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Sample records for brachial plexus injury

  1. Brachial Plexus Injuries

    Science.gov (United States)

    ... Disability, Independent Living, and Rehabilitation Research (NIDILRR) National Rehabilitation Information ... is a network of nerves that conducts signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to ...

  2. Management of Brachial Plexus Injuries

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    J Gordon Millichap

    2005-02-01

    Full Text Available The results of early neurosurgical treatment of 58 infants with various types of brachial plexus birth injury have been compared with non-surgical intervention in 91 patients followed by a multidisciplinary team at the Brachial Plexus Program, Miami Children’s Hospital, FL.

  3. Systematic evaluation of brachial plexus injuries.

    Science.gov (United States)

    Haynes, S

    1993-01-01

    Brachial plexus injuries offer a unique challenge to the athletic trainer because of their relatively high frequency rate in contact sports and because of the complexity of the neuroanatomy in the cervical area. During a game, athletic trainers must make a fast, accurate decision regarding a player's return to competition. It is imperative that the athletic trainer be able to quickly differentiate between minor injuries and more serious injuries warranting removal from the game and/or physician referral. A systematic approach to the evaluation of a brachial plexus injury is essential to ensure proper treatment. This paper will present a structured approach to an on-the-field assessment of brachial plexus injuries.

  4. Electroacupuncture attenuates neuropathic pain after brachial plexus injury

    Institute of Scientific and Technical Information of China (English)

    Shenyu Zhang; Hailiang Tang; Junming Zhou; Yudong Gu

    2014-01-01

    Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root (associated with upper-limb chronic neuropathic pain) were given electroacu-puncture stimulation at bilateralQuchi(LI11),Hegu(LI04),Zusanli(ST36) andYanglingquan (GB34). After electroacupuncture therapy, chronic neuropathic pain in the rats’ upper limbs was signiifcantly attenuated. Immunolfuorescence staining showed that the expression of β-endorphins in the arcuate nucleus was signiifcantly increased after therapy. Thus, experimental ifndings indi-cate that electroacupuncture can attenuate neuropathic pain after brachial plexus injury through upregulatingβ-endorphin expression.

  5. Traumatic injuries of brachial plexus: present methods of surgical treatment Part II. Treatment policy for brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    M. L. Novikov

    2013-01-01

    Full Text Available The task of this paper is to familiarize practicing neurologists, neurosurgeons, traumatologists, and orthopedists with the current principles of diagnosis and treatment of different brachial plexus (BP injuries. Part I describes the anatomy of BP in detail, considers the main mechanisms of its injuries, and gives their current classification (Nervno-Myshechnye Bolezni (Neuromuscular Diseases 2012;4:19–27.Part II presents the author's approach to treatment of brachial plexus injuries according to the type of lesion and period of denervation: nonoperative methods; rehabilitation; preoperative management; indications for surgical treatment. The tactics and techniques of primary brachial plexus reconstructions are discussed in detail.

  6. Electrodiagnosis in traumatic brachial plexus injury

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    K A Mansukhani

    2013-01-01

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

  7. Electrodiagnosis in traumatic brachial plexus injury.

    Science.gov (United States)

    Mansukhani, K A

    2013-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

    In the treatment of brachial plexus injury, nerves that are functionally less important are trans-ferred 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 brachi-al 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.

  9. Clinical research of comprehensive rehabilitation in treating brachial plexus injury patients

    Institute of Scientific and Technical Information of China (English)

    ZHOU Jun-ming; GU Yu-dong; XU Xiao-jun; ZHANG Shen-yu; ZHAO Xin

    2012-01-01

    Background Brachial plexus injury is one of the difficult medical problems in the world.The aim of this study was to observe the clinical therapeutic effect of comprehensive rehabilitation in treating dysfunction after brachial plexus injury.Methods Forty-three cases of dysfunction after brachial plexus injury were divided into two groups randomly.The treatment group,which totaled 21 patients (including 14 cases of total brachial plexus injury and seven cases of branch brachial plexus injury),was treated with comprehensive rehabilitation including transcutaneous electrical nerve stimulation,mid-frequency electrotherapy,Tuina therapy,and occupational therapy.The control group,which totaled 22patients (including 16 cases of total brachial plexus injury and six cases of branch brachial plexus injury),was treated with home-based electrical nerve stimulation and occupational therapy.Each course was of 30 days duration and the patients received four courses totally.After four courses,the rehabilitation effect was evaluated according to the brachial plexus function evaluation standard and electromyogram (EMG) assessment.Results In the treatment group,there was significant difference in the scores of brachial plexus function pre- and post-treatment (P <0.01 ) in both "total" and "branch" injury.The scores of two "total injury" groups had statistical differences (P <0.01),while the scores of two "branch injury" groups had statistical differences (P<0.05) after four courses.EMG suggested that the.appearance of regeneration potentials of the recipient nerves in the treatment group was earlier than the control group and had significant differences (P <0.05).Conclusion Comprehensive rehabilitation was more effective in treating dysfunction after brachial plexus injury thannonintegrated rehabilitation.

  10. Brachial plexus injury: the London experience with supraclavicular traction lesions.

    Science.gov (United States)

    Birch, Rolfe

    2009-01-01

    In this article, the author details the experiences of his hospital and other London hospitals in treating brachial plexus injury. As noted, important advances have been made in methods of diagnosis and repair. Myelography was replaced by CT scan and later by MRI. Among the topics the author explores are diagnosis (including pain, the presence or absence of the Tinel sign, and the irradiation of pins and needles) and the principles of repair. The author emphasizes that it is imperative that ruptured nerves be repaired as soon as possible, with the closed traction lesion coming, in urgency, close behind reattachment of the amputated hand or repair of a great artery and a trunk nerve in the combined lesion. Finally, the article concludes that the surgeon must be actively engaged in the whole process of rehabilitation and treatment of pain. This is part of a Point-Counterpoint discussion with Dr. David G. Kline's presentation of "A Personal Experience."

  11. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

    Science.gov (United States)

    Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

    2017-01-01

    Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. Participants The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. Outcome measures An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. Results 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. Conclusions The process established a new network of opinion leaders and researchers for further

  12. Surgical outcomes following nerve transfers in upper brachial plexus injuries

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    Bhandari P

    2009-01-01

    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

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

    LENUS (Irish Health Repository)

    Walsh, Jennifer M

    2011-04-01

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

  14. Potentialities Of Tendomyoplasty In Rehabilitation Of Patients With Rough Injuries Of Brachial Plexus Trunks

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    G.A.Korshunova

    2009-09-01

    Full Text Available To improve functional results after surgical treatment of consequences of brachial plexus trunks rough injuries rehabilitation results of 111 patients with consequences of brachial plexus trunks rough injuries were studied. Thanks to the adequate tendomyoplasty rehabilitation of shoulder abduction, forearm flexion and of hand grasping is obtained in 85% of patients. The suggested method of treatment may be recommended for wide usage in practical health care

  15. Role of еlectromyography in assessing prognosis for children with obstetric brachial plexus injury in practice of a specialized center

    OpenAIRE

    M. L. Novikov; D. S. Druzhinin; V. A. Bulanova; T. E. Torno

    2014-01-01

    The aim of current publication – to present our own experience in use of electromyographic examination in prognosis for children with obstetric brachial plexus injury to practical neurologists and neurophysiologists. Review of literature shows that common approaches to electrotrophysiological diagnosis of obstetric brachial plexus injury do not exist. The aim of this study– to evaluate retrospectively electrophysiological and sonographic parameters of obstetric brachial plexus injury in child...

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

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

    2006-12-15

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

  17. [Pain caused by brachial plexus injury during coronary revascularization. Report of 3 cases].

    Science.gov (United States)

    Martín, M A; Marí, C; Miranda, A F; Burón, J A; Fernández, F E; Suárez, R

    1992-01-01

    We report three cases of injury of the brachial plexus after coronary revascularization surgery. During the postoperative phase all patients presented plexopathy involving the left C8 and D1 roots. The symptoms were pain, paresthesia, and motor deficits. The proposed mechanisms for injury of the brachial plexus during cardiac surgery are: hyperabduction of the arm, direct traumatism produced by the needle during catheterization of the internal jugular vein, and traction and compression associated with sternal retraction. In the three patients we ruled out alterations during cannulation of the internal jugular vein and malposition of the arms. We think that in our cases the fundamental mechanism was an excessive and assymetrical opening of sternal and Favoloro's separators that were used in all cases during dissection of the left internal mammary artery. We conclude that injury of the brachial plexus can be minimized by reducing the opening of both separators and by placing Favaloro's separator in a lower position.

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

    Directory of Open Access Journals (Sweden)

    Ying Liu

    2015-01-01

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

  19. A Case of Scapulothoracic Dissociation with Brachial Plexus Injury: Magnetic Resonance Imaging Findings

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    Lee, G.K.; Suh, K.J.; Choi, J.A.; Oh, O.Y. [Dept. of Radiology, Hallym Univ. College of Medicine, Hangang Sacred Heart Hospital, Seoul (Korea)

    2007-11-15

    Scapulothoracic dissociation is defined as violent lateral or rotational displacement of the shoulder girdle from its thoracic attachments with severe neurovascular injury. We describe the radiographic and associated magnetic resonance (MR) imaging findings of a case of scapulothoracic dissociation with brachial plexus injury in a 17-year-old man, and include a review of the relevant literature.

  20. Functional reconstruction following brachial plexus root avulsion

    Institute of Scientific and Technical Information of China (English)

    Guixin Sun; Cunyi Fan; Yudong Gu

    2007-01-01

    OBJECTIVE: To sum up the treatment of brachial plexus root avulsion and the progress in functional reconstruction and rehabilitation following brachial plexus root avulsion.DATA SOURCES: A search of Medline was performed to select functional reconstruction and rehabilitation following brachial plexus injury-related English articles published between January 1990 and July 2006, with key words of "brachial plexus injury, reconstruction and rehabilitation". Meanwhile, a computer-based search of CBM was carried out to select the similar Chinese articles published between January 1998 and July 2006,with key words of "brachial plexus injury, reconstruction and rehabilitation".STUDY SELECTION: The materials were checked primarily, and the literatures of functional reconstruction and rehabilitation of brachial plexus injury were selected and the full texts were retrieved.Inclusive criteria: ① Functional reconstruction following brachial plexus injury. ② Rehabilitation method of brachial plexus injury. Exclusive criteria: Reviews, repetitive study, and Meta analytical papers.DATA EXTRACTION: Forty-six literatures about functional reconstruction following brachial plexus injury were collected, and 36 of them met the inclusive criteria.DATA SYNTHESIS: Brachial plexus injury causes the complete or incomplete palsy of muscle of upper extremity. The treatment of brachial plexus is to displace not very important nerves to the distal end of very important nerve, called nerve transfer, which is an important method to treat brachial plexus injury.Postoperative rehabilitations consist of sensory training and motor functional training. It is very important to keep the initiativeness of exercise. Besides recovering peripheral nerve continuity by operation, combined treatment and accelerating neural regeneration, active motors of cerebral cortex is also the important factor to reconstruct peripheral nerve function.CONCLUSION: Consciously and actively strengthening functional

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

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    Darshan Kumar A Jain

    2012-01-01

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

  2. Brachial plexus injury in two red-tailed hawks (Buteo jamaicensis).

    Science.gov (United States)

    Shell, L; Richards, M; Saunders, G

    1993-01-01

    Two red-tailed hawks (Buteo jamaicensis), found near Deltaville, Virginia (USA), were evaluated because of inability to use a wing. Results of needle electromyographic studies of the affected wing muscles in both hawks were compatible with denervation. On euthanasia, one hawk had extensive axon and myelin loss with multifocal perivascular lymphocytic inflammation of its brachial plexus and radial nerve. Demyelination and axon loss in the dorsal white matter of the spinal cord on the affected side also were found at the origin of the brachial plexus. The other hawk's wing had not returned to functional status > 2 yr after injury.

  3. 3.0-T magnetic resonance imaging in children with brachial plexus birth injury

    Institute of Scientific and Technical Information of China (English)

    Shinong Pan; Qiyong Guo; Lijie Tian; Wei Liao; Feng Tian; Jian Mao; Fei Wang; Rongjie Bai; Qi Li; Zhian Chen

    2011-01-01

    Brachial plexus birth injuries in children are usually diagnosed using 1.5-T magnetic resonance imaging, while the application of high-field magnetic resonance imaging is rarely reported. Therefore, a retrospective comparison of 18 cases of children with brachial plexus injury was performed to investigate the characteristics of 3.0-T magnetic resonance imaging and intraoperative observations. Magnetic resonance examinations in 18 cases of children showed that pseudo-meningocele sensitivity, specificity, accuracy, and positivity rates were 83.3%, 79.6%, 81.1%, and 40.0%, respectively. As for the neuroma and fibrous scar encapsulation, the sensitivity, specificity, accuracy, and positivity rates were 92.9%, 50.0%, 83.3%, and 77.8%, respectively. These results confirm that 3.0-T high-field magnetic resonance imaging can clearly reveal abnormal changes in brachial plexus injury, in which pseudo-meningocele, fibrous scar encapsulation, and neuroma are the characteristic changes of obstetric brachial plexus preganglionic and postganglionic nerve injury.

  4. Brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    周友清; 陈亮; 胡韶楠; 顾玉东

    2002-01-01

    @@ Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter.

  5. Degeneration of primary afferent terminals following brachial plexus extensive avulsion injury in rats

    OpenAIRE

    Muñetón-Gómez, Vilma; Taylor, Julian S.; Averill, Sharon; Priestley, John V.; Nieto-Sampedro, Manuel

    2004-01-01

    Important breakthroughs in the understanding regeneration failure in an injured CNS have been made by studies of primary afferent neurons. Dorsal rhizotomy has provided an experimental model of brachial plexus (BP) avulsion. This is an injury in which the central branches of primary afferents are disrupted at their point of entry into the spinal cord, bringing motor and sensory dysfunction to the upper limbs. In the present work, the central axonal organization of primary afferents was examin...

  6. Phrenic Nerve Transfer for Reconstruction of Elbow Extension in Severe Brachial Plexus Injuries.

    Science.gov (United States)

    Flores, Leandro P; Socolovsky, Mariano

    2016-09-01

    Background Restoring elbow extension is an important objective to pursue when repairing the brachial plexus in patients with a flail arm. Based upon the good results obtained using the phrenic nerve to restore elbow flexion and shoulder stability, we hypothesized that this nerve could also be employed to reconstruct elbow extension in patients with severe brachial plexus injuries. Methods A retrospective study of 10 patients in which the phrenic nerve targeted the radial nerve (7 patients) or the branch to the long head of the triceps (3 patients) as a surgical strategy for reconstruction of the brachial plexus. Results The mean postoperative follow-up time was 34 months. At final follow-up, elbow extension graded as M4 was measured in three patients, Medical Research Council MRC M3 in five patients, and M2 in one patient, while one patient experienced no measurable recovery (M0). No patient complained or demonstrated any signs of respiratory insufficiency postoperatively. Conclusions The phrenic nerve is a reliable donor for reanimation of elbow extension in such cases, and the branch to the long head of the triceps should be considered as a better target for the nerve transfer.

  7. Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries

    Science.gov (United States)

    Qin, Ben-Gang; Yang, Jian-Tao; Yang, Yi; Wang, Hong-Gang; Fu, Guo; Gu, Li-Qiang; Li, Ping; Zhu, Qing-Tang; Liu, Xiao-Lin; Zhu, Jia-Kai

    2016-01-01

    Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury. PMID:27782162

  8. Role of еlectromyography in assessing prognosis for children with obstetric brachial plexus injury in practice of a specialized center

    Directory of Open Access Journals (Sweden)

    M. L. Novikov

    2014-01-01

    Full Text Available The aim of current publication – to present our own experience in use of electromyographic examination in prognosis for children with obstetric brachial plexus injury to practical neurologists and neurophysiologists. Review of literature shows that common approaches to electrotrophysiological diagnosis of obstetric brachial plexus injury do not exist. The aim of this study– to evaluate retrospectively electrophysiological and sonographic parameters of obstetric brachial plexus injury in children, determining the most informative variables. Since 2007 to 2014 we examined 218 children, 74 of them were operated. Electrophysiological investigation in young children have difficulties in performance.We present our algorithm of diagnostic of obstetric brachial plexus injury: 1 testing main muscles, which perform basic movementsin upper limb (needle EMG of supra- and infraspinatus muscles and cutaneous EMG of biceps muscles; 2 localization of injury (paralysis or Duchenne – Erb palsy and electrophysiological criteria of spinal cord root avulsion. We found out that the most crucial role in assessing prognosis plays an examination of motor unit potentials (MUPs duration. Absence of MUPs within needle EMG from supraspinatus muscle and absence of interference curve from biceps muscle during first 6 months have poor prognosis. After 6 months careful, dynamic study of MUPs duration in infraspinatus muscle and co-contraction of agonist and antagonist muscles is needed. To decide whether reconstructive surgery in a patient with obstetric brachial plexus injury is necessary, surgeon must analyze clinical and instrumental data. The possibility of usage of the ultrasonogrophy in brachial plexus injury requires further investigation.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  10. Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report

    Directory of Open Access Journals (Sweden)

    Yajima Hiroshi

    2008-03-01

    Full Text Available Abstract Introduction Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated with axillary injury after blunt trauma in the shoulder region has been rarely reported. In previous reports, this condition only occurred in old patients with sclerotic vessels. We present a case of a young patient who suffered axillary artery injury associated with brachial plexus palsy that occurred tardily due to compressive hematoma after blunt trauma in the shoulder region without association of either shoulder dislocation or humeral neck fracture. Case presentation A 16-year-old male injured his right shoulder in a motorbike accident. On initial physical evaluation, the pulses on the radial and ulnar arteries in the affected arm were palpable. Paralysis developed later from 2 days after the injury. Functions in the right arm became significantly impaired. Angiography showed complete occlusion of the axillary artery. Magnetic resonance imaging demonstrated a mass measuring 4 × 5 cm that was suspected to be a hematoma compressing the brachial plexus in a space between the subscapular muscle and the pectoralis minor muscle. Surgery was performed on the third day after injury. In intraoperative observations, the axillary artery was occluded with thrombus along 5 cm; a subscapular artery was ruptured; the brachial plexus was compressed by the hematoma. After evacuation of the hematoma, neurolysis of the brachial plexus, and revascularization of the axillary artery, the patient had an excellent functional recovery of the affected upper limb, postoperatively. Conclusion Surgeons should be aware that axillary artery injuries may even occur in young people after severe blunt

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

    Science.gov (United States)

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

    2013-07-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does retraction of the sternum during median sternotomy result in brachial plexus injuries or peripheral neuropathies?' Altogether 58 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, date, journal and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Caudal placement of the retractor or relieving the pressure superiorly by removing the upper blades of a retractor (P = 0.02) and use of a caudally placed symmetrical retractor has been shown to reduce neuropathy. Positioning of the patient with 'hands up' positioning showed significant reduction in the incidence of brachial plexus injuries. Furthermore, how wide the retractor is opened and use of an asymmetrical retractor for internal mammary artery (IMA) harvesting are also important factors in quantifying risk of postoperative neuropathy. Wider sternal retraction and longer bypass time did increase the risk of developing postoperative neuropathy. Three asymmetrical retractors were looked at that demonstrates the Delacroix-Chevalier to be the safest (P retractor and using a caudally placed retractor.

  12. Occult rib fractures and brachial plexus injury following median sternotomy for open-heart operations.

    Science.gov (United States)

    Baisden, C E; Greenwald, L V; Symbas, P N

    1984-09-01

    The incidence and the sites of rib fractures during open-heart operations through a median sternotomy incision were studied in 36 consecutive patients divided into two groups. In Group 1 (24 patients), a conventional Ankeney retractor was used to expose the heart, and in Group 2 (12 patients), a similar retractor was used but with its uppermost pair of blades removed. Thorough physical examinations and preoperative and postoperative chest roentgenograms were obtained, and postoperative bone scans were done in all patients. No rib fractures were detected on the routine chest roentgenograms in patients in either group. Bone scans, however, showed 44 rib fractures (15 of the first rib, 13 of the second rib, 4 of the third rib, 6 of the fourth rib, 3 of the fifth rib, and 3 of the sixth rib) in 16 patients in Group 1. Six patients in Group 2 had 9 rib fractures (2 of the first rib, 4 of the second rib, and 1 each of the third, fifth, and sixth ribs). None of the patients in Group 2 had brachial plexus injury and neither of the first rib fractures in this group were located posteriorly, whereas 3 patients in Group 1 had both brachial plexus injury and posterior first rib fractures.

  13. Standard versus a novel technique for restoring neurological function following brachial plexus injuries

    Institute of Scientific and Technical Information of China (English)

    Damien Kuffler

    2011-01-01

    The brachial plexus, a complex network of peripheral nerves, involves the motor, sensory, and sympathetic nerve supply to the upper extremity, and is formed by the union of the ventral primary rami of the spinal nerves. Brachial plexus trauma, damage to the complex of nerves, has a high incidence from delivery throughout life, leading to loss of all innervation of the arm and hand, their paralysis, and frequently results in excruciating neuropathic pain. The most frequent brachial plexus repair techniques use autologous sensory nerve grafts to bridge the nerve gaps. However, these do not induce reliable neurological recovery or reduce neuropathic pain, thus permanent neurological loss and neuropathic pain frequently occur. The present study evaluated the current best brachial plexus repair techniques and another involving a collagen tube filled with autologous platelet-rich fibrin that clinically induces extensive neurological recovery and a reduction/elimination of neuropathic pain, which are not possible by sural nerve grafts, even across long nerve gaps that are repaired years post trauma, and in older patients. This novel technique is proposed for use in restoring brachial plexus neurological function and in reducing/eliminating neuropathic pain.

  14. Treatment of 150 Cases of Infantile Brachial Plexus Injury by Tuina

    Institute of Scientific and Technical Information of China (English)

    HAN Shi-chun; ZHU Zhong-chun

    2005-01-01

    The author selected the acupoints Fengfu (GV 16), Fengchi (GB 20), Hegu (LI 4),Jianjing (GB 21), and adopted manual techniques such as Yizhichan-Thumb waving pressing,An-pressing, Rou-stationary circular pressing, Nie-pinching, Nian-finger twisting, Na-holding,Yao-rotation and Cuo-palm twisting to warm and dredge meridians and collaterals, promote the circulation of qi and blood, and lubricate the joints, to treat 150 cases of infantile brachial plexus injury. The total effective rate was 99.3%.%取风府、风池、合谷、肩井等穴,应用一指禅推法,按、揉、捏、捻、拿、摇、搓等手法,以温经通络、行气活血、通利关节.治疗150例臂丛神经损伤小儿患者,总有效率99.3%.

  15. Attenuation of brain grey matter volume in brachial plexus injury patients.

    Science.gov (United States)

    Lu, Yechen; Liu, Hanqiu; Hua, Xuyun; Xu, Jian-Guang; Gu, Yu-Dong; Shen, Yundong

    2016-01-01

    Brachial plexus injury (BPI) causes functional changes in the brain, but the structural changes resulting from BPI remain unknown. In this study, we compared grey matter volume between nine BPI patients and ten healthy controls by means of voxel-based morphometry. This was the first study of cortical morphology in BPI. We found that brain regions including the cerebellum, anterior cingulate cortex, bilateral inferior, medial, superior frontal lobe, and bilateral insula had less grey matter in BPI patients. Most of the affected brain regions of BPI patients are closely related to motor function. We speculate that the loss of grey matter in multiple regions might be the neural basis of the difficulties in the motor rehabilitation of BPI patients. The mapping result might provide new target regions for interventions of motor rehabilitation.

  16. MRI of the brachial plexus

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-02-01

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

  17. Therapeutic application of electrical stimulation and constraint induced movement therapy in perinatal brachial plexus injury: A case report.

    Science.gov (United States)

    Berggren, Jamie; Baker, Lucinda L

    2015-01-01

    Infants and children with perinatal brachial plexus injury (PBPI) have motion limitations in the shoulder, elbow, forearm and hand that are dependent on the level of injury and degree of recovery. The injury and subsequent recovery period occur during critical periods of central and spinal neural development placing infants and children at-risk for developmental disregard and disuse of the affected arm and hand. A case report outlines the therapy and surgical interventions provided in the first 2 years of life for a child with global PBPI and a positive Horner's sign. Electrical stimulation and constraint induced movement therapy provided sequentially were effective therapy interventions. Neurosurgery to repair the brachial plexus was performed at an optimal time period.(2) The Assisting Hand Assessment,(12) Modified Mallet(13) and Active Movement Scale(14) are effective outcome measures in PBPI and served as valuable guides for therapy intervention. Oxford Level of Evidence: 3b; Individual Case Control Study.

  18. Substance P mRNA expression in the rat spinal cord following selective brachial plexus injury

    Institute of Scientific and Technical Information of China (English)

    Na Liu; Longju Chen; Feng Li; Wutian Wu

    2008-01-01

    BACKGROUND: The neuropeptide, substance P, has various bioactivities and is widely distributed in the central nervous system. Substance P participates in neural transmission in the spinal cord and plays an important role in regeneration and repair of nerve injury.OBJECTIVE: To investigate substance P mRNA expression in the anterior horn of the spinal cord following brachial plexus injury.DESIGN, TIME AND SETTING: A molecular cell biology randomized controlled study was performed at the Department of Anatomy, Zhongshan Medical College, Sun Yat-sen University and the DaAn Gene Laboratory in May 2005.MATERIALS: A total of 29 adult male Sprague Dawley rats were randomly assigned to a control group (n=5) and an injury group (n = 24).METHODS: The injury group was divided into three subgroups. In subgroup A, the right seventh cervical vertebra (C7) anterior root was avulsed, and the residual nerve root at the distal end was removed. In subgroup B, the right C7 anterior root was avulsed, and the right C5 first thoracic vertebrae (TO posterior root was incised. Thus afferent pathways of the posterior root that connected with the anterior horn motor neurons were blocked. In subgroup C, the right C7 anterior root was avulsed, and a right C5-6 hemisection was performed. Thus the descending fiber pathways of the cortex that connected with anterior horn motor neurons were blocked. In the control group, the C5-T1 vertebral plate was opened, and then the skin was sutured.MAIN OUTCOME MEASURE: Substance P mRNA expression in the anterior horn of the spinal cord was quantified using fluorescent quantitative reverse transcription-polymerase chain reaction.RESULTS: Substance P mRNA expression was low in the anterior horn of the rat spinal cord in the control group. Substance P mRNA expression in the anterior horn of the spinal cord was upregulated and was significantly higher in the injury group compared with the control group (P < 0.01 ). Substance P mRNA expression was highest in

  19. Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury

    NARCIS (Netherlands)

    Fraiman, D.; Miranda, M.F.; Erthal, F.; Buur, P.F.; Elschot, M.; Souza, L.; Rombouts, S.A.; Schimmelpenninck, C.A.; Norris, D.G.; Malessy, M.J.; Galves, A.; Vargas, C.D.

    2016-01-01

    This study aims at the effects of traumatic brachial plexus lesion with root avulsions (BPA) upon the organization of the primary motor cortex (M1). Nine right-handed patients with a right BPA in whom an intercostal to musculocutaneous (ICN-MC) nerve transfer was performed had post-operative resting

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

    Directory of Open Access Journals (Sweden)

    Björkman Anders

    2010-07-01

    Full Text Available Abstract Background As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries. Methods Seven consecutive male patients (median age 33; range 15-61 with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI, computed tomography myelography (CT-M or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-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 (К = 0.76 compared with only fair (К = 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.

  1. Elective cesarean section to prevent anal incontinence and brachial plexus injuries associated with macrosomia--a decision analysis.

    Science.gov (United States)

    Culligan, Patrick J; Myers, John A; Goldberg, Roger P; Blackwell, Linda; Gohmann, Stephan F; Abell, Troy D

    2005-01-01

    Our aim was to determine the cost-effectiveness of a policy of elective C-section for macrosomic infants to prevent maternal anal incontinence, urinary incontinence, and newborn brachial plexus injuries. We used a decision analytic model to compare the standard of care with a policy whereby all primigravid patients in the United States would undergo an ultrasound at 39 weeks gestation, followed by an elective C-section for any fetus estimated at > or =4500 g. The following clinical consequences were considered crucial to the analysis: brachial plexus injury to the newborn; maternal anal and urinary incontinence; emergency hysterectomy; hemorrhage requiring blood transfusion; and maternal mortality. Our outcome measures included (1) number of brachial plexus injuries or cases of incontinence averted, (2) incremental monetary cost per 100,000 deliveries, (3) expected quality of life of the mother and her child, and (4) "quality-adjusted life years" (QALY) associated with the two policies. For every 100,000 deliveries, the policy of elective C-section resulted in 16.6 fewer permanent brachial plexus injuries, 185.7 fewer cases of anal incontinence, and cost savings of $3,211,000. Therefore, this policy would prevent one case of anal incontinence for every 539 elective C-sections performed. The expected quality of life associated with the elective C-section policy was also greater (quality of life score 0.923 vs 0.917 on a scale from 0.0 to 1.0 and 53.6 QALY vs 53.2). A policy whereby primigravid patients in the United States have a 39 week ultrasound-estimated fetal weight followed by C-section for any fetuses > or =4500 g appears cost effective. However, the monetary costs in our analysis were sensitive to the probability estimates of urinary incontinence following C-section and vaginal delivery and the cost estimates for urinary incontinence, vaginal delivery, and C-section.

  2. Expression of nitric oxide synthase in the spinal cord after selective brachial plexus injury

    Institute of Scientific and Technical Information of China (English)

    Na Liu; Feng Li; Longju Chen; Wutian Wu

    2006-01-01

    BACKGROUND: Some researches showed that motoneurons in spinal cord anterior horn wound die following brachial plexus injury, but the concrete mechanism of motoneurons death remains unclear.OBJECTIVE: To observe the expression of nitric oxide synthase (NOS) and survival of C7 motoneurons in spinal cord of rats after selective brachial plexus injury.DESIGN: A randomized controlled animal experiment.SETTING: Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University.MATERIALS: Totally 35 adult healthy male Sprague-Dawley rats with the body mass of 200-300 g were provided by Experimental Animal Center, Sun Yet-sen Medical College, Sun Yat-sen University. The rats were divided into control group (n =5) and experimental group (n=30) by random number table method, and the experimental group was divided into three injury subgroups: anterior root avulsion group, dorsal root transection group and spinal cord hemisection group, 10 rats in each group. There were horse anti-neuronal NOS (Nnos) polycolonal antibody (Sigma company) and nicotina mideadeninedinucleotide phosphate (NADPH-d) (SigmaCompany).METHODS: The experiment was performed at Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University between September 2004 and April 2005. ①After anesthetizing the rats, the spinous process of second thoracic vertebra as a marker, the vertebra was exposed from C5 to T1 and the lamina of vertebra was unclenched, and spinal dura mater was carved to expose the spinal nerve dorsal roots of C5-T1.The right ventral root of C7 was avulsed, and the residual root was removed in anterior root avulsion group. The right ventral root of C7 was avulsed and the right dorsal roots of brachial plexus (C5-T1) were cut off in dorsal root transection group. In spinal cord hemisection group, the hemisection between the C5 and C6 spinal segment on right side and avulsion of right ventral root of C7 were made. In the control group, the vertebra from C5 to T1 was

  3. Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation

    Science.gov (United States)

    Souza, Lidiane; Lemos, Thiago; Silva, Débora C.; de Oliveira, José M.; Guedes Corrêa, José F.; Tavares, Paulo L.; Oliveira, Laura A.; Rodrigues, Erika C.; Vargas, Claudia D.

    2016-01-01

    Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions. Results: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818). Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition. PMID:26834610

  4. Balance impairments after brachial plexus injury as assessed through clinical and posturographic evaluation

    Directory of Open Access Journals (Sweden)

    Lidiane eSouza †

    2016-01-01

    Full Text Available Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI affects the upright balance. Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment includes the Berg Balance Scale (BBS, the number of feet touches on the ground while performing a 60s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60s trial. The body weight distribution (BWD between the legs was estimated from the center of pressure (COP lateral position. The COP variability was quantified in the anterior-posterior and lateral directions.Results: BPI patients presented lower BBS scores (p=0.048 and a higher frequency of feet touches during the single-leg stance (p=0.042 compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was showed by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p=0.020, but not for lateral direction (p=0.818.Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.

  5. Coracoid Abnormalities and Their Relationship with Glenohumeral Deformities in Children with Obstetric Brachial Plexus Injury

    Directory of Open Access Journals (Sweden)

    Wentz Melissa J

    2010-10-01

    Full Text Available Abstract Background Patients with incomplete recovery from obstetric brachial plexus injury (OBPI usually develop secondary muscle imbalances and bone deformities at the shoulder joint. Considerable efforts have been made to characterize and correct the glenohumeral deformities, and relatively less emphasis has been placed on the more subtle ones, such as those of the coracoid process. The purpose of this retrospective study is to determine the relationship between coracoid abnormalities and glenohumeral deformities in OBPI patients. We hypothesize that coracoscapular angles and distances, as well as coracohumeral distances, diminish with increasing glenohumeral deformity, whereas coracoid overlap will increase. Methods 39 patients (age range: 2-13 years, average: 4.7 years, with deformities secondary to OBPI were included in this study. Parameters for quantifying coracoid abnormalities (coracoscapular angle, coracoid overlap, coracohumeral distance, and coracoscapular distance and shoulder deformities (posterior subluxation and glenoid retroversion were measured on CT images from these patients before any surgical intervention. Paired Student t-tests and Pearson correlations were used to analyze different parameters. Results Significant differences between affected and contralateral shoulders were found for all coracoid and shoulder deformity parameters. Percent of humeral head anterior to scapular line (PHHA, glenoid version, coracoscapular angles, and coracoscapular and coracohumeral distances were significantly lower for affected shoulders compared to contralateral ones. Coracoid overlap was significantly higher for affected sides compared to contralateral sides. Significant and positive correlations were found between coracoscapular distances and glenohumeral parameters (PHHA and version, as well as between coracoscapular angles and glenohumeral parameters, for affected shoulders. Moderate and positive correlations existed between coracoid

  6. Postoperative monitoring in free muscle transfers for reconstruction in brachial plexus injuries.

    Science.gov (United States)

    Dodakundi, Chaitanya; Doi, Kazuteru; Hattori, Yasunori; Sakamoto, Soutetsu; Yonemura, Hiroshi; Fujihara, Yuki

    2012-03-01

    Free gracilis transfers are done for reanimation of the upper limb in traumatic total brachial plexus palsy. Because of buried nature of the free muscle and monitoring skin flap in the axillary or infraclavicular region, it is always a tricky situation for continuous and repeated monitoring to assess vascular status. Critical ischemia times vary between the muscle and monitoring skin flap because of which signs of ischemic changes in the monitoring skin flap are always delayed with respect to the muscle. We describe a novel method that uses the principle of evoked potentials from the muscle to assess the vascular status of the free muscle and detects vascular compromise early before the skin changes are apparent.

  7. MR imaging of the brachial plexus.

    Science.gov (United States)

    Posniak, H V; Olson, M C; Dudiak, C M; Wisniewski, R; O'Malley, C

    1993-08-01

    The brachial plexus is difficult to evaluate with conventional radiologic techniques, including CT. However, it is well shown by MR imaging, which has direct multiplanar imaging capability and superior soft-tissue resolution [1-4]. We present our technique for evaluating the brachial plexus, discuss the anatomy, and illustrate normal and abnormal findings.

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

    Directory of Open Access Journals (Sweden)

    Jimmy Thomas

    2014-01-01

    Full Text Available This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

  9. Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury.

    Science.gov (United States)

    Fraiman, D; Miranda, M F; Erthal, F; Buur, P F; Elschot, M; Souza, L; Rombouts, S A R B; Schimmelpenninck, C A; Norris, D G; Malessy, M J A; Galves, A; Vargas, C D

    2016-01-01

    This study aims at the effects of traumatic brachial plexus lesion with root avulsions (BPA) upon the organization of the primary motor cortex (M1). Nine right-handed patients with a right BPA in whom an intercostal to musculocutaneous (ICN-MC) nerve transfer was performed had post-operative resting state fMRI scanning. The analysis of empirical functional correlations between neighboring voxels revealed faster correlation decay as a function of distance in the M1 region corresponding to the arm in BPA patients as compared to the control group. No differences between the two groups were found in the face area. We also investigated whether such larger decay in patients could be attributed to a gray matter diminution in M1. Structural imaging analysis showed no difference in gray matter density between groups. Our findings suggest that the faster decay in neighboring functional correlations without significant gray matter diminution in BPA patients could be related to a reduced activity in intrinsic horizontal connections in M1 responsible for upper limb motor synergies.

  10. Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury

    Directory of Open Access Journals (Sweden)

    D. Fraiman

    2016-01-01

    Full Text Available This study aims at the effects of traumatic brachial plexus lesion with root avulsions (BPA upon the organization of the primary motor cortex (M1. Nine right-handed patients with a right BPA in whom an intercostal to musculocutaneous (ICN-MC nerve transfer was performed had post-operative resting state fMRI scanning. The analysis of empirical functional correlations between neighboring voxels revealed faster correlation decay as a function of distance in the M1 region corresponding to the arm in BPA patients as compared to the control group. No differences between the two groups were found in the face area. We also investigated whether such larger decay in patients could be attributed to a gray matter diminution in M1. Structural imaging analysis showed no difference in gray matter density between groups. Our findings suggest that the faster decay in neighboring functional correlations without significant gray matter diminution in BPA patients could be related to a reduced activity in intrinsic horizontal connections in M1 responsible for upper limb motor synergies.

