibres was examined in painful and unaffected skin of patients who developed complex regional pain syndrome (CRPS) after a peripheral nerve injury (CRPS type II). Four days after partial ligation of the sciatic nerve, ?1-AR expression was greater on dermal nerve fibres that survived the injury than on dermal nerve fibres after sham surgery. This heightened ?1-AR expression was observed on nonpeptidergic nociceptive afferents in the injured sciatic nerve, dermal nerve bundles, and the papillary dermis. Heightened expression of ?1-AR in dermal nerve bundles after peripheral nerve injury also colocalized with neurofilament 200, a marker of myelinated nerve fibres. In each patient examined, ?1-AR expression was greater on nerve fibres in skin affected by CRPS than in unaffected skin from the same patient or from pain-free controls. Together, these findings provide compelling evidence for an upregulation of ?1-ARs on cutaneous nociceptive afferents after peripheral nerve injury. Activation of these receptors by circulating or locally secreted catecholamines might contribute to chronic pain in CRPS type II. PMID:24342464

Drummond, Peter D; Drummond, Eleanor S; Dawson, Linda F; Mitchell, Vanessa; Finch, Philip M; Vaughan, Christopher W; Phillips, Jacqueline K

2014-03-01

51

Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty.  

Science.gov (United States)

The anterior supine approach for total hip arthroplasty (THA) offers the advantage of operating through a true intravascular and intranervous plane, but it places the lateral femoral cutaneous nerve at risk. The purpose of this study was to identify the incidence of and impairment relating to injury of the lateral femoral cutaneous nerve. We performed a retrospective chart review of 81 hips undergoing anterior supine THA from November 2005 through May 2007 to determine operative time, estimated blood loss, fluoroscopic time, type of anesthesia used, intraoperative complications, and postoperative systemic and wound complications. Postoperative radiographs were evaluated for leg-length discrepancy, acetabular inclination and anteversion, and femoral stem position. Patients were reassessed at 6 weeks, 3 months, 6 months, 1 year, and 2 years. At each visit, patients were questioned about numbness or paresthesias in the distribution of the lateral femoral cutaneous nerve; if present, the patient outlined the area with a marking pen. This area was photographed, and data were collected. No hip had frank numbness; 12 hips (14.8%) had paresthesias. For those 12, symptoms resolved in 4 by 6 months, in 6 by 1 year, and in 10 (83.3%) by 2 years; 2 remained unresolved. No significant difference was found between patients with and without paresthesias or between patients with resolved or unresolved paresthesias. Impaired sensation did not appear to affect functional outcome or Harris Hip Score. Incision position, dissection plane, retractor placement, tension and soft tissue handling, and surgeon experience may affect incidence of injury to the lateral femoral cutaneous nerve. PMID:20608633

Bhargava, Tarun; Goytia, Robin N; Jones, Lynne C; Hungerford, Marc W

2010-07-01

52

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

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Full Text Available OBJETIVO: Avaliar de forma crítica os fatores que influenciam os resultados da neurotização do nervo ulnar no ramo motor do músculo bíceps braquial, visando a restauração da flexão do cotovelo em pacientes com lesão do plexo braquial. MÉTODOS: 19 pacientes, 18 homens e uma mulher, com idade média de 28,7 anos foram avaliados entre fevereiro de 2003 e maio de 2007. Oito pacientes apresentavam lesão das raízes C5-C6 e 11, das raízes C5-C6-C7. O intervalo de tempo médio entre a injúria e o tratamento cirúrgico foi 7,5 meses. Quatro pacientes apresentavam fraturas cervicais associadas à lesão do plexo braquial. O seguimento pós-operatório foi de 15,7 meses. RESULTADO: Oito pacientes recuperaram força de flexão do cotovelo MRC grau 4; dois, MRC grau 3 e nove, MRC OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachial biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight patients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC <3. There was no impairment of the previous ulnar nerve function. CONCLUSION: The surgical results of ulnar nerve neurotization at the motor branch of brachial biceps muscle are dependent on the interval between brachial plexus injury and surgical treatment, the presence of associated fractures of the cervical spine and occipital condyle, residual function of the C8-T1 roots after the injury and the involvement of the C7 root. Signs of reinnervation manifested up to 3 months after surgery showed better results in the long term. Level of Evidence: IV, Case Series.

Marcelo Rosa de Rezende

2012-12-01

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Effect of brachial plexus co-activation on phrenic nerve conduction time  

OpenAIRE

BACKGROUND—Diaphragm function can be assessed by electromyography of the diaphragm during electrical phrenic nerve stimulation (ES). Whether phrenic nerve conduction time (PNCT) and diaphragm electrical activity can be reliably measured from chest wall electrodes with ES is uncertain.?METHODS—The diaphragm compound muscle action potential (CMAP) was recorded using an oesophageal electrode and lower chest wall electrodes during ES in six normal subjects. Two patients...

Luo, Y.; Polkey, M.; Lyall, R.; Moxham, J.

1999-01-01

54

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

OpenAIRE

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...

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

2014-01-01

55

Dorsal cutaneous branch of the ulnar nerve: a light and electron microscopy histometric study.  

Science.gov (United States)

This study describes the normal morphology and morphometry of the dorsal cutaneous branch of the ulnar nerve (DCBU) in humans. Fourteen nerves of eight donors were prepared by conventional techniques for paraffin and epoxy resin embedding. Semiautomatic morphometric analysis was performed by means of specific computer software. Histograms of the myelinated and unmyelinated fiber population and the G-ratio distribution of fibers were plotted. Myelinated fiber density per nerve varied from 5,910 to 10,166 fibers/mm(2) , with an average of 8,170 ± 393 fibers/mm(2) . The distribution was bimodal with peaks at 4.0 and 9.5 µm. Unmyelinated fiber density per nerve varied from 50,985 to 127,108, with an average of 78,474 ± 6,610 fibers/mm(2) , with a unimodal distribution displaying a peak at 0.8 µm. This study thus adds information about the fascicles and myelinated and unmyelinated fibers of DCBU nerves in normal people, which may be useful in further studies concerning ulnar nerve neuropathies, mainly leprosy neuropathy. PMID:21692907

Oliveira, Adriana L C R D; Fazan, Valéria P S; Marques, Wilson; Barreira, Amilton A

2011-06-01

56

Brachial plexus variation involving the formation and branches of the cords  

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

Fabian-Taylor FM

2010-11-01

57

Acetylcholine released from cholinergic nerves contributes to cutaneous vasodilation during heat stress  

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Nitric oxide (NO) contributes to active cutaneous vasodilation during a heat stress in humans. Given that acetylcholine is released from cholinergic nerves during whole body heating, coupled with evidence that acetylcholine causes vasodilation via NO mechanisms, it is possible that release of acetylcholine in the dermal space contributes to cutaneous vasodilation during a heat stress. To test this hypothesis, in seven subjects skin blood flow (SkBF) and sweat rate were simultaneously monitored over three microdialysis membranes placed in the dermal space of dorsal forearm skin. One membrane was perfused with the acetylcholinesterase inhibitor neostigmine (10 microM), the second membrane was perfused with the NO synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME; 10 mM) dissolved in the aforementioned neostigmine solution (l-NAME(Neo)), and the third membrane was perfused with Ringer solution as a control site. Each subject was exposed to approximately 20 min of whole body heating via a water-perfused suit, which increased mean body temperature from 36.4 +/- 0.1 to 37.5 +/- 0.1 degrees C (P l-NAME(Neo): 37.1 +/- 0.1 degrees C, control: 36.9 +/- 0.1 degrees C), whereas no significant threshold difference was observed between the l-NAME(Neo)-treated and control sites. At the end of the heat stress, SkBF was not different between the neostigmine-treated and control sites, whereas SkBF at the l-NAME(Neo)-treated site was significantly lower than the other sites. These results suggest that acetylcholine released from cholinergic nerves is capable of modulating cutaneous vasodilation via NO synthase mechanisms early in the heat stress but not after substantial cutaneous vasodilation.

Shibasaki, Manabu; Wilson, Thad E.; Cui, Jian; Crandall, Craig G.

2002-01-01

58

Neural control of rhythmic, cyclical human arm movement: task dependency, nerve specificity and phase modulation of cutaneous reflexes.  

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1. The organization and pattern of cutaneous reflex modulation during rhythmic cyclical movements of the human upper limbs has received much less attention than that afforded the lower limb. Our working hypothesis is that control mechanisms underlying the modulation of cutaneous reflex amplitude during rhythmic arm movement are similar to those that control reflex modulation in the leg. Thus, we hypothesized that cutaneous reflexes would show task dependency and nerve specificity in the upper limb during rhythmic cyclical arm movement as has been demonstrated in the human lower limb. 2. EMG was recorded from 10 muscles crossing the human shoulder, elbow and wrist joints while bilateral whole arm rhythmic cyclical movements were performed on a custom-made, hydraulic apparatus. 3. Cutaneous reflexes were evoked with trains (5 x 1.0 ms pulses at 300 Hz) of electrical stimulation delivered at non-noxious intensities (approximately 2 x threshold for radiating parasthesia) to the superficial radial, median and ulnar nerves innervating the hand. 4. Cutaneous reflexes were typically modulated with the movement cycle (i.e. phase dependency was observed). There was evidence for nerve specificity of cutaneous reflexes during rhythmic movement of the upper limbs. Task-dependent modulation was also seen as cutaneous reflexes were of larger amplitude or inhibitory (reflex reversal) during arm cycling as compared to static contraction. 5. While there are some differences in the patterns of cutaneous reflex modulation seen between the arms and legs, it is concluded that cutaneous reflexes are modulated similarly in the upper and lower limbs implicating similar motor control mechanisms. PMID:11744775

Zehr, E P; Kido, A

2001-12-15

59

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

60

Acetylcholine released from cholinergic nerves contributes to cutaneous vasodilation during heat stress  

Science.gov (United States)

Nitric oxide (NO) contributes to active cutaneous vasodilation during a heat stress in humans. Given that acetylcholine is released from cholinergic nerves during whole body heating, coupled with evidence that acetylcholine causes vasodilation via NO mechanisms, it is possible that release of acetylcholine in the dermal space contributes to cutaneous vasodilation during a heat stress. To test this hypothesis, in seven subjects skin blood flow (SkBF) and sweat rate were simultaneously monitored over three microdialysis membranes placed in the dermal space of dorsal forearm skin. One membrane was perfused with the acetylcholinesterase inhibitor neostigmine (10 microM), the second membrane was perfused with the NO synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME; 10 mM) dissolved in the aforementioned neostigmine solution (l-NAME(Neo)), and the third membrane was perfused with Ringer solution as a control site. Each subject was exposed to approximately 20 min of whole body heating via a water-perfused suit, which increased mean body temperature from 36.4 +/- 0.1 to 37.5 +/- 0.1 degrees C (P heat stress, SkBF at each site was normalized to its maximum value, identified by administration of 28 mM sodium nitroprusside. Mean body temperature threshold for cutaneous vasodilation was significantly lower at the neostigmine-treated site relative to the other sites (neostigmine: 36.6 +/- 0.1 degrees C, l-NAME(Neo): 37.1 +/- 0.1 degrees C, control: 36.9 +/- 0.1 degrees C), whereas no significant threshold difference was observed between the l-NAME(Neo)-treated and control sites. At the end of the heat stress, SkBF was not different between the neostigmine-treated and control sites, whereas SkBF at the l-NAME(Neo)-treated site was significantly lower than the other sites. These results suggest that acetylcholine released from cholinergic nerves is capable of modulating cutaneous vasodilation via NO synthase mechanisms early in the heat stress but not after substantial cutaneous vasodilation.

Shibasaki, Manabu; Wilson, Thad E.; Cui, Jian; Crandall, Craig G.

2002-01-01

61

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

62

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

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

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

2011-01-01

63

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

Science.gov (United States)

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

2014-01-01

64

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

Science.gov (United States)

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

65

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

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

Ana Reynders

2015-02-01

66

A computational model and simulation study of the efferent activity in the brachial nerves during voluntary motor intent.  

Science.gov (United States)

Inherent limitations of the surface myoelectric signal, such as the lack of recording sites in high-level amputations, and the sensitivity to placement and impedance effects, confound its wider application in powered prostheses. Since a functionally topographic distribution (somatotopic organization) of nerve fascicles exists within the peripheral nerves, it is theoretically possible that complete motor control information can be retrieved from peripheral nerve signals. In this study, we present a computational model that simulates the recording from specific nerve fascicles in the upper limb during voluntary contractions while they innervate relevant muscles. A procedure of classifying the nerve data is presented using a set of time domain features and a spike detection algorithm. Recommendations are made to achieve optimal neural signal recognition, with regard to electrode geometry and signal analysis. PMID:19937394

Zhou, Rui; Jiang, Ning; Englehart, Kevin; Parker, Philip

2010-01-01

67

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

68

Neurinomas of the brachial plexus: case report.  

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

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

1999-01-01

69

Skin-derived precursors as a source of progenitors for cutaneous nerve regeneration  

OpenAIRE

Peripheral nerves have the potential to regenerate axons and reinnervate end organs. Chronic denervation and disturbed nerve regeneration are thought to contribute to peripheral neuropathy, pain and pruritus in the skin. The capacity of denervated distal nerves to support axonal regeneration requires proliferation by Schwann cells, which guide regenerating axons to their denervated targets. However, adult peripheral nerve Schwann cells do not retain a growth-permissive phenotype, as is requir...

Chen, Zhiguo; Pradhan, Sanjay; Liu, Chiachi; Le, Lu Q.

2012-01-01

70

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

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

Kato, K; Hopwood, P; Sato, T

1990-12-01

71

Brachial plexus injury: treatment options and outcomes.  

Science.gov (United States)

The brachial plexus is a series of nerves formed by roots of cervical segments 5 to 8 (C5-C8) as well as the first thoracic nerve (T1). It functions to provide sensation and motor innervation to the skin and muscles of the chest and upper limb. It does so through different segments: roots, trunks, divisions, and cords. Injuries to the brachial plexus occur relatively frequently and are due mainly to traumatic accidents that lead to traction or compression of the nerve roots. When considering the etiology and treatment of such injuries, it is important to make a distinction between adult versus obstetric brachial plexus injury. Although several surgical treatment options are described and used for patients with brachial plexus injury, no perfect remedy currently exists. Prevention and safety should be the focus. At the same time, high-quality studies and new technology and techniques are needed to determine more effective treatments for this group. PMID:25006897

Arzillo, Samantha; Gishen, Kriya; Askari, Morad

2014-07-01

72

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

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

Faruquee Sajedur

2008-05-01

73

High-Frequency Transcutaneous Peripheral Nerve Stimulation Induces a Higher Increase of Heat Pain Threshold in the Cutaneous Area of the Stimulated Nerve When Confronted to the Neighbouring Areas  

OpenAIRE

Background. TENS (transcutaneous electrical nerve stimulation) is probably the most diffused physical therapy used for antalgic purposes. Although it continues to be used by trial and error, correct targeting of paresthesias evoked by the electrical stimulation on the painful area is diffusely considered very important for pain relief. Aim. To investigate if TENS antalgic effect is higher in the cutaneous area of the stimulated nerve when confronted to neighbouring areas. Methods. 10 voluntee...

Buonocore, M.; Camuzzini, N.; Cecini, M.; Dalla Toffola, E.

2013-01-01

74

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

Scientific Electronic Library Online (English)

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

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

2012-06-01

75

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. 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

76

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

77

Bilateral, hypertrophic neuritis of the brachial plexus in a cat: magnetic resonance imaging and pathological findings.  

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A 9-year-old Burmese cat was presented for investigation of a subacute onset of bilateral forelimb paresis. Magnetic resonance imaging of the cervico-thoracic vertebral column and brachial plexus revealed a bilaterally symmetrical, severe and diffuse swelling of the spinal nerves forming the caudal part of the brachial plexus. Histopathology of the abnormal nerve roots, spinal nerves and brachial plexi showed inflammatory and marked proliferative changes with similar features to that of hypertrophic neuritis of man. Hypertrophic neuritis in man is a rare, tumor-like, chronic inflammatory peripheral nerve disorder of unknown origin most frequently involving the brachial plexus. PMID:16213764

Garosi, Laurent; de Lahunta, Alexander; Summers, Brian; Dennis, Ruth; Scase, Tim

2006-02-01

78

Identity of Myelinated Cutaneous Sensory Neurons Projecting to Nocireceptive Laminae Following Nerve Injury in Adult Mice  

OpenAIRE

It is widely thought that, after peripheral injury, some low-threshold mechanoreceptive (LTMR) afferents “sprout” into pain-specific laminae (I–II) of the dorsal horn and are responsible for chronic pain states such as mechanical allodynia. Although recent studies have questioned this hypothesis, they fail to account for a series of compelling results from single-fiber analyses showing extensive projections from large-diameter myelinated afferents into nocireceptive layers after nerve i...

Woodbury, C. Jeffery; Kullmann, Florenta A.; Mcilwrath, Sabrina L.; Koerber, H. Richard

2008-01-01

79

Cutaneous vasodilatation induced by nitric oxide-evoked stimulation of afferent nerves in the rat.  

OpenAIRE

1. The site of action at which nitric oxide (NO) may contribute to neurogenic vasodilatation in the hindpaw skin of urethane-anaesthetized rats was examined by the use of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase. 2. Skin blood flow was measured by laser Doppler flowmetry, and neurogenic vasodilatation was evoked either by topical application of mustard oil (5%) or antidromic electrical stimulation of the saphenous nerve (antidromic vasodilatation). 3. L-NAME (60 ...

Holzer, P.; Jocic, M.

1994-01-01

80

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

Science.gov (United States)

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

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

2015-01-01

81

MRI of the brachial plexus: A pictorial review  

Energy Technology Data Exchange (ETDEWEB)

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.

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

2010-05-15

82

MRI of the brachial plexus: A pictorial review  

International Nuclear Information System (INIS)

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

83

Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: A prospective comparison study between total and hemicontralateral C7 nerve root transfer  

OpenAIRE

Purpose: We conducted a clinical study to evaluate the effects of neurotization, especially comparing the total contralateral C7 (CC7) root transfer to hemi-CC7 transfer, on total root avulsion brachial plexus injuries (BPI). Methods: Forty patients who received neurotization for BPI were enrolled in this prospective study. Group 1 (n = 20) received hemi-CC7 transfer for hand function, while group 2 (n = 20) received total-CC7 transfer. Additional neurotization included spinal accessory, phre...