  11. Neurinomas of the brachial plexus: case report.

    Science.gov (United States)

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

    1999-01-01

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

  12. Neonatal brachial plexus palsy: a permanent challenge

    Directory of Open Access Journals (Sweden)

    Carlos Otto Heise

    2015-09-01

    Full Text Available Neonatal brachial plexus palsy (NBPP has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

  13. MR imaging of the brachial plexus

    NARCIS (Netherlands)

    Es, Hendrik Wouter van

    2001-01-01

    In this retrospective study we describe the MR imaging findings in 230 consecutive patients with suspected pathology in or near the brachial plexus. These patients were studied from 1991 through to 1996. Chapter 2 describes the anatomy and the MR imaging techniques. As the anatomy of the brachial pl

  14. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

    NARCIS (Netherlands)

    Eng, GD; Binder, H; Getson, P; ODonnell, R

    1996-01-01

    Resurgence of neurosurgical intervention oi obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus p

  15. Coordination and balance in children with birth-related brachial plexus injury: a preliminary study.

    Science.gov (United States)

    Bellows, Doria; Bucevska, Marija; Verchere, Cynthia

    2015-01-01

    Objet : La plupart des enfants qui ont une grave lésion du plexus brachial reliée à la naissance (LPBRN) ont une déficience fonctionnelle, mais l'information au sujet de l'effet de la LPBRN sur la coordination et l'équilibre est toutefois limitée. L'étude visait à déterminer si les enfants qui ont une LPBRN montrent des déficiences de la coordination et de l'équilibre. Méthode : On a procédé à une étude de cohorte prospective portant sur 39 enfants ayant subi une LPBRN âgés de 5 à 15 ans. On a évalué l'amplitude du mouvement, la force, le mouvement actif, l'équilibre et la coordination de la motricité au moyen du test de Bruininks–Oseretsky de la maîtrise de la motricité (BOT-2) et du test d'évaluation du mouvement chez les enfants (MABC-2). On a aussi administré une mesure autodéclarée de l'incapacité physique, la version de l'échelle des activités pour la performance des enfants (ASKp). Résultats : Les participants ont obtenu une moyenne de 44,72 comme score composite de la coordination du corps BOT-2, qui peut varier de 20 à 80. Onze participants (28,2%) ont obtenu un résultat inférieur à la moyenne. Les participants ont obtenu un résultat moyen de 7,3 au sous-test de l'équilibre du test MABC-2, résultat qui peut varier de 1 à 19; 26 participants (66,7%) ont obtenu un résultat inférieur à la moyenne. Sur 39 participants, 25 (65,8%) ont obtenu un résultat ASKp indiquant une certaine incapacité (<95/100); il y avait une différence statistiquement significative au niveau de l'équilibre (p=0,007) entre ces 25 participants et ceux qui n'avaient pas d'incapacité (résultat ASKp de 95 à 100). Conclusions : La majorité des membres de la population à l'étude ont obtenu un résultat dans les catégories « à risque » ou « à difficultés importantes » au niveau de l'équilibre indiqué par le test MABC-2. Le rétablissement de l'équilibre peut constituer un traitement d'appoint valable pour les enfants

  16. The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury.

    Science.gov (United States)

    Bahm, J

    2016-01-01

    In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.

  17. Effect of Co-Morbid Conditions on Persistent Neuropathic Pain after Brachial Plexus Injury in Adult Patients

    Science.gov (United States)

    Chaudakshetrin, Pongparadee; Chotisukarat, Haruthai; Mandee, Sahatsa

    2016-01-01

    Background and Purpose Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up. Methods The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively. Results Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (ppain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (ppain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief.

  18. Restoration and protection of brachial plexus injur y:hot topics in the last decade

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  19. MRI of rotator cuff muscle atrophy in relation to glenohumeral joint incongruence in brachial plexus birth injury

    Energy Technology Data Exchange (ETDEWEB)

    Poeyhiae, Tiina H. [Helsinki University Central Hospital, Department of Radiology, PO Box 281, Helsinki (Finland); Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki (Finland); Nietosvaara, Yrjaenae A.; Peltonen, Jari I. [Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki (Finland); Remes, Ville M. [Helsinki University Central Hospital, Department of Orthopaedics, Surgical Hospital, Helsinki (Finland); Kirjavainen, Mikko O. [Helsinki University Central Hospital, Department of Orthopaedics and Traumatology, Helsinki (Finland); Lamminen, Antti E. [Helsinki University Central Hospital, Department of Radiology, PO Box 281, Helsinki (Finland)

    2005-04-01

    Purpose: To evaluate rotator cuff muscles and the glenohumeral (GH) joint in brachial plexus birth injury (BPBI) using MRI and to determine whether any correlation exists between muscular abnormality and the development of glenoid dysplasia and GH joint incongruity. Thirty-nine consecutive BPBI patients with internal rotation contracture or absent active external rotation of the shoulder joint were examined clinically and imaged with MRI. In the physical examination, passive external rotation was measured to evaluate internal rotation contracture. Both shoulders were imaged and the glenoscapular angle, percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) and the greatest thickness of the subscapular, infraspinous and supraspinous muscles were measured. The muscle ratio between the affected side and the normal side was calculated to exclude age variation in the assessment of muscle atrophy. All muscles of the rotator cuff were atrophic, with the subscapular and infraspinous muscles being most severely affected. A correlation was found between the percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) and the extent of subscapular muscle atrophy (r{sub s}=0.45, P=0.01), as well as between its ratio (r{sub s}=0.5, P P=0.01). Severity of rotator cuff muscle atrophy correlated with increased glenoid retroversion and the degree of internal rotation contracture. Glenoid retroversion and subluxation of the humeral head are common in patients with BPBI. All rotator cuff muscles are atrophic, especially the subscapular muscle. Muscle atrophy due to neurogenic damage apparently results in an imbalance of the shoulder muscles and progressive retroversion and subluxation of the GH joint, which in turn lead to internal rotation contracture and deformation of the joint. (orig.)

  20. The evaluation of function of the flail upper limb classification system: its application to unilateral brachial plexus injuries.

    Science.gov (United States)

    Eggers, I M; Mennen, U

    2001-01-01

    The evaluation of function of the flail upper limb (EFFUL) classification system measures in numerical terms the improvement achieved through hand surgery and hand therapy in patients with peripheral nerve injuries. To research the effectiveness of the EFFUL system a study was conducted that included 103 adult traumatic brachial plexus palsies. The measurement of upper limb function has 2 distinct phases: function without adaptation and function with adaptation. Patients will naturally adapt in order to cope whether we encourage them or not. This jump in gain of function by adaptation is a bonus that cannot be measured for comparison with other patients because each patient is different. Differences include factors such as each individual's personal pattern of adaptation with or without assistive devices, intelligence, dominant hand, and, in particular, motivation. Measurement of preoperative and postoperative function (with its associated hand therapy) therefore may not include adaptation. The EFFUL system is a method developed to measure unadapted function; it measures residual function of the flail upper arm using practical, everyday tasks performed by the shoulder, elbow, forearm, wrist, and hand, ie, all upper limb regions. It is a ranking system with a hierarchy of increasingly higher demands placed on function until normal function has been achieved. The execution of the tasks focuses on 2-handed coordination and hand dominance. The score is divided into no function, minimal nondominant arm function, supportive arm (nondominant side) function, minimal dominant arm function, useful arm function as done by the dominant arm, and normal arm function. These descriptive scores are subdivided into scores ranging from 0 to 10. Thus, the EFFUL classification system is an objective method of measuring residual function before and after treatment. The clinical examination and functional evaluation ought to have equal significance in the final report on outcome. This

  1. Direct anastomosis of contralateral C7 nerve root transfer with affected-side inferior trunk for repair of brachial plexus avulsion injury

    Institute of Scientific and Technical Information of China (English)

    Houjun Yan; Changqing Hu; Yingli Jia; Chunjie Cui; Xuefeng Li; Jingyang Zhang

    2006-01-01

    AIM:To observe the effect of direct anastomosis of contralateral C7 nerve root transferred through prespinal route with affected-side inferior trunk for repair of brachial plexus avulsion injury,and investigate its feasibility. METHODS:Two male patients.with the age of 24 and 41 years respectively,were retrieved.When admitted to the hospital,they were diagnosed as brachial plexus avulsion injury.They subjected the operation in the 252 Hospital of Chinese PLA in March 2006 and May 2006 respectively.The proximal end of contralateral C7 nerve root was dissociated to nerve root pore and the distal end was dissociated to anterior and posterior divisions of middle trunk.The injured C7 nerve root was widely dissociated to inferior trunk,medial cord,ulnar nerve and medial head of median nerve.When elbow and shoulder joints were in flexion,the injured C7 nerve root was directly anastomosed with contralateral C7 nerve root in the gap between affected-side cervical vagina vasorum and esophagus with no tensions. RESULTS:Durling 3 to 5 hours of operation,little hemorrhage was found,nerves were not used for connection.Dyspnea,hoarse voice and other complications did not appear,either.In the postoperative 7th to 8th months.electremyogram examination showed that the growth velocity of anastomosed nerve was normal.CONCLUSION:Direct anastomosis of contralateral C7 nerve root transferred through prespinal route with affected-side inferior trunk can be used for repair of brachial plexus avulsion injury with satisfying therapeutic effects.

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

    Energy Technology Data Exchange (ETDEWEB)

    Mallouhi, Ammar, E-mail: Ammar.Mallouhi@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Marik, Wolfgang, E-mail: Wolfgang.Marik@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Prayer, Daniela, E-mail: Daniela.Prayer@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kainberger, Franz, E-mail: Franz.Kainberger@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Bodner, Gerd, E-mail: Gerd.Bodner@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kasprian, Gregor, E-mail: Gregor.Kasprian@meduniwien.ac.at [Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

    2012-09-15

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

  3. Calcitonin gene-related peptide in anterior and posterior horns of spinal cord after brachial plexus injury

    Institute of Scientific and Technical Information of China (English)

    Longju Chen; Peijun Wang; Feng Li; Wutian Wu

    2007-01-01

    BACKGROUND: The changes of calcitonin gene-related peptide (CGRP) expression are closely associated with peripheral nerve injury, whereas it should be further investigated whether the damage of central nerve can lead to the changes of CGRP expression, and whether it is associated with the neural regeneration and repair.OBJECTIVE: To observe the changing law of CGRP expression in the anterior and posterior horns of spinal cord following brachial plexus injury.DESIGN: A randomized controlled trial.SETTINGS: Department of Anatomy, Yunyang Medical College; Department of Anatomy, Basic Medical College, Sun Yat-sen University.MATERIALS: Sixty-five adult male SD rats of clean degree, weighing 180 - 220 g, provided by the experimental animal center of the Basic Medical College, Sun Yat-sen University, were randomly divided into control group (n =5) and experimental group (n =60), and the latter was subdivided into three damage groups: avulsion of anterior root group (n =20), disjunction of posterior root group (n =20) and transection of spinal cord group (n =20). Diaminobenzidine (DAB) chromogen, rabbit anti-CGRP polyclonal antibody were the products of Sigma Company; Leica image analytical apparatus was produced by QUIN Company (Germany); Histotome by Sigma Company.METHODS: The experiments were carried out in the Department of Anatomy, Basic Medical College, Sun Yat-sen University from September 2004 to March 2005. Three kinds of models of brachial plexus injury were established: In the avulsion of anterior root group, right C7 anterior root was avulsed, and the distal nerve residual root was transected. In the disjunction of posterior root group, right C7 anterior root was avulsed and right C5 - T1 posterior horns were cut to block the sensory afferent pathway. In the transection of spinal cord group, right C7 anterior root was avulsed and C5-6 segments of right spinal cord were semi-transected to block the cortical descending pathway. In the control group, C5 - T1

  4. Electroacupuncture stimulation of the brachial plexus trunk on the healthy side promotes brain-derived neurotrophic factor mRNA expression in the ischemic cerebral cortex of a rat model of cerebral ischemia/reperfusion injury

    Institute of Scientific and Technical Information of China (English)

    Zongjun Guo; Lumin Wang

    2012-01-01

    A rat model of cerebral ischemia/reperfusion was established by suture occlusion of the left middle cerebral artery. In situ hybridization results showed that the number of brain-derived neurotrophic factor mRNA-positive cells in the ischemic rat cerebral cortex increased after cerebral ischemia/ reperfusion injury. Low frequency continuous wave electroacupuncture (frequency 2-6 Hz, current intensity 2 mA) stimulation of the brachial plexus trunk on the healthy (right) side increased the number of brain-derived neurotrophic factor mRNA-positive cells in the ischemic cerebral cortex 14 days after cerebral ischemia/reperfusion injury. At the same time, electroacupuncture stimulation of the healthy brachial plexus truck significantly decreased neurological function scores and alleviated neurological function deficits. These findings suggest that electroacupuncture stimulation of the brachial plexus trunk on the healthy (right) side can greatly increase brain-derived neurotrophic factor mRNA expression and improve neurological function.

  5. Electroacupuncture stimulation of the brachial plexus trunk on the healthy side promotes brain-derived neurotrophic factor mRNA expression in the ischemic cerebral cortex of a rat model of cerebral ischemia/reperfusion injury.

    Science.gov (United States)

    Guo, Zongjun; Wang, Lumin

    2012-07-25

    A rat model of cerebral ischemia/reperfusion was established by suture occlusion of the left middle cerebral artery. In situ hybridization results showed that the number of brain-derived neurotrophic factor mRNA-positive cells in the ischemic rat cerebral cortex increased after cerebral ischemia/ reperfusion injury. Low frequency continuous wave electroacupuncture (frequency 2-6 Hz, current intensity 2 mA) stimulation of the brachial plexus trunk on the healthy (right) side increased the number of brain-derived neurotrophic factor mRNA-positive cells in the ischemic cerebral cortex 14 days after cerebral ischemia/reperfusion injury. At the same time, electroacupuncture stimulation of the healthy brachial plexus truck significantly decreased neurological function scores and alleviated neurological function deficits. These findings suggest that electroacupuncture stimulation of the brachial plexus trunk on the healthy (right) side can greatly increase brain-derived neurotrophic factor mRNA expression and improve neurological function.

  6. Axillary brachial plexus blockade in moyamoya disease?

    Directory of Open Access Journals (Sweden)

    Saban Yalcin

    2011-01-01

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

  7. MRI of the brachial plexus: A pictorial review

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-05-15

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

  8. Vertical infraclavicular brachial plexus block in children: a preliminary study.

    NARCIS (Netherlands)

    Jose Maria, B. de; Tielens, L.K.P.

    2004-01-01

    BACKGROUND: Brachial plexus blockade is a well-established technique in upper limb surgery. Among the infraclavicular approaches, the vertical infraclavicular brachial plexus (VIP) block is easy to perform and has a large spectrum of nerve blockade. The aim of this preliminary study was to determine

  9. Preliminary research on the clinical classification of the brachial plexus root injury in adult%成人臂丛根性损伤临床分型的初步研究

    Institute of Scientific and Technical Information of China (English)

    顾立强; 刘小林; 朱家恺; 张德春; 向剑平; 秦本刚; 戚剑; 李平; 朱庆棠; 傅国; 劳镇国

    2011-01-01

    目的 探讨成人臂丛根性损伤的临床分型. 方法 回顾性研究中山大学附属第一医院近5年来收治并手术探查证实、资料完整的成人臂丛根性损伤病例,分析、归纳出成人臂丛根性损伤临床分型. 结果 总结155例臂丛根性损伤病例,结合术前临床诊断与影像学诊断、术中探查与电生理学检测、术后随访研证,初步归纳出成人臂丛根性损伤临床分型,在上臂丛损伤(A型)、下臂丛损伤(B型)、全臂丛损伤(C型)三大类基础上,可进一步细分为七小类:①上臂丛损伤AⅠ型:C5、6根完全性损伤(撕脱或断裂),伴或不伴膈神经损伤;②AⅡ型:C5-7根完全性损伤;③AⅢ型:C5~7根完全性损伤伴C8、T1不全性损伤;④下臂丛损伤BⅠ型:C8、T1(或伴C7)完全性损伤;⑤BⅡ型:T1、C7、8完全性损伤伴C5、6不全损伤;⑥全臂丛损伤CⅠ型C5~T1根性撕脱伤;⑦CⅡ型:T1、C7、8根性撕脱伤伴C5、6根断裂. 结论 成人臂丛根性损伤可分为三大类七小类,但臂丛根性损伤临床分型的分布不平均,以上臂丛损伤(A型)(55.5%)和全臂丛损伤(C型)(40.6%)最为常见,下臂丛损伤(C型)最少(3.9%).上臂丛损伤A型中,AⅢ型最多(61.6%),AⅡ型次之(31.4%),AⅠ型最少(7%).%Objective To explore the clinical classification of the brachial plexus root injury in adult. Methods All 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University,were collected and analyzed on their characteristic,operative methods,and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury.Results Brachial plexus root injuries in adult could be classified into three types and seven subtypes.Type A is upper brachial plexus root injury,including type AⅠ (C5,C6 completely avulsion or rupture injury

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

    Directory of Open Access Journals (Sweden)

    Hua Jin

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as em-bryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site (1 × 106 cells/mL, 3μL/injection, 25 injections) immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also signiifcantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effec-tively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals.

  12. Repair of brachial plexus lower trunk injury by transferring brachialis muscle branch of musculocutaneous nerve:anatomic feasibility and clinical trials

    Institute of Scientific and Technical Information of China (English)

    ZHENG Xian-you; HOU Chun-lin; GU Yu-dong; SHI Qi-lin; GUAN Shi-bing

    2008-01-01

    Background There are few effective methods for treating injuries to the lower trunk of brachial plexus,and the curative effect is usually poor.The purpose of this study was to provide anatomic references for transferring the brachialis muscle branch of musculocutaneous nerve(BMBMCN)for selective neurotization of finger flexion in brachiaI plexus lower trunk injury,and to evaluate its clinical curative effects.Methods Microanatomy and measurement were done on 50 limbs from 25 adult human cadavers to obserye the origin,branch,type of the BMBMCN and median nerve,as well as their adjacent structures.Internal topographic features of the fascicular groups of the median nerve at the level of the BMBMCN were observed.In addition,the technique of BMBMCN transfer for selective neurotization of finger flexion of the median nerve was designed and tested in 6 fresh adult human cadavers.Acetylcholinesterase(AchE)staining of the BMBMCN and median nerve was done to observe the features of the nerve fibers.This technique was clinically tried to restore digital flexion in 6 cases of adult brachial plexus lower trunk injury.These cases were followed up for 3,6,9 and 12 months postoperatively.Recovery of function,grip strength,nerve electrophysiology and muscle power of the affected limbs were observed and measured.Results The brachialis muscle was totally innervated by the musculocutaneous nerve(MCN).Based on the Hunter's line,the Ievel of the origin of the BMBMCN was(13.18±2.77)cm.AchE histochemical staining indicated that the BMBMCN were totally made up of medullated nerve fibers.At the level of the BMBMCN,the median nerve consistently collected into three fascicular groups as shown by microanatomy in combination with AchE stain.The posterior fascicular group was mainly composed of anterior Interosseous nerves and branches to the palmaris longus.The technique was tested in six fresh cadavers successfully,except that stoma split occurred in one case.Five of the six cases recovered

  13. Nerve transfer for treatment of brachial plexus injury: comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves

    Institute of Scientific and Technical Information of China (English)

    侯之启; 徐中和

    2002-01-01

    Objective: To compare the effect of using partial median and ulnar nerves for treatment of C5-6 or C5-7 avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.Methods: The patients were divided into 2 groups randomly according to different surgical procedures. Twelve cases were involved in the first group. The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft, and the spinal accessary nerve was to the suprascapular nerve. Eleven cases were classified into the second group. A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve. The cases were followed up from 1 to 3 years and the clinical outcome was compared between the two groups. Results: There were 2 cases (16.6%) who got the recovery of M4 strength of biceps muscle in the first group but 7 cases (63.6%) in the second group, and the difference was statistically significant (P<0.025). However, it was not statistically different in the recovery of shoulder function between the two groups. Conclusions: Partial median and ulnar nerve transfer, phrenic and spinal accessary nerve transfer were all effective for the reconstruction of elbow or shoulder function in brachial plexus injury, but the neurotization using a part of median nerve could obtain more powerful biceps muscle strength than that of phrenic nerve transfer procedure.

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

    Science.gov (United States)

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

    2014-12-01

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

  15. Lack of evidence of the effectiveness of primary brachial plexus surgery for infants (under the age of two years) diagnosed with obstetric brachial plexus palsy.

    Science.gov (United States)

    Bialocerkowski, Andrea; Gelding, Bronwyn

    2006-12-01

    Background  Obstetric brachial plexus palsy, which occurs in 1-3 per 1000 live births, results from traction and/or compression of the brachial plexus in utero, during descent through the birth canal or during delivery. This results in a spectrum of injuries that range in extent of damage and severity and can lead to a lifelong impairment and functional difficulties associated with the use of the affected upper limb. Most infants diagnosed with obstetric brachial plexus palsy receive treatment, such as surgery to the brachial plexus, physiotherapy or occupational therapy, within the first months of life. However, there is controversy regarding the most effective form of management. This review follows on from our previous systematic review which investigated the effectiveness of primary conservative management in infants with obstetric brachial plexus palsy. This systematic review focuses on the effects of primary surgery. Objectives  The objective of this review was to systematically assess and collate all available evidence on effectiveness of primary brachial plexus surgery for infants with obstetric brachial plexus palsy. Search strategy  A systematic literature search was performed using 13 databases: TRIP, MEDLINE, CINAHL, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, the Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, the Australian Digital Thesis program. Those studies that were reported in English and published between July 1992 to June 2004 were included in this review. Selection criteria  Quantitative studies that investigated the effectiveness of primary brachial plexus surgery for infants with obstetric brachial plexus palsy were eligible for inclusion into this review. This excluded studies where infants were solely managed conservatively or with pharmacological agents, or underwent surgery for the management of

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

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    Farah ASHRAFZADEH

    2011-02-01

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

  17. Estudo epidemiológico das lesões traumáticas de plexo braquial em adultos Epidemiological study of the traumatic brachial plexus injuries in adults

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    Leandro Pretto Flores

    2006-03-01

    Full Text Available OBJETIVO: Determinar informações epidemiológicas sobre as variáveis relacionadas ao trauma de plexo braquial em adultos. MÉTODO: Foram analisados 35 pacientes, de maneira prospectiva, atendidos consecutivamente no período de um ano. RESULTADOS: A maioria das lesões apresentou localização supraclavicular (62%, sendo 21 lesões por mecanismo de tração (60%, nove por projétil de arma de fogo (25%, três por compressão (8,5% e dois ferimentos cortantes (5,7%. Acidentes motociclísticos responderam por 54% das causas do trauma. A TC-mielografia identificou avulsão radicular em 16 casos (76%. Melhora neurológica parcial espontânea foi observada em 43% dos pacientes. Dor neuropática foi observada em 25 casos (71% sendo que em 16 (64% pôde ser controlada com medicações orais. CONCLUSÃO: Os traumas de plexo braquial são mais freqüentemente associados aos mecanismos de tração, sendo comum identificação de avulsão radicular. Em geral produzem dor no membro afetado e estão associados a lesões em outros órgãos. Na presente série, a incidência calculada para a população de abrangência foi 1,75/100000/ano.OBJECTIVE: This study aims to provide information about epidemiological factors related to traumatic brachial plexus injuries in adults. METHOD: Prospective analysis of 35 consecutive cases, observed in a period of one year. RESULTS: Most of the lesions were supraclavicular (62%. Twenty-one cases occurred due to traction (60%, 9 to gun shot wound (25%, 3 to compression (8.5% and two perforation/laceration (5.7%. Motorcycle accidents were the cause of trauma in 54% of patients. CT myelography demonstrated root avulsion in 16 cases (76%. Parcial spontaneous neurological recovery was observed in 43% of the patients. Neuropathic pain occurred in 25 (71% cases, and the use of some oral intake drugs (as amitriptiline or carbamazepine controlled it in 64% of times. CONCLUSION: Traction is the most frequent mechanism related to

  18. Massive hemothorax: A rare complication after supraclavicular brachial plexus block.

    Science.gov (United States)

    Singh, Shiv Kumar; Katyal, Surabhi; Kumar, Amit; Kumar, Pawan

    2014-01-01

    Plexus block is the preferred anesthesia plan for upper limb surgeries. Among the known complications, hematoma formation following the vascular trauma is often occur but this complication is frequently underreported. We present a case where a massive hemothorax developed post operatively in a patient who underwent resection of giant cell tumor of the right hand radius bone followed by arthroplasty under brachial plexus block using supraclavicular approach. This case report attempts to highlight the essence of remaining vigilant postoperatively for first initial days after brachial plexus block, especially after failed or multiple attempts. Ultrasound guided technique in combination with nerve stimulator has proven to be more reliable and safer than traditional techniques.

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

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    Faruquee Sajedur

    2008-05-01

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

  20. The effects of denervation, reinnervation, and muscle imbalance on functional muscle length and elbow flexion contracture following neonatal brachial plexus injury.

    Science.gov (United States)

    Weekley, Holly; Nikolaou, Sia; Hu, Liangjun; Eismann, Emily; Wylie, Christopher; Cornwall, Roger

    2012-08-01

    The pathophysiology of paradoxical elbow flexion contractures following neonatal brachial plexus injury (NBPI) is incompletely understood. The current study tests the hypothesis that this contracture occurs by denervation-induced impairment of elbow flexor muscle growth. Unilateral forelimb paralysis was created in mice in four neonatal (5-day-old) BPI groups (C5-6 excision, C5-6 neurotomy, C5-6 neurotomy/repair, and C5-T1 global excision), one non-neonatal BPI group (28-day-old C5-6 excision), and two neonatal muscle imbalance groups (triceps tenotomy ± C5-6 excision). Four weeks post-operatively, motor function, elbow range of motion, and biceps/brachialis functional lengths were assessed. Musculocutaneous nerve (MCN) denervation and reinnervation were assessed immunohistochemically. Elbow flexion motor recovery and elbow flexion contractures varied inversely among the neonatal BPI groups. Contracture severity correlated with biceps/brachialis shortening and MCN denervation (relative axon loss), with no contractures occurring in mice with MCN reinnervation (presence of growth cones). No contractures or biceps/brachialis shortening occurred following non-neonatal BPI, regardless of denervation or reinnervation. Neonatal triceps tenotomy did not cause contractures or biceps/brachialis shortening, nor did it worsen those following neonatal C5-6 excision. Denervation-induced functional shortening of elbow flexor muscles leads to variable elbow flexion contractures depending on the degree, permanence, and timing of denervation, independent of muscle imbalance.

  1. Use of quantitative intra-operative electrodiagnosis during partial ulnar nerve transfer to restore elbow flexion: the treatment of eight patients following a brachial plexus injury.

    Science.gov (United States)

    Suzuki, O; Sunagawa, T; Yokota, K; Nakashima, Y; Shinomiya, R; Nakanishi, K; Ochi, M

    2011-03-01

    The transfer of part of the ulnar nerve to the musculocutaneous nerve, first described by Oberlin, can restore flexion of the elbow following brachial plexus injury. In this study we evaluated the additional benefits and effectiveness of quantitative electrodiagnosis to select a donor fascicle. Eight patients who had undergone transfer of a simple fascicle of the ulnar nerve to the motor branch of the musculocutaneous nerve were evaluated. In two early patients electrodiagnosis had not been used. In the remaining six patients, however, all fascicles of the ulnar nerve were separated and electrodiagnosis was performed after stimulation with a commercially available electromyographic system. In these procedures, recording electrodes were placed in flexor carpi ulnaris and the first dorsal interosseous. A single fascicle in the flexor carpi ulnaris in which a high amplitude had been recorded was selected as a donor and transferred to the musculocutaneous nerve. In the two patients who had not undergone electrodiagnosis, the recovery of biceps proved insufficient for normal use. Conversely, in the six patients in whom quantitative electrodiagnosis was used, elbow flexion recovered to an M4 level. Quantitative intra-operative electrodiagnosis is an effective method of selecting a favourable donor fascicle during the Oberlin procedure. Moreover, fascicles showing a high-amplitude in reading flexor carpi ulnaris are donor nerves that can restore normal elbow flexion without intrinsic loss.

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

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    Farah Ashrafzadeh MD

    2010-10-01

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

  3. Obstetric Brachial Plexus Palsy in the Context of Early Physical Rehabilitation

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    Vivian Lucía Yanes Sierra

    2014-08-01

    Full Text Available Cuban health system currently promotes prenatal testing and monitoring of pregnancy; nevertheless obstetric brachial plexus palsy remains an unfortunate consequence of a difficult delivery and is one of the most common birth trauma. Traditionally, its treatment has been conservative, based on multidisciplinary monitoring and consultations with various specialists to deal with the consequences. After conducting an extensive literature review, we discussed in this paper the etiology, anatomy, pathophysiology, types of injuries, prognosis and outcome, consequences, assessment tools, existing treatments and series of exercises for obstetric brachial plexus palsy.

  4. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

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    Leandro Pretto Flores

    2011-08-01

    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.

  5. Valproic acid protects neurons and promotes neuronal regeneration after brachial plexus avulsion****

    Institute of Scientific and Technical Information of China (English)

    Qiang Li; Dianxiu Wu; Rui Li; Xiaojuan Zhu; Shusen Cui

    2013-01-01

    Valproic acid has been shown to exert neuroprotective effects and promote neurite outgrowth in several peripheral nerve injury models. However, whether valproic acid can exert its beneficial effect on neurons after brachial plexus avulsion injury is currently unknown. In this study, brachial plexus root avulsion models, established in Wistar rats, were administered daily with valproic acid dis-solved in drinking water (300 mg/kg) or normal water. On days 1, 2, 3, 7, 14 and 28 after avulsion injury, tissues of the C 5-T 1 spinal cord segments of the avulsion injured side were harvested to in-vestigate the expression of Bcl-2, c-Jun and growth associated protein 43 by real-time PCR and western blot assay. Results showed that valproic acid significantly increased the expression of Bcl-2 and growth associated protein 43, and reduced the c-Jun expression after brachial plexus avulsion. Our findings indicate that valproic acid can protect neurons in the spinal cord and enhance neuronal regeneration fol owing brachial plexus root avulsion.

  6. 26例臂丛神经损伤的神经肌电图分析%The Analysis of Electroneuromyography in 26 Cases with Brachial Plexus Injuries

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    黄沚荷; 林深镇; 罗映辉; 丘春柳; 郭美云

    2000-01-01

    目的:探讨神经肌电图在臂丛受损诊断及定位中的作用.方法:对26例臂丛受损者采用表面电极法沿神经走行的不同部位顺向检测正中神经、尺神经、桡神经、肌皮神经、腋神经共91条神经的感觉及运动传导速度(或末端潜伏期)、F波;并用同心圆针电极观察拇短展肌、小指展肌、指总伸肌、肱二头肌、三角肌、冈上肌、冈下肌共114块肌肉的病理自发电位及募集形式.结果:91条运动神经在不同节段收集共有64条异常(70.3%);60条感觉神经有40条异常(66.7%);26例中F波异常者8例(30.8%).检测114块肌肉,其中59块肌肉静息状态出现≥两处纤颤和(或)正锐波; 49块肌肉重收缩时无运动单位电位,9块肌肉募集电位明显减小.结论:神经肌电图在臂丛神经损伤的诊断及定位中具有重要作用.%Objective:To investigate the significance of electroneuromyography in localization and clinical diagnosis of brachial plexus injuries. Methods: Othodromic surface stimulation and recording were used for nerve conduction studies . The motor and sensory conduction velocity were recoreded in different segments of 91 nerves including median,ulnar, radial, musculocutaneous and axillary nerves.F-wave latencies of the median nerves were obtained too. The standard concentric needle electromyography examination was performed on total 114 muscles containing abductor pollicis brevis, abductor digiti minimi, extensor digitorum,biceps brachii,deltoid, supraspinatus and infraspinatus. The pathological spontaneous electric activities and the pattern of motor unit recruitment were observed .Results: Abnormalities were noted in 64 out of 91 motor nerves(70.3% )and in 40 out of 60 sensory nerves (66.7%). Eight out of 26 F-wave latencies prolonged(30.8%). At least two localization fibrillation potentials and/or positive sharp waves occured in 59 out of 114 resting muscles .The motor unit active potentials disappeared during maximal

  7. Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus

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    Frederico Barra de Moraes

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1 range of motion (ROM of elbow flexion, in degrees, using manual goniometry and (2 grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1 elbow flexion ROM ≥ 80° and (2 elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05. RESULTS: The patients' mean age was 32 years (range: 17-56 and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100% in group 1 and in five patients (83.3% in group 2 (p = 0.462. None of the patients presented M5, and one patient (16.7% in group 2 had a poor result (M2. Elbow flexion ROM with a gain ≥ 80° (daily functions was found in six patients (86% in group 1 and in three patients (50% in group 2 ( p = 0.1. CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used.

  8. Clinical research of electromyogram biofeedback therapy on brachial plexus injury%肌电生物反馈治疗臂丛神经损伤的临床研究

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    施少云; 卢惠苹; 宋林; 陈昕; 陈述荣

    2015-01-01

    AIM:To observe the changes of surface electromyogram (sEMG) of electromyogram biofeedback therapy on brachial plexus injury, compared with conventional treatment,so as to investigate the curative effect of electromyogram biofeedback therapy on brachial plexus injury. Methods:24 patients whose brachial plexus were injury were divided into 2 groups randomly:a control group and a therapy group. 12 patients of the control group were treated with routine acupuncture and physical therapy. 12 patients of the therapy group were treated with electromyogram biofeedback on the basis of routine therapy. All patients’ maximum amplitude and electromyographic integral value were recorded to estimate curative effect and analyze statistics. Results:All the indications of the two groups were improved,compared with pretherapy. There were distinctive differences between the two groups.Conclusion:Electromyogram biofeedback therapy in conjunction with routine acupuncture and physical therapy can increase curative effect on brachial plexus injury more effectively than conventional therapy.%目的:观察肌电生物反馈对臂丛神经损伤治疗前后的表面肌电活动变化,并与常规治疗效果相比较,探讨肌电生物反馈对臂丛神经损伤的疗效。方法将臂丛神经损伤患者24例,随机分为2组,其中对照组12例采用常规针灸、运动治疗,治疗组12例在常规治疗的基础上,加用肌电生物反馈治疗,采用表面肌电图收缩的最大波幅、肌电积分值来评定疗效并进行统计学分析。结果治疗后两组各项指标与治疗前比较均有改善,但两组间差异有统计学意义(P<0.05)。结论肌电生物反馈治疗结合常规针灸、运动治疗较单纯常规治疗能更有效地提高臂丛神经损伤的治疗效果。

  9. Hamartoma fibroso infantil: lesão volumosa com envolvimento de plexo braquil Children's fibrous hamartoma: extensive injury involving brachial plexus

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    Lisieux Eyer de Jesus

    2006-01-01

    Full Text Available OBJETIVO: Apresentar um caso de hamartoma fibroso da infância em lactente ressecado tardiamente e se apresentando como lesão extensa, com envolvimento de elementos vasculares e neurais do plexo braquial. MÉTODOS: Estudo de caso clínico e revisão de literatura pertinente. RESULTADOS: Criança do sexo masculino, com massa tumoral axilar direita, irregular surgida aos 2 meses de idade e relacionada à administração da vacina BCG, sendo tratada com agentes anti-tuberculosos, sem resposta. Mediante biópsia a lesão foi diagnosticada como hamartoma fibroso infantil, e, após sofrer período de crescimento rápido, foi submetida à exérese cirúrgica completa. CONCLUSÃO: O hamartoma fibroso juvenil é um tumor benigno raro, tipicamente se apresentando no primeiro ano de vida em meninos, com localização mais comum no oco axilar. O diagnóstico diferencial se faz com tumores de partes moles em geral e, em casos de apresentação na axila direita, com adenopatias axilares causadas por reação à BCG. O tratamento é exerese completa da lesão e o prognóstico é favorável.OBJECTIVE: To present a case of fibrous hamartoma in a late-dried infant presenting as an extensive injury, involving vascular and neural elements of brachial plexus. METHODS: Clinical case study and pertinent literature review. RESULTS: Male child, with right axillary irregular tumoral mass, of which onset occurred at 2 months of age and related to BCG vaccine application, being treated with anti-tuberculosis agents, not responding to therapy. Upon biopsy, the injury was diagnosed as children’s fibrous hamartoma, and, after a fast growing period, was submitted to total surgical exeresis. CONCLUSION: The juvenile fibrous hamartoma is a rare benign tumor, typically occurring within the first year of life in boys, most commonly located at axillary gap. The differential diagnosis is performed with soft parts tumors in general, and, in right axillary location cases, with

  10. Brachial plexus neuropathy - A long-term outcome study

    NARCIS (Netherlands)

    Geertzen, JHB; Groothoff, JW; Nicolai, JP; Rietman, JS

    2000-01-01

    This retrospective study assessed the long-term outcome of brachial plexus neuropathy in 16 patients. The mean follow up was 8 years. Nine patients complained of persistent pain and muscle weakness, four had continuing problems with various activities of daily living and 11 had trouble with some hou

  11. 神经肌电图检测应用于臂丛神经损伤诊断研究%Study on Electromyography Detection in Diagnosis of Brachial Plexus Injury

    Institute of Scientific and Technical Information of China (English)

    魏天

    2015-01-01

    Objective To analyze the value of electromyography(EMG) detection in diagnosis of bra-chial plexus injury.Methods A total of 50 patients with brachial plexus injury in Nanshi Hospital from Aug.2012 to Aug.2013 were included in the study.All were checked by magnetic resonance imaging (MRI),preoperative EMG and intraoperative somatosensory evoked potential(SEP) examination.The diag-nostic accordance rate was compared.Results The coincidence rate of preoperative EMG examination in the diagnosis of nerve types in brachial plexus injury was very good,all Kappa >0.75.The coincidence rate of preoperative neurological EMG in the qualitative diagnosis of brachial plexus injury was 82.2%(125/152), which was significantly higher than 68.4% (104/152) of MRI diagnosis and equivalent to SEP diagnosis 80.9%(123/152).The difference was not statistically significant(P >0.05).Conclusion Preoperative EMG examination can effectively improve the coincidence rate in diagnosis of brachial plexus injury , help judge the injury nature correctly,and reduce misdiagnosis.%目的:探讨神经肌电图( EMG)检测对臂丛神经损伤的诊断价值。方法选择2012年8月至2013年8月河南省南阳南石医院收治的臂丛神经损伤患者50例,均经磁共振成像( MRI)、术前EMG和术中体感诱发电位( SEP)检查,比较诊断符合率。结果术前神经 EMG检查诊断上臂丛损伤、下臂丛损伤及全臂丛损伤的结果与手术探查结果的一致性程度极好, Kappa 值均大于0.75。术前神经EMG检查对臂丛神经损伤定性诊断的符合率为82.2%(125/152),显著高于MRI诊断的68.4%(104/152),差异有统计学意义(P<0.05),与SEP诊断符合率80.9%(123/152)相当,差异无统计学意义(P>0.05)。结论术前神经EMG检查可有效提高臂丛神经损伤的诊断符合率和正确判断损伤性质,减少漏诊。

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

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    Duz Bulent

    2009-07-01

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

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

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    Gessica Ariane de Melo Cruz

    2013-09-01

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

  14. 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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    Marcelo Rosa de Rezende

    2012-12-01

    Full Text Available OBJETIVO: Avaliar de forma crítica os fatores que influenciam os resultados da neurotização do nervo ulnar no ramo motor do músculo bíceps braquial, visando a restauração da flexão do cotovelo em pacientes com lesão do plexo braquial. MÉTODOS: 19 pacientes, 18 homens e uma mulher, com idade média de 28,7 anos foram avaliados entre fevereiro de 2003 e maio de 2007. Oito pacientes apresentavam lesão das raízes C5-C6 e 11, das raízes C5-C6-C7. O intervalo de tempo médio entre a injúria e o tratamento cirúrgico foi 7,5 meses. Quatro pacientes apresentavam fraturas cervicais associadas à lesão do plexo braquial. O seguimento pós-operatório foi de 15,7 meses. RESULTADO: Oito pacientes recuperaram força de flexão do cotovelo MRC grau 4; dois, MRC grau 3 e nove, MRC 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

  15. Ultrasonographic evaluation of brachial plexus tumors in five dogs.

    Science.gov (United States)

    Rose, Scott; Long, Craig; Knipe, Marguerite; Hornof, Bill

    2005-01-01

    Five dogs with unilateral thoracic limb lameness, neurologic deficits, muscle atrophy, and pain, or a combination of these signs, were examined using ultrasonograghy. Large, hypoechoic tubular masses that displaced vessels and destroyed the normal architecture were found in each dog. The affected axilla of each patient was then imaged with computed tomography or magnetic resonance to fully assess the extent of the masses. We describe the use of ultrasound in screening patients for brachial plexus tumors.