Tu, Yuan-kun; Tsai, Yi-jung; Chang, Chih-han; Su, Fong-chin; Hsiao, Chih-kun; Tan, Jacqueline Siau-woon

2013-01-01

84

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

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The release of /sup 3/H-dopamine (DA) continuously synthesized from /sup 3/H-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 /sup 3/H-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 reestablish sufficient release of DA when the dopaminergic function is impaired as in Parkinson's disease.

Nieoullon, A.; Dusticier, N. (Centre National de la Recherche Scientifique, 13 - Marseille (France). Inst. de Neurophysiologie et Psychophysiologie)

1982-01-01

85

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

Science.gov (United States)

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?TENS group, the decrease in TNF-?, IL-1?, and IL-6 immunoreaction in the skin was significant compared to the other forms of treatment (P?TENS group suggest that TENS shortened the healing process by inhibating the inflammation phase. PMID:24357416

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

2014-06-01

86

Variations of the ventral rami of the brachial plexus.  

OpenAIRE

We studied the variations in the ventral rami of 152 brachial plexuses in 77 Korean adults. Brachial plexus were composed mostly of the fifth, sixth, seventh and eighth cervical nerves and the first thoracic nerve (77.0%). In 21.7% of the cases examined, the fourth, fifth, sixth, seventh and eighth cervical and the first thoracic nerves contributed to the plexus. A plexus composed of the fourth, fifth, sixth, seventh and eighth cervical and the first and second thoracic nerves, and a plexus c...

Lee, H. Y.; Chung, I. H.; Sir, W. S.; Kang, H. S.; Lee, H. S.; Ko, J. S.; Lee, M. S.; Park, S. S.

1992-01-01

87

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

Energy Technology Data Exchange (ETDEWEB)

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% CO{sub 2}. 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 10{sup 4} 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)

Sanchez, S.; Poulletier De Gannes, F.; Haro, E.; Ruffie, G.; Lagroye, I.; Billaudel, B.; Veyret, B. [PIOM laboratory, UMR 5501 CNRS, ENSCPB, 33 -Pessac (France)

2006-07-01

88

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

Scientific Electronic Library Online (English)

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

89

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

90

Avulsão do plexo braquial em cães - 3: eletroneuroestimulação dos nervos radial, mediano, ulnar e musculocutâneo Brachial plexus avulsion in dogs - 3: electroneurostimulation of radial, median, ulnar and musculocutaneous nerves  

Directory of Open Access Journals (Sweden)

Full Text Available O objetivo deste trabalho foi relacionar os aspectos clínicos, neurológicos e histopatológicos (descritos nas partes l e 2 deste trabalho com os resultados obtidos após estimulação elétrica dos nervos radiai, mediano, ulnar e musculocutâneo. Realizou-se a estimulação elétrica destes nervos durante o ato cirúrgico no qual foram coletados os fascículos para histopatolo gia. Os nervos radial, mediano e ulnar de todos os cães submetidos à eletroneuroestimulação apresentaram evidências de degenera- ção. enquanto que o nervo musculocutâneo apresentava função próxima do normal em 25% dos casos. A associação dos resultados do exame neurológico, da histologia e da eletroneuroestimulação sugeriu envolvimento quase que total das raízes do plexo braquial, enfatizando a necessidade de continuidade de pesquisas na área, visando principalmente a recuperação das raízes nervosas envolvidas.The purpose ofthis work was to relate lhe clinicai, neurological and histopathotogical aspects (as described in the sections I and 2 ofthis work with the obtained results after the electric stimulation of radial, median, ulnar and musculocutaneous nerrves. The electric stimulation of these nerves was realized during the cirurgic act, when the fascicle were obtained for the histopathologic examination. The radial, median and ulnar nerves of ali dogs submitted to electroneurostimulation presented evidences of degeneration, while the musculocutaneous nerve present almost normal functions in 25% of the cases. The interpretation ofthe results obtained from neurologic, histologic and electroneurostimulation examination suggested the almost total involvement of brachial plexus in ali cases. This work emphasized the need for further research in this área with lhe main purpose of recuperating the involved roots.

Mônica Vicky Bahr Arias

1997-03-01

91

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

OpenAIRE

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 po...

Ayse Tokcaer; Feride Gogus; Sumer Gullap; Isik Keles; Mustafa Gokce

2007-01-01

92

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

93

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

94

Cutaneous schwannoma of the foot.  

Science.gov (United States)

Schwannomas usually present as solitary subcutaneous tumors adherent to a peripheral nerve. A solitary cutaneous schwannoma presenting as a solitary cutaneous nodule on the foot of a 19-year-old male is described. This is an unusual presentation of schwannoma. Saucerized excision produced an excellent result with no adverse effect on function or cutaneous sensation. PMID:11236222

Ritter, S E; Elston, D M

2001-02-01

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Association of nerve growth factor, chemokine (C-C motif) ligands and immunoglobulin E with pruritus in cutaneous T-cell lymphoma.  

Science.gov (United States)

Many patients with cutaneous T-cell lymphoma (CTCL) experience severe pruritus. This study evaluated serum levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) in patients with CTCL. Although serum NGF and BDNF levels in patients with CTCL were not significantly higher than in healthy controls, serum NGF levels in patients with Sézary syndrome were higher than in those with mycosis fungoides and in healthy controls. Enhanced NGF expression by keratinocytes and increased dermal nerve fibres were detected in lesional skin of subjects with Sézary syndrome. Correlations between pruritus in CTCL and serum levels of NGF, BDNF, chemokine (C-C motif) ligand 1 (CCL1), CCL17, CCL26, CCL27, lactate dehydrogenase (LDH), IgE, and soluble interleukin-2 receptor were analysed. Serum CCL1, CCL26, LDH, and IgE levels correlated with pruritus in patients with CTCL. NGF may be associated with increased dermal nerve fibres and pruritus in Sézary syndrome, and CCL1, CCL26, and IgE may be associated with pruritus in CTCL. PMID:22948508

Suga, Hiraku; Sugaya, Makoto; Miyagaki, Tomomitsu; Ohmatsu, Hanako; Fujita, Hideki; Kagami, Shinji; Asano, Yoshihide; Tada, Yayoi; Kadono, Takafumi; Sato, Shinichi

2013-03-27

96

Documentation of brachial plexus compression (in the thoracic inlet) utilizing provocative neurosensory and muscular testing.  

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Diagnosis and documentation of brachial plexus compression in the thoracic inlet, "thoracic outlet syndrome", remains difficult because the syndrome complex overlaps that of patients with cervical disc disease, intrinsic shoulder pathology, and peripheral nerve compression. While traditional electrodiagnostic testing can identify cervical radiculopathy and the rare isolated lower trunk compression, it cannot identify brachial plexus compression in the thoracic inlet. In 2000, neurosensory testing with the Pressure-Specified Sensory Device (PSSD) was applied to this diagnostic dilemma, demonstrating a significant increase in the one-point static touch cutaneous pressure threshold between controls and patients, when the index finger (upper trunk) and little finger (lower trunk) were tested with the hands at rest and after provoking the plexus by elevating the hands above the head. In the present study, this approach has been extended to include two-point static touch thresholds with the PSSD, and pinch and grip strength (Digit-Grip). Sixteen controls (mean: 34.2, range: 11 to 48 years) were tested and the 99 percent upper confidence limit calculated for percent change after elevation of the hands for 3 min. Forty-one patients symptomatic for brachial plexus compression (mean: 41.0, range: 21 to 62 years) were tested. The clinical severity of the plexus compression was dichotomized as either "severe" or "not severe" judged by the Roos and Tinel sign. Results demonstrated that when five or more of the eight possible neurosensory and motor test results were > 99 percent normal confidence limit for change, this testing has a sensitivity of 82 percent, a specificity of 100 percent, and a positive predictive value of 100 percent for the diagnosis of clinically severe brachial plexus compression. Seventeen patients who were in the "severe" category prior to surgery, were tested before and after plexus neurolysis and anterior scalenectomy. All 17 patients were clinically improved and in 16 of these patients, postoperative neurosensory and motor testing returned to a normal pattern (no significant increase in thresholds with hand elevation). It is concluded that neurosensory (PSSD) and motor testing (Digit-Grip) can help in the diagnosis and documentation of brachial plexus compression. PMID:14506578

Howard, Michael; Lee, Cathy; Dellon, A Lee

2003-07-01

97

Lightning strike-induced brachial plexopathy.  

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We describe a patient who presented with a history of lightning strike injury. Following the injury, he sustained acute right upper limb weakness with pain. Clinically, the lesion was located to the upper and middle trunk of the right brachial plexus, and the same confirmed with electrophysiological studies. Nerve damage due to lightning injuries is considered very rare, and a plexus damage has been described infrequently, if ever. Thus, the proposed hypothesis that lightning rarely causes neuropathy, as against high-voltage electric current, due to its shorter duration of exposure not causing severe burns which lead to nerve damage, needs to be reconsidered. PMID:25288846

Bhargava, Amita N; Kasundra, Gaurav M; Khichar, Subhakaran; Bhushan, Bharat S K

2014-10-01

98

Management of traumatic brachial plexus injuries in adults.  

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Adult brachial plexus injury (BPI) is a closed injury. It usually involves a plexus of nerves formed by a number of roots, spinal nerves, trunks, cords, and numerous terminal branches, in a complicated fashion. Successful results in the management of adult BPI are based on the knowledge of anatomic arrangement, pathophysiology considerations, preoperative evaluation and diagnosis, surgical technique, postoperative management, rehabilitation and regular patient follow-up, surgical treatment of sequelae deformities, and factors influencing its results. This article deals with traumatic lesions of the brachial plexus in adults, and focuses on controversial questions and philosophy of treatment of adult BPI. PMID:10563273

Chuang, D C

1999-11-01

99

[Brachial plexus tumors].  

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The brachial plexus is a primary site of tumours originating from peripheral nervous system, such as neurilemmoma and neurofibroma. Moreover, the brachial plexus is affected by various neoplasms spreading from the neighbouring anatomic structures. Surgical treatment of neoplasms provoking plexopathy is often realised by multidisciplinary teams. The authors present the series of 7 patients operated on for brachial plexus affection between 1993-2000, the pathologic findings were as follows: neurofibroma, neurilemmoma, lymphogranulomatosis, neurofibrosarcoma, lipoma, chordoma, sarcoma neurogenes. The analysis of clinical course includes: main symptoms, diagnostic procedures and results of treatment. Surgical technique is also described. PMID:12418135

Zapa?owicz, Krzysztof; Radek, Andrzej; ?yczak, Piotr; B?aszczyk, Bogdan; Skiba, Piotr

2002-01-01

100

Brachial plexopathy after prone positioning  

OpenAIRE

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

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

2002-01-01

101

Evaluation of brachial plexus injury by MRI  

International Nuclear Information System (INIS)

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

102

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

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

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

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

2012-01-01

104

Brachial plexus variations in its formation and main branches  

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Full Text Available PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.

Fazan Valéria Paula Sassoli

2003-01-01

105

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

Scientific Electronic Library Online (English)

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

106

Femoral nerve dysfunction  

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Felice, KJ. Focal neuropathies of the femoral, obturator, lateral femoral cutaneous and other nerves of the thigh and pelvis. In: Bromberg MB, Smith GA, eds. Handbook of Peripheral Neuropathy. Boca Raton, Fl: Taylor and Francis; 2005:chap ...

107

Brachial plexus block in a parturient.  

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We report a novel circumstance of brachial plexus anesthesia in a parturient. A 25-year-old woman at 34 weeks of gestation presented with a pathologic proximal right humerus fracture from an intramedullary mass. She was scheduled for tumor biopsy which was performed using a two-site ultrasound-guided brachial plexus block to maximize odds of complete anesthesia while minimizing the risk of phrenic nerve paresis. After a supraclavicular block with 0.5% ropivacaine 20 mL, we translated our ultrasound probe cephalad, inferior to the root of C7 where the divisions of the superior trunk could be seen in a tightly compact arrangement. An additional injection of 0.5% ropivacaine 20 mL was administered at this site, and the patient subsequently underwent successful biopsy without sedatives or analgesics, aside from local anesthetics. In the post-anesthesia care unit, she had normal respirations and oxygen saturations breathing room air, denied any shortness of breath or difficulty breathing, and was discharged shortly after her arrival. While we did not pursue radiologic examination to rule out hemidiaphragm paralysis, we assumed, as evidenced in a previous case report, that unlike most healthy patients, a parturient would demonstrate some clinical signs and/or symptoms of hemidiaphragm paralysis, given that the diaphragm is almost totally responsible for inspiration in the term parturient. This represents only the second brachial plexus block in a parturient reported in the literature; the first using ultrasound guidance and without respiratory embarrassment. PMID:24631059

Patzkowski, M; Scheiner, J

2014-05-01

108

[The neuronal mechanisms of the defensive reaction to stimulation of the cutaneous nerve in the freshwater snail].  

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The whole body withdrawal reaction of freshwater snail Planorbarius corneus consists of two phases. In the first phase the shell is rapidly moved down to cover the head, in the second one the body is slowly retracted into the shell. The columellar muscle is involved in this behaviour. Motoneurons of the columellar muscle are identified in the cerebral, parietal and pedal ganglia. In the preparation of the central nervous system connected with the columellar muscle it is demonstrated that stimulation of the lip nerve evoked a biphasic motoneuron excitation responsible for two phases of the muscle contraction. A similar biphasic excitation of the motoneurons could arise spontaneously. This implies that the whole body withdrawal reaction is, at least partly, a fixed act generated by a central mechanism (a central program) which is triggered by a sensory stimulus. The central mechanism of the withdrawal reaction could be also activated by a depolarization of some columellar motoneurons. This suggests that the central mechanism received a feedback from the motoneurons. PMID:2097506

Arshavski?, Iu I; Deliagina, T G; Okshte?n, I L; Orlovski?, G N; Panchin, Iu V

1990-01-01

109

Multiple polymerase chain reaction markers for the differentiation of canine cutaneous peripheral nerve sheath tumours versus canine fibrosarcomas.  

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Currently canine fibrosarcomas and peripheral nerve sheath tumours (PNSTs) are differentiated by their histopathological phenotype. Preliminary global transcriptomic analysis has identified genes with significant differential expression in both tumour types that may act as potential tumour markers. The aim of the present study was to establish reverse transcriptase polymerase chain reaction (RT-PCR) assays for the differentiation of formalin-fixed and paraffin wax-embedded tumours of both types. Fifty histologically well-defined examples of canine fibrosarcomas and PNSTs were characterized immunohistochemically for the expression of S100, laminin and PGP 9.5. RT-PCR assays for the potential fibrosarcoma markers FHL2-Ex4 and FHL2-Ex9 and the PNST markers GLI1 and CLEC3B were established and tested for their specificity and sensitivity to differentiate fibrosarcomas and PNSTs by their mRNA expression. Immunohistochemical analysis challenged the value of S100, laminin and PGP 9.5 for the diagnosis of PNSTs, since both PNSTs and fibrosarcomas showed similar expression of these proteins. In contrast, a combination of the markers GLI1 and CLEC3B differentiated PNSTs from fibrosarcomas with a sensitivity of 89% and a specificity of 87%. The proposed fibrosarcoma markers FHL2-Ex4 and FHL2-Ex9 failed to separate PNSTs and fibrosarcomas (sensitivity 50%, specificity 88%). The failure of these markers to unequivocally separate fibrosarcomas and PNSTs raises questions as to whether histologically uniform PNSTs are less uniform at the molecular level than expected or if both tumour types, despite their different morphology, are more closely related in terms of their histogenesis than previously thought. PMID:24650889

Meyer, A; Klopfleisch, R

2014-01-01

110

Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization  

OpenAIRE

Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attentio...

Magistroni, Ernesta; Ciclamini, Davide; Panero, Bernardino; Verna, Valter

2014-01-01

111

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

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Full Text Available 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. [West J Emerg Med. 2014;15(6:703-705

Christopher Hahn

2014-09-01

112

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

OpenAIRE

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

Christopher Hahn; Arun Nagdev

2014-01-01

113

Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG  

International Nuclear Information System (INIS)

The results of clinical, radiologic, and electrophysiologic studies are retrospectively reviewed for 55 patients with neoplastic and 35 patients with radiation-induced brachial plexopathy. The presence or absence of pain as the presenting symptom, temporal profile of the illness, presence of a discrete mass on CT of the plexus, and presence of myokymic discharges on EMG contributed significantly to the prediction of the underlying cause of the brachial plexopathy. The distribution of weakness and the results of nerve conduction studies were of no help in distinguishing neoplastic from radiation-induced brachial plexopathy

114

Reconstruction of Shoulder Abduction and External Rotation in Obstetrical Brachial Plexus Palsy Patients  

OpenAIRE

Stability of the shoulder joint and restoration of abduction are important following obstetrical brachial plexus paralysis, as more distal functions depend on having a stable and functioning shoulder. Both deltoid and supraspinatus muscles are active and play a significant role during arm abduction. Along with the suprascapular nerve reinnervation, it is our policy to also neurotize the axillary nerve. The purpose of this report is to present our experience of suprascapular nerve reconstructi...

Terzis, Julia K.; Kostas, Ioannis

2005-01-01

115

Traumatic Pseudoaneurysm of Axillary Artery Combined with Brachial Plexus Injury  

OpenAIRE

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 de...

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

2014-01-01

116

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

International Nuclear Information System (INIS)

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

117

Origins and branchings of the brachial plexus of the gray brocket deer Mazama gouazoubira (Artiodactyla: Cervidae  

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Full Text Available The brachial plexus is a set of nerves originated in the cervicothoracic medular region which innervates the thoracic limb and its surroundings. Its study in different species is important not only as a source of morphological knowledge, but also because it facilitates the diagnosis of neuromuscular disorders resulting from various pathologies. This study aimed to describe the origins and branchings of the brachial plexus of Mazama gouazoubira. Three specimens were used, belonging to the scientific collection of the Laboratory for Teaching and Research on Wild Animals of Universidade Federal de Uberlandia (UFU; they were fixed in 3.7% formaldehyde and dissected. In M. gouazoubira, the brachial plexus resulted from connections between the branches of the three last cervical spinal nerves, C6, C7, C8, and the first thoracic one, T1, and it had as derivations the nerves suprascapular, cranial and caudal subscapular, axillary, musculocutaneous, median, ulnar, radial, pectoral, thoracodorsal, long thoracic and lateral thoracic. The muscles innervated by the brachial plexus nerves were the supraspinatus, infraspinatus, subscapularis, teres major, teres minor, deltoid, cleidobrachial, coracobrachialis, biceps brachialis, brachial, triceps brachialis, anconeus, flexor digitorum superficialis, flexor digitorum profundus, flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, lateral ulnar, extensor carpi obliquus, extensor digitorum, superficial pectoral, deep pectoral, ventral serratus, and external oblique abdominal.