  16. Brachial plexus injury in newborns

    Science.gov (United States)

    ... as the shoulders pass through the birth canal Stretching of the infant's shoulders during a head-first ... shows a lack of movement of either arm. Prevention Taking measures to avoid a difficult delivery, whenever ...

  17. Evaluation of an education day for families of children with obstetrical brachial plexus palsy.

    Science.gov (United States)

    Ho, Emily S; Ulster, Alissa A

    2011-09-01

    Children with obstetrical brachial plexus palsy may have chronic physical impairment in their affected upper extremity. Affected children and their families may benefit from psychosocial interventions including therapeutic relationships with health professionals, meeting other families living with obstetrical brachial plexus palsy, support groups, and social work. One method of addressing psychosocial needs is through a support and education day. The purpose of this quality improvement project is to evaluate parental perceptions of a support and education day called the "Brachial Plexus Family Day." Families of children with obstetrical brachial plexus palsy who attended the Brachial Plexus Family Day completed a questionnaire to evaluate the different programs offered during the day. The families also ranked the importance of different psychosocial supports offered in the clinic. Sixty-three out of 69 families completed the questionnaire. Each program of the Brachial Plexus Family Day was rated as good or excellent by the respondents. Ninety-seven percent of respondents rated meeting other families and children with obstetrical brachial plexus palsy as helpful supports. Attending a Brachial Plexus Family day event (86%), followed by connecting with a doctor (60%), and physical or occupational therapist (59%) were the highest ranked supports reported by the families. The parents and caregivers that attended the Brachial Plexus Family Day rated the program highly. This group also valued the opportunity to connect with other families and children affected with the same condition.

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

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    Cihangir Tetik

    2014-01-01

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

  19. Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.

    Science.gov (United States)

    Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen

    2005-03-01

    Background  Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1-3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives  The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy  A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria  Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis

  20. Correlation Between Ultrasound Imaging, Cross-Sectional Anatomy, and Histology of the Brachial Plexus A Review

    NARCIS (Netherlands)

    van Geffen, Geert J.; Moayeri, Nizar; Bruhn, Joergen; Scheffer, Gert J.; Chan, Vincent W.; Groen, Gerbrand J.

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanato

  1. Structure of the brachial plexus root and adjacent regions displayed by ultrasound imaging

    Institute of Scientific and Technical Information of China (English)

    Zhengyi Li; Xun Xia; Xiaoming Rong; Yamei Tang; Dachuan Xu

    2012-01-01

    Brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C7 vertebra is a marker for identifying the position of brachial plexus nerve roots.

  2. Vibration sensation as an indicator of surgical anesthesia following brachial plexus block

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    Seema Jindal

    2016-01-01

    Conclusions: Vibration sense serves as a reliable indicator for the onset of surgical anesthesia following brachial plexus block. Vibration sense testing with 128 Hz Rydel–Seiffer tuning fork along with motor power assessment should be used as an objective tool to assess the onset of surgical anesthesia following brachial plexus block.

  3. Correlation between ultrasound imaging, cross-sectional anatomy, and histology of the brachial plexus: a review.

    Science.gov (United States)

    van Geffen, Geert J; Moayeri, Nizar; Bruhn, Jörgen; Scheffer, Gert J; Chan, Vincent W; Groen, Gerbrand J

    2009-01-01

    The anatomy of the brachial plexus is complex. To facilitate the understanding of the ultrasound appearance of the brachial plexus, we present a review of important anatomic considerations. A detailed correlation of reconstructed, cross-sectional gross anatomy and histology with ultrasound sonoanatomy is provided.

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

    LENUS (Irish Health Repository)

    Frizelle, H P

    2012-02-03

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

  5. Obesity in children with brachial plexus birth palsy.

    Science.gov (United States)

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

    2015-11-01

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

  6. Brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis

    Institute of Scientific and Technical Information of China (English)

    QIAN Bang-ping; QIU Yong; WANG Bin; YU Yang; ZHU Ze-zhang

    2007-01-01

    Objective: To explore the clinical features and treatment results of brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.Methods: A total of 300 cases of severe scoliosis received halo traction before posterior correction in our department from July 1997 to November 2004. Among them, 7 cases were complicated with brachial plexus palsy.The average Cobb angle was 110° (range, 90°-135°).Diagnoses were made as idiopathic scoliosis in 1 case,congenital scoliosis in 3 cases, and neuromuscular scoliosis in 3 cases. Additionally, diastematomyelia and tethered cord syndrome were found in 3 cases and thoracolumbar kyphosis in 2 cases. Weight of traction was immediately reduced when the patient developed any abnormal neurological symptoms in the upper extremity, and rehabilitation training was undertaken. Simultaneously,neurotrophic pharmacotherapy was applied, and the neurological function restoration of the upper limbs and the recovery time were documented.Results: Traction was used for an average of 3.5 weeks (range, 2-6 weeks) before spinal fusion for these 7 patients. The average traction weight was 8 kg, which was 19% on average (range, 13%-26%) of the average body weight (40.2 kg). These 7 patients had long and thin body configuration with a mean height of 175 cm. The duration between symptoms of brachial plexus paralysis and the diagnosis was 1-3 hours. All of these 7 patients presented various degrees of numbness in the ulnar side of the hand and forearm. Median nerve paresis was found in 3 cases and ulnar nerve paresis in 4 cases. Complete recovery of the neurological function had been achieved by the end of three months.Conclusions: The clinical features of brachial plexus palsy caused by halo traction include median nerve paresis,ulnar nerve paralysis, and numbness in the ulnar side of the hand and forearm, which may be due to the injury of the inferior part of the brachial plexus, i.e. , damage of Cs and

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

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    Rachana Gandhi

    2012-02-01

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

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

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    Ömer Uslukaya

    2012-03-01

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

  9. Brachial plexus variations in its formation and main branches

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    Valéria Paula Sassoli Fazan

    2003-01-01

    Full Text Available PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.OBJETIVOS: O plexo braquial apresenta uma estrutura anatômica complexa, desde sua origem, no pescoço, até sua ramificação terminal, na região axilar. Ele também apresenta relações importantes com outras estruturas anatômicas locais, o que o torna vulnerável ao aparecimento de uma série de variações anatômicas, marcando sua importância clínica e cirúrgica. Os objetivos desse estudo foram de descrever as variações anatômicas do plexo braquial, desde sua origem até seus

  10. Misdiagnosis of Brachial Plexus Schwannoma as Cervical Radiculopathy

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    Mahnaz Khajepour

    2013-01-01

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

  11. Avaliação do ganho funcional do cotovelo com a cirurgia de Steindler na lesão do plexo braquial Evaluation of functional gain of the elbow following Steindler surgery for brachial plexus injury

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    Marcelo Rosa de Rezende

    2011-01-01

    Full Text Available OBJETIVO: Avaliar ganho de força e amplitude de movimento do cotovelo após cirurgia de Steindler Modificada em pacientes com lesão do tronco superior do plexo braquial. MÉTODO: Foram acompanhados de 1998 a 2007 onze pacientes com lesão traumática fechada do tronco superior do plexo braquial. Todos apresentavam evolução de pelo menos 1 ano da lesão e grau de força de flexão do cotovelo que variou de M1 a M3. Os pacientes foram submetidos à cirurgia de Steindler modificada e seguidos por período mínimo de 6 meses. Realizadas avaliações pré e pós-operatórias do ganho de força muscular, amplitude de movimento do cotovelo e pontuação conforme escala DASH. RESULTADOS: Dos onze pacientes analisados, nove (82% atingiram nível de força igual ou maior a M3 (MRC. Dois (18% chegaram ao nível de força M2(MRC. Observamos que os pacientes apresentaram ganho médio de amplitude de movimento do cotovelo pós-operatória de 43,45 graus. A média de flexão do cotovelo pós-operatória foi de 88 graus. Houve melhora da função do cotovelo demonstrada na Escala DASH em 81% dos pacientes do estudo. CONCLUSÃO: A cirurgia de Steindler Modificada mostrou-se eficaz no tratamento dos pacientes com lesão de tronco superior de plexo braquial, com ganho estatisticamente significativo de amplitude de movimento. Em todos os casos algum grau de ganho de força e amplitude de flexão do cotovelo, sendo tanto maior quanto maior a força muscular inicial. Nível de Evidência: Nível II, ensaio clínico prospective.OBJECTIVE: To evaluate the gain in strength and range of motion after modified Steindler surgery of the elbow in patients with lesions of the upper trunk of the brachial plexus. METHOD: From 1998 to 2007, eleven patients with traumatic closed upper trunk lesion of the brachial plexus were studied. All the patients had development of at least 1 year of injury and degree of strength of elbow flexion ranging from M1 to M3. The patients

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

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    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

    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.).

  13. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Hall, William H. [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Li, Judy; Beckett, Laurel [Department of Biostatistics, University of California, Davis School of Medicine, Sacramento, California (United States); Farwell, D. Gregory [Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California (United States); Lau, Derick H. [Department of Medical Oncology, University of California, Davis School of Medicine, Sacramento, California (United States); Purdy, James A. [Department of Radiation Oncology, University of California, Davis School of Medicine, Sacramento, California (United States)

    2012-09-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

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

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    Marco Rosati

    2013-07-01

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

  15. Reliability of 3D upper limb motion analysis in children with obstetric brachial plexus palsy.

    Science.gov (United States)

    Mahon, Judy; Malone, Ailish; Kiernan, Damien; Meldrum, Dara

    2017-03-01

    Kinematics, measured by 3D upper limb motion analysis (3D-ULMA), can potentially increase understanding of movement patterns by quantifying individual joint contributions. Reliability in children with obstetric brachial plexus palsy (OBPP) has not been established.

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

    Energy Technology Data Exchange (ETDEWEB)

    Wouter van Es, H. [Dept. of Radiology, University Hospital, Utrecht (Netherlands); Witkamp, T.D. [Dept. of Radiology, University Hospital, Utrecht (Netherlands); Feldberg, M.A.M. [Dept. of Radiology, University Hospital, Utrecht (Netherlands)

    1995-08-01

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

  17. Neuroanatomy of the brachial plexus: normal and variant anatomy of its formation.

    Science.gov (United States)

    Johnson, Elizabeth O; Vekris, Marios; Demesticha, Theano; Soucacos, Panayotis N

    2010-03-01

    The brachial plexus is the complex network of nerves, extending from the neck to the axilla, which supplies motor, sensory, and sympathetic fibers to the upper extremity. Typically, it is formed by the union of the ventral primary rami of the spinal nerves, C5-C8 & T1, the so-called "roots" of the brachial plexus. By examining the neural architecture of the brachial plexus, the most constant arrangement of nerve fibers can be delineated, and the most predominate variations in the neural architecture defined. A thorough understanding of the neuroanatomy of the brachial plexus, with an appreciation of the possible anatomic variations that may occur is necessary for effective clinical practice.

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

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    Matakwa Ludia C

    2011-06-01

    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.

  19. Brachial plexus palsy due to subclavian artery pseudo aneurysm from internal jugular cannulation

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    Modi Manisha

    2007-01-01

    Full Text Available Internal jugular vein is the preferred route for central venous cannulation because of easy accessibility and high success rate. Arterial puncture is the most common complication, the reported incidence being 9.3%. However, brachial plexus palsy following arterial puncture is a rare complication of this procedure. We report a case of brachial plexus palsy due to compression by right subclavian pseudoaneurysm as a result of internal jugular vein cannulation in chronic renal failure patient.

  20. The clinical study of reconstruction of traumatic brachial plexus root avulsion injury in children%儿童创伤性臂丛神经撕脱伤的屈指功能重建

    Institute of Scientific and Technical Information of China (English)

    王树锋; 栗鹏程; 薛云皓; 李玉成; 陆健; 郑炜; 孙燕琨

    2010-01-01

    目的 观察健侧C_7,经椎体前通路移位与下干直接吻合,重建儿童创伤性臂从神经撕脱伤屈指功能的效果.方法 健侧C_7,在其前后股的远端切断,向近端游离至椎间孔,经椎体前通路牵至患侧.游离患侧臂丛下干及内侧束,切断下干后股及胸前内侧神经.将正中神经、尺神经及前臂内侧皮神经自内侧束的起始处一直游离到上臂中段.息肩前屈、内收至0°位,肘关节屈曲90°,上提患侧下干并与健侧C_7,直接吻合.2004年8月至2008年3月对20例患儿进行了健侧C_7,与患侧下干或内侧束直接吻合术.其中男16例,女4例;年龄5-18岁,平均13岁;伤后到手术时间1-11个月,平均4.6个月.全臂丛撕脱伤13例,中、下干撕脱伤7例.为减少吻合口张力,11例进行了肱骨短缩,短缩长度2.5-4.5 cm,平均(3.1±0.7)cm.结果 术后患者随访时间12-51个月,平均 27.4个月.屈指肌力4级18例,2级2例;屈拇长肌力4级10例、3级8例、2级2例.小指展肌肌力3级l例,2级1例;拇短展肌肌力3级1例.结论 健侧C_7,与患侧下干直接吻合,由于只有一个吻 合口及缩短了神经再生的距离,其重建屈指、屈拇功能的效果满意,并可恢复手内在肌的部分功能.%Objective To observe the primary result of finger flexion reconstruction in the procedure of direct anastomosis of contralateral C_7,transfered through the prespinal route with lower trunk in children suffered traumatic brachial plexus root avulsion injury.Methods On the healthy side.the C_7 nerve root was identified anatomically and transected at the level of division by dissecting its anterior and posterior division as far distal as possible up to the level where the nerve fihers interweaving with other division,then the contralateral C_7,nerve root W88 dissected proximally up to the neuroforamina.The contralateral C_7 nerve root was transferred to contralateral side through the prespinal route.The entire brachial plexus of

  1. Superficial siderosis of the central nervous system due to brachial plexus injury: a case report; Siderose superficial do sistema nervoso central por lesao do plexo braquial: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Setogutti, Enio Tadashi; Cassuriaga, Jefferson; Valduga, Simone Gianella [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Instituto de Cardiologia. Setor de Ressonancia Magnetica]. E-mails: pesquisa@cardiologia.org.br; editoracao-pc@cardiologia.org.br; Lorenzzoni, Pablo Longhi; Severgnini, Giancarlo Muraro [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Instituto de Cardiologia; Feldman, Carlos Jader [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Instituto de Cardiologia. Setor de Radiologia

    2005-10-15

    Superficial siderosis can be caused by hemosiderin deposition o the leptomeninges and subpial layers of the neuro-axis due to recurrent subarachnoid haemorrhage. Probable intrathecal bleeding sites must be investigated. In ut t 50% of the patients the bleeding source may be identified and the progression of the disease can be interrupted. In this study, the authors present a case of superficial siderosis of the central nervous system developed two decades after a traumatic lesion of the brachial plexus.(author)

  2. EFFICACY OF DEXAMETHASONE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Rakesh

    2015-08-01

    Full Text Available AIMS: Brachial plexus nerve blocks have analgesic and opioid sparing benefits for upper extremity surgery. Single - injection techniques are limited by duration of local anaesthetic agents, however Continuous block techniques can be used for prolonged anaesthesia and analgesia but it presents management challenges. The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset , duration and postoperative analgesia following upper limb surgeries. METHODS AND MATERIAL: A prospective, double - blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Sixty patients were randomly divided into two groups, Group B and BD . Group B received 30 ml of 0.375% bupivacaine with 2 ml normal saline while Group BD received 30 ml of 0.375% bupivacain with 2ml(8mg dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post operative analgesia and intra and postoperative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group BD as compared to Group B patients ( P < 0.0001. No significant side effects were noted. CONCLUSIONS: The addition of 8 mg of dexamethasone to bupivac a ine in supraclavicular brachial plexus block prolongs the duration of motor and sensory block and extends the analgesia period. KEYWORDS: A naesthesia adjuvants; D examethasone; B rachial plexus block .

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

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    Yong Jun Choi

    2013-01-01

    Full Text Available Neurolymphomatosis (NL is a rare clinical disease where neoplastic cells invade the cranial nerves and peripheral nerve roots, plexus, or other nerves in patients with hematologic malignancy. Most NL cases are caused by B-cell non-Hodgkin’s lymphoma (NHL. Diagnosis can be made by imaging with positron emission tomography (PET and magnetic resonance imaging (MRI. We experienced two cases of NL involving the brachial plexus in patients with NHL. One patient, who had NHL with central nervous system (CNS involvement, experienced complete remission after 8 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy but relapsed into NL of the brachial plexus 5 months later. The other patient, who suffered from primary central nervous system lymphoma (PCNSL, had been undergoing chemoradiotherapy but progressed to NL of the brachial plexus.

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

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    Kohyama Sho

    2011-11-01

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

  5. Is it possible to reduce obstetrical brachial plexus palsy by optimal management of shoulder dystocia?

    Science.gov (United States)

    Doumouchtsis, Stergios K; Arulkumaran, Sabaratnam

    2010-09-01

    Obstetrical brachial plexus palsies (OBPP) have been historically attributed to the impaction of the fetal shoulder behind the symphysis pubis and to excessive lateral traction of the fetal head during maneuvers to deliver the fetal shoulders in shoulder dystocia. Shoulder dystocia is indeed a major risk factor as it increases the risk for OBPP 100-fold. The incidence of OBPP following shoulder dystocia varies widely from 4% to 40%. However, a significant proportion of OBPPs are secondary to in utero injury. The propulsive forces of labor, intrauterine maladaptation, and compression of the posterior shoulder against the sacral promontory as well as uterine anomalies are possible intrauterine causes of OBPP. Many risk factors for OBPP may be unpredictable. Early identification of risk factors for shoulder dystocia, as well as appropriate management when it occurs, may improve our ability to prevent the occurrence of OBPP in those cases that are caused by shoulder dystocia.

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

    Science.gov (United States)

    Buesch, Francisca Eugster

    2010-01-01

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

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

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    Lucélia Gonçalves Vieira

    2013-03-01

    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.

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

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    Andreas Vincent Handoyo

    2010-06-01

    Full Text Available Obstetrical brachial plexus palsy (OBPP is an injury of entire or part of brachial plexus correlated with delivery process. Incidence in developing countries is around 0.15%. Risk factors include intrapartum and intrauterine. Three types of OBPP are Duchenne Erb, Klumpke, and whole arm palsy. This was a retrospective study of characteristic and risk factors of OBPP in Hasan Sadikin Hospital, Bandung, period January 2002-April 2007. Data were collected from perinatology ward medical records, and analyzed using binary logistic regression. OBPP incidence was 0.141%. All were Erb palsy and single pregnancy, 68.75% were head-occiput posterior presentation, 50% were spontaneous birth, 18.75% had meconeal staining, 62.5% had birth weight ≥3,500 g, 56.25% were male, 68.75% asphyxia, 12.5% shoulder dystocia, and 6.25% clavicle fracture. Risk factors significantly correlated were foot presentation (OR 9.357; 95%CI, transverse fetal position (OR 5.136; 95%CI, vacuum, forceps, breech/foot extraction (OR 5.240;95%CI, 4.320; 95%CI, 14.411; 95%CI, respectively, birth weight 3,500-3,999 g (OR 4.571;95%CI, birth weight ≥4,500 g (OR 57.759; 95%CI, asphyxia (ORs 5.992; 95%CI, and severe asphyxia (OR 6.094; 95%CI. Sectio cesarea tend to have protective effect {OR 0.244; 95%CI; p=0.062 (>0.05}. The important risk factors of OBPP are foot presentation, breech/foot extraction, and birth weight >4,500 g.

  9. Assessment tools used by occupational therapists in children with obstetric brachial plexus palsy

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    Thaianny Taís Dantas de Brito

    2016-04-01

    Full Text Available Introduction: The Obstetric Brachial Plexus Palsy (OBPP is a result of brachial plexus injury at birth and may cause dysfunction of the affected upper limb, reflecting significantly in the child’s life. When evaluating a child with OBPP the occupational therapist can use evaluation tools, and has to have knowledge to choose and apply the most appropriate instrument. Objective: This review aimed to analyze the literature on the use of evaluation tools by occupational therapists in children with OBPP. Method: The search for articles was performed in the databases Scirus, Cinahl, Medline, Psycinfo, Scopus and Lilacs using the following selection criteria: studies with 0-12 years old children with OBPP in English, Portuguese and Spanish, published in the last 10 years, with the occupational therapist as one of the authors and/or reporting the application of the instrument by this professional. Results: There were 15 studies from six countries that reported 17 evaluation instruments, five of which, recently developed, were specific to this clientele. The study did not identify the need to modify the non-specific instruments to the application in children with OBPP, demonstrating that they can be used in its original format, facilitating the use in the clinical practice. Most instruments included aspects related to occupational performance inserted in the field of Activity and Participation of the International Classification of Functioning, indicating the concern of this professional in suiting the assessment process of the child with the OBPP to the current paradigm of health understanding and occupational therapy field.

  10. On the morphology of the brachial plexus of the platypus (Ornithorhynchus anatinus) and the echidna (Tachyglossus aculeatus).

    Science.gov (United States)

    Koizumi, M; Sakai, T

    1997-04-01

    Four forelimbs of 3 platypuses and 3 forelimbs of 2 echidnas were examined to study the precise form of the brachial plexus and to clarify the structural characteristics of the brachial plexus in phylogeny. The spinal components contributing to the plexus (C4-T2) and the formation patterns of the 3 trunks of the plexus were the same as those generally observed in mammals. In the cranial half of the brachial plexus from C4, 5 and 6 in monotremes, division into the ventral bundle (lateral cord) and dorsal bundle (axillary nerve) is clear, as in other mammals. However, for monotremes, in the caudal half of the plexus from C7 and T1 (+T2) and the nerves arising from the caudal plexus there is no definite division into the ventral and dorsal bundles, which distribute to the flexor and extensor parts of the forelimbs, respectively. The lower trunk of the monotreme brachial plexus forms a cord which contains both ventral and dorsal components. This characteristic diverges from the generally accepted idea that the tetrapod limb plexus is divided clearly into 2 layers: a dorsal layer for extensors and a ventral layer for flexors of the limb. Considering the incomplete dorsoventral division of forelimb nerves in some reptiles and urodeles, the caudal half of the monotreme brachial plexus has characteristics in common with those of lower tetrapods.

  11. Distal infrared thermography and skin temperature after ultrasound-guided interscalene brachial plexus block

    DEFF Research Database (Denmark)

    Asghar, Semera; Bjerregaard, Lars S; Lundstrøm, Lars H

    2014-01-01

    BACKGROUND: Increases in skin temperature may be used as an early predictor of the success of interscalene brachial plexus block (IBPB), but we lack detailed information on the thermographic response. OBJECTIVE: To investigate and characterise the thermographic response after IBPBs. DESIGN: Prosp...

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

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    Rohini V Bhat Pai

    2013-01-01

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

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

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    Ahmet Can Senel

    2014-01-01

    Full Text Available Background and Objectives. A prospective, randomized, controlled, double-blind clinical trial to assess the effect of tramadol and ketamine, 50 mg, added to ropivacaine in brachial plexus anesthesia. Methods. Thirty-six ASA physical statuses I and II patients, between 18 and 60 years of age, scheduled for forearm and hand surgery under axillary brachial plexus block, were allocated to 3 groups. Group R received 0.375% ropivacaine in 40 mL, group RT received 0.375% ropivacaine in 40 mL with 50 mg tramadol, and group RK received 0.375% ropivacaine in 40 mL with 50 mg ketamine for axillary brachial plexus block. The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events (nausea, vomiting, and feeling uncomfortable were recorded. Results. The onset time of sensorial block was the fastest in ropivacaine + tramadol group. Duration of sensorial and motor block was the shortest in the ropivacaine + tramadol group. Duration of analgesia was significantly longer in ropivacaine + tramadol group. Conclusion. We conclude that when added to brachial plexus analgesia at a dose of 50 mg, tramadol extends the onset and duration time of the block and improves the quality of postoperative analgesia without any side effects.

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

    LENUS (Irish Health Repository)

    Sultan, S F

    2012-05-01

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

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

    Science.gov (United States)

    Pai, Rohini V Bhat; Hegde, Harihar V; Santhosh, McB; Roopa, S; Deshpande, Shrinivas S; Rao, P Raghavendra

    2013-01-01

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

  16. Variation in brachial plexus formation, branching pattern and relation with major vessels

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    G. Anwer Khan

    2014-08-01

    Conclusion: The present study carried out on adult human cadavers revealed some rare variations in the formation, branching pattern and relations of the brachial plexus. These variations are of clinical significance for the surgeons, radiologists and the anesthesiologists. [Int J Res Med Sci 2014; 2(4.000: 1591-1594

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

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    Soma C.

    2015-07-01

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

  18. Brachial plexopathy

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    Satish V Khadilkar

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-01-15

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

  20. Axillary Brachial Plexus Blockage in Treatment of Upper Extremity Ischemic Disorder in Critically Ill Patient: A Report of Two Cases

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    İlkay Ceylan

    2015-08-01

    Full Text Available Arterial catheterization, vasoactive agents, autonomic dysfunction and septic embolus may cause ischemia at distal ends of upper extremity in critically ill patients. Axillary brachial plexus blockage is highly reliable intervention when appropriate technique is used. Sympathetic blockage occurs after administration of local anesthetic drug and can resolve the circulatory disorder of extremity. We aimed to present two cases with ischemia of upper distal extremity that resolves after axillary brachial plexus blockage.

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

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2009-07-01

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

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

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    Cevdet Düger

    2013-06-01

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

  3. Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches.

    Science.gov (United States)

    Goel, Shivi; Rustagi, Shaifaly Madan; Kumar, Ashwani; Mehta, Vandana; Suri, Rajesh Kumar

    2014-03-01

    During routine dissection of the upper extremity of an adult male cadaver, multiple variations in branches of medial and lateral cords of brachial plexus were encountered. Three unique findings were observed. First, intercordal neural communications between the lateral and medial cords were observed. Second, two lateral pectoral nerves and one medial pectoral nerve were seen to arise from the lateral and medial cord respectively. The musculocutaneous nerve did not pierce the coracobrachialis. Finally, the ulnar nerve arose by two roots from the medial cord. Knowledge of such variations is of interest to anatomists, radiologists, neurologists, anesthesiologists, and surgeons. The aim of our study is to provide additional information about abnormal brachial plexus and its clinical implications.

  4. Prolonged blockade of the brachial plexus for the early rehabilitation of children with posttraumatic elbow contractures

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    D. V. Zabolotsky

    2015-01-01

    Full Text Available Objective. Improvement of surgical treatment outcomes in children with post-traumatic elbow contractures. Materials and methods. The study is based on the diagnostic findings of 48 children with post-traumatic elbow contractures who were treated at the Turner Scientific and Research Institute for Children’s Orthopedics. All children underwent complex rehabilitation after reconstructive intra-articular surgery to work out passive motions in the elbow using ARTROMOT-E2 device. The patients of the study group started rehabilitation in the first days after reconstructive intra-articular surgery in the background of prolonged blockade of the brachial plexus. In the control group, the rehabilitation was carried out traditionally on the 6th day after surgery without regional anesthesia. The patients of the study group were supplied with Contiplex SU perinural catheters for prolonged blockade of the brachial plexus using ultrasound (Edge SonoSite and neurostimulation (Stimuplex® HNS12 before surgery. For perioperative blockade of the brachial plexus we used intermittent injection of 0.5% ropivacaine (2 mg / kg. The severity of pain at the stages of rehabilitation was assessed using 10-point grading scale (FPS-R. The range of active and passive motions in the joints was evaluated by measuring the range of motions with a fleximeter. Results. Intermittent injection of ropivacaine before rehabilitation allowed to correct post-traumatic elbow contractures in children in the first days after surgery associated with the minimum subjective pain level and stable hemodynamic parameteres, accompanied with a significant increase of the elbow motion range in comparison with the group of the patients who were not performed regional anesthesia . Conclusion. Prolonged blockade of the brachial plexus in rehabilitation treatment of children with post-traumatic contractures provides appropriate analgesic and myoneural block components from the 1st day after intra

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

    LENUS (Irish Health Repository)

    O'Sullivan, Owen

    2012-07-13

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

  6. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor

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    Khaled M Krisht

    2016-01-01

    Full Text Available Background: Malignant peripheral nerve sheath tumors (MPNSTs of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7-T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2-3 months to re-evaluate the size of the mass.

  7. Obstetric Brachial Plexus Palsy in the Context of Early Physical Rehabilitation

    OpenAIRE

    2014-01-01

    Cuban health system currently promotes prenatal testing and monitoring of pregnancy; nevertheless obstetric brachial plexus palsy remains an unfortunate consequence of a difficult delivery and is one of the most common birth trauma. Traditionally, its treatment has been conservative, based on multidisciplinary monitoring and consultations with various specialists to deal with the consequences. After conducting an extensive literature review, we discussed in this paper the etiology, anatomy, p...

  8. FORMATION AND BRANCHING PATTERN OF CORDS OF BRACHIAL PLEXUS- A CADAVERIC STUDY IN NORTH INDIAN POPULATION

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    Priti Chaudhary

    2014-03-01

    Full Text Available BACKGROUND: The anatomical variations in the different parts of brachial plexus in human have been described by many authors. These variations have clinical significance for the surgeons, radiologists and the anatomists. A lot of work has been done on the morphology of branching pattern of the different cords of brachial plexus but almost all the workers are silent about their morphometry. That’s why this study is planned on morphology & morphometry of branching pattern of different cords of brachial plexus. MATERIAL AND METHODS: The present study was conducted on 60 upper limbs belonging to 30 cadavers (Male:Female = 28:02, (Right:Left = 30:30 obtained from Department of Anatomy, Govt. Medical College, Amritsar. These were dissected to expose the different components of brachial plexus. OBSERVATIONS: Out of 60 limbs, the lateral and the medial cords were formed in the usual way in 56 limbs, while the posterior cord was normal in 57 limbs. The average lengths of lateral, medial & posterior cords were 3.37 cm, 4.05 cm & 1.95 cm respectively. The branches of lateral cord depicted more variations in the form of origin as compared with those of medial & posterior cords. The distance of different branches of all the cords from the point of origin to parent cord varied between the two sides of same cadaver as well as on the same side of different cadavers. DISCUSSION & CONCLUSION: The present study on the adult human cadavers is an essential prerequisite for the initial built up of the data base at the grass root level. The anatomy has always provided a bedrock for the sound surgical endeavors. It definitely has an upper edge to widely and indiscriminately used radiological and sophisticated CT and MRI observations which carry a margin of error inherent to any diagnostic procedure because no doubt the machines are a good bet but the eyes see the best.

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

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    Amiri HR

    2009-05-01

    Full Text Available "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction, unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics. "n"n Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control opioid consumption during surgery, patient satisfaction and block related complications were reported

  10. COMPARISON BETWEEN INTERSCALENE AND SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A CADAVERIC STUDY

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    Suvalagna

    2014-07-01

    Full Text Available INTRODUCTION: Without mastery of the anatomy, luck rather than skill becomes the primary determinant of successful neural blockade. In this educational study our intent was to compare the level of nerve roots blocked by these two techniques of peripheral nerve block, widely used in clinical anesthesia practice. AIMS: To have a three dimensional view of nerve plexus involvement in inter scalene and supraclavicular techniques of brachial plexus block and compare in between them. MATERIAL AND METHOD: 6 recently deceased cadavers preserved in formalin were used. In both the techniques the classical methods usually pursued in daily clinical practice were followed. Dyes used were methylene blue and tartrazine of same dilution. RESULTS: Careful dissection showed that in all cases of inter scalene approach the dye was more concentrated in upper and middle trunk than in lower trunk of brachial plexus. In contrast in supraclavicular approach dye concentration was more in lower and middle trunk and less in upper trunk. DISCUSSION: After reviewing the anatomy it can be concluded that injection of local anesthetic at the interscalene level tends to produce a block that is most intense at the C5-C7 distribution and injection at supraclavicular level provide more compact anesthesia in C8-T1 distribution. CONCLUSION: Supraclavicular block is preferable for operations on the elbow, forearm, and hand and inter scalene block for shoulder.

  11. Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study

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    Luiz Carlos Buarque de Gusmão

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS: 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION: Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS: The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

  12. Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report

    DEFF Research Database (Denmark)

    Sørensen, Jens Christian Hedemann; Meier, Kaare; Perinpam, Larshan;

    Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report......Peripheral nerve stimulation (PNS) in the trapezius muscle region alleviate chronic neuropathic pain after lower brachial plexus root avulsion lesion: A case report...

  13. Reimplantation combined with transplantation of transgenic neural stem cells for treatment of brachial plexus root avulsion

    Institute of Scientific and Technical Information of China (English)

    CHEN Lei; LU Lai-jin; MENG Xiao-ting; CHEN Dong; ZHANG Zhi-xin; YANG Fan

    2008-01-01

    Objective: To explore a new method to treat brachial plexus root avulsion experimentally by reimplantation combined with transplantation of neural stem cells (NSCs) modified by neurotrophin-3 gene (NT-3).Methods: The total RNA was extracted from neonatal rat striatum and the NT-3 cDNA was obtained by reverse transcription and amplified by polymerase chain reaction.The NT-3 gene was transferred into NSCs via the pLEGFP-Cl,an expression plasmid vectors.The untransfected NSCs,the pLEGFP-Cl treated NSCs,and the pLEGFP-Cl-NT-3 treated NSCs were transplanted into corresponding spinal cord segment with brachial plexus root avulsion.The survival,differentiation,and migration of the transplanted cells were determined under confoeal laser scanning microscope or by immunohistochemistry method.The nerve regeneration was evaluated by gross observation,electrophysiologieal examination and reverse horseradish peroxidase tracing.Results: The NT-3 gene was successfully amplified and transferred into neural stem cells via the plasmid vectors.The transplanted cells survived,differentiated,and migrated and NT-3 was expressed within the spinal cord.The animals regained some muscle strength which was less than 3-degree muscular strength according to the British Medical Research Council (BMRC) evaluating system.The resuits of electrophysiological examination and reverse horseradish peroxidase tracing were superior in the pLEGFP-Cl-NT-3 group to the NSCs untransfected group orthe pLEGFP-Cl group.Conclusion: Transplantation of NSCs modified by NT-3gene combined with reimplantantion is a relatively effective way to treat brachial plexus root avuision experimentally.It still need further study to improve the results.

  14. Effect of dexamethasone in low volume supraclavicular brachial plexus block: A double-blinded randomized clinical study

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    Arun Kumar Alarasan

    2016-01-01

    Full Text Available Background and Aims: With the use of ultrasound, a minimal effective volume of 20 ml has been described for supraclavicular brachial plexus block. However achieving a long duration of analgesia with this minimal volume remains a challenge. We aimed to determine the effect of dexamethasone on onset and duration of analgesia in low volume supraclavicular brachial plexus block. Material and Methods: Sixty patients were randomly divided into two groups of 30 each. Group C received saline (2 ml + 20 ml of 0.5% bupivacaine and Group D received dexamethasone (8 mg + 20 ml of 0.5% bupivacaine in supraclavicular brachial plexus block. Hemodynamic variables and visual analog scale (VAS score were noted at regular intervals until 450 min. The onset and duration of sensory and motor block were measured. The incidence of "Halo" around brachial plexus was observed. Student′s t-test and Chi-square test were used for statistical analysis. Results: The onset of sensory and motor block was significantly earlier in dexamethasone group (10.36 ± 1.99 and 12 ± 1.64 minutes compared to control group (12.9 ± 2.23 and 18.03 ± 2.41 minutes. The duration of sensory and motor block was significantly prolonged in dexamethasone group (366 ± 28.11 and 337.33 ± 28.75 minutes compared to control group (242.66 ± 26.38 and 213 ± 26.80 minutes. The VAS score was significantly lower in dexamethasone group after 210 min. "Halo" was present around the brachial plexus in all patients in both the groups. Conclusion: Dexamethasone addition significantly increases the duration of analgesia in patients receiving low volume supraclavicular brachial plexus block. No significant side-effects were seen in patients receiving dexamethasone as an adjunct.