Lucélia Gonçalves Vieira

2013-03-01

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)  

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.

2012-09-01

119

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  

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

Rafael José Soares Dias

2004-09-01

120

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

121

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 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.)

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

2006-12-15

122

Brachial plexus lesions after backpack carriage in young adults.  

Science.gov (United States)

Carrying a heavy backpack exerts compression on shoulders, with the potential to cause brachial plexopathy. We evaluated the incidence and predisposing factors of compression plexopathy of the shoulder region in 152,095 military conscripts, hypothesizing that a low body mass index and poor physical fitness predispose to the plexus lesion. Reports of conscripts with neural lesions of the upper arm associated with load carriage were reviewed retrospectively for details associated with the condition onset, symptoms, signs, nerve conduction studies, and electromyographic examinations. Height, weight, and physical fitness scores were obtained from their military training data. The incidence of neural compression after shoulder load carriage in Finnish soldiers was 53.7 (95% confidence interval, 39.5-67.8) per 100,000 conscripts per year. The long thoracic nerve was affected in 19, the axillary nerve in 13, the suprascapular nerve in seven, and the musculocutaneous nerve in six patients. Four patients (7%) had hereditary neuropathy with susceptibility to pressure palsies (HNPP). Symptoms were induced by lighter loads in patients with HNPP. Vulnerability to brachial plexopathy was not predictable from body structure or physical fitness level. To prevent these lesions, awareness of the condition and its symptoms should be increased and backpack designs should be improved. PMID:16906084

Mäkelä, Jyrki P; Ramstad, Raimo; Mattila, Ville; Pihlajamäki, Harri

2006-11-01

123

Cutaneous Anthrax  

Science.gov (United States)

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

124

Platysma motor branch transfer in brachial plexus repair: report of the first case  

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Full Text Available Abstract Background Nerve transfers are commonly employed in the treatment of brachial plexus injuries. We report the use of a new donor for transfer, the platysma motor branch. Methods A patient with complete avulsion of the brachial plexus and phrenic nerve paralysis had the suprascapular nerve neurotized by the accessory nerve, half of the hypoglossal nerve transferred to the musculocutaneous nerve, and the platysma motor branch connected to the medial pectoral nerve. Results The diameter of both the platysma motor branch and the medial pectoral nerve was around 2 mm. Eight years after surgery, the patient recovered 45° of abduction. Elbow flexion and shoulder adduction were rated as M4, according to the BMC. There was no deficit after the use of the above-mentioned nerves for transfer. Volitional control was acquired for independent function of elbow flexion and shoulder adduction. Conclusion The use of the platysma motor branch seems promising. This nerve is expendable; its section led to no deficits, and the relearning of motor control was not complicated. Further anatomical and clinical studies would help to clarify and confirm the usefulness of the platysma motor branch as a donor for nerve transfer.

Bertelli Jayme

2007-05-01

125

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

126

Brachial plexus injury in newborns  

Science.gov (United States)

... brachial plexus injury: Breech delivery Larger-than-average newborn (such as an infant of a diabetic mother ) ... birth. They may include: No movement in the newborn’s upper or lower arm or hand Absent Moro ...

127

[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

128

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

Scientific Electronic Library Online (English)

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

Niladri Kumar, Mahato.

1241-12-01

129

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

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

Niladri Kumar Mahato

2010-12-01

130

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.)

131

MRI of the brachial plexus  

Energy Technology Data Exchange (ETDEWEB)

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

132

Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report.  

Science.gov (United States)

The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer. PMID:23390150

Hu, S; Chu, B; Song, J; Chen, L

2014-02-01

133

Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve.  

Science.gov (United States)

An anatomical study was performed to define the course of the radial nerve in the posterior aspect of the arm, with particular reference to its relationship to operative exposures of the posterior aspect of the humeral diaphysis. In ten cadaveric specimens, the radial nerve was found to cross the posterior aspect of the humerus from an average of 20.7 +/- 1.2 centimeters proximal to the medial epicondyle to 14.2 +/- 0.6 centimeters proximal to the lateral epicondyle. As it crossed the posterior aspect of the humerus in each specimen, the nerve had several branches to the lateral head of the triceps; however, no branches were found innervating the medial head of the triceps in the posterior aspect of any of the specimens. At the lateral aspect of the humerus, the nerve trifurcated into a branch to the medial head of the triceps, the lower lateral brachial cutaneous nerve, and the continuation of the radial nerve into the distal part of the upper arm and the forearm. Three operative approaches were performed in each specimen. The posterior triceps-splitting approach exposed an average of 15.4 +/- 0.8 centimeters of the humerus from the lateral epicondyle to the point at which the radial nerve crossed the posterior aspect of the humerus. For the second approach, the radial nerve was mobilized proximally to allow an additional six centimeters of the humeral diaphysis to be visualized. The third approach (the modified posterior approach) involved the identification of the radial nerve distally as it crossed the lateral aspect of the humerus, followed by reflection of both the lateral and the medial heads of the triceps medially. This exposure permitted visualization of 26.2 +/- 0.4 centimeters of the humeral diaphysis from the lateral epicondyle proximally. The results after use of the modified posterior approach in seven patients were also reviewed. PMID:8934483

Gerwin, M; Hotchkiss, R N; Weiland, A J

1996-11-01

134

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2008-02-15

135

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.)

136

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

137

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 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

138

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

Directory of Open Access Journals (Sweden)

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

139

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

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

Peri? Stojan

2011-01-01

140

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

141

[Cutaneous mucinosis].  

Science.gov (United States)

The cutaneous mucinoses are a heterogeneous group of diseases in which mucin accumulates in the skin or within the hair follicle. We divide the cutaneous mucinoses into two groups: the distinctive cutaneous mucinoses in which the mucin deposit is a distinctive histopathologic feature that manifests as a clinically specific lesion, and the diseases associated with histopathologic mucin deposition as an additional finding. This article deals with the clinical and histopathologic features and the treatment of the distinctive cutaneous mucinoses and updates their classification. They may be divided, according to the microscopic location of mucin, into dermal and follicular mucinoses. The former group includes; lichen myxedematosus, acral persistent papular mucinosis, reticular erythematous mucinosis, scleredema, dysthyroidotic mucinoses (i.e. localized myxedema, generalized myxedema, papular mucinoses associated with thyroid diseases), papular and nodular mucinosis associated with lupus erythematosus, self-healing juvenile cutaneous mucinosis, cutaneous mucinosis of the infancy, cutaneous toxic mucinoses (papular mucinosis of the toxic oil syndrome and of eosinophiliamyalgia syndrome), neuropathia mucinosa cutanea, cutaneous focal mucinosis, mucous cyst (digital and of the oral mucosa), while the latter group includes Pinkus' follicular mucinosis and urticaria-like follicular mucinosis. PMID:8338331

Rongioletti, F; Rebora, A

1993-01-01

142

Changes of cutaneous sensory thresholds induced by non-painful transcutaneous electrical nerve stimulation in normal subjects and in subjects with chronic pain.  

OpenAIRE

Transcutaneous electrical nerve stimulation (TENS) of the nervi cutaneus surae medialis was applied to 59 healthy subjects and 30 patients suffering from chronic myofascial pain in one lower limb, with an intensity of current that induced a well tolerated tingling sensation. Each period of stimulation lasted 24 minutes. The thresholds of the tactile, tingling and painful sensations were tested at fixed intervals before, during and after stimulation. Trains of constant current square waves in ...

Zoppi, M.; Francini, F.; Maresca, M.; Procacci, P.

1981-01-01

143

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

144

Digital nerve reconstruction by multiple Y-shaped nerve grafts at the metacarpophalangeal joint level.  

Science.gov (United States)

Digital nerve injuries are common; injuries of the common digital nerves are less frequent than those involving the proper digital nerves. Traditional techniques used to reconstruct peripheral nerves are: direct suture, autologous nerve grafts, autologous vein grafts, vascularised nerve graft and alloplastic nerve grafts. Autologous nerve grafts remain the most common conduits for segmental defects. Difficulties can arise when attempting to repair complex nerve gaps, particularly when joining the proximal stump of the common digital nerve with two distal stumps of proper digital nerves as in lesions involving the web space. We present below a case of such a lesion. We describe the use of the lateral antebrachial cutaneous nerve (LABCN) as donor nerve, by exploiting its natural branchings. PMID:18703388

Schonauer, Fabrizio; Taglialatela Scafati, Salvatore; La Rusca, Ivan; Molea, Guido

2008-11-01

145

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

146

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

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

C López

2010-01-01

147

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

Scientific Electronic Library Online (English)

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

C, López; JU, Carmona; I, Samudio.

148

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

Science.gov (United States)

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

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

2015-03-01

149

Restoration of Contralateral Representation in the Mouse Somatosensory Cortex after Crossing Nerve Transfer  

OpenAIRE

Avulsion of spinal nerve roots in the brachial plexus (BP) can be repaired by crossing nerve transfer via a nerve graft to connect injured nerve ends to the BP contralateral to the lesioned side. Sensory recovery in these patients suggests that the contralateral primary somatosensory cortex (S1) is activated by afferent inputs that bypassed to the contralateral BP. To confirm this hypothesis, the present study visualized cortical activity after crossing nerve transfer in mice through the use ...

Yamashita, Haruyoshi; Chen, Shanlin; Komagata, Seiji; Hishida, Ryuichi; Iwasato, Takuji; Itohara, Shigeyoshi; Yagi, Takeshi; Endo, Naoto; Shibata, Minoru; Shibuki, Katsuei

2012-01-01

150

Variant formation and course of the median nerve  

OpenAIRE

Many formative variations of median nerve are known but this variant formation and course of median nerve is rare. A variant formation of median nerve was noted in the left axilla and arm of a male cadaver, in the form of formation of median nerve behind the third part of axillary artery and its course in arm entirely behind the brachial artery. There may be compression of axillary artery due to the roots of the nerve passing around the artery. Also there may be compression of median nerve be...

Ar, Nene; Ks, Gajendra; Mvr, Sarma

2010-01-01

151

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

Science.gov (United States)

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

152

Surgical treatment of adult traumatic brachial plexus injuries: an overview Tratamento cirúrgico das lesões traumáticas do plexo braquial em adultos: uma visão geral  

OpenAIRE

Traumatic injuries to the brachial plexus in adults are severely debilitating. They generally affect young individuals. A thorough understanding of the anatomy, clinical evaluation, imaging and electrodiagnostic assessments, treatment options and proper timing of surgical interventions will enable nerve surgeons to offer optimal care to patients. Advances in microsurgical technique have improved the outcome for many of these patients. The treatment options offer patients with brachial plexus ...

Siqueira, Mario G.; Martins, Roberto S.

2011-01-01

153

Brachial Amyotrophic Diplegia: Case Report  

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Full Text Available Two forms of Amyotrophic lateral sclerosis (ALS subtypes have been recognized since the late 19th and early 20th centuries but relatively inadequately studied, these being the flail arm (FA and flail leg (FL syndromes. The FA phenotype was described by Vulpian in 1886 as a syndrome of proximal weakness and wasting of the upper limbs (scapulohumeral variant of progressive muscular atrophy or forme scapulo-hume´rale. The condition has been variously termed as Vulpian-Bernhardt syndrome, hanging-arm syndrome, neurogenic man-in-a-barrel syndrome, brachial amyotrophic diplegia, or the FA syndrome. The syndrome typically presents with progressive upper limb weakness and wasting that is often symmetric and proximal, without significant functional involvement of lower limbs or bulbar muscles. Here we presented a patient with complaints of difficulty in lifting his right arm in his medical history. Brachial amyotrophic diplegia was diagnosed with neurological examination and EMG findings. It is presented because of rarity.

Mehmet YÜCEL

2011-03-01

154

The upper brachial plexus defect model in rhesus monkeys: a cadaveric feasibility study.  

Science.gov (United States)

To establish a model for nerve grafts and determine the anatomic characteristics of the brachial plexus in rhesus monkeys. Ten specimens of the brachial plexus were obtained from five rhesus monkey cadavers. Anatomic dissection of the brachial plexus was systemically performed. The length of each root, trunk, and each division was measured using a Vernier caliper proximodistally. The anatomic distributions of the suprascapular, axillary, and musculocutaneous nerve were documented. The brachial plexus of rhesus monkeys included the spinal nerves or roots of C5, C6, C7, C8, and T1 (80%, 8/10), with a small contribution from the C4 root (20%, 2/10) occasionally. The upper trunk was not measurable because of their irregular structures. The lower trunk had a mean length of 1.62 (range, 0.96-2.1 mm) and a mean diameter of 2.29 (range, 1.9-2.94 mm). For the upper trunk, the C5 and C6 roots either divided into two very short divisions or sent out very long divisions before they joined together. For the middle trunk, the C7 root had a straight course after leaving the foramen and blended imperceptibly into the middle trunk before dividing into the anterior and posterior divisions. The lower trunk was noted in almost all the specimens (80%, 8/10), which was formed by C8 and T1. The brachial plexus in rhesus monkeys varies from that of humans, and defects can be made at the level of C5 and C6 roots and the C7 root should also be cut off and ligated. PMID:24025797

Lu, Qingsen; Gu, Liqiang; Jiang, Li; Qin, Bengang; Fu, Guo; Li, Xiangming; Yang, Jiangtao; Huang, Xijun; Yang, Yi; Zhu, Qingtang; Liu, Xiaolin; Zhu, Jiakai

2013-11-13

155

Coexistent Malignant Peripheral Nerve Sheath Tumor and Lateral Spinal Meningoceles  

OpenAIRE

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

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

2012-01-01

156

Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus.  

Science.gov (United States)

The peripheral nerves of the upper limb are affected by a number of entrapment and compression neuropathies. These discrete syndromes involve the brachial plexus as well as the musculocutaneous, axillary, suprascapular, ulnar, radial, and median nerves. Clinical examination and electrophysiologic studies are the traditional mainstay of diagnostic work-up; however, ultrasonography and magnetic resonance imaging provide spatial information regarding the affected nerve and its surroundings, often assisting in narrowing the differential diagnosis and guiding treatment. Imaging is particularly valuable in complex cases with discrepant nerve function test results. Familiarity with the clinical features of various peripheral neuropathies of the upper extremity, the relevant anatomy, and the most common sites and causes of nerve entrapment assists in diagnosis and treatment. PMID:20833856

Linda, Dorota Dominika; Harish, Srinivasan; Stewart, Brian G; Finlay, Karen; Parasu, Naveen; Rebello, Ryan Paul

2010-09-01

157

Cutaneous protothecosis.  

Science.gov (United States)

Prototheca species are an achlorophyllic algae that cause infections primarily in immunocompromised individuals. At least one-half of infectious cases are cutaneous. Because protothecosis is seldom suspected clinically, patients may be subjected to various treatment modalities for extended periods without satisfactory results. Cutaneous protothecosis shares similar clinical and pathologic findings with deep tissue fungal mycoses. The typical presentation occurs most commonly on the face and extremities as erythematous plaques, nodules, or superficial ulcers. Prototheca spp are spherical, unicellular, nonbudding organisms that are sometimes noted on routine hematoxylin-eosin staining but are best visualized with periodic acid-Schiff and Gomori methenamine-silver histochemical stains. Although protothecosis can be diagnosed on biopsy, culture of the organism on a medium such as Sabouraud dextrose agar is required for definitive diagnosis. Treatment may require a combination of surgical excision and antifungal agents. Therefore, cutaneous protothecosis should be considered in a lesion that appears suspicious for the more-common fungal infections. PMID:21732787

Hillesheim, Paul B; Bahrami, Soon

2011-07-01

158

Central nervous system networks involved in the processing of meningeal and cutaneous inputs from the ophthalmic branch of the trigeminal nerve in the rat.  

Science.gov (United States)

This study analysed the organization of central nervous system networks involved in the processing of meningeal inputs in the male, Sprague-Dawley rat. We injected the anterograde tracer, biotin dextran, into areas of the medullary trigeminal nucleus caudalis (Sp5C), which receive inputs from the ophthalmic division of the trigeminal nerve. Double-labelling immunohistochemical studies were then performed to compare calcitonin gene-related peptide (CGRP) or serotonin 1D (5HT1(D)) receptor distributions in the areas innervated by Sp5C neurons. Dense, topographically organized intratrigeminal connections were observed. Sp5C neurons projected to the commissural subnucleus of the solitary tract, A5 cell group region/superior salivatory nucleus, lateral periaqueductal grey matter, inferior colliculus and parabrachial nuclei. Trigeminothalamic afferents were restricted to the posterior group and ventroposteromedial thalamic nuclei. Some of these areas are also immunoreactive for 5HT1(D) and CGRP and thus remain potential central targets of triptan molecules and other antimigraine drugs. PMID:18498395

Noseda, R; Monconduit, L; Constandil, L; Chalus, M; Villanueva, L

2008-08-01

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

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  

Directory of Open Access Journals (Sweden)

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

161

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

Scientific Electronic Library Online (English)

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 des [...] te 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. Abstract in spanish 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. Abstract in english 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 an

Lúcia, Beato; Gustavo, Camocardi; Luiz Eduardo, Imbelloni.

2005-08-01

162

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

Science.gov (United States)

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

163

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

Directory of Open Access Journals (Sweden)

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. CONCLUS?ES: 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

164

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

Scientific Electronic Library Online (English)

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.

2012-07-01

165

Misdiagnosis of Brachial Plexus Schwannoma as Cervical Radiculopathy  

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

Mahnaz Khajepour

2013-01-01

166

Radiation-induced brachial plexus neuropathy in breast cancer patients  

Energy Technology Data Exchange (ETDEWEB)

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

167

Schwannomatosis of the sciatic nerve  

International Nuclear Information System (INIS)

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.)

168

Schwannomatosis of the sciatic nerve  

Energy Technology Data Exchange (ETDEWEB)

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

169

Hyperemic Brachial Artery Blood Flow Velocity  

OpenAIRE

This thesis aims to evaluate the blood flow velocity in the Brachial artery during reactive hyperemia. Primarily to appraise the information it might contain regarding cardiovascular function and cardiovascular risk. Ultrasonographic doppler measurements of the Brachial artery were made on the 1016 men and women aged 70 included in the prospective investigation of the vasculature in Uppsala seniors (PIVUS) study. Analysis of the blood flow velocity in the forearm was made in comparison to est...

Ja?rhult, Susann J.

2010-01-01

170

Cutaneous Vasculitis  

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

Nilsel ?lter

2010-06-01

171

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

OpenAIRE

OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% ...

Leandro Pretto Flores

2011-01-01

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 | Languages: English, 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 c

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

2008-04-01

173

Brachial plexus variations in its formation and main branches  

Scientific Electronic Library Online (English)

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

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

174

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

Directory of Open Access Journals (Sweden)

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

175

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)

176

Nerve conduction  

Science.gov (United States)

... spinal cord to muscles and sensory receptors. A peripheral nerve is composed of nerve bundles (fascicles) that contain hundreds of individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The dendrites are the tree- ...

177

Cutaneous leishmaniasis.  

Science.gov (United States)

Cutaneous leishmaniasis is the most common form of leishmaniasis, which also appears in mucosal and visceral forms. It is a disease found worldwide, caused by an intracellular protozoan parasite of which there are more than 20 different species. The disease is transmitted by the bite of an infected, female, phlebotomine sand fly, causing skin lesions that can appear weeks to years after a bite. A typical lesion will start out in a papular form, progressing to a nodular plaque and, eventually, to a persistent ulcerative lesion. Special Operations Forces medical providers should be aware of this disease, which must be in the differential diagnosis of a patient who has lived in endemic areas and who has a persistent skin lesion nonresponsive to typical therapies. PMID:25770811

Burnett, Mark W

2015-01-01

178

Variation in the Formation of Sural Nerve –A Case Report  

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

Tanvi Mahajan

2014-07-01

179

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

180

Variant formation and course of the median nerve  

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Full Text Available Many formative variations of median nerve are known but this variant formation and course of median nerve is rare. A variant formation of median nerve was noted in the left axilla and arm of a male cadaver, in the form of formation of median nerve behind the third part of axillary artery and its course in arm entirely behind the brachial artery. There may be compression of axillary artery due to the roots of the nerve passing around the artery. Also there may be compression of median nerve between the fork of axillary artery and its branch. This variation may be clinically important because symptoms of median nerve compression arising from similar variations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

Nene AR

2010-07-01

181

Phenotyping sensory nerve endings in vitro in the mouse  

OpenAIRE

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

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

2009-01-01

182

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

Energy Technology Data Exchange (ETDEWEB)

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.

Brogdon, B.G.; Arcement, L.J.

1986-08-01

183

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.)

184

TRPA1 modulates mechanotransduction in cutaneous sensory neurons  

OpenAIRE

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

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

2009-01-01

185

Cutaneous denervation of psoriasiform mouse skin improves acanthosis and inflammation in a sensory neuropeptide dependent manner  

OpenAIRE

Nervous system involvement in psoriasis pathogenesis is supported by increases in nerve fiber numbers and neuropeptides in psoriatic skin and by reports detailing spontaneous plaque remission following nerve injury. Using the KC-Tie2 psoriasisform mouse model, we investigated the mechanisms by which nerve injury leads to inflammatory skin disease remission. Cutaneous nerves innervating dorsal skin of KC-Tie2 animals were surgically axotomized and beginning 1d following denervation, CD11c+ cel...

Ostrowski, Stephen M.; Belkadi, Abdelmadjid; Loyd, Candace M.; Diaconu, Doina; Ward, Nicole L.

2011-01-01

186

[Cutaneous leishmaniasis].  

Science.gov (United States)

Infections with Leishmania are increasing worldwide because of tourism and job-related travel; central Europe is no exception. Infections often first become apparent after return from an endemic region. Depending on the Leishmania species and the host immune status, different forms of cutaneous (CL), mucocutaneous (MCL) (L. brasiliensis complex) or visceral leishmaniasis (L. donovani as well as L. infantum) may develop. CL may heal spontaneously with scarring but can evolve into diffuse CL (with reduced immune response to L. amazonensis, L. guyanensis, L. mexicana or L. aethiopica) or into recurrent CL. Diagnostic criteria include travel to an endemic area as well as ulcerated plaques or nodules on an exposed site which show no tendency towards healing over 3-4 weeks. Differential diagnostic considerations include ecthyma, other infectious ulcers, and malignant neoplasms. The diagnosis is confirmed by finding Leishmania in a smear or tissue biopsy, as well as by culture. Therapy options range from topical treatment of simple CL of the Old World caused by L. major to systemic therapy which is needed for most complex cases of CL as well as MCL. Miltefosine is a less toxic option to replace the antimony compounds. PMID:17447043

von Stebut, E; Sunderkötter, C

2007-05-01

187

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

188

Brachial artery approach for outpatient arteriography  

International Nuclear Information System (INIS)

To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, with particular regard to safety and image quality. The angiographic findings and follow-up medical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 F pigtail catheters were used in 125 cases and 5-F OCU-A catheters were used in three cases of renal arteriography, and three of upper extremity arteriography without catheter. Except for three cases of brachial artery puncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremity arteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were three in which there was multiple obstruction at the distal common iliac artery and one with insufficient contrast amount due to renal failure In four cases there were complications : two involved arterial thrombosis, one was an intramuscular hematoma, and one an A-V fistula. For outpatients, brachial approach arteriography can replace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate of complications is relatively low

189

What has changed in brachial plexus surgery?  

Scientific Electronic Library Online (English)

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

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

190

Coexistent malignant peripheral nerve sheath tumor and lateral spinal meningoceles.  

Science.gov (United States)

Malignant peripheral nerve sheath tumor (MPNST) is a malignant spindle cell tumor of the soft tissue thought to be derived from the components of nerve sheath. MPNSTs are mainly located in the buttocks, thighs, brachial plexus, and paraspinal region. The objective of this article is to describe a case of neurofibromatosis type 1 who developed neurofibrosarcoma of the right lateral thoracic nerve with thoracic meningoceles, a rare coincidental finding which has not yet been reported in the English medical literature, and how both the conditions were managed in the same sitting. PMID:23066463

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

2012-01-01

191

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

192

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

Scientific Electronic Library Online (English)

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

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

193

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

Directory of Open Access Journals (Sweden)

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

194

Brachial amyotrophic diplegia in the setting of complete HIV viral load suppression.  

Science.gov (United States)

Brachial amyotrophic diplegia (BAD) is a rare segmental form of motor neuron disease which presents with asymmetric lower motor neuron weakness largely confined to the upper extremities (UE). In the case being reported, a 62-year-old gentleman on antiretroviral treatment since 1993, presented with left-arm weakness in 2007 that quickly progressed to involve the right arm. Complete HIV-viral load suppression had been achieved since 2003. Examination revealed lower motor neuron weakness in both UEs, worse proximally than distally and normal strength in the lower extremities (LEs). Nerve conduction studies showed reduced amplitudes of bilateral median and ulnar nerves' motor responses. Needle electromyography of bilateral UE showed active and chronic denervation/reinnervation changes with normal findings in both LEs. MRI of the cervical spine showed cord atrophy. This is the first case report describing a patient who presented with BAD in the setting of complete HIV-viral load suppression for many years. PMID:23220836

Cachia, David; Izzy, Saef; Ionete, Carolina; Salameh, Johnny

2012-01-01

195

Total obstetric brachial plexus palsy: results and strategy of microsurgical reconstruction.  

Science.gov (United States)

From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3-60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5-7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3- or 4-months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor. PMID:20049908

El-Gammal, Tarek A; El-Sayed, Amr; Kotb, Mohamed M; Ragheb, Yasser Farouk; Saleh, Waleed Riad; Elnakeeb, Ramy Mohamed; El-Sayed Semaya, Ahmad

2010-01-01

196

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

Science.gov (United States)

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 µg 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. PMID:25653791

Ghadirian, Safoura; Vesal, Nasser

2013-01-01

197

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

Directory of Open Access Journals (Sweden)

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

Kaplan anastomosis of the ulnar nerve: a case report  

OpenAIRE

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

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

2008-01-01

199

Ultrasound-guided pulse-dose radiofrequency: treatment of neuropathic pain after brachial plexus lesion and arm revascularization.  

Science.gov (United States)

Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain. PMID:25525439

Magistroni, Ernesta; Ciclamini, Davide; Panero, Bernardino; Verna, Valter

2014-01-01

200

Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization  

Science.gov (United States)

Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain. PMID:25525439

Magistroni, Ernesta; Panero, Bernardino; Verna, Valter

2014-01-01

201

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

Science.gov (United States)

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

202

Fibromuscular dysplasia of the brachial artery associated with unilateral clubbing  

OpenAIRE

A 46-year old male patient was admitted with a history of an extremely painful right upper arm, associated with unilateral clubbing. Duplex scanning and magnetic resonance imaging were suggestive of a pseudo-aneurysm of the brachial artery. Digital angiography showed an irregular brachial artery, associated with a small pseudo-aneurysm. The brachial artery was partially resected and reconstructed with a venous interposition graft. Pathological examination provided the final diagnosis of fibro...

Waele, Miche?le; Lauwers, Patrick; Hendriks, Jeroen; Schil, Paul

2012-01-01

203

Zosteriform cutaneous leiomyoma: a rare cutaneous neoplasm  

International Nuclear Information System (INIS)

Cutaneous leiomyomas are firm, round to oval, skin-coloured to brownish papules and nodules that may present as a solitary, few discrete or multiple clustered lesions. Different uncommon patterns of multiple leiomyoma distribution have been noted as bilateral, symmetrical, linear, zosteriform, or dermatomal-like arrangement. One such rare presentation was seen in a 23-year-old patient who presented with zosteriform skin coloured, occasionally painful cutaneous lesions over left shoulder region. Histopathology confirmed the diagnosis of cutaneous leiomyoma. He was symptomatically managed with non-steroidal anti-inflammatory agents and topical capcicum cream. Case is reported here due to rare occurrence of this benign cutaneous neoplasm in an atypical pattern and on uncommon site. (author)

204

Bronchospasm following supraclavicular brachial plexus block  

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Supraclavicular brachial plexus block is commonly performed for upper limb surgeries. In patients with compromised respiratory function or in the elderly it may be preferred over general anaesthesia. Bronchospasm, albeit a rare complication of this procedure, may turn the advantages of regional anaesthesia in these patients into a disadvantage. Bronchospasm following interscalene approach has been previously reported. However, the same following the supraclavicular approach has not yet been r...

Pai, Rohini V. Bhat; Hegde, Harihar V.; Santosh, M. C. B.; Roopa, S.

2011-01-01

205

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

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

2014-06-01

206

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

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

Fabiano Rebouças

2010-01-01

207

Brachial artery-to-brachial vein arterio-venous fistula in a pediatric patient  

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Full Text Available The National Kidney Foundation’s Disease Outcome Quality Initiative (NKF-DOQI guidelines, produced in 1997, emphasized the superiority of arterio-venous fistulae (AVF as vascular access in patients on chronic hemodialysis. Challenges in pediatric hemodialysis patients include poor superficial venous vasculature. We describe an approach to brachial artery to brachial vein AVF creation in a pediatric dialysis patient. The fistula is patent for greater than one year after creation. A great deal of passion and enthusiasm is a prerequisite for successful and technically challenging cases such as the one described.

Deborah P. Jones

2009-05-01

208

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

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

Björkman Anders

2010-07-01

209

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

210

Giant cutaneous horn  

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

Kumaresan M

2008-01-01

211

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

212

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

Science.gov (United States)

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. PMID:16440223

Oguz, Berna; Oguz, Kader Karli; Cila, Aysenur; Tan, Ersin

2003-12-01

213

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

214

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.)

215

Dexmedetomidine Added to Ropivacaine Prolongs Axillary Brachial Plexus Block  

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

Feroz Ahmad Dar

2013-10-01

216

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

217

DISSOCIATION BETWEEN SYMPATHETIC NERVE TRAFFIC AND SYMPATHETICALLY-MEDIATED VASCULAR TONE IN NORMOTENSIVE HUMAN OBESITY  

OpenAIRE

Obesity increases the risk of hypertension and its cardiovascular complications. This has been partly attributed to increased sympathetic nerve activity, as assessed by microneurography and catecholamine assays. However, increased vasoconstriction in response to obesity-induced sympathoactivation has not been unequivocally demonstrated in obese subjects without hypertension. We evaluated sympathetic ?-adrenergic vascular tone in the forearm by brachial arterial infusion of the ?-adrenorecep...

Agapitov, Alexei Vasilievich; Gusma?o Correia, Marcelo Lima; Sinkey, Christine Ann; Haynes, William Geoffrey

2008-01-01

218

Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques.  

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Brachial plexus injury (BPI) is a severe neurologic injury that causes functional impairment of the affected upper limb. Imaging studies play an essential role in differentiating between preganglionic and postganglionic injuries, a distinction that is crucial for optimal treatment planning. Findings at standard myelography, computed tomographic (CT) myelography, and conventional magnetic resonance (MR) imaging help determine the location and severity of injuries. MR imaging sometimes demonstrates signal intensity changes in the spinal cord, and enhancement of nerve roots and paraspinal muscles at MR imaging indicates the presence of root avulsion injuries. New techniques including MR myelography, diffusion-weighted neurography, and Bezier surface reformation can also be useful in the evaluation and management of BPI. MR myelography with state-of-the-art technology yields remarkably high-quality images, although it cannot replace CT myelography entirely. Diffusion-weighted neurography is a cutting-edge technique for visualizing postganglionic nerve roots. Bezier surface reformation allows the depiction of entire intradural nerve roots on a single image. CT myelography appears to be the preferred initial imaging modality, with standard myelography and contrast material-enhanced MR imaging being recommended as additional studies. Work-up will vary depending on the equipment used, the management policy of peripheral nerve surgeons, and, most important, the individual patient. PMID:17050511

Yoshikawa, Takeharu; Hayashi, Naoto; Yamamoto, Shinichi; Tajiri, Yasuhito; Yoshioka, Naoki; Masumoto, Tomohiko; Mori, Harushi; Abe, Osamu; Aoki, Shigeki; Ohtomo, Kuni

2006-10-01

219

Anatomical Variation: Median Nerve Formation – A Case Vignette  

OpenAIRE

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 m...

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

2014-01-01

220

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

221

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

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

Anderson, A. J.; Harvey, A. L.

1988-01-01

222

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

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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

223

Dermatological and immunological conditions due to nerve lesions  

OpenAIRE

Some syndromes are of interest to both neurologists and dermatologists, because cutaneous involvement may harbinger symptoms of a neurological disease. The aim of this review is to clarify this aspect. The skin, because of its relationships with the peripheral sensory nervous system, autonomic nervous system and central nervous system, constitutes a neuroimmunoendocrine organ. The skin contains numerous neuropeptides released from sensory nerves. Neuropeptides play a precise role in cutaneous...

Bove, Domenico; Lupoli, Amalia; Caccavale, Stefano; Piccolo, Vincenzo; Ruocco, Eleonora

2013-01-01

224

Motor cortex neuroplasticity following brachial plexus transfer  

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Full Text Available In the past decade, research has demonstrated that cortical plasticity, once thought only to exist in the early stages of life, does indeed continue on into adulthood. Brain plasticity is now acknowledged as a core principle of brain function and describes the ability of the central nervous system to adapt and modify its structural organization and function as an adaptive response to functional demand. In this clinical case study we describe how we used neuroimaging techniques to observe the functional topographical expansion of a patch of cortex along the sensorimotor cortex of a 27 year-old woman following brachial plexus transfer surgery to re-innervate her left arm. We found bilateral activations present in the thalamus, caudate, insula as well as across the sensorimotor cortex during an elbow flex motor task. In contrast we found less activity in the sensorimotor cortex for a finger tap motor task in addition to activations lateralised to the left inferior frontal gyrus and thalamus and bilaterally for the insula. From a pain perspective the patient who had experienced extensive phantom limb pain before surgery found these sensations were markedly reduced following transfer of the right brachial plexus to the intact left arm. Within the context of this clinical case the results suggest that functional improvements in limb mobility are associated with increased activation in the sensorimotor cortex as well as reduced phantom limb pain.

JimLagopoulos

2013-08-01

225

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

226

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

Science.gov (United States)

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

227

MRI of the brachial plexus: a review of 51 cases.  

Science.gov (United States)

We present a magnetic resonance imaging (MRI) study in 51 patients where the brachial plexus was evaluated. Using a 1.5 T clinical imaging system, we obtained T1-weighted sequences, and double-echo (intermediate- and T2-weighted) spin-echo images. The coronal plane was imaged in all examinations and was supplemented by images in the sagittal and/or axial planes. Twenty cases had proven pathological brachial plexus involvement, whereas, in 31 cases, no brachial plexus involvement was present. In 4 cases, the MRI findings were not in agreement with the final diagnosis found in the charts. PMID:8448763

de Verdier, H J; Colletti, P M; Terk, M R

1993-01-01

228

Obstetrical brachial plexus injuries: a MRI diagnostic approach  

International Nuclear Information System (INIS)

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

229

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

Scientific Electronic Library Online (English)

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

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

230

Isolated axillary nerve involvement: a case report  

Directory of Open Access Journals (Sweden)

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

231

Staging of cutaneous melanoma  

OpenAIRE

The American Joint Committee on Cancer (AJCC) staging of cutaneous melanoma is a continuously evolving system. The identification of increasingly more accurate prognostic factors has led to major changes in melanoma staging over the years, and the current system described in this review will likely be modified in the near future. Likewise, application of new imaging techniques has also changed the staging work-up of patients with cutaneous melanoma. Chest and abdominal computed tomography (CT...

Mohr, P.; Eggermont, A. M. M.; Hauschild, A.; Buzaid, A.

2009-01-01

232

ADVERSE CUTANEOUS DRUG REACTION  

OpenAIRE

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 ...

Nayak Surajit; Acharjya Basanti

2008-01-01

233

Radiological imaging findings of a case with vertebral osteoid osteoma leading to brachial neuralgia.  