  15. Recovery of brachial plexus lesions resulting from heavy backpack use: A follow-up case series

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    Pihlajamäki Harri K

    2011-03-01

    Full Text Available Abstract Background Brachial plexus lesions as a consequence of carrying a heavy backpack have been reported, but the typical clinical course and long-term consequences are not clear. Here we evaluated the clinical course and pattern of recovery of backpack palsy (BPP in a large series of patients. Methods Thirty-eight consecutive patients with idiopathic BPP were identified from our population of 193,450 Finnish conscripts by means of computerised register. A physiotherapist provided instructions for proper hand use and rehabilitative exercises at disease onset. The patients were followed up for 2 to 8 years from the diagnosis. We also searched for genetic markers of hereditary neuropathy with pressure palsies. Mann-Whitney U-test was used to analyze continuous data. The Fischer's exact test was used to assess two-way tables. Results Eighty percent of the patients recovered totally within 9 months after the onset of weakness. Prolonged symptoms occurred in 15% of the patients, but daily activities were not affected. The weight of the carried load at the symptom onset significantly affected the severity of the muscle strength loss in the physiotherapeutic testing at the follow-up. The initial electromyography did not predict recovery. Genetic testing did not reveal de novo hereditary neuropathy with pressure palsies. Conclusions The prognosis of BPP is favorable in the vast majority of cases. Electromyography is useful for diagnosis. To prevent brachial plexus lesions, backpack loads greater than 40 kg should be avoided.

  16. Faster onset time of supraclavicular brachial plexus block using local anesthetic diluted with dextrose

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    Hong Jin Lim

    Full Text Available Abstract Background and objectives: A high sodium concentration is known to antagonize local anesthetics when infiltrated around neural tissue. Thus, we hypothesized that the onset time for sensory and motor blockade, in supraclavicular brachial plexus block using ropivacaine diluted with dextrose would be shorter than with saline. Methods: Patients scheduled for upper limb surgery were randomized to receive ultrasound guided supraclavicular brachial plexus block with 0.5% ropivacaine. Evaluation of sensory and motor blockade was performed every 5 min for 60 min. Patients were followed-up on postoperative day 1, and between days 7 and 10 for the presence of any complications. Twenty-five patients in each group were analyzed. Results: Mean time for onset of analgesia for the dextrose group was 37.6 ± 12.9 min while the mean time for the saline group was 45.2 ± 13.9 min with a p-value of 0.05. The effect size was 0.567, which was moderate to large. No major complications were observed. Conclusion: We conclude that there was a decrease in onset time of analgesia when dextrose was used as a diluent instead of saline for ultrasound guided supraclavicular block.

  17. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound

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    Alexandre Takeda

    2015-06-01

    Full Text Available INTRODUCTION: The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90 of bupivacaine for axillary brachial plexus block. METHODS: Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous. The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability or the same concentration (0.9 probability. Surgical anesthesia was defined as driving force ≤2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4 h after the blockade. RESULTS: MEC90 was 0.241% [R 2: 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4 h. CONCLUSION: This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.

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

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    Safoura Ghadirian

    2013-09-01

    Full Text Available This blinded, randomized experimental study was designed to evaluate the analgesic effects of adding epinephrine or xylazine to lidocaine solution for brachial plexus block (BPB in sheep. Nine healthy, fat-tailed female lambs (26.6 ± 1.5 kg were randomly allocated into three groups: lidocaine 2%, 5 mg kg-1 (LID, n = 6, lidocaine (5 mg kg-1 with epinephrine 5 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.

  19. Clonidine as an adjuvant to local anesthetic in supraclavicular brachial plexus block: a randomized, double blinded placebo controlled study

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    Preeti Rustagi

    2016-10-01

    Conclusions: Clonidine 2 and micro;g / kg added to 10 ml of 0.5 % Bupivacaine + 20 ml of 2% lignocaine with adrenaline (1:200000 is a good option for improving the quality and duration of supraclavicular brachial plexus block. [Int J Basic Clin Pharmacol 2016; 5(5.000: 1892-1897

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

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    Krutika B Rupera

    2013-06-01

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

  1. Effectiveness of low-field magnetic resonance imaging in diagnosing brachial plexus tumours in dogs – short communication

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    Adamiak Zbigniew

    2015-06-01

    Full Text Available The aim of the study was to identify magnetic resonance imaging (MRI sequences that contribute to a quick and reliable diagnosis of brachial plexus tumours in dogs. The tumours were successfully diagnosed in 6 dogs by the MRI with the use of SE, FSE, STIR, Turbo 3 D, 3D HYCE, and GE sequences and the gadolinium contrast agent

  2. DEXMEDETOMIDINE IN EMERGENCY HAND SURGERY AS AN ADJUVANT TO ROPIVACAINE-INDUCED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A PROSPECTIVE, DOUBLE-BLINDED AND RANDOMIZED CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Sudipta Kumar

    2015-12-01

    Full Text Available BACKGROUND Accidental industrial hand injury very often requires early intervention. Assuming as full stomach condition, regional anaesthesia is preferred to avoid the risk of aspiration in general anaesthesia. Different additives have been used to prolong the duration of brachial plexus block. We evaluated the effect of adding dexmedetomidine to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. MATERIALS AND METHODS Seventy six patients aged 20-50 years with ASA grade I, II who were presented with industrial hand injury and required emergency operative interventions were randomly allocated into two groups. Group-RD (n=38 received ropivacaine (30ml 0.5% with dexmedetomidine 1ml (100µg and patients in group-RP (n=38 received ropivacaine (30ml 0.5% with 0.9% normal saline 1ml solution as placebo. Sensory and motor block onset times and durations, time to first analgesic use, total analgesic need, postoperative VAS, hemodynamics and side effects were recorded for each patient. RESULTS Though having comparable demographic profile, the onset of motor and sensory block was significantly fastened by dexmedetomidine (p<0.05. Sensory and motor block duration and time to first analgesic use were significantly prolonged and the total need for rescue analgesics was lower in group RD (P<0.05 than group RD. Postoperative VAS value at 12 hours were significantly lower in group RD (P<0.05. Side effects and hemodynamics were quite comparable among two groups. CONCLUSION It can be concluded that adding dexmedetomidine to brachial plexus block increases the sensory and motor block duration and time to first analgesic use and decreases block onset time and total analgesic use with no side effects

  3. Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anesthetic approach

    Science.gov (United States)

    Singh, Arvinder Pal; Mahindra, Malika; Gupta, Ruchi; Bajwa, Sukhminder Jit Singh

    2016-01-01

    Aims and Objectives: Supplementation of dexmedetomidine produces a dose-dependent sedation, anxiolysis and analgesia without respiratory depression. This study was conducted to evaluate the possible effect of dexmedetomidine as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in upper limb surgery. Settings and Design: Tertiary care institute, Department of Anaesthesiology and Intensive Care, a placebo-controlled study. Materials and Methods: After obtaining Ethical Committee approval, a randomized, double-blind, placebo-controlled study was conducted on sixty American Society of Anesthesiologists physical status I and II patients in the age group of 18–60 years, divided randomly into two groups, Group I received 30 ml of 0.5% levobupivacaine with 1 ml of isotonic sodium chloride solution and Group II received 30 ml of 0.5% levobupivacaine and 1 ml (100 mcg) of dexmedetomidine for supraclavicular brachial plexus block. The onset and duration of sensory and motor blockade, duration of analgesia (DOA) and any adverse effects were noted. At the end of the study, data were compiled and analyzed using appropriate statistical tests. The value of P < 0.05 was considered significant. Results: Demographic profile was comparable in both the groups. The time to onset of sensory and motor block was 10.54 ± 2.333 min and 12.21 ± 2.529 min in Group I while it was 3.24 ± 0.951 min and 2.83 ± 1.197 min in Group II, respectively. The duration of sensory and motor block was 7.79 ± 2.007 h and 9.18 ± 1.701 h in Group I, and it was 16.31 ± 2.606 h and 17.52 ± 2.098 h in Group II, respectively. The DOA was 678.68 ± 20.492 min in Group I and 1273.79 ± 83.139 min in Group II. On statistical comparison, these values were highly significant (P < 0.001). Side effects such as nausea, vomiting, hypoxemia, pruritis, or urinary retention were not observed in either of the groups. Conclusion: Dexmedetomidine shortens the onset time for sensory and motor block

  4. [A case of subacute necrotizing lymphadenitis complicated with brachial plexus neuritis].

    Science.gov (United States)

    Sugiyama, A; Araki, E; Arakawa, K; Kikuchi, H; Iwaki, T; Yamada, T; Kira, J

    1998-01-01

    A 22-year-old female noted a low grade fever and swelling of the cervical lymph nodes in May 1997, and later developed a dry cough. She was diagnosed to have interstitial pneumonitis, and then administration of corticosteroids alleviated her symptoms. On February 6, 1998, however, a high fever recurred and her swollen cervical lymph node on the right side was biopsied on February 9, 1998. A histological examination revealed an increased number of histiocytes and karyorrhexis of the lymphocytes in the paracortical areas, and she was therefore diagnosed to have histiocytic necrotizing lymphadenitis. She could not fully elevate her arm on February 16, 1998. On admission, her cervical lymph node was swollen on the left side. A neurological examination revealed a marked weakness of the right deltoid muscle, moderate weakness of the right latissimus dorsi, triceps and brachioradialis muscles and also a mild weakness of the serratus anterior, supra- and infra-spinatus, and biceps brachii muscles. The muscle power of the other muscles were normal and no muscle atrophy was evident. Winging of the right scapula was observed. The deep tendon reflexes were normal in all four limbs, and her sensation was also normal. No cerebellar sign was found. The Jackson, Spurling, Allen, Morley and Adson tests were all negative. ESR was mildly elevated to 18 mm/hr, but CRP was negative. RF, ANA and anti-SS-A and SS-B antibodies were positive, whereas LE-test, direct and indirect Coombs tests and other autoantibodies were negative. Needle EMG disclosed fasciculation potentials in the right triceps muscle and polyphasic waves in the right deltoid muscle. MRI showed gadolinium-enhancement of the right brachial plexus. Although an abnormal accumulation of gallium was detected in the right parotid and bilateral submandibular glands, no sicca symptoms were found and the Schirmer test findings were normal. Oral prednisolone (50 mg/day with gradual tapering) alleviated both her symptoms and the

  5. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block

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    Sandhya Agarwal

    2014-01-01

    Full Text Available Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints. Materials and Methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25, 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25, 30 ml of 0.325% bupivacaine + 1 ml (100 μg dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR, systolic arterial blood pressure (SBP, and diastolic arterial blood pressure (DBP were also monitored. Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001, while the duration of blocks was significantly longer (P < 0.001 in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min, heart rate levels in group SD were significantly lower (P < 0.001. SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001. In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001 in group SD. The duration of analgesia (DOA was significantly longer in SD group than S group (P < 0.001. Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups. Conclusion

  6. The prognostic value of concurrent Horner syndrome in extended Erb obstetric brachial plexus palsy.

    Science.gov (United States)

    El-Sayed, Amel A F

    2014-10-01

    Horner syndrome may be seen in infants with extended Erb obstetric brachial plexus palsy. However, its prognostic value in these infants has not been previously investigated. A total of 220 infants with extended Erb palsy were included and divided into 2 groups: group I (n = 209) were infants with extended Erb palsy without Horner syndrome, and group II (n = 11) were infants with extended Erb palsy and concurrent Horner syndrome. The rate of good spontaneous recovery of elbow flexion was 59% in group I and 27% in group II, and the difference was significant (P = .038). The rate of good spontaneous recovery of wrist extension was 61% in group I and 0% in group II, and the difference as highly significant (P Horner syndrome in infants with extended Erb palsy may be considered as a poor prognostic sign for recovery of the sixth and seventh cervical roots.

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

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    Vikas Trehan

    2010-01-01

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

  8. Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: A multicentre retrospective study with surgical findings and clinical follow-up as reference standard

    Energy Technology Data Exchange (ETDEWEB)

    Tagliafico, Alberto, E-mail: alberto.tagliafico@unige.it [Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Largo Rosanna Benzi 8, 16132 Genoa (Italy); Succio, Giulia; Serafini, Giovanni [Department of Radiology, Santa Corona Hospital, Pietra Ligure, Italy via XXV Aprile, 38- Pietra Ligure, 17027 Savona (Italy); Martinoli, Carlo [Radiology Department, DISC, Università di Genova, Largo Rosanna Benzi 8, 16138 Genova (Italy)

    2012-10-15

    Objective: To evaluate brachial plexus MRI accuracy with surgical findings and clinical follow-up as reference standard in a large multicentre study. Materials and methods: The research was approved by the Institutional Review Boards, and all patients provided their written informed consent. A multicentre retrospective trial that included three centres was performed between March 2006 and April 2011. A total of 157 patients (men/women: 81/76; age range, 18–84 years) were evaluated: surgical findings and clinical follow-up of at least 12 months were used as the reference standard. MR imaging was performed with different equipment at 1.5 T and 3.0 T. The patient group was divided in five subgroups: mass lesion, traumatic injury, entrapment syndromes, post-treatment evaluation, and other. Sensitivity, specificity with 95% confidence intervals (CIs), positive predictive value (PPV), pre-test-probability (the prevalence), negative predictive value (NPV), pre- and post-test odds (OR), likelihood ratio for positive results (LH+), likelihood ratio for negative results (LH−), accuracy and post-test probability (post-P) were reported on a per-patient basis. Results: The overall sensitivity and specificity with 95% CIs were: 0.810/0.914; (0.697–0.904). Overall PPV, pre-test probability, NPV, LH+, LH−, and accuracy: 0.823, 0.331, 0.905, 9.432, 0.210, 0.878. Conclusions: The overall diagnostic accuracy of brachial plexus MRI calculated on a per-patient base is relatively high. The specificity of brachial plexus MRI in patients suspected of having a space-occupying mass is very high. The sensitivity is also high, but there are false-positive interpretations as well.

  9. Remote therapeutic effect of early nerve transposition in treatment of obstetric al brachial plexus palsy

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To report a method and remote therape utic effect of early nerve transposition in treatment of obstetrical brachial pl exus palsy.   Methods: From May 1995 to August 1996, 12 patients who had no r ecovery of biceps 3 months after birth were treated with nerve transposition. Ei ght had neuroma at the upper trunk and 4 had rupture or avulsion of the upper tr unk. Mallet test was used to evaluate the results.   Results: The follow-up of 40-52 months showed that excellent and good recovery in functions was found in 75% of the patients and the excellen t rate of phrenic nerve and accessory nerve transposition was 83.3% and 6 6.7% respectively. A complete recovery in shoulder and elbow joint function wa s in 3 patients and Mallet Ⅳ was in 6 patients.   Conclusions: Satisfactory outcome can be obtained by using earl y nerve transposition in treating obstetrical brachial plexus.Paralysis, obstetric; Peripheral nerves; Nerve trans position

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

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    Prashant A Biradar

    2013-01-01

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

  11. Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mürtz, P., E-mail: petra.muertz@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Kaschner, M., E-mail: Marius.Kaschner@med.uni-duesseldorf.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Lakghomi, A., E-mail: Asadeh.Lakghomi@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Gieseke, J., E-mail: juergen.gieseke@ukb.uni-bonn.de [Philips Healthcare, Lübeckertordamm 5, 20099 Hamburg (Germany); Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Willinek, W.A., E-mail: winfried.willinek@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Schild, H.H., E-mail: hans.schild@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany); Thomas, D., E-mail: daniel.thomas@ukb.uni-bonn.de [Department of Radiology, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn (Germany)

    2015-04-15

    Highlights: •DW MRN of brachial and lumbosacral plexus at 1.5 T and at 3.0 T was compared. •For lumbosacral plexus, nerve conspicuity on MIP images was superior at 3.0 T, also visible length and mean sharpness of the nerves. •For brachial plexus, nerve conspicuity at 3.0 T was rather inferior, nerve length was not significantly different, mean sharpness was superior at 3.0 T. -- Abstract: Purpose: To compare intraindividually the nerve conspicuity of the brachial and lumbosacral plexus on diffusion-weighted (DW) MR neurography (MRN) at two different field strengths. Materials and methods: 16 healthy volunteers were investigated at 3.0 T and 1.5 T applying optimized variants of a DW spin-echo echo-planar imaging sequence with short TI inversion recovery fat suppression. Full-volume (FV) and curved sub-volume (CSV) maximum intensity projection (MIP) images were reconstructed and nerve conspicuity was visually assessed. Moreover, visible length and sharpness of the nerves were quantitatively analyzed. Results: On FV MIP images, nerve conspicuity at 3.0 T compared to 1.5 T was worse for brachial plexus (P = 0.00228), but better for lumbosacral plexus (P = 0.00666). On CSV MIP images, nerve conspicuity did not differ significantly for brachial plexus, but was better at 3.0 T for lumbosacral plexus (P = 0.00091). The visible length of the analyzed nerves did not differ significantly with the exception of some lumbosacral nerves, which were significantly longer at 3.0 T. The sharpness of all investigated nerves was significantly higher at 3.0 T by about 40–60% for cervical and 97–169% for lumbosacral nerves. Conclusion: DW MRN imaging at 3.0 T compared to 1.5 T is superior for lumbosacral plexus, but not for brachial plexus.

  12. Axillary Brachial Plexus Blockage in Treatment of Upper Extremity Ischemic Disorder in Critically Ill Patient: A Report of Two Cases

    OpenAIRE

    İlkay Ceylan; Nermin Kelebek Girgin; Mehmet Ali Kopan; Alp Gurbet

    2015-01-01

    Arterial catheterization, vasoactive agents, autonomic dysfunction and septic embolus may cause ischemia at distal ends of upper extremity in critically ill patients. Axillary brachial plexus blockage is highly reliable intervention when appropriate technique is used. Sympathetic blockage occurs after administration of local anesthetic drug and can resolve the circulatory disorder of extremity. We aimed to present two cases with ischemia of upper distal extremity that resolves after axillary ...

  13. Infraclavicular brachial plexus block: Comparison of posterior cord stimulation with lateral or medial cord stimulation, a prospective double blinded study

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    Dushyant Sharma

    2013-01-01

    Full Text Available Background: Infraclavicular approach to the brachial plexus sheath provides anesthesia for surgery on the distal arm, elbow, forearm, wrist, and hand. It has been found that evoked distal motor response or radial nerve-type motor response has influenced the success rate of single-injection infraclavicular brachial plexus block. Aim: We conducted this study to compare the extent and effectiveness of infraclavicular brachial plexus block achieved by injecting a local anesthetic drug after finding specific muscle action due to neural stimulator guided posterior cord stimulation and lateral cord/medial cord stimulation. Methods: After ethical committee approval, patients were randomly assigned to one of the two study groups of 30 patients each. In group 1, posterior cord stimulation was used and in group 2 lateral/medial cord stimulation was used for infraclavicular brachial plexus block. The extent of motor block and effectiveness of sensory block were assessed. Results: All four motor nerves that were selected for the extent of block were blocked in 23 cases (76.7% in group 1 and in 15 cases (50.0% in group 2 (P:0.032. The two groups did not differ significantly in the number of cases in which 0, 1, 2, and 3 nerves were blocked (P>0.05. In group 1, significantly lesser number of patients had pain on surgical manipulation compared with patients of group 2 (P:0.037. Conclusion: Stimulating the posterior cord guided by a nerve stimulator before local anesthetic injection is associated with greater extent of block (in the number of motor nerves blocked and effectiveness of block (in reporting no pain during the surgery than stimulation of either the lateral or medial cord.

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

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    Tagliafico, Alberto; Neumaier, Carlo Emanuele; Calabrese, Massimo [National Institute for Cancer Research, Department of Radiology, Genova (Italy); Succio, Giulia; Serafini, Giovanni; Ghidara, Matteo [Santa Corona Hospital, Radiology Department, Savona (Italy); Martinoli, Carlo [Universita di Genova, Radiology Department, Genova (Italy)

    2011-06-15

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

  15. Different functional reorganization of motor cortex after transfer of the contralateral C7 to different recipient nerves in young rats with total brachial plexus root avulsion.

    Science.gov (United States)

    Pan, Feng; Wei, Hai-feng; Chen, Liang; Gu, Yu-dong

    2012-12-07

    Clinically, contralateral C7 transfer is used for nerve reconstruction in brachial plexus injuries. Postoperatively, synchronous motions at the donor limb are noteworthy. This study studied if different recipient nerves influenced transhemispheric functional reorganization of motor cortex after this procedure. 90 young rats with total root avulsion of the brachial plexus were divided into groups 1-3 of contralateral C7 transfer to anterior division of the upper trunk, to both the musculocutaneous and median nerves, and to the median nerve, respectively. After reinnervation of target muscles, number of sites for forelimb representations in bilateral motor cortices was determined by intracortical microstimulation at 1.5, 3, 6, 9, and 12 months postoperatively. At nine months, transhemispheric reorganization of nerves neurotized by contralateral C7 was fulfilled in four of six rats in group 1, one of six in group 2 and none in group 3, respectively; at 12 months, that was fulfilled in five of six in group 1, four of six in groups 2 and 3, respectively. Logistic regression analysis showed that rate of fulfilled transhemispheric reorganization in group 1 was 12.19 times that in group 3 (95% CI 0.006-0.651, p=0.032). At 12 months, number of sites for hindlimb representations which had encroached upon original forelimb representations on the uninjured side was statistically more in group 3 than in group 2 (t=9.5, pnerves induces faster transhemispheric functional reorganization of motor cortex than that to median nerve alone in rats.

  16. Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study

    Science.gov (United States)

    Padur, Ashwini Aithal; Shanthakumar, Swamy Ravindra; Shetty, Surekha Devadas; Prabhu, Gayathri Sharath; Patil, Jyothsna

    2016-01-01

    Introduction Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. Aim Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. Materials and Methods Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. Results In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. Conclusion Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb. PMID:27190783

  17. Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

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    Özkan Safiye

    2011-04-01

    Full Text Available Abstract Background The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not. Methods A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion. Results In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively. Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p 0.05, respectively for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. Conclusions In this study, it was found that in patients with total

  18. 脊髓后根入髓区切开术治疗臂丛神经损伤后疼痛的疗效和并发症分析%Dorsal root entry zone incision for pain induced by brachial plexus injury: an analysis of curative effect and complications

    Institute of Scientific and Technical Information of China (English)

    郑喆; 胡永生; 陶蔚; 张晓华; 李勇杰

    2010-01-01

    目的 评价脊髓后根入髓区(dorsal root entry zone,DREZ)切开术治疗臂丛神经损伤后疼痛的有效性及安全性. 方法 队列研究2005年7月-2007年12月因臂丛神经损伤后疼痛行DREZ切开术治疗的患者41例,其中19例截肢并存在幻肢觉.由1名专人随访患者术后的口述疼痛缓解率和并发症,口述疼痛缓解率≥50%认为疼痛缓解良好. 结果 41例患者术后2周、3个月、6个月和最后随访时(1年6个月)疼痛缓解良好的患者比率分别为90%(37/41)、81%(30/37)、77%(24/31)和70%(16/23).疼痛病程≥10年的16例患者最后随访时15例疼痛缓解良好,而痛病程<10年的25例患者最后随访时16例疼痛缓解良好(x2=4.682,P=0.030).随访3个月以上幻肢觉有变化的7例患者全部疼痛缓解良好,幻肢觉无变化的9例患者只有4例疼痛缓解良好.随访3个月以上的37例患者中严重并发症3例,其中同侧下肢轻度力弱1例,同侧下肢深感觉严重障碍2例. 结论 DREZ切开术治疗臂丛神经损伤后疼痛安全有效,疼痛病程长和术后幻肢觉变化可能预示手术疗效良好.%Objective To evaluate the efficacy and safety of dorsal root entry zone (DREZ) incision for pain induced by brachial plexus injury. Methods A cohort study was performed in 41 consecutive patients with pain induced by brachial plexus injury treated with DREZ incision from July 2005 to December 2007. Of all, 19 patients were amputated and had phantom limb sensation. Oral pain relief (0%-100%) and complications were followed up by one professional doctor. Oral pain relief rate ≥50% was considered satisfactory outcome. Results The proportion of patients with satisfactory pain relief was 90% (37/41), 81% (30/37), 77% (24/31) and 70% (16/23) at 2 weeks, 3 months, 6 months and last follow-up (over one year) after surgery. At last follow-up, 15 out of 16 patients with over 10 years of pain duration got satisfactory pain relief; while only 16 out of 25

  19. 臂神经丛联合阻滞的应用%Application of combined brachial plexus block

    Institute of Scientific and Technical Information of China (English)

    曾玲双

    2011-01-01

    Objective To summarize the experience of applying combined brachial plexus block with four point injection and to guide the proper use of nerve stimulator. Methods The clinical data of 356 patients treated with brachial plexus block were retrospectively analyzed. The patients in study group ( n= 148) were received combined brachial plexus block including interscalene block, axillary block and intercostobrachial nerve block simultaneously. The patients in control group ( n= 208 ) only received interscalene block ( n= 176) or axillary block (n =32). Results Significant differences in anesthesia effect and puncture paresthesia were observed between the two groups. The excellent anesthesia effect in study group was 97.3% while that in control group was 87.0%. Puncture paresthesia was existed in 47.3% of study group and 69.7% of control group. Conclusion The success rate of brachial plexus block can be improved by employing combined brachial plexus block with four point injection.%目的 总结"四针法"臂丛神经联合阻滞的经验,指导神经刺激仪的合理应用.方法 回顾性分析臂神经丛阻滞356例,根据阻滞方法分为联合组(n=148),联合组同时实施肌间沟阻滞加腋路阻滞加肋间臂神经阻滞;传统组(n=208),传统组只实施肌间沟阻滞(n=176),或腋路阻滞(n=32),不行肋间臂神经阻滞.结果 联合组麻醉效果优占97.3%,穿刺异感占47.3%;传统组优占87.0%,穿刺异感占69.7%.联合组与传统组比较,具有显著差异(P<0.01).结论 "四针法"臂神经丛联合阻滞可提高臂神经丛阻滞的成功率.

  20. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

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    Chagas-Neto, Francisco Abaete [Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil). Divisao de Radiologia; Dalto, Vitor Faeda, E-mail: fdalto@gmail.com [Universidade de Sao Paulo (FMRP/USP), Ribeirao, Preto, SP (Brazil). Faculdade de Medicina. Divisao de Radiologia; Crema, Michel Daoud [Department of Radiology, Quantitative Imaging Center, University School of Medicine, Boston, MA (United States); Waters, Peter M. [Orthopedic Center, Boston Children' s Hospital, Harvard Medical School, Boston, MA (United States); Gregio-Junior, Everaldo [Uniao Medica Radiologica Catanduva (UMERC), Catanduva, SP (Brazil); Mazzer, Nilton; Nogueira-Barbosa, Marcello Henrique [Universidade de Sao Paulo (FM/USP), Ribeirao, Preto, SP (Brazil). Faculdade de Medicina

    2016-05-15

    Objective: to assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and methods: we conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: the mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6°, versus +1.6° for the normal, contralateral limbs. Conclusion: the main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head. (author)

  1. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy*

    Science.gov (United States)

    Chagas-Neto, Francisco Abaete; Dalto, Vitor Faeda; Crema, Michel Daoud; Waters, Peter M.; Gregio-Junior, Everaldo; Mazzer, Nilton; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    Objective To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head. PMID:27403013

  2. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks

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    Ping, Yongmei; Ye, Qigang; Wang, Wenwei; Ye, Pingke; You, Zhibin

    2017-01-01

    Abstract Background: Brachial plexus block (BPB) for upper extremity surgery provides superior analgesia, but this advantage is limited by the pharmacological duration of local anesthetics. Dexmedetomidine (DEX) as a local anesthetics adjuvant for BPB has been utilized to prolong the duration of the nerve block in some randomized controlled trials (RCTs) but is far from unanimous in the efficacy and safety of the perineural route. Hence, an updated meta-analysis was conducted to assess the efficacy and safety of DEX as local anesthetic adjuvants on BPB. Methods: A search in electronic databases was conducted to collect the RCTs that investigated the impact of adding DEX to local anesthetics for BPB. Sensory block duration, motor block duration, onset time of sensory and motor block, time to first analgesic request, the common adverse effects were analyzed. Results: Eighteen trails (1014 patients) were included with 515 patients receiving perineural DEX. The addition of DEX prolonged the duration of sensory block (WMD 257 minutes, 95%CI 191.79–322.24, P administration of DEX. PMID:28121930

  3. THE EFFECT OF CLONIDINE ON LIDOCAINE INDUCED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Shrinivas

    2014-08-01

    Full Text Available BACKGROUND: Brachial plexus nerve blocks (BPB are the most common nerve blocks used for upper limb surgeries. Techniques using only Local Anaesthetics (LA have limited duration of post-operative analgesia. Clonidine has been used to prolong the duration of LA s for neuraxial blocks. Hence the effect of clonidine on Lidocaine induced BPB was studied. METHODS: 60 patients of American Society of Anesthesiologists (ASA class I and II were randomly divided into 2 groups. Group L given 30 ml of Lidocaine with adrenaline 1.5% with 0.6 ml of normal saline and the Group C given 30 ml of same LA with 0.6 ml of 90mcg of Clonidine. All the patients’ supraclavicular BPB was given using Winnies’ peri-vascular approach. The primary outcome was onset, duration of sensory and motor blockade. The secondary outcomes were motor block duration, opioid supplementation, and BPB complication. RESULTS: There was no statistically significant difference in the onset of sensory and motor block, motor blockade quality and overall quality of block. Duration of sensory and motor blockade was prolonged in groups with Clonidine. No adverse events / hemodynamic instability noted in either group. Sedation scores were higher in Clonidine group. No patients required any intervention. CONCLUSIONS: 90µg Clonidine added to Lidocaine 1.5% with adrenaline produces prolongation of both the duration of sensory and motor blockade with minimal adverse effects.

  4. [A case of brachial plexus neuropathy who presented with acute paralysis of the hand after sleep].

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    Iijima, Makiko; Okuma, Yasuyuki; Ohizumi, Hideki; Fujishima, Kenji; Goto, Keigo; Mizuno, Yoshikuni

    2002-09-01

    We report a 46-year-old woman who presented with acute paresis of the right hand and arm. She was well until when she noted a paresis and dysesthesia in her right hand in the morning. Neurological examination revealed weakness in the muscles which were supplied by lower cervical segments, with increased deep tendon reflexes in the right arm. Allen's test and Wright's test were positive. The nerve conduction studies disclosed a reduced CMAPs more severely by right median than ulnar nerve stimulation. The frequency and amplitude of the F waves was also reduced. Needle electromyogram showed a mild neurogenic pattern in the right hand muscles. Digital subtraction angiography revealed a tapering of the subclavian artery when the right arm was abducted. She underwent decompression surgery. A remarkable improvement of the symptoms was observed after surgery. Our patient suggests that brachial plexus neuropathy should be considered in the acute paresis of the hand after sleep, and that surgical procedure would lead to a successful outcome.

  5. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

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    Francisco Abaete Chagas-Neto

    2016-06-01

    Full Text Available Abstract Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP, in comparison with those obtained for healthy shoulders. Materials and Methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

  6. 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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    C López

    2010-01-01

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

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

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    Basta Ivana

    2014-01-01

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

  8. Traumatic plexus lesion.

    NARCIS (Netherlands)

    Dongen, R.T.M. van; Cohen, S.P.; Kleef, M. van; Mekhail, N.; Huygen, F.

    2011-01-01

    Pain, motor, and sensory deficits characterize patients with a traumatic lesion of the brachial plexus. Frequently, more severe injuries co-exist that require immediate surgical attention. Early rehabilitation and physical therapy are the cornerstones of treatment. Pharmacological management can be

  9. Effect of Acupuncture Signal after Brachial Plexus Blockade on Cerebral Blood Perfusion and Brain Cell Function

    Institute of Scientific and Technical Information of China (English)

    任永功; 郭长春; 贾少微

    2003-01-01

    Objective: Using single photon emission computed tomography (SPECT) to observe the influence of the up-transmitting of acupuncture signal into the brain in health volunteers whose nerve trunk was blocked by anesthetics. Methods: Thirty-one healthy volunteers were divided into two groups, the control group of 20 cases, and the brachial plexus blockade (BPB) group of 11 cases, with supraclavicular BPB route adopted. With the control group 2 acupoints were randomly selected (Hegu and Quchi of both sides), while with the BPB group Hegu and Quchi of anesthetic arm side were selected. Siemens ECAM/ICON SPECT system was used to conduct brain imaging using double imaging assay before acupuncture and 99mTc-ECD imaging agent during acupuncture for cerebral perfusion. The data were quantitatively analyzed by blood functional changing rate (BFCR%) mathematics model. Results: Before acupuncture, the control and BPB groups showed insignificant change by SPECT, but after electro-acupuncture (EA), the control group displayed improved motor and sensory cortex excitability in basal nuclei, contra-lateral thalamus, parietal and frontal lobe; while BPB group was characterized with reduction of the blood perfusion and cell function of contra-lateral thalamus of anesthetized arm. The difference between the two groups was significant (P<0.01). Conclusion: (1) After BPB, the up-transmitting of the acupuncture signal via upper limb into the brain, and its strength was impaired or blocked; (2) After BPB, the effect of acupuncture on cerebral perfusion and brain cell function of contra-lateral thalamus was impaired or blocked.

  10. An Anatomically Validated Brachial Plexus Contouring Method for Intensity Modulated Radiation Therapy Planning

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    Van de Velde, Joris, E-mail: joris.vandevelde@ugent.be [Department of Anatomy, Ghent University, Ghent (Belgium); Department of Radiotherapy, Ghent University, Ghent (Belgium); Audenaert, Emmanuel [Department of Physical Medicine and Orthopedic Surgery, Ghent University, Ghent (Belgium); Speleers, Bruno; Vercauteren, Tom; Mulliez, Thomas [Department of Radiotherapy, Ghent University, Ghent (Belgium); Vandemaele, Pieter; Achten, Eric [Department of Radiology, Ghent University, Ghent (Belgium); Kerckaert, Ingrid; D' Herde, Katharina [Department of Anatomy, Ghent University, Ghent (Belgium); De Neve, Wilfried [Department of Radiotherapy, Ghent University, Ghent (Belgium); Van Hoof, Tom [Department of Anatomy, Ghent University, Ghent (Belgium)

    2013-11-15

    Purpose: To develop contouring guidelines for the brachial plexus (BP) using anatomically validated cadaver datasets. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to obtain detailed visualizations of the BP region, with the goal of achieving maximal inclusion of the actual BP in a small contoured volume while also accommodating for anatomic variations. Methods and Materials: CT and MRI were obtained for 8 cadavers positioned for intensity modulated radiation therapy. 3-dimensional reconstructions of soft tissue (from MRI) and bone (from CT) were combined to create 8 separate enhanced CT project files. Dissection of the corresponding cadavers anatomically validated the reconstructions created. Seven enhanced CT project files were then automatically fitted, separately in different regions, to obtain a single dataset of superimposed BP regions that incorporated anatomic variations. From this dataset, improved BP contouring guidelines were developed. These guidelines were then applied to the 7 original CT project files and also to 1 additional file, left out from the superimposing procedure. The percentage of BP inclusion was compared with the published guidelines. Results: The anatomic validation procedure showed a high level of conformity for the BP regions examined between the 3-dimensional reconstructions generated and the dissected counterparts. Accurate and detailed BP contouring guidelines were developed, which provided corresponding guidance for each level in a clinical dataset. An average margin of 4.7 mm around the anatomically validated BP contour is sufficient to accommodate for anatomic variations. Using the new guidelines, 100% inclusion of the BP was achieved, compared with a mean inclusion of 37.75% when published guidelines were applied. Conclusion: Improved guidelines for BP delineation were developed using combined MRI and CT imaging with validation by anatomic dissection.

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

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    Manoel Baldoíno Leal Filho

    2004-03-01

    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.

  12. Clinical outcome of shoulder muscle transfer for shoulder deformities in obstetric brachial plexus palsy: A study of 150 cases

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    Mukund R Thatte

    2011-01-01

    Full Text Available Background: Residual muscle weakness, cross-innervation (caused by misdirected regenerating axons, and muscular imbalance are the main causes of internal rotation contractures leading to limitation of shoulder joint movement, glenoid dysplasia, and deformity in obstetric brachial plexus palsy. Muscle transfers and release of antagonistic muscles improve range of motion as well as halt or reverse the deterioration in the bony architecture of the shoulder joint. The aim of our study was to evaluate the clinical outcome of shoulder muscle transfer for shoulder abnormalities in obstetric brachial plexus palsy. Materials and Methods: One hundred and fifty patients of obstetric brachial plexus palsy with shoulder deformity underwent shoulder muscle transfer along with anterior shoulder release at our institutions from 1999 to 2007. Shoulder function was assessed both preoperatively and postoperatively using aggregate modified Mallet score and active and passive range of motion. The mean duration of follow-up was 4 years (2.5-8 years. Results: The mean preoperative abduction was 45° ± 7.12, mean passive external rotation was 10° ± 6.79, the mean active external rotation was 0°, and the mean aggregate modified Mallet score was 11.2 ± 1.41. At a mean follow-up of 4 years (2.5-8 years, the mean active abduction was 120° ± 18.01, the mean passive external rotation was 80° ± 10.26, while the mean active external rotation was 45° ± 3.84. The mean aggregate modified Mallet score was 19.2 ± 1.66. Conclusions: This procedure can thus be seen as a very effective tool to treat internal rotation and adduction contractures, achieve functional active abduction and external rotation, as well as possibly prevent glenohumeral dysplasia, though the long-term effects of this procedure may still have to be studied in detail clinico-radiologically to confirm this hypothesis. Level of evidence: Therapeutic level IV

  13. Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial

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    Chakraborty Susmita

    2010-01-01

    Full Text Available Objective: Clonidine has been used as adjuvant to local anesthetics in order to extend the duration of analgesia in various regional and central neuraxial blocks. It is previously reported that clonidine added to bupivacaine increases analgesia duration in brachial plexus block. We evaluated the effect of this combination in supraclavicular brachial plexus block for upper limb orthopedic procedures. Materials and Methods: A randomized double-blind placebo controlled trial was done with 70 patients of American Society of Anesthesiologists Grade I or II status undergoing upper limb orthopedic procedures. Group A (n = 35 patients received 25 ml of 0.5% bupivacaine and 0.2 ml (30 mcg clonidine, whereas group B (n = 35 received 25 ml of 0.5% bupivacaine and 0.2 ml normal saline through a supraclavicular approach for brachial plexus block. Vital parameters were recorded 10 min prior to block placement and every 3 min thereafter till the end of the procedure. Onset and duration of both sensory and motor blocks and sedation score were recorded. All patients were observed in postanesthesia care unit and received tramadol injection as soon as they complained of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till injection of rescue analgesic. Results: Analgesia duration was 415.4 ± 38.18 min (mean ± standard deviation in Group A (clonidine compared to 194.2 ± 28.74 min in Group B (control. No clinically significant difference was observed in heart rate, blood pressure, and oxygen saturation. Sedation score was higher in the clonidine group. Conclusion: Addition of a small dose of clonidine to 0.5% bupivacaine significantly prolonged the duration of analgesia without producing any clinically important adverse reactions other than sedation.