Science.gov (United States)

Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT) findings. Because magnetic resonance imaging (MRI) findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms. PMID:24404413

Gokce, Erkan; Ayan, Erdo?an; Celikyay, Fatih; Acu, Berat

2013-01-01

234

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Languages: English, 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.

2013-03-01

235

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.)

236

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

Energy Technology Data Exchange (ETDEWEB)

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

237

Bladder and cutaneous sensory neurons of the rat express different functional P2X receptors.  

OpenAIRE

The expression and functional responses of P2X receptors in bladder and cutaneous sensory neurons of adult rats and mice have been studied using immunohistochemistry and patch clamp techniques. Cell bodies of bladder pelvic afferents were identified in L6 and S1 dorsal root ganglia (DRG), following Fast Blue injection into the muscle wall of the urinary bladder. Similarly, cutaneous sensory neurons were identified in L3 and L4 DRG, following Fast Blue injection into the saphenous nerve innerv...

Zhong, Y.; Banning, As; Cockayne, Da; Ford, Ap; Burnstock, G.; McMahon, SB

2003-01-01

238

IA-DSA using brachial artery  

International Nuclear Information System (INIS)

It is proved to be advantageous that (trans-brachial DSA) TB-DSA can perform in the outpatient cases and further more, an excellent image quality can be obtained even in a small amount of contrast medium use. From a review of 113 TB-DSA studies in 108 cases, 38 cases of which are the out-patients, the distinctive feature is summarized as follows. 1) TB-DSA can demonstrate excellently the posterior fossa lesions by the selective vertebral artery injection if a catheter-tip is placed in the subclavian artery. 2) TB-DSA can also produce excellent demonstration of the vascular disease in the kidneys, the pelvic cavity or the lower legs by the abdominal aorta injection if a catheter is advanced to just above the renal arteries through the thoracic aorta. This procedure should not be indicated in the case of dissecting aortic aneurysm and occlusion or severe stenosis of the bilateral subclavian artery. (author)

239

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

240

Anomalous median nerve associated with persistent median artery.  

OpenAIRE

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

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

1994-01-01

241

Cardiac manifestations of cutaneous disorders.  

Science.gov (United States)

A number of cutaneous disorders encountered by the dermatologist have overlapping cardiac pathology. In recent years, many genetic linkages common to pathological processes in the cutaneous and cardiovascular systems have been identified. This review will describe primary cutaneous disorders with potential cardiac manifestations, including congenital syndromes, inherited cutaneous disorders associated with later cardiovascular disease, and syndromes associated with early cardiovascular pathology. The dermatologist may be the first to diagnose cutaneous findings associated with underlying cardiovascular disease; therefore, it is of prime importance for the dermatologist to be aware of these associations and to direct the appropriate workup. PMID:22902045

O'Neill, Jenna L; Narahari, Swetha; Sane, David C; Yosipovitch, Gil

2013-01-01

242

Automated analysis of brachial ultrasound time series  

Science.gov (United States)

Atherosclerosis begins in childhood with the accumulation of lipid in the intima of arteries to form fatty streaks, advances through adult life when occlusive vascular disease may result in coronary heart disease, stroke and peripheral vascular disease. Non-invasive B-mode ultrasound has been found useful in studying risk factors in the symptom-free population. Large amount of data is acquired from continuous imaging of the vessels in a large study population. A high quality brachial vessel diameter measurement method is necessary such that accurate diameters can be measured consistently in all frames in a sequence, across different observers. Though human expert has the advantage over automated computer methods in recognizing noise during diameter measurement, manual measurement suffers from inter- and intra-observer variability. It is also time-consuming. An automated measurement method is presented in this paper which utilizes quality assurance approaches to adapt to specific image features, to recognize and minimize the noise effect. Experimental results showed the method's potential for clinical usage in the epidemiological studies.

Liang, Weidong; Browning, Roger L.; Lauer, Ronald M.; Sonka, Milan

1998-07-01

243

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

Scientific Electronic Library Online (English)

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

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

2011-10-01

244

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

Directory of Open Access Journals (Sweden)

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

Gregorio Rodríguez Boto

2011-10-01

245

Primaty Cutaneous Histoplasmosis  

OpenAIRE

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

Nair S; Vijayadharan M; Vincent Maya

2000-01-01

246

Primary cutaneous rhinosporidiosis  

OpenAIRE

Primary cutaneous rhinosporidiosis is very rare and only 10 cases have been reported in India. A 51 year old man had a painless, progressive ulcer for 6 months on the right leg. The ulcer was 2 cm x 2 cm and, had raised, irregular, nodular and partly, undermined margins. Biopsy of the ulcer margin revealed rhinosporidiosis. Excision led to uneventful healing.

Hadke N; Ananthakrishnan N; Ratnakar C; Baruah M

1990-01-01

247

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

Directory of Open Access Journals (Sweden)

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

248

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

Science.gov (United States)

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

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

2014-10-01

249

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

250

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

Scientific Electronic Library Online (English)

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

Leandro Pretto, Flores.

2011-08-01

251

[An autopsy case of malignant schwannoma in the brachial plexus extending into the spinal canal].  

Science.gov (United States)

A 40-year-old woman had pain and numbness in the left upper extremity, on Dec. 1982. These symptoms progressed gradually. She was admitted to our department on Jan. 26, 1984 because of neck pains and progressive paraplegia. Neurological examination revealed monoplegia of the left arm with absent DTRs, spastic paraplegia, sensory disturbances below Th 11 level and severe sphincter disturbance. A metrizamide myelogram showed intradural extramedullary mass at C 4-7. Laminectomy was immediately performed from C 3 to C 7. A soft and brown tumor was attached at the ventral aspect of the cord at C 3 and C 7 and it was firmly attached at the root sleeve of the C 5 level. The histological diagnosis of the tumor was malignant schwannoma. One month later, she was discharged on foot. However, she was re-admitted to our department because of intractable pains in left neck and arm in Aug. '84. The second operation was done on Sept. 15. A soft and brown mass was found intra- and extradurally and it invaded into paravertebral muscules. On Sep. 30 '84 she died from respiratory failure. Postmortem examination revealed that intra-extradural tumor was found at C 4-Th 3, and the left brachial plexus was swollen. In the brachial plexus, the nerve fiber was replaced with tumor in the perineurium. The tumor invaded to the vertebral body and the paravertebral muscles. There were numerous metastasis of the tumor in both lungs. The tumor was formed by variable and scanty cytoplasm with many mitotic figures.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3790359

Kurita, S; Itoyama, Y; Nagara, H; Nakagaki, H; Hodozuka, A; Iwaki, T; Hasuo, K; Kuroiwa, Y

1986-10-01

252

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 arteriales 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 radialSUMMARY: 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 level 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

2002-01-01

253

Ganglioneuroma of the brachial plexus in two cockatiels (Nymphicus hollandicus).  

Science.gov (United States)

Ganglioneuroma involving the brachial plexus, paraspinal ganglia, and cervical-thoracic spinal cord was diagnosed in 2 adult cockatiels (Nymphicus hollandicus). Both birds had a chronic 1-year history of ataxia and perching difficulty. At necropsy, each bird had a unilateral, firm, gelatinous white to tan multilobular mass at the thoracic inlet expanding and partially obliterating the brachial plexus and cervical spinal cord. Histologically, the masses were characterized by a locally infiltrative neoplasm comprised of spindloid cells forming streams and sheets with interspersed distinct neuron cell bodies consistent with ganglion cells. The spindloid cell population was immunohistochemically positive for neurofilament protein in one of the birds. PMID:18725475

Murphy, B G; Shivaprasad, H L

2008-09-01

254

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

OpenAIRE

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

255

Spectrum of Suprascapular Nerve Lesions: Normal and Abnormal Neuromuscular Imaging Appearances on 3-T MR Neurography.  

Science.gov (United States)

OBJECTIVE. In this article, we will review the normal anatomy and imaging features of various neuromuscular abnormalities related to suprascapular neuropathy. CONCLUSION. Suprascapular neuropathy can be difficult to distinguish from rotator cuff pathology, plexopathy, and radiculopathy. Electrodiagnostic studies are considered the reference standard for diagnosis; however, high-resolution 3-T MR neurography (MRN) can play an important role. MRN enables direct visualization of the nerve and simultaneous assessment of the cervical spine, brachial plexus, and rotator cuff. PMID:25714290

Ahlawat, Shivani; Wadhwa, Vibhor; Belzberg, Allan J; Batra, Kiran; Chhabra, Avneesh

2015-03-01

256

Influence of spontaneously occurring bursts of muscle sympathetic nerve activity on conduit artery diameter  

OpenAIRE

Large increases in muscle sympathetic nerve activity (MSNA) can decrease the diameter of a conduit artery even in the presence of elevated blood pressure, suggesting that MSNA acts to regulate conduit artery tone. Whether this influence can be extrapolated to spontaneously occurring MSNA bursts has not been examined. Therefore, we tested the hypothesis that MSNA bursts decrease conduit artery diameter on a beat-by-beat basis during rest. Conduit artery responses were assessed in the brachial ...

Fairfax, Seth T.; Padilla, Jaume; Vianna, Lauro C.; Holwerda, Seth H.; Davis, Michael J.; Fadel, Paul J.

2013-01-01

257

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

258

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

259

Clonidine as an adjuvant for ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet: A clinical study  

Science.gov (United States)

Background and Aims: Clonidine has been used as an adjuvant to local anesthetic to extend the duration of block. The present study was aimed to compare the onset and duration of sensory and motor blockade of 0.75% ropivacaine alone or in combination with clonidine during ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet. Materials and Methods: Sixty four adult American Society of Anesthesiologist grade 1 and 2 patients, scheduled for upper extremity surgeries were randomized to receive either 19.8 mL of 0.75% ropivacaine with 0.2 mL of normal saline (Group R) or 0.2 mL (30 ?g) of clonidine (Group RC) in supraclavicular block. Onset and duration of sensory and motor blockade was compared. The hemodynamic variability, sedation, respiratory adequacy and any other adverse effects were also recorded. Result: Ultrasound helped to visualize the nerves, needle and spread of local anesthetic at the brachial plexus block site. There was no statistically significant difference in the onset of sensory and motor blockade between the groups. Surgical anesthesia was achieved at the mean time of 20 min in all patients. Prolonged post-operative analgesia (mean duration 956 min) was observed in RC group as compared with R group (736 min). No complication of technique or adverse effect of ropivacaine and clonidine was reported. Conclusion: Clonidine as an adjuvant to ropivacaine for ultrasound guided supraclavicular brachial plexus enhanced duration of post-operative analgesia. There was no incidence of vessel puncture or pneumothorax. PMID:25425780

Gupta, Kumkum; Tiwari, Vaibhav; Gupta, Prashant K; Pandey, Mahesh Narayan; Singhal, Apoorva B; Shubham, Garg

2014-01-01

260

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

Science.gov (United States)

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

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

2014-01-01

261

Cutaneous Myeloid Sarcoma of the Penile Foreskin.  

Science.gov (United States)

Myeloid sarcoma, considered to herald the onset of a blast crisis in the setting of chronic myeloproliferative neoplasm/dysplasia, typically presents during the course of the disorder. Cutaneous involvement is uncommon and lesions on genital skin are seldom seen. We present a case of a well-differentiated myeloid sarcoma in the penile foreskin in an apparently healthy 29-year-old male presenting with phimosis. The unusual composition of the inflammatory cell infiltrate, and characteristic sparing of dermal blood vessels, nerves and smooth muscle fibres led to the correct diagnosis. Absence of commonly observed changes in the circumcision skin like those of balanitis xerotica was also helpful. Detailed hematological work up revealed a previously undiagnosed chronic myeloid leukemia in chronic phase. The patient also had simultaneous priapism, another rare presentation of chronic myeloid leukemia. One year hence, the patient is in hematological remission with no evidence of extramedullary disease. Although priapism has been described as a rare presenting symptom in chronic myeloid leukemia, the present case is unique as this is the first time a cutaneous myeloid sarcoma has been documented in the penile foreskin. PMID:24913300

Afrose, Ruquiya; Nebhnani, Deepa; Wadhwa, Neelam

2014-06-10

262

Chitosan against cutaneous pathogens  

OpenAIRE

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

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

2013-01-01

263

[Cutaneous immune system].  

Science.gov (United States)

Human skin is constantly exposed to environmental factors. It does not only function as a physical barrier but also exhibits the capacity to generate innate and adaptative immune responses. So, the skin protect the host from microbial and chemical insults. However, it may also develop an immune response against malignant cells. Cutaneous immunity can be controlled by some factors such as ageing, ultraviolet irradiation, topical therapies. PMID:19931681

Doutre, M-S

2009-10-01

264

Update on cutaneous tuberculosis*  

OpenAIRE

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 whe...

Dias, Maria Fernanda Reis Gavazzoni; Bernardes Filho, Fred; Quaresma, Maria Victo?ria; Do Nascimento, Leninha Vale?rio; Nery, Jose? Augusto Da Costa; Azulay, David Rubem

2014-01-01

265

Adult cutaneous myofibroma  

Directory of Open Access Journals (Sweden)

Full Text Available A 63-year-old male presented with an asymptomatic, slow-growing swelling on the right lower limb for the past one and half years. The histopathology revealed a lobular neoplasm with a biphasic pattern of spindle shaped cells and hemangiopericytoma like areas at the periphery of the lobule. The diagnosis of adult cutaneous myofibroma was made. This case highlights the importance of histopathology in reaching a definitive diagnosis.

Patel V

2008-01-01

266

Sarcoidosis cutánea / Cutaneous sarcoidosis  

Scientific Electronic Library Online (English)

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

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

2013-12-30

267

Primary cutaneous PEComa.  

Science.gov (United States)

A 48-year-old woman attended a physician because of a solitary cutaneous nodule on the left lower leg. Microscopic examination of the excisional specimen revealed a dermal tumor composed of nests of epithelioid cells exhibiting clear cytoplasm. They had centrally located vesicular nuclei with distinct nucleoli. A rich network of capillaries was present throughout. The tumor showed an infiltrative border. There was no epidermal involvement. Periodic acid-Shif (PAS) and PAS-Diastase stains demonstrated glycogen deposition within the cytoplasm of the clear cells. Immunohistochemical evaluation revealed that the tumor cells were positive for HMB-45 and microftalmia associated transcription factor (MITF). Focal desmin positivity was also seen. The tumor cells were negative for S-100 protein, alfa smooth muscle actin, HHF-35, and various cytokeratins. The case is one of a primary cutaneous pecoma. Pecomas are rare, recently described mesenchymal tumors composed of perivascular epithelioid cells. They constitute a spectrum of lesions in different organs including angiomyolipoma of the kidney and liver, sugar tumor of the lung, lymphangiomatosis, and lymphangiomyoma. Primary cutaneous PEComas are exceptionally rare and have only recently been recognized. To date, these are approximately 22 cases in the English literature. Follow-up data is limited but they appear to behave in a benign fashion. We report an additional case with the goal of alerting dermatopathologists to this distinctive unusual neoplasm. PMID:20139753

Chaplin, Anna; Conrad, David M; Tatlidil, Cuneyt; Jollimore, Jason; Walsh, Noreen; Covert, Alan; Pasternak, Sylvia

2010-05-01

268

Primary localized cutaneous amyloidosis.  

Science.gov (United States)

A 61-year-old man presented for evaluation of a bruise-like lesion of the right knee. He was found to have an ill-defined, light brown patch with focal areas of dark red and brown. The histopathologic diagnosis was consistent with amyloidosis. Further subtyping showed that the amyloid protein was AL (?). A systemic evaluation failed to show internal involvement. Amyloidosis comprises a spectrum of diseases, which range from systemic to localized cutaneous types, and is characterized by the extracellular deposition of amyloidosis protein as beta-pleated sheets. The forms of amyloidosis are differentiated by the specific types of protein-derived amyloidosis fibers. Both nodular and primary systemic amyloidosis can present as nodules on the skin owing to deposition of AL type amyloid protein. Primary systemic amyloidosis, which carries a poorer prognosis than does nodular amyloidosis, also may give rise to ecchymoses and many other cutaneous and extracutaneous findings. Histopathologic features are similar in both cases and involve the deposition of amorphous, eosinophilic material in the dermis. Nodular amyloidosis may progress to primary systemic disease in up to 50% of cases. Because our patient had no systemic involvement and the lesions did not appear nodular in nature, the patient was given a diagnosis of primary localized AL cutaneous amyloidosis. Routine follow-up for this patient is necessary to detect any potential disease progression. PMID:24365002

Terushkin, Vitaly; Boyd, Kevin P; Patel, Rishi R; McLellan, Beth

2013-12-01

269

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

Scientific Electronic Library Online (English)

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

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

2008-09-01

270

Palsies of Cranial Nerves That Control Eye Movement  

Science.gov (United States)

... Cranial Nerve (Oculomotor Nerve) Palsy Fourth Cranial Nerve (Trochlear Nerve) Palsy Sixth Cranial Nerve (Abducens Nerve) Palsy Trigeminal ... Nerve (Oculomotor Nerve) Palsy , see Fourth Cranial Nerve (Trochlear Nerve) Palsy , and see Sixth Cranial Nerve (Abducens Nerve) ...

271

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

272

Nerve conduction velocity  

Science.gov (United States)

... the presence of a myelin sheath on the axon) of the nerve. Newborn infants have values that ... systemic amyloidosis Sensorimotor polyneuropathy Tibial nerve dysfunction Ulnar nerve dysfunction Any peripheral neuropathy can cause abnormal results. Damage to the ...

273

Tibial nerve dysfunction  

Science.gov (United States)

... through the nerve. The tibial nerve is often injured by pressure from a ligament on the inner part of the ankle. Injury or disease of structures near the knee may also damage the tibial nerve. The tibial ...

274

Short-latency tachycardia evoked by stimulation of muscle and cutaneous afferents.  