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

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    Gregorio Rodríguez Boto

    2011-10-01

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

  15. Aberrant Dual Origin of the Dorsal Scapular Nerve and Its Communication with Long Thoracic Nerve: An Unusual Variation of the Brachial Plexus.

    Science.gov (United States)

    Shilal, Poonam; Sarda, Rohit Kumar; Chhetri, Kalpana; Lama, Polly; Tamang, Binod Kumar

    2015-06-01

    Pre and post-fixed variations at roots of the brachial plexus have been well documented, however little is known about the variations that exist in the branches which arise from the brachial plexus. In this paper, we describe about one such rare variation related to the dorsal scapular and the long thoracic nerve, which are the branches arising from the roots of the brachial plexus. The variation was found during routine dissection. The dorsal scapular nerve, which routinely arises from the fifth cervical nerve root (C5), was seen to receive contributions from C5 as well as sixth cervical nerve (C6), while the long thoracic nerve arose from C6 and seventh cervical nerves (C7) only. Furthermore along with variations in origin of the dorsal scapular and long thoracic nerves, the brachial plexus was seen to exist as a prefixed plexus receiving a contribution from C4 nerve root. An aberrant communicating branch between the dorsal scapular and long thoracic nerve was also identified. Knowledge about the course and anatomy of such variations can be vital for understanding the aetiology of various conditions such as winging of scapula, interscapular pain, administration of cervical nerve blocks, surgeries and for effective management of regions and muscles supplied by dorsal scapular and long thoracic nerve.

  16. EFFECT OF BUPRENORPHINE ON POST OPERATIVE ANALGESI A IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK USING PERIPHE RAL NERVE LOCATOR

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    Ritesh

    2013-01-01

    Full Text Available ABSTRACT : Supraclavicular brachial plexus block is known for its simplicity, effectiveness, safety, reliability and being economical for day ca re and emergency surgery, circumventing problems of full stomach. In our randomized prospective, double blind study, t otal 60 adult ASA class I and II patients undergoing upper limb surgeri es were given supraclavicular brachial plexus block with peripheral nerve locator and studied for effect of addition of buprenorphine on post operative analgesia. 30 Patients received 0.2 5% bupivacaine 40 ml in group Bupivacaine (B and added buprenorphine 3 μgm/kg in th e other group Bupivacaine + Buprenorphine (BB. All the patients were monitored fo r onset of effect, post op analgesia, time of first analgesic drug and number of analgesic dru g require in first 24 hrs. Onset and duration of motor and sensory block were same in both groups. Post operative analgesia was significantly better in BB. Consequently, number of doses of analgesic required in first 24 hours was less in buprenorphine group (BB.

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

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    Kamal Achôa Filho

    2014-09-01

    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.

  18. Low-concentration, continuous brachial plexus block in the management of Purple Glove Syndrome: a case report

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    Cherian Verghese T

    2010-02-01

    Full Text Available Abstract Introduction Purple Glove Syndrome is a devastating complication of intravenous phenytoin administration. Adequate analgesia and preservation of limb movement for physiotherapy are the two essential components of management. Case presentation A 26-year-old Tamil woman from India developed Purple Glove Syndrome after intravenous administration of phenytoin. She was managed conservatively by limb elevation, physiotherapy and oral antibiotics. A 20G intravenous cannula was inserted into the sheath of her brachial plexus and a continuous infusion of bupivacaine at a low concentration (0.1% with fentanyl (2 μg/ml at a rate of 1 to 2 ml/hr was given. She had adequate analgesia with preserved motor function which helped in physiotherapy and functional recovery of the hand in a month. Conclusion A continuous blockade of the brachial plexus with a low concentration of bupivacaine and fentanyl helps to alleviate the vasospasm and the pain while preserving the motor function for the patient to perform active movements of the finger and hand.

  19. A modeling approach to compute modification of net joint forces caused by coping movements in obstetric brachial plexus palsy

    Science.gov (United States)

    2013-01-01

    Background Many disorders of the musculoskeletal system are caused by modified net joint forces resulting from individual coping movement strategies of patients suffering from neuromuscular diseases. Purpose of this work is to introduce a personalized biomechanical model which allows the calculation of individual net joint forces via inverse dynamics based on anthropometry and kinematics of the upper extremity measured by 3D optoelectronical motion analysis. Methods The determined resulting net joint forces in the anatomical axis of movement may be used to explain the reason for possible malfunction of the musculoskeletal system, especially joint malformation. For example the resulting net joint forces in the humerothoracic joint from simulations are compared to a sample of children presenting obstetric brachial plexus palsy showing an internal shoulder rotation position and a sample of healthy children. Results The results presented from the simulation show that an increased internal shoulder rotation position leads to increased net joint forces in the humerothoracic joint. A similar behavior is presented for the subjects suffering from brachial plexus palsy with an internal shoulder rotation position. Conclusions The increased net joint forces are a possible reason for joint malformation in the humerothoracic joint caused by coping movements resulting from neuromuscular dysfunction as stated in literature. PMID:24139445

  20. Role of ultrasound-guided continuous brachial plexus block in the management of neonatal ischemia in upper limb

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    Vrushali C Ponde

    2012-01-01

    Full Text Available Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of ultrasound guidance in this particular case scenario. A 1.1 kg infant suffered from distal forearm ischemia due to accidental arterial damage, which was treated with brachial plexus block. An ultrasound-guided single shot block with 0.5 mL/kg of 0.25% bupivacaine was followed by ultrasound-guided catheter placement in the target area. A continuous infusion of 0.03% of bupivacaine at the rate of 0.5 mL/kg/hr (approx. 0.15 mg/kg/h of bupivacaine was administered for 36 h. This treatment resulted in reversal of ischemia. Permanent ischemic damage was eventually confined to the tips of 4 fingers. We conclude that ultrasound-guided continuous infraclavicular block has a therapeutic role to play in the treatment of hand ischemia due to arterial damage and subsequent arterial spasm in neonates with added benefits.

  1. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

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    Velde, Joris van de [Ghent University, Department of Anatomy, Ghent (Belgium); Ghent University, Department of Radiotherapy, Ghent (Belgium); Vercauteren, Tom; Gersem, Werner de; Vandecasteele, Katrien; Vuye, Philippe; Vanpachtenbeke, Frank; Neve, Wilfried de [Ghent University, Department of Radiotherapy, Ghent (Belgium); Wouters, Johan; Herde, Katharina d' ; Kerckaert, Ingrid; Hoof, Tom van [Ghent University, Department of Anatomy, Ghent (Belgium)

    2014-07-15

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.) [German] Ziel der Studie war

  2. 早期神经移位治疗臂丛颈5-7根性损伤的长期疗效观察%Long-term efficacy of nerves transfer early for treating the C5-7 root injury of the brachial plexus

    Institute of Scientific and Technical Information of China (English)

    徐房添; 徐芳; 赖光松; 高辉; 姬广林; 杨千绮

    2015-01-01

    Objective To evaluate the long-term results of reconstructing shoulder abduction by transfering nerve early for treating the C5-7 root injury of brachial plexus. Methods Eleven patients with the complete C5-7 root injury were surgically treated to reconstruct shoulder abduction function with the double nerve transfer. The accessory nerve was transferred to the suprascapular nerve,the nerve branch to the long head of triceps muscle from radial nerve to the deltoid branch of axillary nerve. The electrophysiological technique was carried out before and during operation in order to improve the accuracy and feasibility of procedures. Results All patients were followed up from 37months to 96 months (67.8 months on average). The shoulder function was rated as excellent in 9 cases,as good in 7 cases and the recovery results of shoulder abduction,superduction and external ro-tation are satisfied. There was the regenerative potential in deltoid and the supraspinatus and the infraspinatus of 6 patients 3 months after operation. Conclusion The double nerve transfer in reconstructing shoulder abduction is more effective and reason-able after diagnosed as the C5-7 root injury,Which has improved the efficiency of shoulder abduction reconstruction.%目的 分析早期移位桡神经三头肌肌支及副神经治疗臂丛颈5-7根性损伤中重建肩外展功能的长期疗效.方法 臂丛颈5-7根性损伤11例,确诊后早期即施行神经移位术:桡神经肱三头肌长头支移位至腋神经的三角肌支、副神经移位至肩胛上神经,施行双重移位,同时重建冈上下肌与三角肌的功能.术中运用电生理技术,增加手术的准确性和合理性.并进行了平均67.8个月的长期随访,按结果分析疗效.结果 优9例,良2例,肩外展功能恢复满意.6例在术后约3个月冈上下肌、三角肌电生理检查即可检出再生电位.结论 臂丛颈5-7根性损伤确诊后,早期行副神经及肱三头肌肌支双重移位是重建

  3. Effect of dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A randomized double-blind prospective study

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    Haramritpal Kaur

    2015-01-01

    Full Text Available Background and Aims: Regional anesthesia is a recommended technique for upper and lower limb surgeries with better postoperative profile. In this, randomized, double-blind study, we evaluated the effectiveness of the addition of dexmedetomidine to varying concentration of levobupivacaine for supra clavicular brachial plexus block. Material and Methods: After obtaining ethical Committee approval, a double-blind, randomized prospective clinical study was conducted on 90 American Society of Anesthesiologist Grade I and II patients in the age group of 18-55 years, divided randomly into two groups: Group A received 40 ml of solution containing 30 ml 0.5% levobupivacaine and 10 ml 1% lignocaine and group B received 40 ml of solution containing 30 ml 0.25% levobupivacaine and 10 ml 1% lignocaine with dexmedetomidine 1 microg/kg for supraclavicular brachial plexus block. Besides effectiveness, other parameters observed were: duration of sensory blockade; onset and duration of motor blockade; duration of postoperative analgesia; and patient satisfaction score. Results: Onset of sensory and motor blockade was 7.6 ± 1.006 min and 8.3 ± 0.877 min in group A, while it was 6.96 ± 1.077 min an 7.6 ± 1.1 min in group B, respectively. The difference was statistically significant (P 0.05. Duration of motor block was 8.45 ± 0.75 h in group A and 5.6 ± 0.98 in group B (P < 0.05. Duration of analgesia was 8.5 ± 0.77 h in group A and 9.2 ± 1.05 in group B (P < 0.05. Conclusion: Addition of 1 microg/kg dexmedetomidine to 0.25% levobupivacaine for supraclaviclar plexus block shortens sensory, motor block onset time and motor block durations, extends sensory block, and analgesia durations. Reduction in total levobupivacaine dose also increases the safety margin of the block.

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

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    Gessica Ariane M Cruz

    2010-10-01

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

  5. Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk Animal experiments and clinical application

    Institute of Scientific and Technical Information of China (English)

    Lin Zou; Xuecheng Cao; Jing Li; Lifeng Liu; Pingshan Wang; Jinfang Cai

    2012-01-01

    Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications,39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III. Results showed that the improved C3-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

  6. DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANTS TO LEVOBUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A COMPARATIVE RANDOMISED PROSPECTIVE CONTROLLED STUDY

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    Karthik

    2015-03-01

    Full Text Available BACKGROUND: There are always efforts to find better and safer local anaesthetics along with adjuvants for supraclavicular brachial plexus block. Levobupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. Alpha 2 agonists are combined with local anaesthetics to improve the quality of regional anesthesia. AIMS AND OBJECTIVES: This study was conducted to evaluate and compare the onset, duration of sensory and motor blockade along with the duration of analges ia between dexmedetomidine and clonidine when administered along with 0.5% levobupivacaine in supraclavicular brachial plexus block for upper limb orthopaedic surgeries. MATERIALS AND METHODS: A prospective randomized study was carried out in the departmen t of Anaesthesia at Rajarajeswari Medical College and Hospital which included 50 adult patients between the ages of 20 and 50 years (of ASA I/II grade who underwent upper limb orthopaedic surgeries. The patients were randomly allocated into two groups; le vobupivacaine + dexmedetomidine (LD and levobupivacaine + clonidine (LC, comprising of 25 patients each. Group LD was administered 30 ml of 0.5% levobupivacaine and 1μg/kg of dexmedetomidine, while group LC received admixture of 30 ml of 0.5% levobupivac aine and 1 μg/kg of Clonidine. Onset, duration of sensory and motor blockade and duration of analgesia were observed. STATISTICAL ANALYSIS: Statistical analysis was done using student t test, chi - square test and Fisher Exact test. The Statistical Software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Sysatat 12.0 and R environment ver.2.11.1 were also used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. The value of P <0.05 was considered significant and P < 0.001 as highly significant. RESULTS: The onset of sensory and motor blockade was faster in Group LD when compared to Group LC. The duration of sensory

  7. Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus:A rare injury

    Institute of Scientific and Technical Information of China (English)

    Kumar Vishal; R.H.H.Arjun; Aggarwal Sameer; John Rakesh; Kishan Rama

    2015-01-01

    Complications following supracondylar fracture of humerus are well-known.Pre-and post-operative complications have been documented in the literature.Neurovascular injury due to fracture fragments following this type of fracture is described,Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature.So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.

  8. COMPARATIVE CLINICAL EVALUATION OF 0.5% ROPIVACAINE AND 0.5% BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK VIA SUPRACLAVICULAR APPROACH FOR UPPER LIMB SURGERIES.

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    Surendra

    2013-11-01

    Full Text Available ABSTRACT: Ropivacaine, a local anesthetic agent with similar pharmacological profile to that of bupivacaine has lower potential for toxic effect. The aim of our study is to compare the anesthetic characteristics of ropivacaine and bupivacaine when used for supraclavicular brachial plexus blockade in upper limb surgeries. Fifty patients was grouped equally and one group R received 0.5% ropivacaine (100mg 20ml and another group B received 0.5% bupivacaine (100mg 20ml. onset & durat ion of sensory and motor blockade, duration of analgesia and associated complications & side effects were recorded. It was found that there were no significant differences in duration of sensory & motor blockade, in complications or any other side effects in both the groups. But ropivacaine provided rapid onset of action and better quality of surgical anesthesia than bupivacaine when used in supraclavicular brachial plexus blockade.

  9. Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults

    Institute of Scientific and Technical Information of China (English)

    YUAN Jia-min; YANG Xiao-hu; FU Shu-kun; YUAN Chao-qun; CHEN Kai; LI Jia-yi; LI Quan

    2012-01-01

    Background The use of traditional techniques (such as landmark techniques,paresthesia and peripheral nerve stimulator) for upper-limb anesthesia has often been restricted to the expert or enthusiast,which was blind.Recently,ultrasound (US) has been applied to differ blood vessel,pleura and nerve,thus may reduce the risk of complications while have a high rate of success.The aim of this study was to determine if the use of ultrasound guidance (vs.peripheral nerve stimulator,(PNS)) decreases risk of vascular puncture,risk of hemi-diaphragmatic paresis and risk of Horner syndrome and improves the success rate of nerve block.Methods A search strategy was developed to identify randomized control trials (RCTs) reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks (brachial plexus) in adults available through PubMed databases,the Cochrane Central Register of Controlled Trials,Embase databases,SinoMed databases and Wanfang data (date up to 2011-12-20).Two independent reviewers appraised eligible studies and extracted data.Risk ratios (OR)were calculated for each outcome and presented with 95% confidence intervals (CI) with the software of ReviewManager 5.1.0 System (Cochrane Library).Results Sixteen trials involving 1321 adults met our criteria were included for analysis.Blocks performed using US guidance were more likely to be successful (risk ratio (RR) for block success 0.36,95% CI 0.23-0.56,P <0.00001),decreased incidence of vascular puncture during block performance (RR 0.13,95% CI 0.06-0.27,P <0.00001),decreased the risk of complete hemi-diaphragmatic paresis (RR 0.09,95% CI 0.03-0.52,,P=0.0001).Conclusions US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization.Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.

  10. COMPARISON OF BUTORPHANOL AND BUPRENORPHINE AS AN ADJUVANT TO LOCAL ANAESTHESIA IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR POST-OPERATIVE ANALGESIA

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    Vinod

    2014-04-01

    Full Text Available BACKGROUND: Supraclavicular brachial plexus block provides anesthesia for surgeries around elbow, forearm and hand. With advent of opioid receptors, variety of opioid agents is used for postoperative analgesia via brachial plexus block. Butorphanol and Buprenorphine can be used along with local anesthetics to provide post op analgesia. AIMS: 1 To study the onset and extent of sensory and motor blockade. 2 To compare the duration of postoperative analgesia in two groups. METHODOLOGY: A study was carried out in 30 patients aged 18-60yr of ASA grade I & II of either sex in each group undergoing orthopedic upper limb surgeries via supraclavicular brachial plexus block. Injection Butorphanol 1mg (Group-I and Buprenorphine150µg (Group-II were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade and occurrence of any complications were studied in both the groups. All patients were observed for analgesia hourly until patient demanded analgesia post-operatively by VAS pain score. RESULTS: In Group II (Buprenorphine onset of sensory, motor blockade and complete blockade was delayed as compared to Group I (Butorphanol. In Group I patients, VAS score was 39.44  16.66 at the end of 5 hours while in Group II patients 50.35  25.65 VAS score at the end of 8 hours. So the duration of analgesia was upto 5-6 hours in Group I, where it was upto 8-9 hours in Group II. CONCLUSION: Both drugs are potent analgesic in brachial plexus block, but Buprenorphine is more potent and produces longer duration of postoperative analgesia than Butorphanol.

  11. Effect of ketamine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: A double-blind randomized clinical trial study

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    Mohammadreza Lashgarinia

    2014-01-01

    Full Text Available Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. Ketamine has been reported to enhance the analgesic effects of local anesthetics. We have conducted this study to assess whether coadministration of ketamine can prolong the local analgesic effect of lidocaine in the supraclavicular brachial plexus block for patients undergoing elective upper extremity surgery. Materials and Methods: Sixty adult patients undergoing elective surgery of the elbow, forearm, wrist or hand were randomly allocated in two groups of 30 patients each. Group 1 (ketamine group received 5 mg/kg lidocaine 1.5% plus 2 mg/kg ketamine, Group 2 (control group received 5 mg/kg lidocaine 1.5% and saline. The outcome measures included severity of pain by using visual analog scale (VAS, 0 = no pain 10 cm = the most severe pain, time of first request for analgesia, and total dose of postoperative opioid administration. The data was analyzed using the χ2 test, student′s t-test, Kaplan-Meier survival analysis, and Multivariate analysis tests. Results: Patients in the control group had a higher VAS than patients who received ketamine, at all time points during the first 24 hours after surgery (all P < 0.05. The time of first request for analgesia in the ketamine group was significantly more than in the control group (8.93 ± 1.0 vs. 7.30 ± 1.9, respectively, P < 0.001. Conclusion: The addition of ketamine to lidocaine in the ultrasound-guided brachial plexus block could decrease the postoperative pain and need for analgesic. Therefore, it could be considered as an option in the brachial plexus block to enhance the analgesic action of lidocaine.

  12. 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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    Marcos R.G. de Freitas

    2006-12-01

    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.

  13. [Current concepts in perinatal brachial plexus palsy. Part 2: late phase. Shoulder deformities].

    Science.gov (United States)

    Dogliotti, Andrés Alejandro

    2011-10-01

    The incidence of obstetric brachial palsy is high and their sequelaes are frequent. Physiotherapy, microsurgical nerve reconstruction and secondary corrections are used together to improve the shoulder function. The most common posture is shoulder in internal rotation and adduction, because of the antagonist weakness. The muscle forces imbalance over the osteoarticular system, will result in a progressive glenohumeral joint deformity which can be recognized with a magnetic resonance image. Tendon transfers of the internal rotators towards the external abductor/rotator muscles, has good results, but has to be combined with antero-inferior soft-tissue releases, if passive range of motion is limited.

  14. Mobile technology: Creation and use of an iBook to teach the anatomy of the brachial plexus.

    Science.gov (United States)

    Stewart, Stuart; Choudhury, Bipasha

    2015-01-01

    In an era of digitally connected students, there is a demand for academic material to be delivered through electronic mobile devices and not just through traditional methods such as lectures and tutorials. A digital interactive book-iBook (for use on the Apple iPad)-was created to teach undergraduate anatomical science students (n = 26) four key areas of the brachial plexus: definitions, gross anatomy, relative anatomy, and functions of terminal branches. Students were asked to complete preresource and postresource questionnaires, which were used to calculate the mean improvement score and ultimately the efficacy of the resource. Free text comments were gathered to evaluate student opinions on this mode of learning. The mean score on the preresource and postresource questionnaires was 4.07 of 8 and 5.69 of 8, respectively. The overall mean improvement score was 1.62, determined statistically significant by a dependent t-test (P = 0.0004). Findings demonstrate that digital books on the iPad provide a uniquely interactive way of delivering information and engaging students. Furthermore, digital books can be used alongside traditional methods of teaching anatomy to enhance and promote deep learning in students.

  15. To determine block establishment time of supraclavicular brachial plexus block using blunt versus short bevel needle: A prospective randomized trial

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    V Ahuja

    2016-01-01

    Full Text Available Background: Unintentional intraneural injection under ultrasound guidance (USG with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB have been reported. Materials and Methods: We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30: SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30: SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects. Results: The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects. Conclusion: The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events.

  16. Surgical correction of ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy sequelae.

    Science.gov (United States)

    Bhardwaj, Praveen; Parekh, Harshil; Venkatramani, Hari; Raja Sabapathy, S

    2015-01-01

    Ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy is an important cosmetic concern among the patients and their relatives; especially in the patients who have recovered the basic limb functions. Though there is ample literature available regarding the management of the shoulder deformity there is paucity of literature regarding management of wrist ulnar deviation deformity. We report our experience with correction of this deformity in five cases with isolated ulnar deviation deformity without forearm rotational deformity or weakness of the wrist muscles. All the patients underwent extensor carpi ulnaris (ECU) to extensor carpi radialis longus (ECRL) tendon transfer. At a minimum of 18 months follow-up all the patients and their families were satisfied with the cosmetic appearance of the limb. Correction of the deformity improves the appearance of the limb, improves self-confidence of the child, and allows them to integrate well into the society. Interestingly, the patients expressed improvement in their grip strength and overall hand function after this surgery. The notable functions which improved were easy reach of the hand-to-mouth for feeding and easy handling of the things requiring bimanual activities. Although the main aim of this operation was to correct the appearance of the hand it was found to be also functionally useful by the patients and hence we are encouraged to report it for wider use. The results were maintained during the follow-up period of as long as 47 months.

  17. EFFICACY OF ADDING FENTANYL TO LIGNOCAINE – ADRENALINE COMBINATION IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB ORTHOPEDIC SURGERIES A MULTI - CENTER STUDY

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    Anish M

    2015-06-01

    Full Text Available BACKGROUND: Brachial plexus block is a suitable alternative to general anesthesia for surgeries of upper limb and it can be performed even in patients who are not adequately fit for general anesthesia. The significance of brachial plexus block has increased in recent years due to renewed interest in day care surgery. Lignocaine hydrochloride has been used extensively for brachial plexus block and it has the disadvantage of having short duration of action. Opioids when added to anesthetic mixtures may improve and prolo ng the action of local anesthetics during peripheral nerve blocks. Such postoperative pain control can reduce both narcotic requirements and narcotic induced side effects. Studies have shown the efficacy of opioids as analgesic adjuvants in prolonging the duration of brachial plexus block. With this background in mind, this study was conducted to compare the onset and duration of sensory and motor block produced by a mixture of lignocaine and adrenaline with that produced by a mixture of fentanyl, lignocain e and adrenaline. Aims: To assess the effectiveness of addition of fentanyl to a mixture of lignocaine and adrenaline in prolonging the duration of analgesia and motor block for upper limb orthopedic surgeries. MATERIALS AND METHODS: This multi - center rand omized control study was conducted in two tertiary care centers in 80 patients underwent elective upper limb orthopedic surgeries and they were allocated into two groups of 40 each group L and group F. the classical approach of supraclavicular brachial ple xus block. Drug used were 30 ml of lignocaine 1.5%+adrenaline 5mcg/ml + 0.5ml normal saline in group L and 30ml of lignocaine 1.5% + adrenaline 5mcg/ml + fentanyl 50 mcg in group F. Adequacy of block was assessed by the pin prick test and temperature test. Motor power was assessed by the modified Lowett scale. Sedation was monitored using the modified Ramsay scale. An assessment was made for onset of analgesia, onset of

  18. Surgical correction of unsuccessful derotational humeral osteotomy in obstetric brachial plexus palsy: Evidence of the significance of scapular deformity in the pathophysiology of the medial rotation contracture

    Directory of Open Access Journals (Sweden)

    Melcher Sonya E

    2006-12-01

    Full Text Available Abstract Background The current method of treatment for persistent internal rotation due to the medial rotation contracture in patients with obstetric brachial plexus injury is humeral derotational osteotomy. While this procedure places the arm in a more functional position, it does not attend to the abnormal glenohumeral joint. Poor positioning of the humeral head secondary to elevation and rotation of the scapula and elongated acromion impingement causes functional limitations which are not addressed by derotation of the humerus. Progressive dislocation, caused by the abnormal positioning and shape of the scapula and clavicle, needs to be treated more directly. Methods Four patients with Scapular Hypoplasia, Elevation And Rotation (SHEAR deformity who had undergone unsuccessful humeral osteotomies to treat internal rotation underwent acromion and clavicular osteotomy, ostectomy of the superomedial border of the scapula and posterior capsulorrhaphy in order to relieve the torsion developed in the acromio-clavicular triangle by persistent asymmetric muscle action and medial rotation contracture. Results Clinical examination shows significant improvement in the functional movement possible for these four children as assessed by the modified Mallet scoring, definitely improving on what was achieved by humeral osteotomy. Conclusion These results reveal the importance of recognizing the presence of scapular hypoplasia, elevation and rotation deformity before deciding on a treatment plan. The Triangle Tilt procedure aims to relieve the forces acting on the shoulder joint and improve the situation of the humeral head in the glenoid. Improvement in glenohumeral positioning should allow for better functional movements of the shoulder, which was seen in all four patients. These dramatic improvements were only possible once the glenohumeral deformity was directly addressed surgically.

  19. Buprenorphine for postoperative analgesia: Axillary brachial plexus block versus intramuscular administration in a placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Deepali Thakur

    2015-01-01

    Full Text Available Background and Aims: Peripheral administration of opioids has been suggested for prolongation of regional analgesia. This prospective, randomized, double-blind placebo-controlled study was undertaken to compare the effect of regional (axillary brachial plexus block [ABPB] versus intramuscular (IM buprenorphine (2 μg/kg in adults. Material and Methods: Seventy-five adults undergoing upper limb surgery received ABPB with local anaesthetic (15 ml 0.5% bupivacaine, 15 ml 2% lignocaine with adrenaline 1:200,000, 9 ml normal saline [NS]. In addition, regional group RB (n = 25 received buprenorphine 2 μg/kg in ABPB and 1 ml NS IM. Systemic Group SB (n = 25 received 1 ml NS in ABPB and buprenorphine 2 μg/kg IM. Group C (n = 25 received 1 ml NS in ABPB and IM. Onset, duration of sensory and motor block, hemodynamic parameters, sedation score, pain scores using visual analog scale, duration of postoperative analgesia, rescue analgesic (RA requirement, adverse events, and patient satisfaction were noted. Results: Demographics, onset and duration of sensory, motor block were similar. RB group had longest duration of analgesia (20.61 ± 1.33 h compared to SB (10.91 ± 0.90 h and control group (5.86 ± 0.57 h (P < 0.05 RB vs. SB/C and SB vs. C. RA requirement was highest in the control group and least in RB group (P = 0.000 RB vs. SB/C and SB vs. C. SB group had a maximum number of side effects (P = 0.041, SB vs. RB/C. Patient satisfaction was highest with group RB (P < 0.05 RB vs. SB/C, and P = 0.06 SB vs. C. Conclusion: Buprenorphine 2 μg/kg in axillary plexus block provides significantly prolonged analgesia with less RA requirement and greater patient satisfaction compared to IM administration. This is highly suggestive of action on peripheral opioid receptors.

  20. EFFECT OF ADDITION OF DEXMEDETOMIDINE TO ROPIVACAINE HYDROCHLORIDE (0.75% IN BRACHIAL PLEXUS BLOCK THROUGH SUPRACLAVICULAR ROUTE IN UPPER LIMB SURGERIES: A CLINICAL COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Neelesh

    2014-10-01

    Full Text Available Brachial plexus block is a popular and widely employed regional nerve block of upper extremity which avoids the unwanted effect of anesthetic drugs used during general anesthesia, there complication and the stress of laryngoscopy and tracheal intubation. Patients also have a post-operative period free from nausea, vomiting, cerebral depression and immediate post-operative pain. The brachial plexus via supraclavicular approach block provide safe, effective, low cost complete anesthesia or analgesia of the upper extremity and is carried out at the level of the distal trunks/divisions of the brachial plexus, where it is in its tightest formation thus allowing for rapid and completed anesthesia or analgesia of the upper limb. The present single Centre, prospective, randomized, double blind study was undertaken to compare the effects of Ropivacaine and Ropivacaine-Dexmedetomidine combination in brachial plexus block via supraclavicular route with respect to its onset, duration of action. A total of 60 patients of ASA grading I &II and age ranging 18-50 year of either sex underwent various elective upper limb surgeries were divided in two equal groups Group A (n=30: Received brachial plexus block with 30 ml Ropivacaine (0.75%. Group B (n=30: Received brachial plexus block with 29 ml Ropivacaine (0.75% + 1 ml Dexmedetomidine (50μg. After performing supraclavicular block the following observations were made: 1. Onset of sensory blockade. 2. Duration of sensory blockade. 3. Onset of motor blockade. 4. Duration of motor blockade. 5. Duration of analgesia. The onset and duration of sensory blockade was assessed by pin prick response on area of all four nerves of upper limbs. The onset and duration of motor blockade was assessed by Modified Bromage Scale. The onset and duration of analgesia was assessed by response to pin prick and time of first request of analgesic dose. The observations were as follow: - The average time of onset of sensory blockade was

  1. ORIGINAL ARTICLES Effect of Acupuncture Signal after Brachial Plexus Blockade on Cerebral Blood Perfusion and Brain Cell Function

    Institute of Scientific and Technical Information of China (English)

    RENYong-gong; JIAShao-wei

    2003-01-01

    Objective:Using single photon emission computed tomography (SPECT)to observe the influence of the up-transmitting of acupuncture signal into the brain in health volunteers whose nerve trunk was blocked by anesthetics.Methods:Thirty-one healthy volunteers were divided into two groups,the control group of 20 cases,and the brachial plexus blockade(BPB)group of 11cases,with supraclavicular BPB route adopted.With the control group 2 acupoints were randomly selected(Hegu and Quchi of both sides),while with the BPB group Hegu and Quchi of anesthetic arm side were selected.Siemens ECAM/ICON SPECT system was used to conduct brain imaging using double imaging assay before acupuncture and 99m Tc-ECD imaging agent during acupuncture for cerebral perfusion.The data were quantitatively ana-lyzed by blood functional changing rate (BFCR%) mathematics model.Results:Before acupuncture,the control and BPB groups showed insignificant change by SPECT, but after electro-acupuncture(EA),the control group displayed improved motor and sensory cortex excitability in basal nuclei,contra-lateral thal-amus,parietal and frontal lobe; while BPB group was characterized with reduction of the blood perfusion and cell function of contra-lateral thalamus of anesthetized arm.The difference between the two groups was significant(P<0.01).Conclusion:(1)After BPB,the up-transmitting of the acupuncture signal viaupper limb into the brain,and its strength was impaired or blocked; (2)After BPB, the effect of acupunc-ture on cerebral perfusion and brain cell function of contra-lateral thalamus was impaired or blocked.

  2. Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

    Directory of Open Access Journals (Sweden)

    Recep Aksu

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. METHODS: In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB were applied, while 20 mL 0.25% bupivacaine was given via intra-articular (IA administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA with morphine was used in all three groups for postoperative analgesia. RESULTS: In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24 h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6 h and the same was true for total morphine consumption in 24 h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2 h and lower than the control group in the 4th and 6th hours (p < 0.05. In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p < 0.05. CONCLUSION: Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

  3. Consideration of Dose Limits for Organs at Risk of Thoracic Radiotherapy: Atlas for Lung, Proximal Bronchial Tree, Esophagus, Spinal Cord, Ribs, and Brachial Plexus

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Feng-Ming, E-mail: fengkong@med.umich.edu [Department of Radiation Oncology, University of Michigan and Ann Arbor Veteran Affairs Medical System, Ann Arbor, MI (United States); Ritter, Timothy [Department of Radiation Oncology, University of Michigan and Ann Arbor Veteran Affairs Medical System, Ann Arbor, MI (United States); Quint, Douglas J. [Department of Radiology, University of Michigan, Ann Arbor, MI (United States); Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Gaspar, Laurie E. [Department of Radiation Oncology, University of Colorado Denver, Denver, CO (United States); Komaki, Ritsuko U. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hurkmans, Coen W. [Department of Radiation Oncology, Catharina Hospital, Eindhoven (Netherlands); Timmerman, Robert [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX (United States); Bezjak, Andrea [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Bradley, Jeffrey D. [Department of Radiation Oncology, Washington University, St. Louis, MO (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States); Marsh, Lon [Department of Radiation Oncology, University of Michigan and Ann Arbor Veteran Affairs Medical System, Ann Arbor, MI (United States); Okunieff, Paul [Department of Radiation Oncology, University of Florida, Gainesville, FL (United States); Choy, Hak [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX (United States); Curran, Walter J. [Department of Radiation Oncology, Emory University Cancer Center, and Winship Cancer institute, Atlanta, GA (United States)

    2011-12-01

    Purpose: To review the dose limits and standardize the three-dimenional (3D) radiographic definition for the organs at risk (OARs) for thoracic radiotherapy (RT), including the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Methods and Materials: The present study was performed by representatives from the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Soutwestern Oncology Group lung cancer committees. The dosimetric constraints of major multicenter trials of 3D-conformal RT and stereotactic body RT were reviewed and the challenges of 3D delineation of these OARs described. Using knowledge of the human anatomy and 3D radiographic correlation, draft atlases were generated by a radiation oncologist, medical physicist, dosimetrist, and radiologist from the United States and reviewed by a radiation oncologist and medical physicist from Europe. The atlases were then critically reviewed, discussed, and edited by another 10 radiation oncologists. Results: Three-dimensional descriptions of the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus are presented. Two computed tomography atlases were developed: one for the middle and lower thoracic OARs (except for the heart) and one focusing on the brachial plexus for a patient positioned supine with their arms up for thoracic RT. The dosimetric limits of the key OARs are discussed. Conclusions: We believe these atlases will allow us to define OARs with less variation and generate dosimetric data in a more consistent manner. This could help us study the effect of radiation on these OARs and guide high-quality clinical trials and individualized practice in 3D-conformal RT and stereotactic body RT.

  4. 游离股薄肌移植在臂丛损伤治疗中的临床应用%The Clinical Application of Free Gracilis Muscle Transplantation in Treatment of the Brachial Plexus Avulsion

    Institute of Scientific and Technical Information of China (English)

    林晓岗; 顾立强

    2013-01-01

    目的:探讨游离股薄肌移植在臂丛损伤治疗中的疗效.方法:对47例臂丛根性损伤患者行71次吻合血管、神经的游离股薄肌移植重建上肢主要功能,术后随访观察功能恢复情况.结果:随访32例患者,26例恢复屈肘、伸指、伸拇功能,肌力M3-M4级;18例恢复屈指、屈拇功能,肌力M3-M4级;2例恢复伸肘功能,肌力M3级;4例屈指、屈拇肌力M1级.结论:吻合血管、神经的游离股薄肌移植是治疗臂丛神经根性损伤的有效手术方法.%Objective: To discuss the efficacy of the free gracilis muscle transplantation after brachial plexus injury. Method: 71 free gracilis muscles have been transplanted to reconstruct the main function of upper limb in 47 patients with root avulsion of brachial plexus, after surgery they were followed up to observe the functional recovery. Result: Follow-up were earned out in 32 patients, 26 patients the flexion of elbow and extension of fingers and thumb were restored, Their muscle power were M3 -M4 , 20 of them restored the function of finger and thumb flexion, with muscle power of M3 -M4 , 2 of them restored the function of the elbow extension, with muscle power of M3, the strength of finger and thumb flexion was Mj in the other 4 ca-ses. Conclusion: Free gracilis muscle transplantation with vaseularization and ncurotization is an effective method for treatment of complete root avulsion of brachial plexus.