Science.gov (United States)

The short-latency effect on heart rate of peripheral nerve stimulation was studied in decerebrate cats. Selective activation (17-40 microA, 100 Hz, 1 s long) of low-threshold fibers in the nerves to the triceps surae muscle yielded isometric contractions of maximal force that were accompanied by a cardiac cycle length shortening within 0.4 s from the start of stimulation. This effect was abolished by pharmacologically induced neuromuscular blockade. The cardiac cycle length shortening during paralysis reappeared after a 6- to 10-fold increase of the stimulation strength. Cutaneous (sural) nerve stimulation (15-25 microA, 100 Hz, 1 s long) elicited reflex contractions in the stimulated limb, which were also accompanied by a cardiac acceleration with similar latency. Paralysis prevented the reflex contractions and reduced the cardiac response in some cats and abolished it in others. The response reappeared in either case after a 5- to 10-fold increase of the stimulus strength. It is concluded that muscle nerve and cutaneous nerve activity both cause a similar cardiac acceleration with a latency of less than 0.4 s. The response to muscle nerve stimulation is elicited by activity in group III afferents. It is excluded that the cardiac response to nerve stimulation is secondary to a change in the respiratory pattern. PMID:3985185

Gelsema, A J; Bouman, L N; Karemaker, J M

1985-04-01

275

Brachial plexus injury mimicking a spinal-cord injury  

OpenAIRE

Objective:?High-energy impact to the head, neck, and shoulder can result in cervical spine as well as brachial plexus injuries. Because cervical spine injuries are more common, this tends to be the initial focus for management. We present a case in which the initial magnetic resonance imaging (MRI) was somewhat misleading and a detailed neurological exam lead to the correct diagnosis.

Macyszyn, Luke J.; Gonzalez-giraldo, Ernesto; Aversano, Michael; Heuer, Gregory G.; Zager, Eric L.; Schuster, James M.

2010-01-01

276

Imaging diagnosis of neurogenic tumors of the brachial plexus  

International Nuclear Information System (INIS)

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

277

Collagen nerve wrap for median nerve scarring.  

Science.gov (United States)

Nerve wrapping materials have been manufactured to inhibit nerve tissue adhesions and diminish inflammatory and immunologic reactions in nerve surgery. Collagen nerve wrap is a biodegradable type I collagen material that acts as an interface between the nerve and the surrounding tissues. Its main advantage is that it stays in place during the period of tissue healing and is then gradually absorbed once tissue healing is completed. This article presents a surgical technique that used a collagen nerve wrap for the management of median nerve tissue adhesions in 2 patients with advanced carpal tunnel syndrome due to median nerve scarring and adhesions. At last follow-up, both patients had complete resolution with no recurrence of their symptoms. Complications related to the biodegradable material were not observed. PMID:25665110

Kokkalis, Zinon T; Mavrogenis, Andreas F; Ballas, Efstathios G; Papagelopoulos, Panayiotis J; Soucacos, Panayotis N

2015-02-01

278

Cutaneous nerve fibre depletion in vibration white finger.  

OpenAIRE

Vibration white finger or hand-arm vibration syndrome is the episodic blanching of the fingers in response to cold occurring in those who work with hand held vibrating tools. Clinically the condition differs from primary Raynaud's phenomenon as persistent paraesthesiae and pain are common in the hands and arms and these occur independently from the 'white attacks'. Symptoms can become severe enough to warrant a change of occupation. Industrial compensation may be awarded for vibration white f...

Goldsmith, P. C.; Molina, F. A.; Bunker, C. B.; Terenghi, G.; Leslie, T. A.; Fowler, C. J.; Polak, J. M.; Dowd, P. M.

1994-01-01

279

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.)

280

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

Directory of Open Access Journals (Sweden)

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

Eleusa Marta Mendonça Tavares

2012-03-01

281

Cutaneous malignancies of the perineum.  

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This review discusses multiple cutaneous malignancies that can present on the perineum. Although all of these neoplasms are uncommon, a focus will be on the more common neoplasms including extramammary Paget disease, basal cell carcinoma, squamous cell carcinoma, and melanoma. Other more rare entities discussed are superficial leiomyosarcoma, giant solitary trichoepithelioma, and cutaneous endometriosis. PMID:25517758

Carr, David; Pootrakul, Llana; Harmon, Jenna; Trotter, Shannon

2015-03-01

282

Cutaneous reactions to vaccinations.  

Science.gov (United States)

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

Rosenblatt, Adena E; Stein, Sarah L

2015-01-01

283

[Cutaneous adverse drug reactions].  

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Cutaneous adverse drug reactions (CADR) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Exanthematous eruptions, urticaria and vasculitis are the most common forms of CADR. Fixed eruption is uncommon in western countries. Serious reactions (fatal outcome, sequelae) represent 2% of CADR: bullous reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), DRESS (drug reaction with eosinophilia and systemic symptoms or drug-induced hypersensitivity syndrome) and acute generalized exanthematous pustulosis (AGEP). These forms must be quickly diagnosed to guide their management. The main risk factors are immunosuppression, autoimmunity and some HLA alleles in bullous reactions and DRESS. Most systemic drugs may induce cutaneous adverse reactions, especially antibiotics, anticonvulsivants, antineoplastic drugs, non-steroidal anti-inflammatory drugs, allopurinol and contrast media. Pathogenesis includes immediate or delayed immunologic mechanism, usually not related to dose, and pharmacologic/toxic mechanism, commonly dose-dependent or time-dependent. In case of immunologic mechanism, allergologic exploration is possible to clarify drug causality, with a variable sensitivity according to the drug and to the CADR type. It includes epicutaneous patch testing, prick test and intradermal test. However, no in vivo or in vitro test can confirm the drug causality. To determine the cause of the eruption, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis is required, completed with a literature search. A reporting to pharmacovigilance network is essential in case of a serious CADR whatever the suspected drug and in any case if the involved drug is a newly marketed one or unusually related to cutaneous reactions. PMID:25458866

Lebrun-Vignes, B; Valeyrie-Allanore, L

2015-04-01

284

Chronic zosteriform cutaneous leishmaniasis  

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

Omidian M

2006-01-01

285

Cutaneous drug reactions in childhood  

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Full Text Available Cutaneous Drug reactions (CDR are adverse admissions or harmful effects of drugs according to the definition by the World Health Organization. One of the early lessons learned in dermatology training is “any drug, any rash.” Drug-related cutaneous reactions can be daunting, even for the experienced dermatologist and pediatrics. There have been more than 25 different patterns described in the literature. The most commonly affected organs are the skin in drug reactions and dermatological examination is very important in the diagnosis for drug reactions. Cutaneous drug reactions should be distinguished from viral exanthema which is the most commonly seen in children, and it often is not easily. In treatment of cutaneous drug reactions, the first step is to immediately discontinue the susceptible drug. In this article, the approach to cutaneous drug reactions in children will be evaluated in accordance with current literature. J Clin Exp Invest 2014; 5 (4: 632-638

Sava? Öztürk

2014-12-01

286

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

287

Cutaneous sensory disorder.  

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Cutaneous sensory disorder (CSD) represents a heterogeneous clinical situation where the patient presents with either disagreeable skin sensations (ie, itching, burning, stinging) or pain (ie, allodynia) and/or negative sensory symptoms (ie, numbness, hypoaesthesia). These patients have no apparent diagnosable dermatologic or medical condition that explains the cutaneous symptom, and typically have negative findings upon medical workup. Skin regions that normally have a greater density of epidermal innervation tend to be more susceptible to the development of CSD. CSDs can affect any body region but generally tend to be confined to the face, scalp and perineum, and have been referred to in the literature with region-specific terms such as burning mouth syndrome, glossodynia and vulvodynia. Symptoms such as pruritus with unexplained hyperhidrosis may occur during sleep, as a result of heightened sympathetic tone. Sleep deprivation and insomnia can play a moderating role in CSD. Somatization and dissociation can play a central role in the pathogenesis of CSDs. A review of the literature suggests that CSDs represent a complex, and often poorly understood interplay between neurobiological factors associated with neuropathic pain, neuropathic itch and neurologic/neuropsychiatric states (eg, radiculopathies, stroke, depression and posttraumatic stress disorder). These neurologic/neuropsychiatric states can modulate pain and itch perception by potentially affecting the pain and itch pathways at a structural and/or functional level. PMID:24049969

Gupta, Madhulika A; Gupta, Aditya K

2013-06-01

288

A cutaneous positioning system.  

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Our previous work revealed that torso cutaneous information contributes to the internal representation of the torso and plays a role in postural control. Hence, the aims of this study were to assess whether posture could be manipulated by patterns of vibrotactile stimulation and to determine whether resulting modified postures were associated with specific and consistent spatial attitudes. Ten healthy young adults stood in normal and Romberg stances with six vibrating actuators positioned on the torso in contact with the skin over the anatomical locations corresponding to left and right external oblique, internal oblique and erector spinae muscles at the L4/L5 vertebrae level. A 250-Hz tactile vibration was applied for 5 s either at a single location or consecutively at each location in clockwise or counterclockwise sequences. Kinematic analysis of the body segments indicated that postural responses observed in response to single and sequential stimulation patterns were similar, while the center of pressure remained unaltered in any situations. Moreover, torso inclinations followed rectilinear-like path segments chartered by stimuli loci during sequential stimulations. Comparison of torso attitudes with previous results obtained with co-vibration patterns of the same duration showed that torso inclination amplitudes are equivalent for single (one location) and co-vibration (pairs of locations) patterns inducing the same directional effect. Hence, torso cutaneous information exhibits kinesthetic properties, appears to provide a map of upper body spatial configuration, and could assume the role of an internal positioning system for the upper body. PMID:25600816

Martin, Bernard J; Lee, Beom-Chan; Sienko, Kathleen H

2015-04-01

289

Fibrolipomatous Hamartoma of the Nerve Arising in the Neck: A Case Report With Review of the Literature and Differential Diagnosis.  

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: We report an unusual case of a fibrolipomatous hamartoma that arose in a nuchal nerve. Typically, fibrolipomatous hamartoma, otherwise known as a neural fibrolipoma or lipomatosis of nerve, arises in the median nerve, brachial plexus, cranial nerves, or plantar nerves. The differential diagnosis is broad and includes benign and malignant spindle cell lesions, such as spindle cell lipoma, perineurioma, and myxoid liposarcoma. We were able to identify the lesion based on the typical histology, including triphasic composition with spindle cell, neural, and adipocytic components and whorled architecture. Because of the atypical location in the neck, detailed immunohistochemical staining was performed. The lesional spindle cells were negative for SMA, CD10, CD68, EMA, S100, PGP9.5, CD34, CD56, and beta-catenin. Colloidal iron stain highlighted marked intralesional mucin deposition. This detailed immunohistochemical profile is a useful diagnostic aid and to our knowledge has not been previously described. PMID:25033011

Philp, Lauren; Naert, Karen A; Ghazarian, Danny

2014-07-15

290

Cutaneous denervation of psoriasiform mouse skin improves acanthosis and inflammation in a sensory neuropeptide dependent manner  

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Nervous system involvement in psoriasis pathogenesis is supported by increases in nerve fiber numbers and neuropeptides in psoriatic skin and by reports detailing spontaneous plaque remission following nerve injury. Using the KC-Tie2 psoriasisform mouse model, we investigated the mechanisms by which nerve injury leads to inflammatory skin disease remission. Cutaneous nerves innervating dorsal skin of KC-Tie2 animals were surgically axotomized and beginning 1d following denervation, CD11c+ cell numbers decreased by 40% followed by a 30% improvement in acanthosis at 7d and a 30% decrease in CD4+ T cell numbers by 10d. Restoration of SP signaling in denervated KC-Tie2 skin prevented decreases in CD11c+ and CD4+ cells but had no affect on acanthosis; restoration of CGRP signaling reversed the improvement in acanthosis and prevented denervated-mediated decreases in CD4+ cells. Under innervated conditions, small molecule inhibition of SP in KC-Tie2 animals resulted in similar decreases to those observed following surgical denervation for cutaneous CD11c+ and CD4+ cell numbers; whereas small molecule inhibition of CGRP resulted in significant reductions in CD4+ cell numbers and acanthosis. These data demonstrate that sensory nerve-derived peptides mediate psoriasiform dendritic cell and T cell infiltration and acanthosis and introduce targeting nerve-immunocyte/keratinocyte interactions as potential psoriasis therapeutic treatment strategies. PMID:21471984

Ostrowski, Stephen M.; Belkadi, Abdelmadjid; Loyd, Candace M.; Diaconu, Doina; Ward, Nicole L

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

Schwanoma de plexo braquial: relato de dois casos / Schwannoma of brachial plexus: report of two cases  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Schwanomas, neurinomas ou neurilemomas são tumores benignos de nervos periféricos. Podem ocorrer em associação com a neurofibromatose tipo 2. Relatamos dois casos de tumor cervical originado em plexo braquial sem associação com neurofibromatose. Uma mulher, de 31 anos apresentando uma tumefação em r [...] egião supraclavicular direita, dor irradiada para o membro ipsilateral e sinal de Tinel à percussão da região. Outra mulher, 52 anos, com cervicobraquialgia persistente à direita há um ano. Ambas foram submetidas a microcirurgia, com ressecção total da lesão. O estudo histopatológico foi compatível com schwanoma. As duas pacientes tiveram boa evolução neurológica, com desaparecimento dos sinais e sintomas. Abstract in english Schwannomas, neurinomas or neurilemmomas are benign peripheral nerve tumors. The literature report some cases associated with neurofibromatosis 2. We report two cases of cervical schwannoma originating from the brachial plexus unassociated with neurofibromatosis. A 31-year-old woman presented with a [...] mass in the right supraclavicular region, irradiating pain and distal tingling to percussion (Tinel's sign) for 6 months. And a 52-year-old woman presented with pain in the cervical region and right arm for one year. Both the patients underwent to a microsurgery with total resection of the lesion. Histology of the surgical specimen confirmed the diagnosis of schwannoma. Postoperatively, the patients had a good recovery.

Manoel Baldoíno, Leal Filho; Aline de Almeida Xavier, Aguiar; Bruno Ribeiro de, Almeida; Karoline da Silva, Dantas; Marcelo Adriano da Cunha e Silva, Vieira; Ricardo Keyson Paiva de, Morais; Raimundo Gerônimo da, Silva Júnior.

2004-03-01

293

Schwanoma de plexo braquial: relato de dois casos Schwannoma of brachial plexus: report of two cases  

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Full Text Available Schwanomas, neurinomas ou neurilemomas são tumores benignos de nervos periféricos. Podem ocorrer em associação com a neurofibromatose tipo 2. Relatamos dois casos de tumor cervical originado em plexo braquial sem associação com neurofibromatose. Uma mulher, de 31 anos apresentando uma tumefação em região supraclavicular direita, dor irradiada para o membro ipsilateral e sinal de Tinel à percussão da região. Outra mulher, 52 anos, com cervicobraquialgia persistente à direita há um ano. Ambas foram submetidas a microcirurgia, com ressecção total da lesão. O estudo histopatológico foi compatível com schwanoma. As duas pacientes tiveram boa evolução neurológica, com desaparecimento dos sinais e sintomas.Schwannomas, neurinomas or neurilemmomas are benign peripheral nerve tumors. The literature report some cases associated with neurofibromatosis 2. We report two cases of cervical schwannoma originating from the brachial plexus unassociated with neurofibromatosis. A 31-year-old woman presented with a mass in the right supraclavicular region, irradiating pain and distal tingling to percussion (Tinel's sign for 6 months. And a 52-year-old woman presented with pain in the cervical region and right arm for one year. Both the patients underwent to a microsurgery with total resection of the lesion. Histology of the surgical specimen confirmed the diagnosis of schwannoma. Postoperatively, the patients had a good recovery.

Manoel Baldoíno Leal Filho

2004-03-01

294

Epidermal expression of Lgr6 is dependent on nerve endings and Schwann cells  

Science.gov (United States)

Lgr5/6 proteins are stem cell markers in various tissues. However, what determines their restricted expression pattern in these tissues remains unknown. We found that in skin, Lgr6 is not only expressed in the central isthmus, directly above the hair follicle bulge cells as reported previously, but also in the interfollicular epidermis. Lgr6 expression in skin is highly correlated with the innervation sites of cutaneous nerves. In the hair follicle, Lgr6 closely localizes with the surrounding nerve endings and their corresponding Schwann cells throughout the entire hair cycle. Furthermore, ablation of cutaneous nerves leads to degeneration of Schwann cells and diminished expression of Lgr6. Our results demonstrate that the nerve endings/Schwann cells control Lgr6 expression in skin, implying that they play a role in regulation of skin epithelial cells. PMID:24499442

Liao, Xin-Hua; Nguyen, Hoang

2014-01-01

295

Innominate aterial arteriovenous fistula complicating retrograde brachial arterial catheterization.  

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Arteriovenous fistula of the innominate artery occurred in a patient 3 weeks after retrograde brachial arterial catheterization was performed 1 day before aortocoronary bypass surgery. Intramural dissection was noted at catheterization, and a mediastinal hematoma at operation. Exploration of the hematoma in the course of catheterization might have prevented the arteriovenous fistula, which necessitated a second operation 3 weeks after the first. To our knowlege this complication of retrograde brachial catheterization has not previously been described. We recommend that known injuries to cervical or thoracic arteries occurring just before operations requiring extracorporeal circulation be explored to prevent late complications. Recent injuries to the cervical and thoracic arteries that are not acessible to external compression should be exposed and treated during sternotomy to prevent late complications if heparinization is contemplated. PMID:382824

van Heeckeren, D W; Botti, R E; Cohen, A M

1979-09-01

296

Primary cutaneous lymphoma  

International Nuclear Information System (INIS)

Purpose: A retrospective review analyzed the survival and freedom from relapse of patients with stage IE or IIE primary cutaneous lymphoma (non mycosis fungoides) after treatments with radiation therapy alone (XRT), chemotherapy alone (RX) or combined modality therapy (CMT). Methods and Materials: Fifty two patients with stage IE-IIE cutaneous lymphoma treated at Stanford University Hospital were reviewed. The median age was 57, with a range of 26 to 94 and a male to female ratio of 1.21:1. Patients were staged according to the Ann Arbor System. Pathology was classified according to the Working Formulation. Treatment outcomes were compared using Kaplan-Meier survival curves with a Gehan p-value test. Results: The follow up range was 6 months to 22 years (median 7 years.) Twenty one percent of patients had low grade, 63% had intermediate grade and 15% had high grade lymphoma. The most common histologic subtype was diffuse large cell lymphoma Thirty two patients received radiation alone as initial treatment and sixteen patients received combined modality as initial treatment. Four patients received chemotherapy alone. The only significant prognostic factor for survival was the stage at diagnosis. Patients with stage IE disease had a longer actuarial survival (5-yr=79%, 10-yr=71%), as compared to those with stage IIE (5-yr=49%, 10-yr=33%), (p=0.029). The only significant prognostic factor for freedom from relapse was the initial treatment. Initial combined modality treattreatment. Initial combined modality treatment lead to a longer freedom from relapse compared to patients treated with radiation alone (p=0.002), (median 5 years vs. 1.2 years). Despite this, the actuarial overall survival in the combined modality group and the radiation alone group are similar (median survival 7.7 and 8 years). The efficacy of either radiation or chemotherapy as salvage treatment after radiation failure was equivalent and both salvage treatments lead to equally long survival and freedom from second relapse. Conclusion: Although freedom from relapse is superior after primary treatment with combined modality therapy compared to radiation therapy alone, the efficacy of salvage treatment results in equivalent survival after either primary therapy. Therefore, radiation therapy remains the treatment of choice for primary cutaneous lymphoma

297

Trapezius transfer to treat flail shoulder after brachial plexus palsy  

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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

298

Miliary tuberculosis with left brachial monoplegia: A case report  

OpenAIRE

Tuberculoma of the brain is a major neurological problem in developing countries accounting for 12 to 30 per cent of all intracranial masses. It often presents with focal neurological symptoms or seizures. Simultaneous occurrence of brain tuberculoma with miliary mottling in the lungs is uncommon in the immunocompetent patient. We report only the second case of monoplegia and miliary tuberculosis, wherein the patient presented with acute onset left brachial monoplegia, upper motor neuron faci...