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

    LENUS (Irish Health Repository)

    O'Donnell, Brian

    2010-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Viallon, M.; Vargas, M.I.; Jlassi, H.; Loevblad, K.O.; Delavelle, J. [University Hospital of Geneva, Department of Radiology, Geneva (Switzerland)

    2008-05-15

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

  7. Restoration of hand function in C7-T1 brachial plexus palsies using a staged approach with nerve and tendon transfer.

    Science.gov (United States)

    Zhang, Cheng-Gang; Dong, Zhen; Gu, Yu-Dong

    2014-11-01

    Brachial plexus palsies of C7-T1 result in the complete loss of hand function, including finger and thumb flexion and extension as well as intrinsic muscle function. The task of reanimating such a hand remains challenging, and so far there has been no reliable neurological reconstructive method for restoring hand function. The authors aimed to establish a reliable strategy to reanimate the paralyzed hand. Two patients had sustained C7-T1 complete lesions. In the first stage of the operative procedure, a supinator motor branch to posterior interosseous nerve transfer was performed with brachialis motor branch transfer to the median nerve to restore finger and thumb extension and flexion. In the second stage, the intact brachioradialis muscle was used for abductorplasty to restore thumb opposition. Both patients regained good finger extension and flexion. Thumb opposition was also attained, and overall hand function was satisfactory. The described strategy proved effective and reliable in restoring hand function after C7-T1 brachial plexus palsies.

  8. Effect of buprenorphine as an adjunct with plain local anesthetic solution in supraclavicular brachial plexus block on quality and duration of postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Surekha Patil

    2015-01-01

    Full Text Available Background and Aims: Supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine, an agonist antagonist opioid has been used as an adjunct to prolong analgesia. We aimed to evaluate the quality and duration of postoperative analgesia by addition of buprenorphine to local anesthetic solution. Material and Methods: A prospective, randomized, double-blind control study was conducted on 50 healthy patients of ASA Grade I/II of age group 20-70 years scheduled for orthopedic and reconstructive surgery of upper limb under supraclavicular brachial plexus block. Patients were allocated into two groups, 25 in each group viz.: Group B (buprenorphine group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 3 μg/kg buprenorphine diluted to 1 ml normal saline. Group C (control group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 1 ml normal saline. The parameters observed were onset and duration of sensory and motor block, quality and duration of analgesia and side-effects. Results: The mean duration of postoperative analgesia was significantly longer in Group B (16.04 ± 3.19 h than in Group C (6.20 ± 0.74 h. There was no difference between two groups on mean onset of sensory block. The mean duration motor block was significantly longer in Group B (4.93 ± 0.94 h than in Group C (2.25 ± 0.62 h [P < 0.05]. The mean duration of sensory block was also significantly longer in Group B (5.71 ± 0.94 h than in Group C (4.94 ± 0.70 h with P < 0.05. Conclusion: Addition of 3 μg/kg buprenorphine to 0.5% bupivacaine for supraclavicular brachial plexus block prolonged duration of postoperative analgesia and sensory blockade without an increase in side effects.

  9. Nerve transfer for treatment of brachial plexus injury:comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves

    Institute of Scientific and Technical Information of China (English)

    侯之启; 徐中和

    2002-01-01

    Objective:To compare the effect of using partial median and ulnar nerves for treatment of C5-6 orC5-7 avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.Methods:The patients were divided into 2groups randomly according to different surgical procedures.Twelve cases were involved in the first group.The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft,and the spinal accessary nerve was to the suprascapular nerve.Eleven cases were classified into the second group.A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve.The cases were followed up from 1to 3years and the clinical outcome was compared between the two groups.

  10. Approches anatomique et par imagerie des nerfs du plexus brachial : application pour le bloc échoguidé lors de chirurgie de l'épaule

    OpenAIRE

    Zoccarato, Sophie

    2014-01-01

    La technique d’anesthésie loco-régionale est de plus en plus employée en per-opératoire pour optimiser l’analgésie. Chez le chien, différents blocs axillaires ont déjà montré leurs intérêts pour des chirurgies du membre thoracique. Cependant, lors de chirurgie de la région de l’épaule, seul un bloc paravertébral du plexus brachial est efficace pour anesthésier cette région. Une étude méticuleuse de l’anatomie a permis d’établir les rameaux ventraux des nerfs spinaux à anesthésier pour réussir...

  11. Butorphanol in Patients with Brachial Plexus Block Analgesia%布托啡诺在臂丛麻醉患者中的镇痛效果

    Institute of Scientific and Technical Information of China (English)

    马涛

    2015-01-01

    Objective To investigate the analgesic effect of anesthesia in patients with Bhutto's coffee with the brachial plexus.Methods The ASA I or II in Department of orthopedics, upper extremity surgery patients 70 cases of group, 35 cases in the control group: intravenous injection of pethidine hydrochloride 50 mg Ding; 35 patients of the study group: injecting butorphanol 1 mg; compared two groups of patients with analgesic effect and adverse reactions.Results The anesthesia maintenance and the onset time of the study group were longer than the control group, the VAS score of the patients was significantly decreased (P < 0.05), and the side reaction was minimal, and the difference of the two groups was minimal. Conclusion Bhutto is suitable for brachial plexus block, the effect is fast, the maintenance time is long, the safety is high, it is good narcotic drugs.%目的 探讨布托咖诺对臂丛麻醉患者所具有的镇痛作用.方法 将我院行骨科上肢术病例70例进行分组,对照组35例:静注盐酸哌替丁50 mg;研究组35例:注布托啡诺1 mg;比较两组患者镇痛效果及不良反应.结果 研究组麻醉维持、起效时间均长于对照组,术后患者VAS评分显著下降(P < 0.05),且均无明显副反应.结论 布托啡诺适用于臂丛神经阻滞,起效快、维持时间长,安全性高,是不错的麻醉药物.

  12. Supraclavicular Brachial Plexus Block For Upper Limb Orthopedic Surgery: A Randomized, Double Blinded Comparison Between 0.5%Ropivacaine And 0.5% Bupivacaine.

    Directory of Open Access Journals (Sweden)

    Dr.Jigisha Prahladrai Badheka

    2016-08-01

    Full Text Available Purpose: This prospective double blinded study designedwith the aim of comparing the onset, duration of sensory and motor block and analgesic effect of ropivacaine 0.5%with bupivacaine 0.5% when used in supraclavicular brachial plexus block in patients undergoing upper limb orthopedic surgeries. Materials and method: 60 patients of either sex, aged 20-66 yrs, scheduled for elective upper limb orthopedic surgeries under supraclavicular brachial plexus block, were randomly divided into two groups containing 30 patients in each. Group B received 0.5% 30ml bupivacaine and group R received 0.5% 30ml ropivacaine. Patients were observed for onset, duration of sensory and motor blockade, post-operative analgesia using visual analogue scale and complications if any. Results: In comparison to equal volume of 0.5% bupivacaine, 0.5% ropivacaine provides significant earlier onset of sensory block (9.5±2min& 7.46 ±2.54 min respectively and motor block (12.6±2.2min& 10.66±2.24 min respectively.There is statistically significant longer duration of motor block with bupivacaine (486.16±56.74as compared to ropivacaine (359±55.66 min. However duration of sensory blockade, duration of analgesia and haemodynamics were comparable in both groups. We observed convulsions in one patient in bupivacaine group which was successfully managed. No complications were encountered in ropivacaine group.Conclusion: Ropivacaine provides faster onset of sensory and motor block with less duration of motor block, equal postoperative analgesia and higher safety profile as compared to bupivacaine.

  13. Axillary artery injury as a complication of proximal humerus fractures.

    Science.gov (United States)

    McLaughlin, J A; Light, R; Lustrin, I

    1998-01-01

    Proximal humerus fractures are common injuries and represent approximately 5% of all fractures. These fractures are infrequently associated with neurovascular injuries. Brachial plexus injuries are uncommon, whereas axillary artery injuries are rare. A review of 19 previously reported cases of axillary artery injury after proximal humerus fracture revealed that 84% occurred in patients older than 50 years, 53% were associated with brachial plexus injury, and 21% resulted in upper extremity amputation. This study describes a case of axillary artery injury after proximal humerus fracture and, on the basis of a literature review, offers suggestions for the early diagnosis and effective treatment of this uncommon injury.

  14. 小儿手外科臂丛麻醉联合异丙酚泵注的临床效果分析%Clinical Effect Analysis of Pediatric Hand Surgery Brachial Plexus Anesthesia Combined With Propofol Infusion

    Institute of Scientific and Technical Information of China (English)

    乔辉

    2016-01-01

    目的:研究小儿手外科臂丛麻醉联合异丙酚泵注的临床效果。方法试验对象:我院2014年2月~2016年1月收治的83例小儿手外科患儿。患儿分组方法:随机数字表法。83例患儿分为臂丛麻醉组和联合麻醉组两个组别。臂丛麻醉组采取臂丛麻醉;联合麻醉组采取臂丛麻醉联合异丙酚泵注麻醉。观察指标:(1)麻醉效果;(2)麻醉不良反应率;(3)患儿心率、呼吸、血压的差异。结果(1)联合麻醉组相比于臂丛麻醉组麻醉效果更高,χ2检验结果 P <0.05;(2)联合麻醉组相比于臂丛麻醉组麻醉不良反应率相似,χ2检验结果 P >0.05;(3)联合麻醉组相比于臂丛麻醉组心率、呼吸、血压更低,t 检验结果P <0.05。结论小儿手外科臂丛麻醉联合异丙酚泵注的临床效果确切,可有效提升麻醉效果,减轻对小儿生命体征的影响,且不增加麻醉不良反应,安全性高。%Objective To study the pediatric hand surgery brachial plexus anesthesia combined with propofol infusion clinical results. Methods Subjects: 83 cases of children with pediatric hand surgery in admitted in our hospital from February 2014 to January 2016. Children grouping method:random number table. 83 cases were divided into groups and brachial plexus anesthesia group two groups. Brachial plexus anesthesia take brachial plexus anesthesia, brachial plexus anesthesia group received anesthesia combined with propofol infusion anesthesia: (1) Anesthesia. (2) Anesthesia adverse reaction rate. (3) The difference in heart rate, respiration, blood pressure. Results (1) Anesthesia group compared to the higher brachial plexus anesthesia anesthetic effect, χ2 test results P0.05. (3) Anesthesia group compared to the brachial plexus anesthesia heart rate, respiration, lower blood pressure, t test results P<0.05. Conclusion Pediatric hand surgery brachial plexus anesthesia combined with propofol

  15. latrogenic brachial artery injury during anterolateral plating of humeral shaft fracture

    Institute of Scientific and Technical Information of China (English)

    Vishal Kumar; Prateek Behera; Sameer Aggarwal; Umesh Kumar Meena

    2013-01-01

    There are several well defined indications for surgical management of humeral shaft fractures.Operative procedures on the humerus are associated with their own complications.Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously.We report a case of a 48 years old femalewho received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse.CT angiogram showed that there was segmental non-opacification of the brachial artery.There was distal reformation and the thrombosis was decided to be managed conservatively.We believe that the arterial injury was a result ofimproper surgical technique and the segmental block might be due to improper use of plate holding forceps.This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries.

  16. A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF LEVOBUPIVACAINE WITH CLONIDINE AND LEVOBUPIVACAINE WITH DEXMEDETOMIDINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Neelima

    2016-03-01

    Full Text Available OBJECTIVE The objective of this study is to compare clonidine and dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block with respect to onset, duration of sensory and motor block and duration of analgesia. MATERIALS AND METHODS A total of 90 ASA grade I and II patients of either sex, aged 18-60 yrs. scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into 3 equal groups in a randomized fashion. Group L (n=30 received 1 mL NS, group LC (=30 received 1 mL (150 g clonidine and group LD (n=30 received 1 mL (100 g dexmedetomidine added to 30 mL of 0.5% levobupivacaine. Onset and recovery time of sensory and motor block, duration of analgesia and quality of block were studied in all three groups. RESULTS Onset time of sensory and motor blockade was 12.43±2.56 min and 17.96±3.05 min respectively in group L, 9.03±1.60 min and 15.00±2.40 min respectively in group LC and 8.13±2.51 min and 12.13±2.89 min respectively in group LD. Duration of sensory and motor blockade was 660.16±44.28 min and 535.33±50.66 min respectively in group L, 880.16±55.48 min and 771.83±54.19 min respectively in group LC and 930.66±48.02 min and 811.83±52.08 min respectively in group LD. Time of rescue analgesia was 728.86±45.12 min in group L, 1013.5±59.01 min in group LC and 1159.8±56.8 min in group LD (pLC>C.

  17. Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries

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    Dipal Mahendra Shah

    2015-01-01

    Full Text Available Background and Aims: The role of clonidine as an adjuvant to regional blocks to hasten the onset of the local anesthetics or prolong their duration of action is proven. The efficacy of dexamethasone compared to clonidine as an adjuvant is not known. We aimed to compare the efficacy of dexamethasone versus clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries. Material and Methods: Fifty three American Society of Anaesthesiologists-I and II patients aged 18-60 years scheduled for upper limb surgery were randomized to three groups to receive 1.5% lignocaine with 1:200,000 adrenaline and the study drugs. Group S (n = 13 received normal saline, group D (n = 20 received dexamethasone and group C (n = 20 received clonidine. The time to onset and peak effect, duration of the block (sensory and motor and postoperative analgesia requirement were recorded. Chi-square and ANOVA test were used for categorical and continuous variables respectively and Bonferroni or post-hoc test for multiple comparisons. P < 0.05 was considered significant. Results: The three groups were comparable in terms of time to onset and peak action of motor and sensory block, postoperative analgesic requirements and pain scores. 90% of the blocks were successful in group C compared to only 60% in group D (P = 0.028. The duration of sensory and motor block in group S, D and C were 217.73 ± 61.41 min, 335.83 ± 97.18 min and 304.72 ± 139.79 min and 205.91 ± 70.1 min, 289.58 ± 78.37 min and 232.5 ± 74.2 min respectively. There was significant prolongation of sensory and motor block in group D as compared to group S (P < 0.5. Time to first analgesic requirement was significantly more in groups C and D as compared with group S (P < 0.5. Clinically significant complications were absent. Conclusions: We conclude that clonidine is more efficacious than dexamethasone as an adjuvant to 1.5% lignocaine in brachial

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

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    Elenara B. Araújo

    2012-12-01

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

  19. Sacral plexus injury after radiotherapy for carcinoma of cervix

    Energy Technology Data Exchange (ETDEWEB)

    Stryker, J.A.; Sommerville, K.; Perez, R.; Velkley, D.E. (Pennsylvania State Univ., Hershey (USA))

    1990-10-01

    A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.

  20. Brachial artery injury due to closed posterior elbow dislocation: case report☆

    Science.gov (United States)

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; do Val Sella, Guilherme; Checchia, Caio Santos; Checchia, Sergio Luiz

    2016-01-01

    An association between closed posterior elbow dislocation and traumatic brachial artery injury is rare. Absence of radial pulse on palpation is an important warning sign and arteriography is the gold-standard diagnostic test. Early diagnosis is essential for appropriate treatment to be provided. This consists of joint reduction and immobilization, along with urgent surgical restoration of arterial flow. Here, a case (novel to the Brazilian literature) of an association between these injuries (and the treatment implemented) in a 27-year-old male patient is reported. These injuries were sustained through physical assault. PMID:27069896

  1. Radiation Dose to the Brachial Plexus in Head-and-Neck Intensity-Modulated Radiation Therapy and Its Relationship to Tumor and Nodal Stage

    Energy Technology Data Exchange (ETDEWEB)

    Truong, Minh Tam, E-mail: mitruong@bu.edu [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Romesser, Paul B.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Orlina, Lawrence; Willins, John [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States)

    2012-09-01

    Purpose: The purpose of this retrospective study was to determine tumor factors contributing to brachial plexus (BP) dose in head-and-neck cancer (HNC) patients treated with intensity-modulated radiotherapy (IMRT) when the BP is routinely contoured as an organ at risk (OAR) for IMRT optimization. Methods and Materials: From 2004 to 2011, a total of 114 HNC patients underwent IMRT to a total dose of 69.96 Gy in 33 fractions, with the right and left BP prospectively contoured as separate OARs in 111 patients and the ipsilateral BP contoured in 3 patients (total, 225 BP). Staging category T4 and N2/3 disease were present in 34 (29.8%) and 74 (64.9%) patients, respectively. During IMRT optimization, the intent was to keep the maximum BP dose to {<=}60 Gy, but prioritizing tumor coverage over achieving the BP constraints. BP dose parameters were compared with tumor and nodal stage. Results: With a median follow-up of 16.2 months, 43 (37.7%) patients had {>=}24 months of follow-up with no brachial plexopathy reported. Mean BP volume was 8.2 {+-} 4.5 cm{sup 3}. Mean BP maximum dose was 58.1 {+-} 12.2 Gy, and BP mean dose was 42.2 {+-} 11.3 Gy. The BP maximum dose was {<=}60, {<=}66, and {<=}70 Gy in 122 (54.2%), 185 (82.2%), and 203 (90.2%) BP, respectively. For oropharynx, hypopharynx, and larynx sites, the mean BP maximum dose was 58.4 Gy and 63.4 Gy in T0-3 and T4 disease, respectively (p = 0.002). Mean BP maximum dose with N0/1 and N2/3 disease was 52.8 Gy and 60.9 Gy, respectively (p < 0.0001). Conclusions: In head-and-neck IMRT, dose constraints for the BP are difficult to achieve to {<=}60 to 66 Gy with T4 disease of the larynx, hypopharynx, and oropharynx or N2/3 disease. The risk of brachial plexopathy is likely very small in HNC patients undergoing IMRT, although longer follow-up is required.

  2. In situ cephalic vein bypasses from axillary to the brachial artery after catheterization injuries.

    Science.gov (United States)

    Hudorovic, Narcis; Lovricevic, Ivo; Ahel, Zaky

    2010-07-01

    The need to bypass to the brachial artery is rare. Over a five-year period, 16 patients had suffered iatrogenic post-catheterization injuries of the upper extremity. We have performed 16 bypasses, in 16 patients, mean age was 65 years (range 47-75), to the brachial artery originating from an artery proximal to the shoulder joint. In all cases, the axillary artery was the donor artery. All bypasses were created by using the cephalic vein with the in situ technique and distal anastomoses were made to a distance-free section of brachial artery. No operative mortality, neurological complications or major upper-extremity amputation was associated with the procedure. Life-long-conduit analysis showed 75% patency in the five-year period. After iatrogenic post-catheterization trauma of arterial system of upper extremity, bypasses from axillary to brachial artery with the cephalic vein with the in situ technique is a safe operation with satisfactory long-term patency.

  3. THE EFFICACY OF CLONIDINE ADDED TO BUPIVACAINE AS COMPARED WITH BUPIVACAINE ALONE USED IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

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    Suchismita

    2014-09-01

    Full Text Available : INTRODUCTION: Clonidine when added to local anesthetic solutions improved peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia. MATERIALS AND METHODS: Sixty patients aged 18 to 60 years, scheduled for elective orthopedic operations in the upper limb, of ASA Grade I or II were included in the study. We conducted the study with 2 groups consisting of 30 patients each to compare the effects of Clonidine added to Bupivacaine with Bupivacaine alone in supraclavicular brachial plexus block. First group received 40 ml of Bupivacaine 0.25% plus 0.15mg (1ml of Clonidine, second group had 40 ml of Bupivacaine 0.25% plus 1 ml 0.9% Saline respectively. The onset as well as duration of sensory and motor block along with monitoring of heart rate, NIBP, oxygen saturation were recorded. The level of sedation and side effects were also noted. RESULTS: In this study the addition of Clonidine to Bupivacaine resulted in faster onset (study group 15.2±1.44, control group 20.4±1.12, p˂0.001 and longer duration of sensory block (study group 544±31.2, control group 302±34.4, p=0.0363 as well as analgesia (study group 561.2±30.96, control group 324.4±34.08, p=0.0001 without any adverse hemodynamic changes.

  4. Brain glucose metabolic changes associated with chronic spontaneous Pain due to brachial plexus avulsion:a preliminary positron emission tomography study

    Institute of Scientific and Technical Information of China (English)

    CHEN Fu-yong; TAO Wei; CHENG Xin; WANG Hong-yan; HU Yong-sheng; ZHANG Xiao-hua; LI Yong-jie

    2008-01-01

    Background Previous brain imaging studies suggested that the brain activity underlying the perception of chronic pain maV differ from that underlying acute pain.To investigate the brain regions involved in chronic spontaneous pain due to brachial plexus avulsion(BPA),fluorine-18fluorodeoxygIucose (19F-FDG) positron emission tomography (PET) scanning was applied to determine the glucose metabolic changes in patients with pain due to BPA.Methods Six right-handed patients with chronic spontaneous pain due to left-BPA and twelve right-handed age-and sex-matched healthy control subjects participated in the 18F-FDG PET study.The patients were rated by visual analog scale (VAS) during scanning and Hamilton depression scale and Hamilton anxiety scale after scanning.Statistical parametric mapping 2 (SPM2) was applied for data analysis.Results Compared with healthy subjects,the patients had significant glucose metabolism decreases in the right thalamus and S I(P<0.001,uncorrected),and significant glucose metabolism increases in the right orbitofrontaI cortex (OFC) (BA11),left rostral insula cortex and left dorsolateral prefrontal codex (DLPFC) (BA10/46) (P<0.001,uncorrected).Conclusion These findings suggest that the brain areas involved in emotion.aRention and internal modulation of pain may be related to the chronic spontaneous pain due to BPA.

  5. Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study.

    Science.gov (United States)

    Bharti, N; Bhardawaj, N; Wig, J

    2015-07-01

    This prospective, randomised, observer-blinded study was conducted to compare the ease of performance and surgical effectiveness of interscalene block below the C6 nerve root with supraclavicular and infraclavicular techniques of brachial plexus block for upper arm and forearm surgery. Sixty adult patients of American Society of Anesthesiologists grade 1 to 3, undergoing upper limb surgery, were randomly allocated into three groups. Group SC received supraclavicular blockade, group IC received infraclavicular blockade and Group IS received interscalene blockade. All blocks were guided by ultrasound with nerve stimulator confirmation. The anaesthetic mixture consisted of 0.5 ml/kg of equal volumes of 0.75% ropivacaine and 2% lignocaine-adrenaline. The imaging and block performance time, onset time, success rate, duration of block, and duration of postoperative analgesia were recorded by a blinded observer. The onset time was significantly longer in the interscalene group as compared with supraclavicular and infraclavicular approaches. The imaging time and block performance time were comparable between groups. No significant differences were observed between the three groups in terms of block-related pain scores, success rates, duration of block or of postoperative analgesia. Two patients in the interscalene group developed clinically detectable phrenic nerve palsy. Our findings indicate that, although interscalene block below the C6 nerve root can provide surgical anaesthesia for forearm and hand surgery, it appears to have a longer onset time than supra- and infraclavicular approaches and an unacceptable incidence of phrenic nerve palsy.

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first posterior (second approach and end-to-side side-to-side grafting neurorrhaphy

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    Abdel-Meguid Amr MS

    2009-06-01

    Full Text Available Abstract Background The superiority of a single stage combined anterior (first posterior (second approach and end-to-side side-to-side grafting neurorrhaphy in direct cord implantation was investigated as to providing adequate exposure to both the cervical cord and the brachial plexus, as to causing less tissue damage and as to being more extensible than current surgical approaches. Methods The front and back of the neck, the front and back of the chest up to the midline and the whole affected upper limb were sterilized while the patient was in the lateral position; the patient was next turned into the supine position, the plexus explored anteriorly and the grafts were placed; the patient was then turned again into the lateral position, and a posterior cervical laminectomy was done. The grafts were retrieved posteriorly and side grafted to the anterior cord. Using this approach, 5 patients suffering from complete traumatic brachial plexus palsy, 4 adults and 1 obstetric case were operated upon and followed up for 2 years. 2 were C5,6 ruptures and C7,8T1 avulsions. 3 were C5,6,7,8T1 avulsions. C5,6 ruptures were grafted and all avulsions were cord implanted. Results Surgery in complete avulsions led to Grade 4 improvement in shoulder abduction/flexion and elbow flexion. Cocontractions occurred between the lateral deltoid and biceps on active shoulder abduction. No cocontractions occurred after surgery in C5,6 ruptures and C7,8T1 avulsions, muscle power improvement extended into the forearm and hand; pain disappeared. Limitations include spontaneous recovery despite MRI appearance of avulsions, fallacies in determining intraoperative avulsions (wrong diagnosis, wrong level; small sample size; no controls rule out superiority of this technique versus other direct cord reimplantation techniques or other neurotization procedures; intra- and interobserver variability in testing muscle power and cocontractions. Conclusion Through providing proper

  8. 组织动态测压法在小儿连续臂丛阻滞定位中的应用%Application of Tissue Dynamic Manometry in Positioning Continuous Brachial Plexus Block of Children

    Institute of Scientific and Technical Information of China (English)

    欧阳爱平; 李以平; 黄桂明; 钟宝林

    2014-01-01

    pressure differences at the time of 5s,10s had statistical significance among them. There was a good correlation between the dynamic pressure as-cension range and the anesthesia effect of axillary brachial plexus block guided by it;there was a lower incidence rate of blood vessel and nerve injury in the experimental group guided by it. Conclusion:The tissue dynamic manometry is more applicable to children than the traditional positioning method in continuous axillary brachial plexus block.

  9. [Surgical treatment of the plexus brachialis injury using long-lasting electrostimulation].

    Science.gov (United States)

    Tsymbaliuk, V I; Tretiak, I B; Tsymbaliuk, Iu V

    2013-06-01

    The results of surgical treatment were analyzed in 103 patients, suffering consequences of the plexus brachialis injury, using the system for long-lasting electrostimulation, called "Henci 3M". The system of a domestic manufacture is an individual one, permits to perform the direct electrostimulation seances in a home conditions several times a day for a long time. There were positive results noted: an enhancement in volume and strength of movements in upper extremity of various degree, restoration of sensitivity and disappearance or reduction of a pain syndrome intensity in 90.6% of patients. Long-lasting electrostimulation permits more effectively and valuably to restore a plexus brachialis function in its traumatic injury.

  10. Schwannoma de plexo braquial en el diagnóstico diferencial del hombro doloroso: Diferential diagnostic in the shoulder pain Brachial plexus schwannoma

    Directory of Open Access Journals (Sweden)

    S. Cortés

    2006-11-01

    , with a five years long left atraumatic omalgia. During this time, she was evaluated by different physicians such as traumatologist, neurologist, rheumatologist and rehabilitation doctor. Initially she was treated with NSAID, rehabilitation (physiotherapy, short wave and magnetotherapy without improvement. Diagnostic procedures underwent were neurophysiologic study of left upper-extremity, wich was normal; cervical and shoulder MRI with partial tear of supraspinatus tendon and subacromial bursitis; the patient underwent an arthroscopic subacromial decompression. This treatment did not relieve the pain of the patient with an AVS > 6 at that moment. Subsequently she was treated with NSAID associated to transdermic fentanyl, pregabalin, join steroid injections and new sessions of rehabilitation without improvement. It was decided to make more imaging procedures to find a clear aetiology for upper-extremity pain. A thoracic scanner, a left shoulder ecography and a brachial plexus MRI were made and showed a lesion that was compatible with a brachial plexus schwannoma. After surgical treatment and tumor excision the patient had a progressive pain relief. At this time the patient has no pain nor any neurological damage.

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

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    Fábio Futema

    1999-03-01

    Full Text Available O objetivo do presente estudo foi analisar a viabilidade e a eficácia de uma nova técnica para o bloqueio do plexo braquial em cães. Para tanto, foram utilizados 11 cães, machos e fêmeas, idade e peso variáveis e mestiços. Os animais foram pré-tratados com acepromazina e a indução da anestesia foi realizada com propofol. Posteriormente, os animais foram submetidos ao bloqueio do plexo braquial que constou da associação da técnica de múltiplas injeções com o emprego do estimulador de nervos e a técnica da palpação arterial como ponto de referência para a localização dos nervos. Utilizou-se como anestésico local, a bupivacaína com vasoconstritor administrado na dose total de 4mg/kg a 0,375% . O volume total foi dividido em 4 partes iguais, administradas na velocidade de 30 segundos cada, com o objetivo de se atingir a maior quantidade de nervos. O tempo necessário para realização da técnica foi de 11,30 ± 4,54 minutos; o período de latência para o bloqueio motor foi de 9,70 ± 5,52 minutos e para o bloqueio sensitivo foi de 26,20 ± 8,86 min. , sendo a duração da analgesia de 11:00 ± 0:45 horas. Em 90% dos animais, o bloqueio foi efetivo, constatado através da anestesia de todo membro torácico distal à articulação escápulo-umeral. A única complicação observada foi a hipotensão arterial desenvolvida em um animal. Mediante os resultados obtidos, pode-se pressupor que as cirurgias envolvendo o membro torácico distal à articulação escápulo-umeral poderão ser utilizadas com auxílio desta nova técnica do bloqueio do plexo braquial, bem como na analgesia pós-operatória de longa duração.The aim of this study was to evaluate the viability and efficacy of a new technique of brachial plexus block in dogs. Eleven mongrel dogs of different ages and weight, both male and female were used. Animals were pre-medicated with acepromazine and induction of anesthesia was performed with propofol. The brachial

  12. 产瘫患儿Horner征的临床观察%Clinical observation of concurrent Horner's sign in infants with obstetric brachial plexus palsy

    Institute of Scientific and Technical Information of China (English)

    李清; 陈亮; 胡韶楠

    2012-01-01

    Objective To discuss the diagnostic value of concurrent Horner's sign in infants with obstetric brachial plexus palsy and discover the clinical characteristics of Horner's syndrome caused by C7 nerve root avulsion alone.Methods From January 2009 to July 2009,39 infants with OBPP were identified with concurrent Horner' s syndrome.Clinical signs of Homer's syndrome were recorded which include ipsilateral blepharoptosis,pupillary miosis and facial anhidrosis.Lesions of brachial plexus nerve roots were confirmed during the surgery by direct visualization and electrophysiology.After a period of 6-month follow-up,these signs were recorded again.Results The initial age of Horner's sign evaluation of these OBPP patients was(3.58 ±0.87)months.Average postoperative follow-up interval was(6.19 ± 1.10)months.C7 nerve root avulsion alone was confirmed in 11 patients(case group),while the other 28 patients(control group)lind avulsion of at least one root of C8 and T1 nerve roots.There were not significant differences in anisocoria and blepharoptosis between the two groups(P > 0.05).Facial gland secretary function was recovered more rapidly among patients in case group than their counterparts(P < 0.05).Conclusion In newborns with OBPP,Horner' s syndrome can be correlated with C7 nerve root avulsion alone.No unique feature of Horner's syndrome which caused by C7 nerve root avulsion was found among patients of 3 months old.%目的 探讨Horner征在产瘫中的诊断意义,寻找单纯C7神经根撕脱导致Horner征的特异性临床体征.方法 对2009年1月至7月在我院接受手术治疗的39例Horner征阳性的产瘫患儿,术前记录患侧Horner征3项临床体征:瞳孔大小,睑裂大小及面部汗腺分泌功能.术中通过直视观察联合神经电生理检查明确患儿神经根损伤程度,并在患儿术后首次随访时再次记录Horner征的各项体征.结果 产瘫患儿平均首次评估Horner征时间为(3.58±0.87)个月.

  13. MR neurography in traumatic brachial plexopathy

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    Upadhyaya, Vaishali, E-mail: vshali77@yahoo.co.in [Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India); Upadhyaya, Divya N. [Department of Plastic Surgery, King George Medical University, Shah Meena Road, Chowk, Lucknow 226 003 (India); Kumar, Adarsh [Department of Plastic Surgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India); Gujral, Ratni B. [Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007 (India)

    2015-05-15

    Highlights: • MR neurography is the imaging modality of choice in patients who have sustained brachial plexus injury. It is helpful in determining the level and extent of injury. • The authors have used a Visual Per-operative Scoring system to assess the usefulness of MR neurography in delineating the level and type of the lesion. • The imaging findings were classified based on the level of injury—root, trunk or cord. These findings were correlated with those seen on surgical exploration. A good correlation was found in the majority (65%) of patients and average correlation (30%) in others. - Abstract: Objectives: Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome. Methods: Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus—roots, trunks and cords. Results: Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative

  14. Clinical study on the clinical curative effect of comprehensive rehabilitation for brachial plexus avulsion%综合康复治疗臂丛神经撕脱伤的临床疗效

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    周莹; 周丽

    2014-01-01

    Objective To study the clinical curative effect of comprehensive rehabilitation treatment on acupuncture and physiotherapy in brachial plexus avulsion.Methods Totally 184 patients with brachial plexus avulsion in our hospital were se-lected ,and were randomly divided into control group of 92 cases and observation group of 92 cases ,then the control group wsa treated by low-frequency electrical stimulation pulses with neuromuscular electrical stimulation. The observe group was treaded by comprehensive rehabilitation ,including acupuncture management therapy ,massage and IF electric massage ,then pain visual analog scale assessment of pain ,function of the brachial plexus of two groups were analyzed and compared.Results Before treatment ,brachial plexus function and VAS scores in the patients of two groups had no significant difference (P>0 .05).After treatment of 4 and 8 weeks ,the brachial plexus function and VAS scores of two groups improved after treatment than before treatment ,and the observation group was better than the control group (P<0 .05). The total effective rate in the control group was 77 .17% ,which was 90 .22% in observation group. The patients limb functional recovery was significantly better than the control group ,with a significant difference (P<0 .05).Conclusion Acupuncture management therapy ,massage therapy method and frequency electric comprehensive rehabilitation therapy can be helpful in brachial plexus avulsion recovery of limb function , the efficacy is significantly better than the family functional exercise.%目的:探讨以针灸理疗为主的综合康复治疗臂丛神经撕脱伤的临床疗效。方法纳入臂丛神经撕脱伤患者共184例,随机分为对照组和观察组,对照组采用神经肌肉电刺激仪进行低频脉冲电刺激,观察组采用综合康复疗法,包括针灸理疗法、推拿按摩法和中频电疗法,采用疼痛视觉模拟评分评定疼痛程度和臂丛

  15. Effective background infusion rate of ropivacaine 0.2% for patient-controlled interscalene brachial plexus analgesia after rotator cuff repair surgery

    Institute of Scientific and Technical Information of China (English)

    Wei Yue; Li Min; Rong Yulan; Guo Xiangyang

    2014-01-01

    Background Continuous interscalene nerve block (CISB) is considered to be the most effective method for postoperative analgesia after shoulder surgery with prolonged severe pain.This study was performed to evaluate the minimum effective background infusion rate and the effective background infusion rate of ropivacaine 0.2% for CISB after arthroscopic rotator cuff repair surgery in 95% of patients.Methods Patients scheduled for arthroscopic rotator cuff repair surgery under general anesthesia at Peking University Third Hospital were prospectively enrolled from December 2011 to May 2012.Preoperatively,an interscalene catheter (ISC) was placed under the guidance of ultrasound and nerve stimulation in each patient.Consecutively,30 patients with successful nerve block were included.A continuous infusion of ropivacaine 0.2% with a 5 ml patient-controlled bolus available hourly was started at postoperative anesthesia care unit (PACU) after completion of surgery.The initial background infusion rate was 6 ml/h,which was subsequently varied for each consecutive patient according to the analgesic effects of the previous one.The minimum effective background rate was determined using the Dixon and Massey up-and-down method.The effective background rate in 95% of patients was calculated using isotonic analysis.Results The minimum effective background rate based on the Dixon and Massey up-and-down method was 2.8 ml/h (95% CI,2.3-3.3 ml/h).The effective background rate in 95% of patients calculated with the isotonic regression analysis was 4.4 ml/h (95% CI,3.8-6.5 ml/h).Conclusion The effective background rate for patient-controlled interscalene brachial plexus analgesia after shoulder surgery in 50% and 95% of the patients was 2.8 and 4.4 ml/h,respectively.

  16. Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy

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    Stanic, Sinisa; Mathai, Mathew; Mayadev, Jyoti S.; Do, Ly V.; Purdy, James A. [Department of Radiation Oncology, University of California, Davis, Sacramento, CA (United States); Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California, Davis, Sacramento, CA (United States)

    2012-07-01

    Our goal was to evaluate brachial plexus (BP) dose with and without the use of supraclavicular (SCL) irradiation in patients undergoing breast-conserving therapy with whole-breast radiation therapy (RT) after lumpectomy. Using the standardized Radiation Therapy Oncology Group (RTOG)-endorsed guidelines delineation, we contoured the BP for 10 postlumpectomy breast cancer patients. The radiation dose to the whole breast was 50.4 Gy using tangential fields in 1.8-Gy fractions, followed by a conedown to the operative bed using electrons (10 Gy). The prescription dose to the SCL field was 50.4 Gy, delivered to 3-cm depth. The mean BP volume was 14.5 {+-} 1.5 cm{sup 3}. With tangential fields alone, the median mean dose to the BP was 0.57 Gy, the median maximum dose was 1.93 Gy, and the irradiated volume of the BP receiving 40, 45, and 50 Gy was 0%. When the third (SCL field) was added, the dose to the BP was significantly increased (P = .01): the median mean dose to the BP was 40.60 Gy, and the median maximum dose was 52.22 Gy. With 3-field RT, the median irradiated volume of the BP receiving 40, 45, and 50 Gy was 83.5%, 68.5%, and 24.6%, respectively. The addition of the SCL field significantly increases dose to the BP. The possibility of increasing the risk of BP morbidity should be considered in the context of clinical decision making.

  17. Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy.

    Science.gov (United States)

    Stanic, Sinisa; Mathai, Mathew; Mayadev, Jyoti S; Do, Ly V; Purdy, James A; Chen, Allen M

    2012-01-01

    Our goal was to evaluate brachial plexus (BP) dose with and without the use of supraclavicular (SCL) irradiation in patients undergoing breast-conserving therapy with whole-breast radiation therapy (RT) after lumpectomy. Using the standardized Radiation Therapy Oncology Group (RTOG)-endorsed guidelines delineation, we contoured the BP for 10 postlumpectomy breast cancer patients. The radiation dose to the whole breast was 50.4 Gy using tangential fields in 1.8-Gy fractions, followed by a conedown to the operative bed using electrons (10 Gy). The prescription dose to the SCL field was 50.4 Gy, delivered to 3-cm depth. The mean BP volume was 14.5 ± 1.5 cm(3). With tangential fields alone, the median mean dose to the BP was 0.57 Gy, the median maximum dose was 1.93 Gy, and the irradiated volume of the BP receiving 40, 45, and 50 Gy was 0%. When the third (SCL field) was added, the dose to the BP was significantly increased (P = .01): the median mean dose to the BP was 40.60 Gy, and the median maximum dose was 52.22 Gy. With 3-field RT, the median irradiated volume of the BP receiving 40, 45, and 50 Gy was 83.5%, 68.5%, and 24.6%, respectively. The addition of the SCL field significantly increases dose to the BP. The possibility of increasing the risk of BP morbidity should be considered in the context of clinical decision making.