Iqbal, Nayyar; Natarajan, Nagarajan; Periyasamy, Sivakumar; George, Sanjoy; Basheer, Aneesh; Mookkappan, Sudhagar

2014-01-01

299

Transient brachial monoparesis following epidural anesthesia for cesarean section  

OpenAIRE

Monoparesis following lumbar epidural block is a rare occurrence, with few cases reported in the literature. We report development of transient brachial monoparesis following epidural anesthesia in a parturient for cesarean section. The patient received a mixture of 15 mL of 2% lignocaine with 50 mcg fentanyl epidurally to achieve a blockade up to T6 level. She remained hemodynamically stable throughout the procedure, with no respiratory distress or desaturation. However, near the end of surg...

Anandaswamy, Tejesh C.; Chikkapillappa, Manjunath A.; Rajappa, Geetha C.; Shivanna, Shivakumar

2011-01-01

300

Cutaneous protothecosis - Case report*  

Science.gov (United States)

Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg. PMID:24346914

da Silva, Pâmela Craveiro Gomes; Silva, Sabrina Beirão da Costa e; Lima, Ricardo Barbosa; D'Acri, Antonio Macedo; Lupi, Omar; Martins, Carlos José

2013-01-01

301

Neurolysis and myocutaneous flap for radiation induced brachial plexus neuropathy  

International Nuclear Information System (INIS)

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

302

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)

303

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

304

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

305

Cutaneous lymphoma mimicking seborrhoeic dermatitis  

Directory of Open Access Journals (Sweden)

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

Venkateswaran Sri

1995-01-01

306

Cutaneous reactions of anticonvulsant drugs  

Directory of Open Access Journals (Sweden)

Full Text Available Background and Aim: Cutaneous drug reaction is a common side effect of antiepileptic drugs and a frequent cause of treatment discontinuation. These reactions ranges can be a mild maculopapular rash to Stevens-Johnson Syndrom and toxic epidermal necrolysis. Among the traditional anticonvulsant drugs the aromatic compounds Phenytoin, Phenobarbital and Carbamazepin have been associated with relatively higher incidences of cutaneous reactions which can hospitalized the patient. Some of the newer drugs also can induce this problem, especially lamotrigine."n"nMethods: All records of patiens who were hospitalized at hospitals related to Islamic Azad as well as Rasol Akram hospital with a diagnosis of cutaneous drug reaction to anticonvulsant therapy in 8 years period were reviewed."n"nResults: The most common culprit was phenytoin (32% and the least common drug was lamotrigin (3%."n"nConclusion: Cutaneous reaction to anticonvulsant drugs is common and sometimes may be life threatening which needs serious treatment options.

Franak Najibi

2011-03-01

307

A clinical comparison of psoas compartment and inguinal paravascular blocks combined with sciatic nerve block.  

Science.gov (United States)

The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200,000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve. PMID:12025523

Tokat, O; Türker, Y G; Uckunkaya, N; Yilmazlar, A

2002-01-01

308

Bilateral optic nerve injury.  

OpenAIRE

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...

Mahapatra A

1999-01-01

309

Cutaneous Lymphangioma circumscriptum - dermoscopic features*  

Scientific Electronic Library Online (English)

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

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

2015-04-01

310

Severe cutaneous adverse drug reactions  

OpenAIRE

Severe cutaneous drug reactions are one of the commonest medical challenges presenting to an emergency room in any hospital. The manifestations range from maculopapular rash to severe systemic symptoms like renal failure and cardiovascular compromise. Toxic epidermal necrolysis, erythroderma, drug rash with eosinophilia and systemic symptoms, acute generalised exanthematous pustulosis and drug induced vasculitis are the common cutaneous drug reactions which can have severe morbidity and even ...

Verma, Rajesh; Vasudevan, Biju; Pragasam, Vijendran

2013-01-01

311

Deep Peroneal Nerve Palsy Caused by an Extraneural Ganglion Cyst: A Rare Case  

Science.gov (United States)

Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve. PMID:25632363

Nikolopoulos, Dimitrios; Safos, George; Sergides, Neoptolemos; Safos, Petros

2015-01-01

312

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

313

Diabetes and nerve damage  

Science.gov (United States)

Nerve damage that occurs in people with diabetes is called diabetic neuropathy. This condition is a complicaiton of diabetes . ... About half of people with diabetes develop nerve damage. Symptoms often do not begin until many years ...

314

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

315

The furcal nerve revisited  

OpenAIRE

Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to t...

Harshavardhana, Nanjundappa S.; Dabke, Harshad V.

2014-01-01

316

Continuous axillary brachial plexus analgesia in a patient with severe hemophilia.  

Science.gov (United States)

Until now, the safety of continuous axillary brachial plexus block in a patient with hemophilia has not been reported. We describe the use of continuous axillary brachial plexus block for postoperative pain control in a patient with severe hemophilia after an elbow surgery. PMID:12693408

Kang, Seuk B; Rumball, Kevin M; Ettinger, Robert S

2003-02-01

317

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

International Nuclear Information System (INIS)

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

318

Bullosis diabeticorum in median nerve innervated fingers shortly after carpal tunnel release: case report.  

Science.gov (United States)

Bullosis diabeticorum is a cutaneous manifestation of diabetes mellitus, mainly observed in the lower extremities in patients with longstanding disease. The etiology is unknown, but an association with neurologic or vascular disturbances has been suggested. We have reviewed a case of a 70-year-old man with rapid development of bullae in median nerve innervated fingertips following carpal tunnel release. PMID:25708433

Brogren, Elisabeth; Dahlin, Lars B

2015-03-01

319

Transverse cervical and great auricular nerve distribution in the mandibular area: a study in human cadavers.  

Science.gov (United States)

The angle of the jaw is innervated by the auricular branch of the superficial cervical plexus (SCP). Cervical cutaneous nerves of the CP carry the sensation from the antero-lateral cervical skin. It is clinically relevant to identify the cervical cutaneous nerve distribution and the nerve point using superficial landmarks but published studies describing the emerging patterns and cervical cutaneous nerve branch distributions in the mandible are rare. The overlap between the cervical and trigeminal and facial nerve distributions and anastomoses is highly variable. The objective of this study was to characterize the distribution of the SCP nerves in the different parts of the mandible. Two hundred and fifty fresh and formalin-fixed human cadaver heads were microdissected to observe the distribution of the transverse cervical (TCN) and great auricular (GAN) nerves. Two main groups (G1 and G2) based on the emergence of the TCN and GAN behind the posterior edge of the sternocleidomastoid muscle and three types (T1, T2, and T3) based on their distribution in the different mandibular parts were observed. Statistical analysis showed that parameters related to the mandibular side (P?=?0.307), gender (P?=?0.218), and group (P?=?0.111) did not influence the facial distribution of these nerves. The only parameter influencing the distribution was the type of nerve (GAN and TCN) (P?

Ella, Bruno; Langbour, Nicolas; Caix, Philippe; Midy, Dominique; Deliac, Philippe; Burbaud, Pierre

2015-01-01

320

The Physics of Nerves  

CERN Document Server

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

Heimburg, Thomas

2010-01-01

321

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

322

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

Energy Technology Data Exchange (ETDEWEB)

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.)

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

2007-02-15

323

Prostanoid receptor EP1 and Cox-2 in injured human nerves and a rat model of nerve injury: a time-course study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Recent studies show that inflammatory processes may contribute to neuropathic pain. Cyclooxygenase-2 (Cox-2 is an inducible enzyme responsible for production of prostanoids, which may sensitise sensory neurones via the EP1 receptor. We have recently reported that while macrophages infiltrate injured nerves within days of injury, they express increased Cox-2-immunoreactivity (Cox-2-IR from 2 to 3 weeks after injury. We have now investigated the time course of EP1 and Cox-2 changes in injured human nerves and dorsal root ganglia (DRG, and the chronic constriction nerve injury (CCI model in the rat. Methods Tissue sections were immunostained with specific antibodies to EP1, Cox-2, CD68 (human macrophage marker or OX42 (rat microglial marker, and neurofilaments (NF, prior to image analysis, from the following: human brachial plexus nerves (21 to 196 days post-injury, painful neuromas (9 days to 12 years post-injury, avulsion injured DRG, control nerves and DRG, and rat CCI model tissues. EP1 and NF-immunoreactive nerve fibres were quantified by image analysis. Results EP1:NF ratio was significantly increased in human brachial plexus nerve fibres, both proximal and distal to injury, in comparison with uninjured nerves. Sensory neurones in injured human DRG showed a significant acute increase of EP1-IR intensity. While there was a rapid increase in EP1-fibres and CD-68 positive macrophages, Cox-2 increase was apparent later, but was persistent in human painful neuromas for years. A similar time-course of changes was found in the rat CCI model with the above markers, both in the injured nerves and ipsilateral dorsal spinal cord. Conclusion Different stages of infiltration and activation of macrophages may be observed in the peripheral and central nervous system following peripheral nerve injury. EP1 receptor level increase in sensory neurones, and macrophage infiltration, appears to precede increased Cox-2 expression by macrophages. However, other methods for detecting Cox-2 levels and activity are required. EP1 antagonists may show therapeutic effects in acute and chronic neuropathic pain, in addition to inflammatory pain.

Collins Sue D

2006-01-01

324

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

OpenAIRE

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

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

2013-01-01

325

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

Science.gov (United States)

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

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

2012-01-01

326

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

Directory of Open Access Journals (Sweden)

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

Srijit Das

2005-01-01

327

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

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.OBJETIVO: Análise de resultados das técnicas que comprovadamente melhoraram o prognóstico funcional de pacientes com lesões traumáticas do plexo braquial. MÉTODO: Estudo retrospectivo de cem casos de lesões traumáticas do plexo braquial. Foi realizada comparação dos resultados pós-operatórios obtidos com as diferentes técnicas utilizadas. RESULTADOS: A técnica de enxertia a partir de raízes proximais resultou em bons graus de reinervação em 70% dos casos. Bons resultados (p<0,05 também foram relacionados à técnica de Oberlin e de Sansak, enquanto que a transferência frênico-musculocutâneo e acessório-suprascapular não resultaram em melhora que atingisse significância estatística. Reinervação motora da mão foi observada em menos de 30% dos casos. CONCLSUÃO: A cirurgia de reinervação do plexo braquial em geral resulta em boa recuperação da função proximal do membro, porém esses mesmos bons resultados não são observados em termos de reinervação da mão.

Leandro Pretto Flores

2011-08-01

328

[Opposition-plasty after brachial plexus lesions by osteosynthesis].  

Science.gov (United States)

Secondary reconstruction of lost muscle function in brachial plexus injuries is performed by dynamic muscle and tendon transposition, by free microvascular muscle transplantation and by static surgical procedures. In cases of weak function of the finger flexors, static opponensplasty is required. In these cases our procedure is the internal fixation of the base of the metacarpal I to the base of the metacarpal II without stabilisation of cancellous bone. From 1987 to 1992 we operated 15 patients by this procedure. Results are showing sufficient stabilisation and good function. PMID:8294070

Schaller, E; Berger, A; Mailänder, P; Lassner, F

1993-11-01

329

Miliary tuberculosis with left brachial monoplegia: A case report.  

Science.gov (United States)

Tuberculoma of the brain is a major neurological problem in developing countries accounting for 12 to 30 per cent of all intracranial masses. It often presents with focal neurological symptoms or seizures. Simultaneous occurrence of brain tuberculoma with miliary mottling in the lungs is uncommon in the immunocompetent patient. We report only the second case of monoplegia and miliary tuberculosis, wherein the patient presented with acute onset left brachial monoplegia, upper motor neuron facial palsy, and fever with an MRI of the brain showing multiple granulomas and chest x-ray showing miliary mottling. The patient's neurological deficit started to resolve with corticosteroids and anti-tubercular treatment. PMID:25379061

Iqbal, Nayyar; Natarajan, Nagarajan; Periyasamy, Sivakumar; George, Sanjoy; Basheer, Aneesh; Mookkappan, Sudhagar

2014-01-01

330

Transient brachial monoparesis following epidural anesthesia for cesarean section.  

Science.gov (United States)

Monoparesis following lumbar epidural block is a rare occurrence, with few cases reported in the literature. We report development of transient brachial monoparesis following epidural anesthesia in a parturient for cesarean section. The patient received a mixture of 15 mL of 2% lignocaine with 50 mcg fentanyl epidurally to achieve a blockade up to T6 level. She remained hemodynamically stable throughout the procedure, with no respiratory distress or desaturation. However, near the end of surgery, she developed weakness in the right upper limb. The weakness lasted for 90 min, followed by complete neurological recovery. Subsequent hospital stay was uneventful. PMID:22096299

Anandaswamy, Tejesh C; Chikkapillappa, Manjunath A; Rajappa, Geetha C; Shivanna, Shivakumar

2011-10-01

331

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

332

Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study.  

Science.gov (United States)

Superficial peroneal nerve and its branches are frequently at risk for iatrogenic damage. Although different studies on anatomical variations of superficial peroneal nerve are available in the medical literature, such reports are rare from India. Hence the present study was undertaken on Indian population. A total of 60 specimens of inferior extremities from 30 properly embalmed and formalin fixed cadavers were dissected and examined for the location and course of the superficial peroneal nerve including number, level, course and distributions of branches. The superficial peroneal nerve in 28.3% specimens was located in the anterior compartment of the leg. In 8.3% specimens the superficial peroneal nerve branched before piercing between the peroneus longus and extensor digitorum longus muscle whereas in 11.7% specimens it branched after piercing the aforementioned muscles and before piercing the deep fascia. In 41 out of 60 specimens the sensory division of superficial peroneal nerve branched into the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve distal to its emergence from the deep fascia and proximal to its relation to the extensor retinaculum. In 20 out of 60 specimens the accessory deep peroneal nerve, an additional branch from the sensory division of superficial peroneal nerve, through its course in the anterior compartment of the leg passed deep to the extensor retinaculum and supplied the ankle and the dorsum of foot. Hopefully the present study will help in minimizing iatrogenic damage to the superficial peroneal nerve and its branches while performing arthroscopy, local anesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle. PMID:21287977

Prakash; Bhardwaj, Ajay Kumar; Singh, Deepak Kumar; Rajini, T; Jayanthi, V; Singh, Gajendra

2010-01-01

333

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

International Nuclear Information System (INIS)

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

334

[Cutaneous leishmaniasis of the lid].  

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We report 3 cases of patients presenting with lid cutaneous leishmaniasis in which clinical presentation was a true diagnostic problem. The patients were 3 women aged 46, 36, and 60 years. The first patient presented with an ulceration of the superior eyelid that had been treated as chalazion. The second patient had a chronic lesion of the eyelid, present for 1 year, fitting the criteria for tuberculosis, syphilis, or sarcoidosis. The last patient had an erosive lesion of the internal canthus, which was suspicious of basal cell carcinoma. The presence of other cutaneous lesions and the chronic progression led to a biopsy for anatomopathology and parasitology analysis. These analyses confirmed the diagnosis of cutaneous leishmaniasis. The patients were then treated with antimony derivatives. Progression of the disease was marked by the appearance of a pigmented nonretractile scar. The different clinical characteristics, epidemiology, and treatment of this affection are reviewed. PMID:12048519

Charif Chefchaouni, M; Lamrani, R; Benjelloune, A; El Lyacoubi, M; Berraho, A

2002-05-01

335

Cutaneous mastocytosis: Report of six cases  

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Full Text Available Cutaneous mastocytosis is a rare infiltrative disorder of the skin. Though often asymptomatic, systemic features may be associated with any clinical pattern of the disorder at any age group. We present our experience with six cases of cutaneous mastocytosis, including three with diffuse cutaneous mastocytosis, a rare entity.

Inamadar Arun

2006-01-01

336

Recent advances in research on nitrergic nerve-mediated vasodilatation.  