  18. Effects of Se-phenyl thiazolidine-4-carboselenoate on mechanical and thermal hyperalgesia in brachial plexus avulsion in mice: mediation by cannabinoid CB1 and CB2 receptors.

    Science.gov (United States)

    Del Fabbro, Lucian; Borges Filho, Carlos; Cattelan Souza, Leandro; Savegnago, Lucielli; Alves, Diego; Henrique Schneider, Paulo; de Salles, Helena Domingues; Jesse, Cristiano R

    2012-09-26

    In this study, we investigated the therapeutic effects of treatment with (R)-Se-phenyl thiazolidine-4-carboselenoate (Se-PTC), an organic selenium compound with antinociceptive properties, against mechanical and thermal hyperalgesia induced by brachial plexus avulsion (BPA), a neuropathic model in mice. The involvement of cannabinoid CB(1) and CB(2) receptors in the Se-PTC anti-hyperalgesic effect was also investigated. Se-PTC treatment at (25 and 50mg/kg, per oral, p.o.) lowered (BPA model) induced mechanical and thermal hyperalgesia in mice. Pretreatment with cannabinoid CB(1) (AM251; 1mg/kg, intraperitoneally, i.p.), or CB(2) (AM630; 3mg/kg, i.p.) receptor antagonists reverted the mechanical and thermal anti-hyperalgesic effect of Se-PTC (25mg/kg) in the BPA model. Selective CB(1) (ACEA, 10mg/kg, i.p.) and CB(2) (JWH-133, 10mg/kg, i.p.) receptor agonists lowered mechanical and thermal hyperalgesia in the BPA model, and this effect was prevented by selective CB(1) and CB(2) receptor antagonists. Gabapentin (70mg/kg, p.o.), positive control administration also lowered mechanical and thermal hyperalgesia in the BPA model. The results suggest that the mechanical and thermal hyperalgesia observed following BPA in mice is dependent on cannabinoid receptors. The results indicate that modulating cannabinoid receptors represent a valuable approach for the treatment of neuropathic pain. In conclusion, the results suggested that Se-PTC produces pronounced mechanical and thermal anti-hyperalgesic effects in neuropathic models in mice by modulating CB(1) and CB(2) receptors.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-15

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

  20. The clinical application of interscalene brachial plexus block independent on paresthesia: 327 cases reports%无异感肌间沟臂丛阻滞的临床应用(附327例报告)

    Institute of Scientific and Technical Information of China (English)

    张世龙; 柴晓芳; 郭海燕; 刘建梅; 张国元; 杨蓉; 周丽霞

    2014-01-01

    Objective To investigate the effect of brachial plexus block via Interscalene Route independent on paresthesia.Methods Three hundred and twenty seven patients undergoing collarbone,shoulder and upper limb surgery were collected.All patients received interscalene brachial plexus block independent on Paresthesia.The success of nerve block of nerve blocking was defined as the ability to complete surgery without the help of general anesthesia,or of droperidol-fentanyl.Results Paresthesia was not induced by brachial plexus block in all patients.Block success rate was 99.1% (324 vs 327) and 3 failed(0.9%) in the studying patients.Conclusions Interscalene blocking independent on paresthesia is a simple and useful approach for surgery.%目的 探讨无异感肌间沟臂丛阻滞的效果及异感与阻滞的关系. 方法 327例锁骨、肩部及上肢择期或急诊手术患者.用不探寻异感的方法进行肌间沟臂丛阻滞,观察其阻滞效果.手术无疼痛、手术有疼痛复合氟芬合剂能完成手术为有效. 结果 全部病例在阻滞过程中均未出现异感,其中有效324例(99.1%),失败3例. 结论 不探寻异感肌间沟臂丛阻滞方法简单,易于掌握,效果良好,值得推广.

  1. Avulsão do plexo braquial em cães -1: aspectos clínicos e neurológicos Brachial plexus avulsion in dogs -1: clinical and neurological aspects

    Directory of Open Access Journals (Sweden)

    Mônica Vicky Bahr Arias

    1997-03-01

    Full Text Available A avulsão do plexo braquial é afecção de ordem traumática relativamente comum, ocasionando paralisia grave do membro torácico. É freqüentemente confundida com paralisia do nervo radial, havendo controvérsias sobre o tratamento. O objetivo deste trabalho foi: avaliar clinica e neurologicamente cães com avulsão do plexo braquial, demonstrando os aspectos significativos para o diagnóstico desta afecção. Observou-se predominância de cães sem raça definida, fêmea, com menos de três anos de idade, sendo o atropelamento a etiologia principal. As alterações clinicam/neurológicas mais freqüentes foram: paralisia flácida, ausência do reflexo dopanículo, ausência dos reflexos tricipital, bicipital e extensor do carpo radial, atrofia dos músculos tríceps, bíceps, supra-espinhal, infra-espinhal e extensores do carpo, anestesia cutânea abaixo do nível do cotovelo e abrasão/ulceração em face dorsal da mão. A associação destes resultados com os aspectos da histologia e da eletroneuroestimulação (relatados na parte 2 e 3 deste trabalho, respectivamente sugeriu envolvimento quase que total das raízes do plexo braquial em todos os casos.Brachial plexus avulsion is a relatively common affection, causing serious paralysis of the thoracic limb. It is often misdiagnosed as radial paralysis and there are controversies about the treatment. The main purposes of this work were: to evaluate clinically and neurologically dogs with brachial plexus avulsion and to demonstrate the relevant aspects in the diagnosis of this affection. Predominantly mixed breed dogs, females under three years of age were observed, and the brachial plexus avulsion was mainly a result of road accidents. The more frequent clinical and neurological signs were: flacid paralysis, loss of the panniculus, triceps, biceps and extensor carpi radial muscle reflexes, atrophy of the muscles triceps, biceps, extensor carpi radial, supraspinatus and infraespinatus

  2. A randomized controlled double-blinded prospective study of the efficacy of clonidine added to bupivacaine as compared with bupivacaine alone used in supraclavicular brachial plexus block for upper limb surgeries

    Directory of Open Access Journals (Sweden)

    Shivinder Singh

    2010-01-01

    Full Text Available We compared the effects of clonidine added to bupivacaine with bupivacaine alone on supraclavicular brachial plexus block and observed the side-effects of both the groups. In this prospective, randomized,double-blinded, controlled trial, two groups of 25 patients each were investigated using (i 40 ml of bupivacaine 0.25% plus 0.150 mg of clonidine and (ii 40 ml of bupivacaine 0.25% plus 1 ml of NaCl 0.9, respectively. The onset of motor and sensory block and duration of sensory block were recorded along with monitoring of heart rate, non-invasive blood pressure, oxygen saturation and sedation. It was observed that addition of clonidine to bupivacaine resulted in faster onset of sensory block, longer duration of analgesia (as assessed by visual analogue score, prolongation of the motor block (as assessed by modified Lovett Rating Scale, prolongation of the duration of recovery of sensation and no association with any haemodynamic changes (heart rate and blood pressure, sedation or any other adverse effects. These findings suggest that clonidine added to bupivacaine is an attractive option for improving the quality and duration of supraclavicular brachial plexus block in upper limb surgeries.

  3. The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure

    Directory of Open Access Journals (Sweden)

    Al-mustafa Mahmoud

    2010-01-01

    Full Text Available Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF. The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea-tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients. The mean onset time for impaired or re-duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05. The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019. Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.

  4. Functional compensative mechanism of upper limb with root avulsion of C5-C6 of brachial plexus after ipsilateral C7 transfer

    Institute of Scientific and Technical Information of China (English)

    SONG Jie; CHEN Liang; GU Yu-dong

    2008-01-01

    observed and their ultramicrostructure also had a tendency to mature as compared with those of 3 weeks postoperatively. Twelve weeks after operation, all parameters of the C7-transection group were not significantly different from those of the control group P 0.05. In the C7-transection group, the motor end plates were densely distributed and their ultramicrostructure in four representative muscles appeared to be mature as compared with those of the control group. Conclusions: After ipsilateral C7 transfer for treatment of root avulsion of C5-C6 of the brachial plexus, the nerve fibers of the lower trunk can compensatively innervate fibers of C7-representative muscles by means of motor end plate regeneration, so there is no further impairment on the injured upper limb.

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

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    Moharram Ashraf N

    2006-12-01

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

  6. Joint Manipulation under Brachial Plexus Anesthesia Combined with Physical Therapy for Treatment of Periarthritis of Shoulder%臂丛麻醉下关节松动术结合理疗治疗肩周炎

    Institute of Scientific and Technical Information of China (English)

    陈爱萍; 王娴默; 黄亮; 徐澄; 张忠贵; 肖林

    2013-01-01

    Objective To observe the treatment effect of joint manipulation under brachial plexus anesthesia combined with comprehensive physical therapy in treatment of periarthritis of shoulder. Mehods From 2010.3 to 2010.9, 60 patients with periarthritis of shoulder in the Department of Pain, The First People's Hospital of Jingzhou,were divided into 3 groups:group A,B and C.Twenty patients in Group A were given Joint manipulation under brachial plexus anesthesia for treatment of the periarthritis of shoulder. Twenty patients in Group B were given comprehensive physical therapy fro treatment of periarthritis of shoulder. Twenty patients in Group C were given Joint manipulation under brachial plexus anesthesia combined with comprehensive physical therapy for treatment of periarthritis of shoulder.Results All 60 patients were followed up for 1 months. At the 1st month after surgery, vas score was evaluated for patients. Postoperative and preoperative vas score difference was compared between 3 groups by t test. There was statistically significant difference in the postoperative and preoperative vas score between Group C and Group A,and between Group B and Group A (P<0.05) . Conclusion The treatment effect of Joint manipulation under brachial plexus anesthesia combined with physical therapy in treatment of periarthritis of shoulder is good, but has no obvious difference compared with comprehensive physical therapy.%目的观察臂丛麻醉下关节松动术结合理疗治疗肩周炎的疗效.方法自2010年3~9月对60例肩周炎患者分3组,A组20例使用臂丛麻醉下关节松动术治疗,B组20例行综合性理疗治肩周炎,C组20例使用臂丛麻醉下关节松动术结合理疗.结果60例患者均参加随访1个月.术后1个月后对患者使用VAS评分对比术前VAS评分采用单因素方差分析.结果C组对比A组,差异有统计学意义(P<0.05).B组对比A组,差异有统计学意义(P<0.05).结论臂丛麻醉下

  7. 臂丛神经磁共振IDEAL T2WI 和CUBE Flex T2WI 成像%Imaging of the Brachial Plexus with IDEAL and CUBE FlexT2-Weighted Imaging

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    郭勇; 林伟; 钱明珠; 黄敏华; 孙楠; 吕剑; 盛浩

    2011-01-01

    Purpose To compare the methods ofiterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL), Cube Flex methods with fat-saturated T2-weighted-imaging (T2WI), fast spin-echo (FSE) and short-TI inversion recovery (STIR) imaging of the brachial plexus. Materials and Methods Images were acquired at 3.0T scanner in 14 volunteers. Fat-saturated FSE T2WI and STIR images were compared with IDEAL T2WI images and Cube Flex-T2WI images. Results IDEAL T2WI and Cube Flex-T2WI demonstrated similar fat suppression quality compared with STIR (P > 0.05) and better than fat-saturated FSE T2WI (P < 0.05). Signal noise ratio and contrast noise ratio of brachial plexus showed significant difference in the following sequences: IDEAL T2WI > Cube Flex T2WI > FSE T2WI > STIR (P < 0.05). Images of IDEAL T2WI and Cube Flex T2WI reconstructed with different slice thickness could clearly demonstrate brachial plexus. Conclusion IDEAL T2WI and Cube Flex T2WI can provide high signal noise ratio images with reliable and uniform fat suppression for clearly imaging the brachial plexus.%目的 比较磁共振脂肪抑制FSE T2WI 、STIR T2WI 、IDEAL T2WI 及CUBE Flex T2WI 4 种方法显示正常臂丛神经的优劣.资料与方法对14 例自愿者行臂丛神经MRI 脂肪抑制FSE T2WI 、STIR T2WI 、IDEAL T2WI 及CUBE Flex T2WI 检查.对图像脂肪抑制质量进行肉眼分级评估,并测量信噪比和对比噪声比.结果 IDEAL T2WI 、CUBE Flex T2WI 脂肪抑制质量明显优于FSE T2WI(P <0.05),与STIR T2WI 相比差异无统计学意义(P >0.05).信噪比、对比噪声比均值比较各组间差异均有统计学意义(P <0.05),IDEAL T2WI >CUBE Flex T2WI >FSE T2WI >STIR T2WI.IDEAL T2WI 和CUBE Flex T2WI 图像均可选择不同厚度重建、斜面重建等,从而可显示臂丛神经各段.结论 IDEAL T2WI 、CUBE Flex T2WI 能提供均匀稳定的脂肪抑制,图像信噪比高,可清晰显示臂丛神经.

  8. Comparative study on two brachial plexus anesthesia methods in the emergency surgery of hand trauma%急诊手外伤术中2种臂丛麻醉方法的对比研究

    Institute of Scientific and Technical Information of China (English)

    董桃花

    2014-01-01

    sedation scale score were compared between two groups. Results:Blood pressure in all patients decreased after anesthesia, however, it was higher in group A than in group B and the difference was statistically signiifcant (P<0.05). There were no obvious differences in heart rate and anesthetic effect between two groups before and after anesthesia. The total incidence of adverse reactions occurred at 2.5%in group A and 15%in group B and the difference was statistically signiifcant (P<0.01). The ratio with Ramsay sedation scale score 2~4 points accounted for 80%in group A, which was higher than 62.5%in group B, and the difference was statistically signiifcant (P<0.05). Conclusion:Brachial plexus anesthesia of acute hand injuries can not cause any signiifcant effect on heart rate in patients with axillary block anesthesia. Sedation anesthesia point method is much better than interscalene two block method and can effectively control blood pressure and reduce the adverse reaction.

  9. 利多卡因和左旋布比卡因对大鼠臂丛神经功能的影响%Effects of Lidocaine and Levobupivacaine on Brachial Plexus Nerve Function in Rats

    Institute of Scientific and Technical Information of China (English)

    文婷; 杨晓慧; 梅金红

    2011-01-01

    目的 探讨利多卡因和左旋布比卡因对大鼠臂丛神经功能的影响.方法 将54只SD大鼠按随机数字表法分为9组,每组6只:随机选取大鼠的一侧,生理盐水对照组(NS组)于腋鞘内注入生理盐水1 mL,利多卡因L1-L4组于腋鞘内分别注入0.25%、0.50%、1.00%、2.00%利多卡因1 mL,左旋布比卡因Z1-Z4组于腋鞘内分别注入0.25%、0.50%、1.00%、2.00%左旋布比卡因1 mL.给药5d后,检测9组大鼠臂丛神经动作电位(AP)最大振幅、神经传导速度(NCV)的变化.结果 与NS组相比,L2-L4组、Z3-Z4组臂丛神经AP的最大振幅降低,NCV减慢(P<0.05);组内比较:随着药物浓度递增,L2-L4组、Z3-Z4组臂丛神经AP的最大振幅降低,NCV减慢(P<0.05);相同浓度利多卡因和左旋布比卡因比较:利多卡因组臂丛神经AP的最大振幅降低,NCV减慢(P<0.05).结论 相同浓度利多卡因对臂丛神经功能的损害较左旋布比卡因更大.%Objective To study the effects of lidocaine and levobupivacaine on brachial plexus nerve function in rats. Methods Fifty-four SD rats were randomly divided into nine groups, with 6 rats in each group. Axillary intrathecal injection on one side with 0. 9% saline (1 mL) ,0. 25% lidocaine (1 mL),0. 50% lidocaine (1 mL),l. 00% lidocaine (1 mL),2.00% lidocaine (1 mL), 0.25% levobupivacaine (1 mL) ,0. 50% levobupivacaine (1 mL),1.00% levobupivacaine (1 mL) and 2. 00% levobupivacaine (1 mL) was given to rats in NS group, L1 group,L2 group,L3 group, L4 group, Z1 group, Z2 group, Z3 group and Z4 group, respectively. The changes in the maximum amplitude of compound action potential (AP) and nerve conduction velocity (NCV) of brachial plexus nerve trunks were determined 5 days after injection. Results Compared with NS group, the maximum amplitude of AP and NCV decreased significantly in L2, L3, L4, Z3 and Z4 groups (P<0. 05). Furthermore,the maximum amplitude of AP and NCV decreased with the increase of drug

  10. Clinical Analysis of Motor Nerve and Sensory Nerve Block in Brachial Plexus Block Guided by Nerve Stimulator%神经刺激仪对臂丛神经运动与感觉阻滞的临床分析

    Institute of Scientific and Technical Information of China (English)

    王辉; 王玲

    2013-01-01

    Objective To evaluate the clinical outcomes of motor nerve and sensory nerve separate block in interscalene brachial plexus block guided performed by nerve stimulator. Methods Eighty patients with upper extremity surgery were randomly divided into 2 groups with 40 cases each. The interscalene brachial plexus block was performed with the conventional technique in control group,and with a reformed method guided by the nerve stimulator in observation group. The sensory and motor block, VAS score and recovery of motor function were compared between the two groups at different time point after anesthesia. Results ①There were no significant differences in the outcomes of ulnar and medial nerve block. The success rate of musculo-cutaneous verve and radial nerve block was significantly higher in observation group than that in control group(P <0.05). ②The VAS score of observation group was higher than control group at 6h after anesthesia( P < 0.05). And the cases of myodynamia ≥ 2 in observation group were marked higher that in control group at 1h and 2h after giving drugs (P < 0.05 ). Conclusion Brachial plexus block guided by the nerve stimulator is better than conventional technique with a higher block rate and lesser local anesthetic dosage and faster recovery.%目的 比较传统异感法与神经刺激仪辅助定位法在臂丛神经阻滞中对运动与感觉阻滞的临床效果.方法 选取行上肢手术的80例患者,随机分为对照组和观察组各40例,对照组采用传统异感法进行肌间沟臂丛阻滞,观察组在神经刺激仪引导下行肌间沟臂丛阻滞.比较两组患者麻醉后不同时间感觉和运动阻滞的情况.结果 ①观察组对于尺神经、桡神经、正中神经及肌皮神经组织效果均较好,两组患者在尺神经和正中神经阻滞效果上差异不明显,但观察组对桡神经和肌皮神经的阻滞效果明显优于对照组(P<0.05).②两组患者麻醉后0.5h、1h、2h、24h

  11. 臂丛阻滞镇痛与自控镇静用于断指再植患者的护理%Nursing of replantation of amputated finger patients accepting brachial plexus block analgesia and patient-controlled sedation

    Institute of Scientific and Technical Information of China (English)

    岳红; 徐鹏; 郭俊光

    2010-01-01

    Objective To probe into nursing management methods of replantation of amputated finger patients accepting brachial plexus block analgesia and patient-controlled sedation (PCS) after operation.Methods 48 patients of replantation of amputated fingers accept continuous brachial plexus block analgesia and PCS after operation,Analgesia was 0.2% ropivaeaine,sedation was 0.05% midazolam or compositive liquid mixed 0.05% midazolam and 0.0005% fentanyl,the visual analogue scale (VAS),sedation scores and the changes of vital signs and side effocts after operation were recorded before the operation and at time intervals of 6,12,24,48,72 hours after the operation.Results The visual analogue scale(VAS)in the post-operation was obviously lower than the pre-operation,the Ramsay scores of PCS were higher than the pro-operation.There was no inadequate or excessive sedation.No influence was seen on respiration,circulation system and no other side effects happened.Conclusions Brachial plexus block analgesia and patient-controlled sedation (PCS) can offer a good Analgesia and sedation effect for patients of amputated fingers replantation,in period of analgesia and sedation,we should strengthen nursing and monitoring of vital signs to avoid accident.%目的 探讨臂从阻滞镇痛及自控镇静(PCS)用于断指再植患者术后镇痛镇静处理的效果及护理管理方法.方法 收集48例断指再植患者,术后行持续臂丛阻滞镇痛及静脉自控镇静,镇痛药物为0.2%罗哌卡囚,镇静药物采用0.05%咪唑地西泮或0.05%咪唑地西泮与0.0005%芬太尼复合液,观察术前及术后6,12,24,48,72 h时镇痛镇静评分、术后生命体征变化及不良反应.结果 术后镇痛评分明显低于术前;PCS后各时间点的镇静评分均高于术前,无一例镇静不足或镇静过度发生.患者术后呼吸循环稳定,无明显不良反应发生.结论 臂从阻滞镇痛及自控镇静能为断指再植患者提供良好的镇痛镇静效果,镇痛镇

  12. Análise comparativa da origem do plexo branquial de catetos (Tayassu tajacu Comparative analysis of the origin of the brachial plexus of the collared peccary (Tayassu tajacu

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo B. Moura

    2007-09-01

    .Collared peccary (Tayassu tajacu belongs to the Tayassuidae family, characterized by a "collar" of white hairs that cross behind the neck and extend bilaterally in front of the shoulders. It can be found from south-western United States to Argentina. In the literature a shortage of data is verified regarding the functional anatomy of the collared peccaries, especially of studies that involve the anatomy of the brachial plexus. To elucidate the behavior of this plexus of collared peccaries and with the purpose to contribute for the development of compared anatomy, this study was accomplished. Thirty animals of different ages were used (17 males and 13 females coming from the Wild Animal Multiplication Center of the "Universidade Federal Rural do Semiárido" Mossoró, Rio Grande do Norte, Brazil. After slaughter bilateral dissection of the brachial plexuses took place, and the results were registered in schematic drawings and the dispositions grouped in tables for subsequent statistical analysis based on the percentile frequency. It was found that the Plexus brachialis of collared peccaries is the result of established communications, mainly among the Rami ventrales of the last three cervical nerves and of the first two thoracic nerves, having a contribution of the fourth and fifth cervical nerves in 16.67% and 50.00% of the cases, respectively. In 40.00% of the dissections the most frequent plexus was of the type C6, C7, C8, T1 and T2. The main nerves derived from brachial plexus of the collared peccaries and its respective origins had been: Nervus suprascapularis (C6, C7, Nn. subscapulares (C5, C6 e C7 or C6 e C7, N. axillaris (C6, C7, N. musculocutaneus (C7, C8, N. medianus (C7, C8, T1, T2, N. radialis (C8, T1, T2, N. ulnaris (C8, T1, T2, cranialis (C7, and caudalis (C7, C8 Nn. pectorales , N. thoracodorsalis (C6, C7, C8, N. thoracicus longus (C7, C8, and N. thoracicus lateralis (C8, T1, T2.

  13. Avulsión del plexo braquial traumático no controlado con remifentalino: Papel de la analgesia epidural cervical Traumatic brachial plexus root avulsion unresponsive to remifentanyl role cervical epidural analgesia

    Directory of Open Access Journals (Sweden)

    M. Cortiñas

    2007-04-01

    Full Text Available Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8 de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6. El dolor es controlado en fase crónica (escala visual analógica 2 con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol.We presented you a patient who suffered a left brachial plexus avulsión with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8. High-dose remifentanil infusión was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6 epidural catheter. At discharge pain remained controlled (visual analogue scale 2 with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol.

  14. [Peripheral nerve injuries complicating extracranial vascular surgery (author's transl)].

    Science.gov (United States)

    Grobe, T; Raithel, D

    1978-10-01

    Peripheral nerve injuries may complicate extracranial vascular surgery. Pareses of the recurrent and hypoglossal nerves are clinically important. The nervus laryngeus superior, the ramus marginalis mandibulae of the facial nerve and the brachial plexus may be involved. Horner's syndrom indicating damage of sympathetic fibers may also appear. Lesions of the glossopharyngeal, vagus and phrenic nerves are rather seldom.

  15. Supplementary motor area deactivation impacts the recovery of hand function from severe peripheral nerve injury

    Institute of Scientific and Technical Information of China (English)

    Ye-chen Lu; Han-qiu Liu; Xu-yun Hua; Yun-dong Shen; Wen-dong Xu; Jian-guang Xu; Yu-dong Gu

    2016-01-01

    Although some patients have successful peripheral nerve regeneration, a poor recovery of hand function often occurs after peripheral nerve injury. It is believed that the capability of brain plasticity is crucial for the recovery of hand function. The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury. In this study, we explored the activation mode of the supplementary motor area during a motor imagery task. We investigated the plasticity of the central nervous system after brachial plexus injury, using the motor imagery task. Results from functional magnetic resonance imaging showed that after brachial plexus injury, the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas. This result indicates that it is dififcult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task, thereby impacting brain remodeling. Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing, initiating and executing certain movements, which may be partly responsible for the unsatisfactory clinical recovery of hand function.

  16. 超声引导下连续臂丛神经阻滞对肱动脉-贵要静脉人工血管移植内瘘血流的影响%The influence of ultrasound-guided continuous brachial plexus block on the blood flow in brachial artery-basilic vein arteriovenous graft

    Institute of Scientific and Technical Information of China (English)

    朱开来; 王武; 雷李培

    2016-01-01

    目的 观察超声引导下连续臂丛神经阻滞对肱动脉-贵要静脉人工血管内瘘血流的影响.方法 选择拟行上臂肱动脉-贵要静脉人工血管内瘘成形术患者共78例,采用随机数字表法分为单次臂丛神经阻滞组(SBB组)和连续臂丛神经阻滞组(CBB组),每组39例,操作均在超声引导下进行,CBB组术后接神经阻滞镇痛泵自控镇痛(PCNA),比较两组术前(T0)动脉直径及术后4h(T1)、24 h(T2)、7 d(T3)、3个月(T4)的动脉直径、内瘘血流量及手术成功率;比较两组术后48 h的镇痛药补救次数、镇痛满意度及麻醉相关并发症.结果 CBB组T2、T3、T4的动脉直径[(4.2±0.3)mm、(4.6 ±0.3)mm、(5.2±0.3)mm]及内瘘血流量[(325±15.2) ml/min、(625±32.5)ml/min、(1 125±90.2)ml/min]均较SBB组[(3.8±0.2)mm、(4.1 ±0.2)mm、(4.7±0.3)mm,(162±9.8)ml/min、(442±20.3)ml/min、(778±40.2)ml/min]明显增加(P<0.05);CBB组较SBB组术后48 h的镇痛药补救次数减少,镇痛满意度升高(P<0.05).结论 与单次臂丛神经阻滞相比,连续臂丛神经阻滞可显著减轻肱动脉-贵要静脉人工血管移植内瘘术后疼痛,增加动脉直径及内瘘血流量.%Objective To investigate the effects of ultrasound-guided continuous brachial plexus block on the blood flow in brachial artery-basilic vein arteriovenous graft (AVG).Methods A total of 78 patients undergoing brachial artery-basilic vein AVG were randomly assigned to an experiment group that was received single-injection brachial plexus block (SBB),or to a control group that was received continuousinjection brachial plexus block group (CBB).Operation was conducted by ultrasound-guided technique.CBB group used patient-controlled nerve analgesia (PCNA) after surgery.The difference of artery diameter preoperative (T0),artery diameter,fistula blood flow,and postoperative success at 4 h (T1),20 h (T2),7 d (T3),3 m (T4) were compared between two groups.The remedia painkiller times

  17. The comparison of three different methods of nerve localization applied in interscalene brachial plexus block%三种常用定位方法肌间沟臂丛阻滞的比较

    Institute of Scientific and Technical Information of China (English)

    张干; 袁新平; 何绍明; 周宁; 方凯凯

    2010-01-01

    目的 比较筋膜突破(facial pop,FP)、异感(paresthesia,PAR)、外周神经刺激(peripheral nerve stimulation,PNS)3种定位法应用于肌间沟臂丛阻滞的临床效果以及局麻药在臂丛鞘内的分布与扩散状况.方法 90例拟行上肢手术的患者,采用随机数字表法分为筋膜突破组(FP组)、异感组(PAR组)和外周神经刺激组(PNS组),每组30例.评估感觉和运动神经的阻滞程度、手术过程中的麻醉效果,观察和记录并发症的发生情况,每组6例行C_4~T_3的横断面及注药侧肌问沟的冠、矢状面计算机体层摄影(computed tomography,CT).结果 3组患者中腋神经、肌皮神经、正中神经、桡神经的感觉及运动评分差异均无统计学意义;前臂内侧皮神经的感觉评分和尺神经的感觉及运动评分FP组明显高于PAR组(P<0.05)和PNS组(P<0.01),PAR组明显高于PNS组(P<0.05);损伤血管发生率PAR组明显高于FP组(P<0.01)和PNS组(P<0.05). CT结果显示局麻药在臂从鞘内呈不均匀扩散,仅在肌间沟水平似乎有鞘的特征,其以下有明显的分隔及囊袋,并有伪足.PNS组的总体麻醉效果高于FP组(P<0.05);尺侧手术麻醉效果FP组低于PAR组(P<0.05)和PNS组(P<0.01).结论 上臂及前臂桡侧手术采用3种定位均可,但FP法更安全简便;偏向尺侧的手术宜采用PAR或PNS定位法,以PNS定位为佳.%Objective To compare the effects of the interscalene brachial plexus block performed by three different methods of nerve localization-facial pop (FP), paresthesia (PAR), peripheral nerve stimulation (PINS) and the distribution of local anesthet-ics. Methods 90 patients scheduled for upper extremity operations were randomized to three groups (n=30 in each group): group FP, group PAR and group PNS. The extent of sensory and motor blockade of each innervated region was assessed by scale scores,the anesthetic effects of surgical field and the complications were observed and recorded. Computed tomography (CT

  18. Clinical observation on interscalene brachial plexus block guided by C-arm X-ray machine%C形臂X射线机定位肌间沟臂丛神经阻滞

    Institute of Scientific and Technical Information of China (English)

    周文; 李军; 王维林; 徐德朋

    2012-01-01

    目的 比较肌间沟异感法和C形臂X射线机定位肌间沟臂丛神经阻滞在上臂、前臂、手部手术中的麻醉效果.方法 60例上臂、前臂、手部手术患者,采用随机数字表法将患者随机分为A、B两组,每组30例.A组于C6横突水平与皮肤垂直进针,出现异感时注入1.0%利多卡因+0.3%罗哌卡因混合液25 ml(内含1:200 000肾上腺素);B组运用C形臂X射线机定位,直至针尖触及C7横突尖为止,注入上述麻药25 ml.据患者主诉和骨科医师评定阻滞效果.结果 B组中Ⅰ级的发生率高于A组(P0.05).结论 对于上臂、前臂、手部手术,C形臂X射线机定位肌间沟臂丛神经阻滞的麻醉效果明显优于肌间沟异感法.%Objective To compare the anesthetic effects of interscalene brachial plexus block guided by elicitation of paresthesia and C-arm X-ray machine during surgeries of the upper arm , forearm and hand. Methods Sixty patients scheduled for upper arm , forearm, and hand surgeries were randomly divided into two groups (re =30 in each group). The needle was inserted perpendicularly to the skin at the level of the transverse process of C 6 ,when a paresthesia was elicited ,the mixture of 1.0% lidocaine and 0.3% ropivacaine (with 1: 200 000 epinephrine) was injected in group A. The needle was inserted guided by C -arm X-ray machine, when the posterior tubercle of transverse process of C 7 was encountered, the same mixture was injected in group B. The effects were evaluated by patient ' s chief complaints and orthopedists. Results The incidence of grade Ⅰ was significantly higher in group B than that in group A (P 0.05). Conclusion The anesthetic effects of interscalene brachial plexus block guided by C-arm X-ray machine is more effective than that by elicitation of paresthesia in the upper arm ,forearm,and hand surgeries.

  19. The Research of the Relationship between Music Intervention and Brachial Plexus Anesthetic Patients’ Stress State%音乐干预与臂丛麻醉患者应激状态的相关性研究

    Institute of Scientific and Technical Information of China (English)

    朱芩芩; 方丹青; 刘岷; 杨煜; 胡建荣

    2012-01-01

      目的探讨音乐干预对臂丛麻醉患者应激状态的影响.方法80例ASAI~II级臂丛麻醉患者,随机分为实验组(I)和对照组(II),每组各40例.I组患者入室后即予播放自选的音乐至术毕,II组患者术中不播放音乐.观察两组患者的镇静情况,记录术中镇静药、镇痛药的用量、血流动力学及血液应激激素指标的变化.研究音乐干预对麻醉期患者的影响,并与对照组患者比较.结果I组患者血流动力学指标的变化幅度、四项血液应激激素指标及辅助性镇静镇痛药物的使用量均显著小于II组(P<0.05);I组的VAS疼痛评级,Ramesay镇静评分显著优于II组(P<0.05).结论音乐干预对臂丛麻醉患者可以起到稳定血流动力学、降低麻醉期应激反应、减少麻醉性辅助药物用量的作用,是一种安全,有效,简单的方法.%  Objective To investigate the effect for music intervention on brachial plexus anesthetic patients’ stress state. Method Eighty brachial plexus anesthetic patients (ASA grade I-II) were randomly assigned into study group(Group I) and control group(Group II),and each group contained 40 patients. During the operation, the music was played for Group I until the end of the operation while no music for GroupII. Study indexes contained anesthetic situation,the total dose of sedative and analgesic, hemodynamic criterion and biochemical criterion. Result The hemodynamic fluctuation,the biochemical criterion and the dose of assistant sedative and analgesic for Group 1 were both significantly lower than Group II(P<0.05);VAS analgesia level and Ramesay tranquilizer level for Group 1 were much better than Group 2(P<0.05). Conclusion Music intervention could stabilize hemodynamic, retrain irritated responsiveness and reduce the using for anesthetic. It was a easy, safe and effective method.

  20. Idiopathic brachial neuritis in a child: A case report and review of the literature

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    Shikha Jain

    2014-01-01

    Full Text Available Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2³-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies.

  1. Diffusion-weighted MR neurography for the assessment of brachial plexopathy in oncological practice

    NARCIS (Netherlands)

    Andreou, Adrian; Sohaib, Aslam; Collins, David J.; Takahara, Taro; Kwee, Thomas C.; Leach, Martin O.; MacVicar, David A.; Koh, Dow-Mu

    2015-01-01

    Background: To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy. Methods: 40 oncological patients with symptoms of brachial plexopathy underwent 1.5 T MRI using conventional MR sequences and unidirectional DW-MRN. T

  2. Anatomic study of different mechanisms of Horner syndrome between obstetric brachial plexus palsy and adult brachial plexus injury%产瘫与成人臂丛损伤Horner征产生机制差异的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    黄轶刚; 陈亮; 顾玉东

    2005-01-01

    目的研究产瘫与成人臂丛损伤患者Horner征产生机制差异的解剖学基础,以明确Horner征能否作为产瘫的绝对手术指征. 方法 (1)解剖新生儿及成人尸体各6具(12侧),观察并比较新生儿和成人交感神经节与构成臂丛C5~T1神经根之间的解剖关系.(2)解剖新鲜新生儿及成人尸体各2具,取C5~T1脊髓行乙酰胆碱酯酶(AChE)组化染色,C5~T1脊髓及双侧神经根行交感神经节前神经元标记物--神经型一氧化氮合酶(nNOS)免疫组化染色. 结果 (1)12侧新生儿标本中有10侧(83%)可观察到自C7、C8和T1发出交通支进入星状神经节,其余2侧(17%)交通支发自C8和T1神经根;成人标本可见到进入的星状神经节的交通支分别发自C8和T1神经根(12侧中有9侧,75%)或单纯来自T1神经根(12侧中有3侧,25%).(2)新生儿及成人脊髓T1节段可检测到AChE及nNOS阳性细胞分布于脊髓中间外侧柱. 在新生儿C7、C8和T1神经前根均可检测到nNOS阳性神经纤维,在成人仅在C8和T1神经前根可检测到nNOS阳性神经纤维. 结论新生儿C7~T1均有交感神经节前纤维,产瘫患儿出现Horner征也可能与C7撕脱有关,因此,不能以该征作为产瘫患儿早期臂丛探查的绝对指征.

  3. Neonatal Brachial Plexus Palsy and Causation

    LENUS (Irish Health Repository)

    Turner, M J

    2016-07-01

    A vaginal childbirth is the result of the internal (endogenous) expulsive forces of uterine contractions, usually supplemented by active maternal pushing1. Depending on the clinical circumstances, additional external (exogenous) traction forces may be required from the birth attendant. This blend of internal and external forces varies from birth to birth. Women who have had a previous vaginal delivery, for example, may deliver successfully with uterine contractions alone and the role of the birth attendant may be simply to control and slow the delivery so that trauma to the maternal perineum from stretching by the fetal head is minimised. In contrast, additional traction may be required by an obstetrician at the time of an operative vaginal delivery for fetal distress or dystocia. The strength of the traction required may be increased by clinical factors, for example, fetal macrosomia or malposition. The traction should be axial in the direction of the birth canal, which is a vector combining horizontal and vertical traction at 25-45 degrees below the horizontal when the woman is in the lithotomy position.