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Cerebral vascular resistance and blood flow were widely considered to be regulated solely by tonic innervation of vasoconstrictor adrenergic nerves. However, pieces of evidence suggesting that parasympathetic nitrergic nerve activation elicits vasodilatation in dog and monkey cerebral arteries were found in 1990. Nitric oxide (NO) as a neurotransmitter liberated from parasympathetic postganglionic neurons decreases cerebral vascular tone and resistance and increases cerebral blood flow, which overcome vasoconstrictor responses to norepinephrine liberated from adrenergic nerves. Functional roles of nitrergic vasodilator nerves are found also in peripheral vasculature, including pulmonary, renal, mesenteric, hepatic, ocular, uterine, nasal, skeletal muscle, and cutaneous arteries and veins; however, adrenergic nerve-induced vasoconstriction is evidently greater than nitrergic vasodilatation in these vasculatures. In coronary arteries, neurogenic NO-mediated vasodilatation is not clearly noted; however, vasodilatation is induced by norepinephrine released from adrenergic nerves that activates ?1-adrenoceptors. Impaired actions of NO liberated from the endothelium and nitrergic neurons are suggested to participate in cerebral hypoperfusion, leading to brain dysfunction, like that in Alzheimer's disease. Nitrergic neural dysfunction participates in impaired circulation in peripheral organs and tissues and also in systemic blood pressure increase. NO and vasodilator peptides, as sensory neuromediators, are involved in neurogenic vasodilatation in the skin. Functioning of nitrergic vasodilator nerves is evidenced not only in a variety of mammals, including humans and monkeys, but also in non-mammals. The present review article includes recent advances in research on the functional importance of nitrergic nerves concerning the control of cerebral blood flow, as well as other regions, and vascular resistance. Although information is still insufficient, the nitrergic nerve histology and function in vasculatures of non-mammals are also summarized. PMID:25339222

Toda, Noboru; Okamura, Tomio

2014-10-23

337

Ectopic cutaneous schistosomiasis - Case report  

Scientific Electronic Library Online (English)

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

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

338

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

339

Severe Obstetric Brachial Plexus Palsies Can Be Identified at One Month of Age  

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Objective To establish whether severe obstetric brachial plexus palsy (OBPP) can be identified reliably at or before three months of age. Methods Severe OBPP was defined as neurotmesis or avulsion of spinal nerves C5 and C6 irrespective of additional C7-T1 lesions, assessed during surgery and confirmed by histopathological examination. We first prospectively studied a derivation group of 48 infants with OBPP with a minimal follow-up of two years. Ten dichotomous items concerning active clinical joint movement and needle electromyography of the deltoid, biceps and triceps muscles were gathered at one week, one month and three months of age. Predictors for a severe lesion were identified using a two-step forward logistic regression analysis. The results were validated in two independent cohorts of OBPP infants of 60 and 13 infants. Results Prediction of severe OBPP at one month of age was better than at one week and at three months. The presence of elbow extension, elbow flexion and of motor unit potentials in the biceps muscle correctly predicted whether lesions were mild or severe in 93.6% of infants in the derivation group (sensitivity 1.0, specificity 0.88), in 88.3% in the first validation group (sensitivity 0.97, specificity 0.76) and in 84.6% in the second group (sensitivity of 1.0, specificity 0.66). Interpretation Infants with OBPP with severe lesions can be identified at one month of age by testing elbow extension, elbow flexion and recording motor unit potentials (MUPs) in the biceps muscle. The decision rule implies that children without active elbow extension at one month should be referred to a specialized center, while children with active elbow extension as well as active flexion should not. When there is active elbow extension, but no active elbow flexion an EMG is needed; absence of MUPs in the biceps muscle is an indication for referral. PMID:22043309

Malessy, Martijn J. A.; Pondaag, Willem; Yang, Lynda J.-S.; Hofstede-Buitenhuis, Sonja M.; le Cessie, Saskia; van Dijk, J. Gert

2011-01-01

340

USE OF DEXMEDETOMIDINE ALONG WITH BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK  

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

Rachana Gandhi

2012-02-01

341

Glenoid version in children with obstetric brachial plexus palsy.  

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Glenoid version in a group of 29 children with obstetric brachial plexus paralysis and posterior dislocation of the shoulder was studied by using computed axial tomography (CT). The CT scan in most patients was done before an open release and reduction of the shoulder. A comparison was made between the normal and affected sides in regard to glenoid version and structure. In the study population, there were 16 girls and 13 boys with an average age at the time of initial CT of 2.8 years. Sixteen of the patients had posterior dislocations of the right shoulder, and none was bilateral. In 18 patients, the neurologic lesion was confined to the upper roots of the brachial plexus, with the remaining patients having whole plexus involvement. A significant difference in glenoid version between normal and affected sides was found in these patients. The mean glenoid version for the dislocated side was -29.5 +/- 2.5 degrees and that of the normal side was -6.9 +/- 2.4 degrees. Glenoid structure was different in dislocated shoulders. The glenoid articular surface was observed to be laterally convex in the majority of cases, and in these cases, the posterior rim of the glenoid was often hypoplastic and rounded. PMID:10344320

Beischer, A D; Simmons, T D; Torode, I P

1999-01-01

342

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

343

Complications of Lower-Extremity Outpatient Arteriography via Low Brachial Artery  

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We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients.The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA - DSA in an outpatient setting

344

Complications of lower-extremity outpatient arteriography via low brachial artery.  

Science.gov (United States)

We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients. The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA-DSA in an outpatient setting. PMID:15109225

Chatziioannou, A; Ladopoulos, C; Mourikis, D; Katsenis, K; Spanomihos, G; Vlachos, L

2004-01-01

345

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  

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

Umang G Thakkar

2014-08-01

346

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

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

Marcos R.G. de Freitas

2006-12-01

347

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

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

J.R. Martínez-Méndez

2008-09-01

348

Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.  

Science.gov (United States)

A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce Wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. Median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed. PMID:11216605

Al-Qattan, M M

2001-02-01

349

Cutaneous denervation of psoriasiform mouse skin improves acanthosis and inflammation in a sensory neuropeptide-dependent manner.  

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Nervous system involvement in psoriasis pathogenesis is supported by increases in nerve fiber numbers and neuropeptides in psoriatic skin and by reports detailing spontaneous plaque remission following nerve injury. Using the KC-Tie2 psoriasiform mouse model, we investigated the mechanisms by which nerve injury leads to inflammatory skin disease remission. Cutaneous nerves innervating dorsal skin of KC-Tie2 animals were surgically axotomized and beginning 1 day after denervation, CD11c(+) cell numbers decreased by 40% followed by a 30% improvement in acanthosis at 7 days and a 30% decrease in CD4(+) T-cell numbers by 10 days. Restoration of substance P (SP) signaling in denervated KC-Tie2 skin prevented decreases in CD11c(+) and CD4(+) cells, but had no effect on acanthosis; restoration of calcitonin gene-related peptide (CGRP) signaling reversed the improvement in acanthosis and prevented denervated-mediated decreases in CD4(+) cells. Under innervated conditions, small-molecule inhibition of SP in KC-Tie2 animals resulted in similar decreases to those observed following surgical denervation for cutaneous CD11c(+) and CD4(+) cell numbers; whereas small-molecule inhibition of CGRP resulted in significant reductions in CD4(+) cell numbers and acanthosis. These data demonstrate that sensory nerve-derived peptides mediate psoriasiform dendritic cell and T-cell infiltration and acanthosis and introduce targeting nerve-immunocyte/KC interactions as potential psoriasis therapeutic treatment strategies. PMID:21471984

Ostrowski, Stephen M; Belkadi, Abdelmadjid; Loyd, Candace M; Diaconu, Doina; Ward, Nicole L

2011-07-01

350

The furcal nerve revisited  

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

Nanjundappa S. Harshavardhana

2014-08-01

351

The furcal nerve revisited.  

Science.gov (United States)

Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care. PMID:25317309

Harshavardhana, Nanjundappa S; Dabke, Harshad V

2014-08-01

352

Conjoined lumbosacral nerve roots  

International Nuclear Information System (INIS)

Several kinds of the lumbosacral nerve root anomalies have already been recognized, and the conjoined nerve roots is the most common among them. It does not make symptoms by itself, but if there is a causation of neural entrapment, for example, disc herniation, lateral recessus stenosis, spondylolisthesis, etc., so called ''biradicular syndrome'' should occur. Anomalies of the lumbosacral nerve roots, if not properly recognized, may lead to injury of these nerves during operation of the lumbar spine. Recently, the chance of finding these anomalous roots has been increased more and more with the use of metrizamide myelography and metrizamide CT, because of the improvement of the opacification of nerve roots. We describe the findings of the anomalous roots as revealed by these two methods. They demonstrate two nerve roots running parallel and the asymmetrical wide root sleeve. Under such circumstances, it is important to distinguish the anomalous roots from the normal ventral and dorsal roots. (author)

353

Cutaneous cancer and xeroderma pigmentosum  

International Nuclear Information System (INIS)

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

354

Cutaneous, mucocutaneous and neurocutaneous cysticercosis  

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

Arora P

1990-01-01

355

Cutaneous malignant lymphomas: update 2006.  

Science.gov (United States)

Cutaneous lymphomas represent a unique group of lymphomas and are the second most frequent extranodal lymphomas. As with other neoplasias, the pathogenesis is based mainly on a stepwise accumulation of mutations of suppressor genes and oncogenes caused by genetic, environmental or infectious factors. The diagnostic work-up includes clinical, histological, imaging and hematological investigations and in many cases immunohistochemical and molecular biological analyses. The current WHO/EORTC classification of cutaneous lymphomas differentiates "mature T-cell and NK-cell lymphomas", "mature B-cell lymphomas" and "immature hematopoietic malignancies", their variants and subgroups. It is compatible with the WHO classification for neoplasias of the hematopoietic and lymphoid tissue and respects the organ-specific peculiarities of primary cutaneous lymphomas. The assignment of the various types of cutaneous lymphomas into prognostic categories (pre-lymphomatous "abortive" disorders; definite malignant lymphomas of low-grade malignancy; definite malignant lymphomas of high-grade malignancy) provides essential information on the biological behavior and allows an appropriate planning of the therapeutic strategy, which may be topical or systemic and aggressive or non-aggressive. Besides the classical options for therapy, there are new and "experimental" strategies, the efficacy of which has to be studied in clinical trials. PMID:17081267

Burg, Günter; Kempf, Werner; Cozzio, Antonio; Döbbeling, Udo; Feit, Josef; Golling, Philippa; Michaelis, Sonja; Schärer, Leo; Nestle, Frank; Dummer, Reinhard

2006-11-01

356

Sporotrichoid pattern of cutaneous nocardiosis  

Directory of Open Access Journals (Sweden)

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

Inamadar A

2003-01-01

357

Primary cutaneous B cell lymphoma  

Directory of Open Access Journals (Sweden)

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

Bhat I

2003-07-01

358

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

359

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

International Nuclear Information System (INIS)

Purpose: As the recommended radiation dose for non-small-cell lung cancer (NSCLC) increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum dose tolerated by the brachial plexus. Methods and Materials: We identified 90 patients with NSCLC treated with definitive chemoradiation from March 2007 through September 2010, who had received >55 Gy to the brachial plexus. We used a multiatlas segmentation method combined with deformable image registration to delineate the brachial plexus on the original planning CT scans and scored plexopathy according to Common Terminology Criteria for Adverse Events version 4.03. Results: Median radiation dose to the brachial plexus was 70 Gy (range, 56–87.5 Gy; 1.5–2.5 Gy/fraction). At a median follow-up time of 14.0 months, 14 patients (16%) had brachial plexopathy (8 patients [9%] had Grade 1, and 6 patients [7%] had Grade ?2); median time to symptom onset was 6.5 months (range, 1.4–37.4 months). On multivariate analysis, receipt of a median brachial plexus dose of >69 Gy (odds ratio [OR] 10.091; 95% confidence interval [CI], 1.512–67.331; p = 0.005), a maximum dose of >75 Gy to 2 cm3 of the brachial plexus (OR, 4.909; 95% CI, 0.966–24.952; p = 0.038), and the presence of ple.038), and the presence of plexopathy before irradiation (OR, 4.722; 95% CI, 1.267–17.606; p = 0.021) were independent predictors of brachial plexopathy. Conclusions: For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. We developed a computer-assisted image segmentation method that allows us to rapidly and consistently contour the brachial plexus and establish the dose limits to minimize the risk of brachial plexopathy. Our results could be used as a guideline in future prospective trials with high-dose radiation therapy for unresectable lung cancer.

360

Cutaneous HPV and skin cancer.  

Science.gov (United States)

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

Accardi, Rosita; Gheit, Tarik

2014-10-22

361

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.

2011-12-01

362

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

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

Schmidt Yvonne

2012-11-01

363

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

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

Anton Emil

2014-01-01

364

Does obturator nerve block always occur in 3-1 block?  

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Full Text Available In the femoral “3-in-1 block”, obturator nerve block is routinely unsuccessful. Anatomical studies are not available to explain why blockade of obturator nerve or lumbar plexus does not occur. The aim of this study was to examine the effectiveness of femoral “3-in-1 block” obturator nerve block on a cadaver model.Materials and methods: Totally, 12 mature adult human cadavers were selected. Methylene blue dye (30 ml was injected under the fascia iliaca in eight cadavers and into the femoral nerve sheath in four cadavers. Careful bilateral dissections were performed following dye injections.Results: It was seen that the dye did not spread to the medial part of the psoas major muscle and the obturator nerve was not stained with the dye in eight cadavers in whom dye was injected laterally into the femoral sheat. In four cadavers in whom dye was injected into the femoral nerve sheat, metylene blue spread through fascial layers in the plane under the psoas muscle and stained the obturator nerve just before emerging medially from the fascia psoas. At this point, the obturator nerve pierced the psoas fascia and extended extrafascially in the medial and deep borders of the psoas muscle. In this area, the upper section of the obturator nerve was found also to be stained with the dye.Conclusion: We concluded that the cause of an unsuccessful obturator nerve block might be the fascial anatomy of this region. The lateral cutaneous femoral nerve and the femoral nerve easily can be blocked in the fascia iliaca compartment, but the obturator nerve block fails because of its being extrafascial in this region. J Clin Exp Invest 2011;2(2:149-51

?brahim Tekdemir

2011-06-01

365

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

International Nuclear Information System (INIS)

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

366

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

LENUS (Irish Health Repository)

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

Walsh, Jennifer M

2011-04-01

367

Obstetrical Brachial Plexus Palsy: Electrodiagnostical Study and Functional Outcome  

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

B. Eftekharsadat

2010-01-01

368

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

Jeng JS

2011-08-01

369

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

OpenAIRE

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

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

1997-01-01

370

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

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

Perrin Byron M

2010-12-01

371

Upper limb arterial hemodynamics in high brachial artery bifurcation by color doppler ultrasound  

OpenAIRE

Background: High bifurcation of the brachial artery is a common anatomic variant, with a prevalence of 12-20% and a challenging Doppler identification. This variant may have hemodynamic implications and compromise the success of a native arteriovenous fistula (AVF). The aim of this study is to compare the hemodynamic characteristics of the upper limb arterial axis based on the location of the brachial bifurcation in patients in need of a vascular access for hemodialysis. Methods: Cross se...

Fragoso, M.; Germano, M.; Gomes, A.; Sousa, M.; Rocha, R.; Marinho, R.; Pignatelli, N.; Nunes, V.

2014-01-01

372

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

OpenAIRE

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

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

2014-01-01

373

Optic nerve oxygenation  

DEFF Research Database (Denmark)

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

Stefánsson, Einar; Pedersen, Daniella Bach

2005-01-01

374

Copper-induced cutaneous sarcoidosis.  

Science.gov (United States)

A 52-year-old woman presented with gradual painless enlargement of both earlobes. Indurated plaques were also present elsewhere. There was no evidence of a systemic granulomatous disorder. Histopathology showed foreign material associated with granulomatous inflammation. Scanning electron microscopy and energy-dispersive analysis of X-rays demonstrated foreign material composed primarily of copper. Deposition is likely to have been related to corrosion of copper-containing earrings, or from deposition at the time of ear piercing. The presence of clinically similar granulomatous lesions remote from the earlobes and not containing copper suggest the presence of underlying cutaneous sarcoidosis. The earlobe lesions are more likely to be caused by foreign matter acting non-specifically as a nidus for cutaneous sarcoidosis, rather than by a specific pro-inflammatory effect of dermal copper. After 3 months, the lesions have partially responded to oral hydroxychloroquine 200 mg/day. PMID:15670177

Masel, Grant

2005-02-01

375

The classification of cutaneous melanoma.  

Science.gov (United States)

Forty years ago, a clinical and histological classification scheme and prognostic factors were described for cutaneous melanoma. This scheme included the subtypes superficial spreading, nodular and lentigo maligna, and prognostic factors including tumor thickness, ulceration, and mitotic activity. There have been some tweaks to the classification scheme, but these basic findings form the foundation for melanoma diagnosis and staging today. Currently, no molecular marker or target has proved reliably useful in the staging or treatment of melanoma. Measurement with a simple ruler serves as the basis for the staging of primary cutaneous melanoma, while the recognition of primary tumor mitotic activity and ulceration also remain significant factors. Recently, mutational analysis has revealed a correlation of activating mutations with the morphological descriptors from decades ago. Future classification schemes may have more power in predicting response to therapy by integrating specific genomic and intra-tumoral expression profiles with histologic findings. PMID:19464599

Duncan, Lyn McDivitt

2009-06-01

376

Cutaneous manifestations of viral hepatitis.  

Science.gov (United States)

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

Akhter, Ahmed; Said, Adnan

2015-02-01

377

Orbital metastasis from cutaneous melanoma  

OpenAIRE

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....

Samer Elsherbiny; Parveen Abdullah; Peter Cikatricis; Loukia Tsierkezou

2012-01-01

378

Unusual presentation of cutaneous leiomyoma.  

Science.gov (United States)

Herein, we report a case of leiomyoma cutis because of its rarity and unusual presentation. The case presented with a solitary leiomyoma lesion which was painless. However, the adjacent normal appearing area was tender. A biopsy of the lesion as well as of a portion of the adjacent normal appearing area was taken, which confirmed the diagnosis of cutaneous leiomyoma. This may suggest the dormant nature of the disease which has not yet become apparent. PMID:25484434

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

2014-11-01

379

A case of cutaneous plasmacytosis  

OpenAIRE

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

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

2013-01-01

380

Cutaneous and mucosal pain syndromes  

Directory of Open Access Journals (Sweden)

Full Text Available The cutaneous and mucosal pain syndromes are characterized by pain, burning sensation, numbness or paraesthesia of a particular part of the skin or mucosal surface without any visible signs. They are usually sensory disorders, sometimes with a great deal of psychologic overlay. In this article various conditions have been listed and are described. The possible causative mechanisms are discussed when they are applicable and the outline of their management is described.

Siddappa K

2002-01-01

381

Cutaneous manifestations of diabetes mellitus  

OpenAIRE

87 patients including 64 males and 24 females with diabetes mellitus and skin diseases were studied. The skin manifestations were common during the fifth decade of life. Maturity onset diabetes had increased incidence of skin disease. Incidence of skin disease was common in early diabetes. Infections both bacterial and fungal were seen in majority of patients. Specific cutaneous markers and metabolic changes were rare and seen in long standing diabetes. Infections were the common problems whi...

Rao Gatha; Pai Ganesh

1997-01-01