  4. Joint Mobilization Combined with Continuous Brachial Plexus Block Treating Traumatic Elbow Joint Dysfunction%关节松动术合用臂丛神经连续阻滞治疗创伤性肘关节功能障碍

    Institute of Scientific and Technical Information of China (English)

    张海远; 王倩

    2013-01-01

    目的:探讨关节松动术联合连续斜角肌肌间沟臂丛神经阻滞对创伤性肘关节功能障碍的治疗作用。方法:将100例创伤后肘关节功能障碍患者随机分成对治疗组和对照组,治疗组采用关节松动术联合连续斜角肌肌间沟臂丛神经阻滞,对照组采用关节松动术,分别采用测角计和Mayo评分法评定两组患者治疗前后患肘关节活动范围(ROM)及其功能。结果:治疗后两组ROM、Mayo评分均较治疗前明显提高(P<0.05);且治疗组的ROM、Mayo评分高于对照组(P<0.05)。结论:关节松动术联合连续斜角肌肌间沟臂丛神经阻滞治疗创伤后肘关节功能障碍疗效显著,值得临床推广应用。%Objective:To investigate the therapeutic effects of joint mobilization combined with continuous brachial plexus block of scalene intersca-lene treating traumatic elbow joint dysfunction. Methods:100 cases of traumatic elbow joint dysfunction were randomly divided into the treatment group and control group, treatment group was treated with joint mobilization and continuous brachial plexus block of scalene interscalene, control group with joint mobilization, goniometer and Mayo scores were respectively applied to evaluate the range of motion (ROM) and function of elbow joint in two groups before and after treatment. Results:ROM and Mayo scores of two groups after the treatment were significantly improved, compar-ing with those before the treatment (P<0.05);ROM and Mayo scores of treatment group were both higher than those of control group (P<0.05). Con-clusion:Joint mobilization combined with continuous brachial plexus block of scalene interscalene treating traumatic elbow joint dysfunction is of significant efficacy, being worthy of clinical promotion and application.

  5. Esophageal cancer related gene-4 is a choroid plexus-derived injury response gene: evidence for a biphasic response in early and late brain injury.

    Directory of Open Access Journals (Sweden)

    Sonia Podvin

    Full Text Available By virtue of its ability to regulate the composition of cerebrospinal fluid (CSF, the choroid plexus (CP is ideally suited to instigate a rapid response to traumatic brain injury (TBI by producing growth regulatory proteins. For example, Esophageal Cancer Related Gene-4 (Ecrg4 is a tumor suppressor gene that encodes a hormone-like peptide called augurin that is present in large concentrations in CP epithelia (CPe. Because augurin is thought to regulate senescence, neuroprogenitor cell growth and differentiation in the CNS, we evaluated the kinetics of Ecrg4 expression and augurin immunoreactivity in CPe after CNS injury. Adult rats were injured with a penetrating cortical lesion and alterations in augurin immunoreactivity were examined by immunohistochemistry. Ecrg4 gene expression was characterized by in situ hybridization. Cell surface augurin was identified histologically by confocal microscopy and biochemically by sub-cellular fractionation. Both Ecrg4 gene expression and augurin protein levels were decreased 24-72 hrs post-injury but restored to uninjured levels by day 7 post-injury. Protein staining in the supraoptic nucleus of the hypothalamus, used as a control brain region, did not show a decrease of auguin immunoreactivity. Ecrg4 gene expression localized to CPe cells, and augurin protein to the CPe ventricular face. Extracellular cell surface tethering of 14 kDa augurin was confirmed by cell surface fractionation of primary human CPe cells in vitro while a 6-8 kDa fragment of augurin was detected in conditioned media, indicating release from the cell surface by proteolytic processing. In rat CSF however, 14 kDa augurin was detected. We hypothesize the initial release and proteolytic processing of augurin participates in the activation phase of injury while sustained Ecrg4 down-regulation is dysinhibitory during the proliferative phase. Accordingly, augurin would play a constitutive inhibitory function in normal CNS while down

  6. Cell transplantation for the treatment of spinal cord injury- bone marrow stromal cells and choroid plexus epithelial cells

    Institute of Scientific and Technical Information of China (English)

    Chizuka Ide; Norihiko Nakano; Kenji Kanekiyo

    2016-01-01

    Transplantation of bone marrow stromal cells (BMSCs) enhanced the outgrowth of regenerating axons and promoted locomotor improvements of rats with spinal cord injury (SCI). BMSCs did not survive long-term, disappearing from the spinal cord within 2–3 weeks after transplantation. Astrocyte-devoid areas, in which no astrocytes or oligodendrocytes were found, formed at the epicenter of the lesion. It was remarkable that numerous regenerating axons extended through such astrocyte-devoid areas. Regenerating axons were associated with Schwann cells embedded in extracellular matrices. Transplantation of choroid plexus epithelial cells (CPECs) also enhanced axonal regeneration and locomotor improvements in rats with SCI. Although CPECs disappeared from the spinal cord shortly after transplantation, an extensive outgrowth of regenerating axons occurred through astrocyte-devoid areas, as in the case of BMSC transplantation. These ifndings suggest that BMSCs and CPECs secret neurotrophic factors that promote tissue repair of the spinal cord, including axonal regeneration and reduced cavity formation. This means that transplantation of BMSCs and CPECs promotes “intrinsic” ability of the spinal cord to regenerate. The treatment to stimu-late the intrinsic regeneration ability of the spinal cord is the safest method of clinical application for SCI. It should be emphasized that the generally anticipated long-term survival, proliferation and differentiation of transplanted cells are not necessarily desirable from the clinical point of view of safety.

  7. 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)

    Mônica Vicky Bahr Arias

    1997-03-01

    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.

  8. 喙突入路锁骨下臂丛神经阻滞——改良法与经典法的比较%Infraclavicular brachial plexus nerve block via a coracoid approach: comparison of the anesthestic effects between the classic method and the modified method

    Institute of Scientific and Technical Information of China (English)

    焦微; 车薛华; 徐振东; 张洁

    2013-01-01

    目的 探讨改良(或修正)喙突入路和经典喙突入路定位对锁骨下臂丛神经阻滞的影响.方法 对80例择期行臂丛神经阻滞手术的患者,随机分为2组,采用神经刺激器定位臂丛神经:A组以喙突内下2 cm为穿刺点(经典组);B组穿刺点参考喙突内下2 cm,并用臂丛神经体表的 投影对该穿刺点进行修正(改良组).记录两组患者操作时间、穿刺次数、阻滞成功率、并发症及患者的满意度.结果 改良组的操作时间明显少于经典组(P<0.01),且改良组无需调整阻滞针即可定位到臂丛神经的比例明显高于经典组(P<0.05).结论 改良喙突入路可以明显提高单次穿刺定位到神经的概率,且可减少操作时间,提高了穿刺点体表定位的准确性.%Objective To investigate the impact of the modified and classic coracoid approach for localization in the infraclavicular brachial plexus nerve block.Methods Eighty patients schedtded for elective surgical procedures under infraclavicular brachial plexus block were randomly divided into two groups.The puncture point of Group A was the classic Wilson's approach via the point 2 cm medial and caudal to the coracoid process.The puncture point of Group B was modified by surface projection of the brachial plexus.Peripheral nerve stimulator was used to confirm the proper localization of the plexus.The performance time,the number of puncture,the anesthesia success rate,the incidence of complications and patient satisfaction were recorded.Results The performance time of the modified group was less than that of the classic group (P < 0.01).The chance of locating the bmchial plexus in a single puncture without adjusting the block needle was significantly higher in the modified group (P < 0.05).Conclusion The modified coracoid approach can significantly improve the probability of locating the nerve in one puncture that reduces the performance time.It improves the accuracy of puncture point

  9. Replanlation of amputated finger re- lieving pain by continue brachial plexus block%连续臂丛阻滞治疗断指再植术后疼痛

    Institute of Scientific and Technical Information of China (English)

    吴显杰; 刘玉静; 姜东; 王强; 刘义超; 宿德华

    2003-01-01

    @@ MATERIALS AND METHODS Materials 46 cases of auuputated finger patients were received from August1989 to July 1997, with 26 males and 20 females, age ranging from18 to 46 years, weighing 45 -70 kg. Epidural duct was input in in-termuscular, replantation of amputated finger were operated bybrachial plexus block for 5- 16 h, and all the branchial plexusblock were successful.

  10. Imagens ultra-sonográficas do plexo braquial na região axilar Imágenes ultra-sonográficas del plexo braquial en la región axilar Ultrasound images of the brachial plexus in the axillary region

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2007-12-01

    permite la identificación de las estructuras del plexo braquial ¹. Ese estudio buscó describir el posicionamiento de los nervios del plexo braquial con relación a la arteria axilar. MÉTODO: Fueron estudiados 30 voluntarios de los dos sexos, en posición supina con abducción a 90° y rotación externa del hombro y flexión del codo a 90°. Utilizando transductor digital de 5 cm y 5-10 MHz, fueron identificados los nervios mediano, ulnar y radial, y las respectivas posiciones en relación a la arteria fueron marcadas en una carta gráfica seccional de 8 sectores, enumerados en orden creciente a partir de la hora 12 (medial, cuyo centro representaba la arteria axilar. RESULTADOS: El nervio mediano se ubicó predominante en el sector 8 (55% y en el sector 1 (28% (mediales; el nervio radial se ubicó predominantemente en los sectores 4 (59% y 5 (34% (laterales y el nervio ulnar en los sectores 2 y 3 (inferiores en un 69% y un 24% de los casos, respectivamente. Hubo una considerable variación de la localización de los nervios con relación a los aspectos superior e inferior de la arteria. CONCLUSIÓN: La inspección en tiempo real, por ultrasonido, de las estructuras neuro vasculares del plexo braquial en la axila mostró que los nervios mediano, ulnar y radial pueden presentar diferentes relaciones con la arteria axilar.BACKGROUND AND OBJECTIVES: The axillary artery is the anatomical reference, in the surface, for axillary brachial plexus block. Anatomic studies suggest variability in the location of the structures in the brachial plexus in relation to the axillary artery. These variations can hinder blocks by neurostimulation. The ultrasound allows the identification of the structures within the brachial plexus¹. The objective of this report was to describe the position of the nerves in the brachial plexus in relation to the axillary artery. METHODS: Thirty volunteers of both genders were studied. They were in the supine position with 90° abduction and external

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-03-01

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

  12. Establishment of rabbit models of blast injury to the sacral plexus%兔骶丛爆震伤动物模型的建立

    Institute of Scientific and Technical Information of China (English)

    郭清河; 陈志强; 鹿楠; 杨迪; 朱清华; 陈爱民; 王建民; 李永川; 朱磊; 张志凌; 江曦; 李晓霞; 张良潮

    2012-01-01

    目的 探讨兔骶丛爆震伤动物模型的建立. 方法 取18只日本大耳白兔,致伤物为当量600 mg三硝基甲苯(TNT)炸药的电子雷管,根据雷管与皮肤致伤距离不同分为3组:致伤物与皮肤距离为1 cm(A组)、致伤物与皮肤距离为2 cm(B组)、致伤物与皮肤距离为5 cm(C组),每组6只,以后正中线、右髂后上棘与股骨转子连线及右股骨转子水平连线形成一三角形区域,即骶丛在体表投影区域为致伤点,于距爆炸点10 cm处采集爆震波压力,通过压力公式转换成各组致伤压力,于致伤前、致伤即刻、致伤后1周3个时相点检测下肢短潜伏期体感诱发电位(SLSEP),评估动物的伤情,观察骶丛神经损伤的情况.结果 A、B、C组爆震伤压力平均分别为(413.25±8.09)、(51.34±1.03)、(3.61±7.50) MPa,致伤面积平均分别为(31.47±5.91)、(18.13±8.04)、(4.60±7.16) cm2,以上项目3组间两两比较差异均有统计学意义(P<0.05).A组肉眼下骶丛神经全部断裂,1周存活率为0;B组肉眼下骶丛神经挫伤,骶丛损伤症状明显,伤后即刻SLSEP消失,1周后无恢复,1周存活率为83.3%;C组仅伤及皮肤,未见骶丛损伤症状,伤后即刻、伤后1周SLSEP与伤前比较差异均无统计学意义(P>0.05),1周存活率为100%.结论 600 mg TNT炸药、致伤距离为2 cm,可形成典型的骶丛损伤,稳定性良好,且存活率高,可作为长期实验观察研究.%Objective To establish models of blast injury to the sacral plexus in rabbits.Methods Electronic explosive detonators containing explosion equivalent of 600 mg TNT were used to create explosive injury to 18 rabbits which were divided into 3 even groups at random according to the distance between the detonator and the skin.The distance was 1 cm in group A,2 cm in group B and 5 cm in group C.The hit point was the triangle surface projection of the sacral plexus region formed by the posterior median line,the connection line between the

  13. 帕瑞昔布钠联合锁骨下臂丛神经阻滞对手外科患者术后镇痛的效果观察%Postoperative Analgesic Effects of Parecoxib Sodium Combined with Infraclavicular Brachial Plexus Block on Patients Undergoing Hand Surgery

    Institute of Scientific and Technical Information of China (English)

    王卓群; 张洁; 梁伟民

    2011-01-01

    Objective:To investigate the postoperative analgesic effects of parecoxib sodium combined with infraclavicular brachial plexus block on patients undergoing hand surgery. Methods:One hundred patients undergoing hand surgery were selected and randomly divided into two groups (n = 50): the parecoxib sodium group (Group P) and the control group (Group C). After the success of infraclavicular brachial plexus block, patients in Group P were administered one bolus of parecoxib sodium (40mg, diluted by 2mL N. S. ) intravenously 15 minutes before the beginning of operation, while those in Group C were injected N. S. by the same volume. VAS (visual analogue scale) was performed at postoperative 6, 8, 12 and 24 hours respectively, meanwhile, time and VAS to first pain, the number of patients demanded painkiller, time and VAS to first analgesia demanded were recorded and the adverse reactions were observed as well within 24h after operation. Results: The VAS scores at postoperative 8 and 12 hours, the number of patients demanded painkiller,the VAS score to first analgesia demanded were all less in Group P than those in Group C (P<0. 05), while there was no significant difference in incidence of adverse reactions between the two groups within 24h after operation (P>0. 05). Conclusions.. Parecoxib sodium combined with infraclavicular brachial plexus block is safe and effective on postoperative analgesic effects after hand surgery. Parecoxib sodium could be a good choice of perioperative multimodal analgesia techniques.%目的:探讨帕瑞昔布钠联合锁骨下臂丛神经阻滞用于手外科患者术后镇痛的有效性及安全性.方法:择期行单侧肘关节以下小手术患者100例,随机分为帕瑞昔布钠组(P组)和对照组(C组),每组50例.锁骨下臂丛神经阻滞实施成功后,P组于手术实施前15 min静脉注射帕瑞昔布钠40 mg(用0.9%氯化钠液2 mL稀释),C组给予等体积0.9%氯化钠液.分别于术后6 h、8 h、12 h、24 h进行视

  14. BRAIN GRAY MATTER VOLUME CHANGES ASSOCIATED WITH CHRONIC PAIN IN PATIENTS WITH PAIN DUE TO BRACHIAL PLEXUS AVULSION%臂丛神经撕脱伤后疼痛患者脑区灰质容积变化的研究

    Institute of Scientific and Technical Information of China (English)

    陈富勇; 陶蔚; 秦文; 于春水; 胡永生; 李勇杰

    2011-01-01

    Objective: To investigate brain structural changes involved in chronic pain in patients with pain due to brachial plexus avulsion, voxel-based morphometry was used to determine the brain gray matter changes . Methods: Ten right-handed patients with chronic pain due to left brachial plexus avulsion, whose pain reduced more than 75% after DREZotomy, and ten right-handed age- and sex-matched healthy control subjects participated inparticipated in the study. VAS, HADD and HADA were recorded before and 6 months after DREZotomy, respectively. Statistical parametric mapping 5 was applied for data analysis. Results: Compared with healthy subjects, the patients had gray matter decreases in the periaoueductal gray matter (PAG) and ipsilateral hippocampus, and significant gray matter increases in the ipsilateral anterior cingulate cortex (ACC) (BA24), the contralateral inferior frontal cortex (BA47). Comparing with patients during pain before DREZotomy, VBM analysis after DREZotomy showed there were no, significant gray matters changes.Conclusion: These findings suggest that chronic pain is associated with cortical and subcortical reorganization on a structural level, which may play an important role in the process of the chronication of pain in patients with pain due to brachial plexus avulsion.%目的:应用基于体素的形态学分析技术探讨臂丛神经撕脱伤后疼痛患者与慢性疼痛相关的脑结构改变.方法:选择左侧臂丛神经撕脱伤后慢性疼痛,行脊髓背根入髓区切开术后疼痛减轻>75%的患者,共10例,以及10例性别和年龄匹配的健康志愿者纳入研究.疼痛患者分别在术前和术后半年采集MRI数据,同时行视觉模拟评分(VAS),汉密尔顿抑郁(HADD)和焦虑评分(HADA).用统计参数图5( SPM5)软件分析数据.结果:与健康志愿者相比,在臂丛神经撕脱伤后慢性疼痛患者中,灰质容积减低的脑区为中央导水管周围灰质和患肢同侧的海马;灰质容积增高

  15. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis) (Review)

    NARCIS (Netherlands)

    Alfen, N. van; Engelen, B.G.M. van; Hughes, R.A.

    2009-01-01

    BACKGROUND: Neuralgic amyotrophy (also know as Parsonage-Turner syndrome or brachial plexus neuritis) is a distinct peripheral nervous system disorder characterised by episodes (attacks) of extreme neuropathic pain and rapid multifocal weakness and atrophy in the upper limbs. Neuralgic amyotrophy ha

  16. Intraoperative peripheral nerve injury in colorectal surgery. An update.

    Science.gov (United States)

    Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo

    2016-03-01

    Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.

  17. 分娩性臂丛神经麻痹发病危险因素的探讨%Case-control study of risk factors of obstetrical brachial plexus palsy

    Institute of Scientific and Technical Information of China (English)

    杨素婷; 张向丽

    2011-01-01

    Objective To study the risk factors of obstetrical brachial plexus palsy (OBPP).Methods Forty-six newborn infants with OBPP were recruited between January 1997 and December 2009 from Technical Appraisement Center for Medical Malpractice of Shandong province as OBPP group.In the control group,138 newborn infants delivered in the same time,same hospital and same gender were collected,with a ratio of 1:3.All the cases were analyzed retrospectively.The newborn,maternal,childbirth data and working experience of midwives were analyzed by univariate and multivariate logistic regression analysis.Results ( 1 ) External pelvimetries of the two groups were normal.All were singleton newborns by vaginal deliveries with cephalic presentation.Twenty-two newborns had left unilateral palsies,and the other 24 had right unilateral palsies.The numbers of the whole,upper and fore arm type were 17,26 and 3,respectively.The maternal age,gravidity,parity and gestational weeks were higher in OBPP group than in the control group ( P < 0.05 ).( 2 ) The maternal antepartum body mass index ( BMI ) [ ( 29.5 ± 2.4 ) kg/m2 ],height of the uterus [ (34.9 ± 2.4) cm ] and abdominal circumference [ ( 105 ± 6) cm ] in OBPP group were higher than those in the control group [ ( 26.1 ± 2.5 ) kg/m2,( 33.7 ± 2.2 ) cm and ( 99 ± 5 ) cm,respectively ] ( P < 0.05 ).The newborn birth weight in OBPP group [ ( 4390 ± 489 ) g ] was significantly higher than the control group [ ( 3404 ± 360 ) g] ( P < 0.01 ).The working experience of midwives in OBPP group [ ( 5.2 ± 2.3 ) years ] was less than the control group [ ( 8.9 ± 5.4) years ] ( P < 0.01 ).(3) There was a higher proportion of instrumental delivery ( 28.3% vs.3.6% ),uterine atony (28.3% vs.6.5% ),prolonged second stage(8.7% vs.0.7% ) and fetal malposition( 10.9% vs.2.9% ) in the OBPP group than in the control group ( P < 0.05 ).(4) Univariate logistic analysis showed that the P values of maternal age,antepartum BMI

  18. 神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者的临床观察%Clinical observation of interscalene joint axillary brachial plexus block guided by nerve stimulator in elderly patients

    Institute of Scientific and Technical Information of China (English)

    杨纲华; 卢增停; 马钧阳; 王立勋

    2014-01-01

    目的 比较常规异感法和神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者上肢手术的麻醉效果.方法 将60例ASA分级Ⅱ~Ⅲ级择期行上肢手术的高龄患者按随机数字表法分为神经刺激仪组和异感法组,每组30例.神经刺激仪组采用神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞,异感法组按常规异感法行肌间沟联合腋路臂丛神经阻滞.两组所用局部麻醉药均为0.375%罗哌卡因,剂量为0.4 ml/kg.两组肌间沟、腋路臂丛神经阻滞麻醉药剂量各半.观察和记录两组患者操作时间、阻滞起效时间、镇痛持续时间、术中麻醉效果[采用疼痛视觉模拟量表(VAS)评分法]和不良反应.结果 神经刺激仪组操作时间和阻滞起效时间明显短于异感法组[(5.2±1.7) min比(8.6±2.2) min和(19.4±3.2) min比(29.0±3.9) min],术中VAS评分明显低于异感法组[(0.7±0.4)分比(2.3±0.8)分],差异均有统计学意义(P<0.01);神经刺激仪组和异感法组镇痛持续时间比较差异无统计学意义[(12.4±3.6)h比(13.1±3.8)h,P>0.05].神经刺激仪组无不良反应;异感法组有5例发生不良反应,其中局部血肿2例,喉返神经麻痹1例,霍纳综合征2例.结论 神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者定位准确,成功率高,麻醉效果好,不良反应少,值得在临床中推广.%Objective To compare the anesthetic effect of interscalene joint axillary brachial plexus block guided by nerve stimulator or conventional paresthesia in elderly patients with upper extremity surgery.Methods Sixty cases of ASA grade Ⅱ-Ⅲ elderly patients with upper extremity surgery were divided into two groups by random number table.Nerve stimulator group (30 cases) received interscalene joint axillary brachial plexus block guided by nerve stimulator.Paresthesia group (30 cases) received interscalene joint axillary brachial plexus block guided by

  19. The clinical observation of dexmedetomidine combined with oxycodone or fentanyl during brachial plexus blockade in the thyroid surgery%右美托咪定复合羟考酮或芬太尼辅助颈丛阻滞的临床观察

    Institute of Scientific and Technical Information of China (English)

    邴彦秋; 高光洁; 徐迎阳; 尚宇

    2016-01-01

    Objective To investigate the effect of small dose of dexmedetornidine on venous continuous infusion combined with oxycodone or fentanyl during brachial plexus blockade.Methods Sixty thyroid patients (ASA Ⅰ or Ⅱ) undergone brachial plexus anesthesia for cutting or cutting thyroid tumor patients were randomly and double-blindly into three groups (n =20 in each group).Group A:single brachial plexus anesthesia;group B:dexmedetornidine combined with fentanyl;group C:dexmedetornidine combined with oxycodone.Blood pressure (Bp),heart rate (HR),the determination of plasma norepinephrine (NE),cortisol (Cor),the concentration of blood glucose (Glu),VAS,Ramsay calm score,local anesthetics dosage and side effect formation rate at the beginning operation (To),skin incision (T1),separation of the glands (T2),gland excision (T3),and the end of the surgery (T4) were recorded.Results Compared to group A,the mean arterial pressure (MAP),HR,NE,Cor,and Glu were much lower at each time point (P < 0.05) in groups B and C;Ramsay calm score and VAS score were significantly better at each time point (P < 0.05);the incidence of chills and lidocaine additional quantity were significantly lower (P <0.01).However,compared to groups A and C,choking cough response rates were much higher in group B (P < 0.01).Conclusions Small dose of dexmedetornidine on venous continuous infusion combined with oxycodone during brachial plexus blockade for thyroid patients both can eliminate the preoperative patients nervous anxiety,and effectively restrain perioperative stress response,maintain hemodynamics stable,implementation of intraoperative awaken to reduce complications.It is the new choice of anesthetic adjuvant.%目的 探析小剂量右美托咪啶静脉持续输注复合羟考酮或芬太尼辅助颈丛阻滞的应用效果.方法 60例ASA Ⅰ~Ⅱ级行甲状腺次全切或全切的甲状腺瘤患者,均行单侧颈深丛和双侧颈浅丛阻滞,随机双盲抽签方法均分为三组:

  20. 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)

    Lúcia Beato

    2005-08-01

    ícula 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

  1. Bloqueio do plexo braquial por via supraclavicular: estudo clínico comparativo entre bupivacaína e levobupivacaína Bloqueo del plexo braquial por vía supraclavicular: estudio clínico comparativo entre bupivacaína y levobupivacaína Supraclavicular brachial plexus block: a comparative clinical study between bupivacaine and levobupivacaine

    Directory of Open Access Journals (Sweden)

    José Ricardo Pinotti Pedro

    2009-12-01

    braquial es el territorio potencial para la absorción de anestésicos locales. Estudios de los estereoisómeros de la bupivacaína han venido demostrando un menor potencial de toxicidad de la fracción levógira (levobupivacaína, sobre el sistema cardiovascular. Sin embargo, se discute la eficacia anestésica (bloqueo sensitivo y motor, de la levobupivacaína en anestesia del neuro eje. Este estudio pretende demostrar la eficacia anestésica de la levobupivacaína, comparándola con la bupivacaína racémica en bloqueo de plexo braquial por la vía perivascular subclavia. MÉTODO: Cincuenta pacientes adultos de ambos sexos, ASA I y II, fueron sometidos a la anestesia de plexo braquial vía perivascular subclavia para procedimientos ortopédicos de miembros superiores con la ayuda de un neuroestimulador. Se dividieron de modo aleatorio, en dos grupos: G BUPI - bupivacaína racémica, G LEVO - levobupivacaína, en un volumen de 30 mL a 0,5%. El bloqueo sensitivo fue evaluado por el método de "picada de aguja" en los metámeros de C5 a C8; y el bloqueo motor, en los intervalos en minutos: 1, 2, 5, 10, 15, 20, 25, 30, o hasta la instalación del bloqueo en los movimientos de los dedos, la mano el antebrazo y el brazo. RESULTADOS: No hubo ninguna diferencia estadística entre los dos grupos en cuanto a la latencia, incidencia de fallas, grado del bloqueo motor e incidencia de fallas y grado del bloqueo motor e incidencia de fallas del bloqueo sensitivo, pero sí que se verificó la diferencia estadística de la latencia del bloqueo sensitivo en todos los metámeros analizados. No hubo efectos adversos inherentes a la aplicación del anestésico local. CONCLUSIONES: La levobupivacaína demostró una eficacia anestésica en el bloqueo de plexo braquial, igualable a la solución racémica usualmente utilizada.BACKGROUND AND OBJECTIVES: Brachial plexus block is used in surgical procedures of the upper limbs. The brachial plexus is a potential territory for absorption of local

  2. Etiological factors of traumatic peripheral nerve injuries

    Directory of Open Access Journals (Sweden)

    Eser Filiz

    2009-01-01

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

  3. Estudo comparativo entre ultrassom e neuroestimulação no bloqueio do plexo braquial pela via axilar Estudio comparativo entre ultrasonido y neuroestimulación en el bloqueo del plexo braquial por la vía axilar A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2009-10-01

    seleccionaron 40 pacientes para operaciones por elección en la mano, con bloqueo de plexo braquial vía axilar. Los pacientes se distribuyeron aleatoriamente y electrónicamente en dos grupos de 20 pacientes: Grupo Neuroestimulación (NE y Grupo Ultrasonido (US. Se compararon el tiempo de realización, la tasa de éxito y las complicaciones. RESULTADOS: Las tasas de bloqueo completo, falla parcial y falla total, no presentaron diferencias estadísticas significativa entre los grupos US y NE. El tiempo promedio para la realización del procedimiento en el grupo US (354 segundos no presentó diferencia estadística significativa cuando se le comparó al grupo NE (381 segundos. Los pacientes del grupo NE presentaron una tasa más elevada de punción vascular (40%, cuando se les comparó con el grupo US (10%, p Conceição DB, Helayel PE, Oliveira Filho GR - A Comparative Study between Ultrasound- and Neurostimulation-Guided Axillary Brachial Plexus Block. BACKGROUND AND OBJECTIVES: The use of ultrasound in Regional Blocks is increasingly more frequent. However, very few studies comparing ultrasound and neurostimulation have been conducted. The objective of this study was to compare neurostimulation-guided axillary brachial plexus block with double injection and ultrasound-guided axillary plexus block for hand surgeries. The time to perform the technique, success rate, and complications were compared. METHODS: After approval by the Ethics on Research Committee of the Hospital Governador Celso Ramos, 40 patients scheduled for elective hand surgeries under axillary plexus block were selected. Patients were randomly divided into two groups with 20 patients each: Neurostimulation (NE and Ultrasound (US groups. The time to perform the technique, success rate, and complication rate were compared. RESULTS: Complete blockade, partial failure, and total failure rates did not show statistically significant differences between the US and NE groups. The mean time to perform the technique in

  4. Estudo radiológico da dispersão de diferentes volumes de anestésico local no bloqueio de plexo braquial pela via posterior Estudio radiológico de la dispersión de diferentes volúmenes de anestésico local en el bloqueo de plexo braquial por vía posterior Radiological evaluation of the spread of different local anesthetic volumes during posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2005-10-01

    aleatoriamente en tres grupos de cinco: Grupo 1: volumen de 20 mL; Grupo 2: volumen de 30 mL; Grupo 3: volumen de 40 mL. En un paciente, sometido al bloqueo continuado del plexo braquial por la vía posterior, la administración de un volumen de 10 mL fue estudiada. En todos, el anestésico usado fue la ropivacaína a 0,375% asociada a solución radiopaca. Fueron hechas radiografías de la región cervical inmediatamente después el bloqueo que fue evaluado a través de la pesquisa de la sensibilidad térmica utilizándose algodón embebido en alcohol, treinta minutos después de su realización y en la sala de recuperación anestésica. RESULTADOS: El comportamiento radiológico y clínico del bloqueo de plexo braquial por vía posterior es muy semejante de aquél descrito con la técnica de Winnie (interescalénico. Invariablemente hay envolvimiento del plexo cervical y de las raíces más altas (C5-C7 del plexo braquial. CONCLUSIONES: Este estudio muestra que la dispersión del anestésico local en el bloqueo del plexo braquial por la vía posterior se da primariamente en las raíces responsables por la inervación del hombroBACKGROUND AND OBJECTIVES: Local anesthetic spread during interscalenic block has been thoroughly studied, however there are few studies on posterior block. This study aimed at evaluating the spread of different local anesthetic volumes during posterior brachial plexus block using contrasted X-rays. METHODS: Participated in this study 16 patients submitted to posterior brachial plexus block, 15 of whom were randomly divided in three groups of five patients: Group 1: 20 mL; Group 2: 30 mL.; Group 3 40 mL. The volume of 10 mL was studied in one patient submitted to continuous posterior brachial plexus block. All patients received 0.375% ropivacaine associated to radio-opaque solution. X-rays of the cervical region were obtained immediately after blockade that were evaluated by thermal sensitivity using cotton soaked in alcohol 30 minutes after being

  5. Myokymia in obstetrically related brachial plexopathy.

    Science.gov (United States)

    Sclar, Gary; Maniker, Allen; Danto, Joseph

    2004-06-01

    Myokymic discharges are spontaneous bursts of semirhythmic potentials that are sometimes correlated with rippling movements of skin and muscle. They have been reported in limb muscles in patients with Guillain-Barré syndrome, spinal stenosis, nerve root and nerve compression, and envenomations. They commonly occur with radiation induced plexopathies (approximately 60% of patients), but have not been reported in obstetrically related brachial plexopathies. We report 2 instances of myokymia in children with obstetric brachial plexus palsies. Each child was studied twice, and it was only at the later study, when the child was 10 or 11 months of age, that these potentials were noted. This could represent ongoing recovery from lesions incurred at birth or developmental changes. The final common pathway of all causes of myokymia could be to generate axonal membrane hyperexcitability.

  6. 肌内效贴治疗“产瘫肩”畸形的随机对照临床研究%Kinesiotape Corrects Glenohumeral Deformity Associated with Obstetric Brachial Plexus Palsy and Improves Shoulder Function:a Randomized, Controlled Trial

    Institute of Scientific and Technical Information of China (English)

    朱俞岚; 张备; 陈亮; 白玉龙

    2014-01-01

    ObjectiveTo evaluate the efficency of Kinesiotape in treating glenohumeral deformity caused by ob-stetric brachial plexus palsy(OBPP) by a randomized controlled trial. Methods:Forty-four children diagnosed with OBPP were randomly assigned to control group (n=22) and therapeutic group (n=22). All the patients had re-ceived exercise therapy, and the ones in the therapeutic group received Kinesiotape in addition. The angle be-tween the trunk axis and the axis of the injured arm and posterior glenoid-humeral angle were used to assess the anatomical improvement. Mallet scale and Gilbert grading system were employed to assess the functional improvement. Results:After 6 months' treatment with Kinesiotape and exercise therapy, significant differences in the angle between the trunk axis and the axis of the injured arm and posterior glenoid-humeral angle were observed between the two groups ( <0.05) . However, functional improvement was observed in boththe groups statistically ( <0.05). Greater functional improvements were found in the therapeutic group than that in the control group ( <0.05). Conclusion:Kinesiotape can correct glenohumeral deformity associated with obstetric brachial plexus palsy and improve shoulder function.%目的:随机对照研究使用肌内效贴治疗产瘫患儿“产瘫肩”畸形的疗效。方法:44例产瘫Narakas分型1~4型患儿随机分入肌内效贴组和常规治疗组各22例。2组均采用运动疗法,进行肌力和关节活动度训练。肌内效贴组还给予肌内效贴进行贴扎治疗。治疗前和治疗6个月时,对患儿的肩胛下角-躯干轴线夹角、盂肱夹角、Mallet评分和Gilbert分级进行评估。结果:治疗6个月后,肌内效贴组肩关节解剖结构得以改善,肩胛下角-躯干轴线之间夹角和盂肱夹角较治疗前明显改善(<0.05),常规治疗组改善无统计学意义;与治疗前相比,2组Mallet评分和Gilbert分级提高均有统计学意义(<0.05

  7. Electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies.

    Science.gov (United States)

    Simmons, Zachary

    2013-02-01

    This article describes the normal anatomy of the brachial plexus and its major terminal branches, as well as the major causes and clinical presentations of lesions of these structures. An approach to electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies is provided, with an emphasis on those nerve conduction studies and portions of the needle examination, which permit localization of lesions to specific trunks, cords, and terminal branches. The importance of specific sensory nerve conduction studies for differentiating plexopathies from radiculopathies and mononeuropathies is emphasized.

  8. Comparison of the Effect of Ultrasonic Positioning and Skin Paresthesia Interscalene Brachial Plexus ;Block on the Upper Extremity Operation in Obese Patients%超声定位和体表异感定位肌间沟臂丛神经阻滞在肥胖患者上肢手术中的疗效比较

    Institute of Scientific and Technical Information of China (English)

    王恒跃; 吕虎; 平山; 杨涛

    2015-01-01

    Objective To compare the clinical effect of body surface ultrasound localization and abnor-mal sensation of interscalene brachial plexus block on the operation of upper limb in obese patients .Methods A total of 68 obese patients who underwent upper limb operation in Changhai Hospital of the Second Mili-tary Medical University from Jan.2013 to Oct.2014 were inlcuded as the research objects,and were divided into two groups according to random number table method,each group of 34 cases.Patients in the control group were given surface paresthesia interscalene brachial plexus block,while patients in observation group underwent ultrasound localization.The nerve block onset time,blocking effect,anesthesia effect and complications of the two groups were compared.Results Block onset time of musculocutaneous nerve[(4.4 ±2.1) min vs (9.8 ± 3.6) min],radial nerve[(4.2 ±1.3) min vs (10.6 ±4.5) min],the median nerve[(6.4 ±2.5) min vs (15.1 ±6.6) min],ulnar nerve[(7.3 ±3.0) min vs (18.0 ±7.4) min] of observation group and control group had statistically significant difference(P0.05).Conclusion Compared to surface paresthesia positio-ning,ultrasonic interscalene brachial plexus block has a rapid onset,high success rate,good anesthesia effect and less complications,thus is worthy of clinical promotion.%目的:比较超声定位和体表异感定位肌间沟臂丛神经阻滞在肥胖患者上肢手术中的疗效。方法选择2013年1月至2014年10月第二军医大学附属长海医院择期行上肢手术的68例肥胖患者为研究对象,依据随机数字表法分为两组,各34例。对照组患者采取体表异感定位肌间沟臂丛神经阻滞,观察组患者则行超声定位。比较两组患者神经阻滞起效时间、神经阻滞效果、麻醉效果及并发症情况。结果观察组和对照组肌皮神经[(4.4±2.1) min 比(9.8±3.6) min]、桡神经[(4.2±1.3) min比(10.6±4.5) min]、正中神经[(6.4±2.5) min 比(15

  9. Efficacy of patient-controlled infraclavicular brachial plexus block for analgesia after elbow arthrolysis%自控锁骨下臂丛神经阻滞用于患者肘关节松解术后镇痛的效果

    Institute of Scientific and Technical Information of China (English)

    袁嫕; 刘莹; 刘雪冰; 林惠华; 杨庆国; 王庚

    2015-01-01

    目的 评价自控锁骨下臂丛神经阻滞用于患者肘关节松解术后镇痛的效果.方法 选择拟行肘关节松解术患者80例,年龄18 ~ 64岁,性别不限,ASA分级Ⅰ-Ⅲ级,体重指数18~ 25kg/m2,采用随机数字表法分为2组(n=40):腋路臂丛神经阻滞组(A组)和锁骨下臂丛神经阻滞组(Ⅰ组).2组分别于术前在超声引导下将导管留置在臂丛神经周围.术后苏醒后待患者疼痛时,经导管注射0.2%罗哌卡因20 ml,15 min后采用0.2%罗哌卡因(400 ml)行自控臂丛神经阻滞,背景输注速率5 ml/h,PCA剂量5 ml,锁定时间30 min.术后24 h时进行功能锻炼,1次/d,连续3d.记录置管时间、阻滞成功情况、置管时中重度疼痛[疼痛数字评分法(NRS)评分>4分]和高度置管阻力(置管阻力评分法评分>1分)的发生情况、置管过程中神经异感和血管损伤的发生情况.记录术后24、48和72 h功能锻炼时的NRS评分.记录术后72 h时肘关节活动范围,计算活动范围改善程度,记录活动范围改善满意(活动范围改善≥80%)和活动范围完全改善(活动范围改善达100%)的发生情况.记录术后72 h内导管有关不良反应(渗液、堵塞、脱出等)和局麻药有关不良反应(恶心呕吐、全身毒性反应)的发生情况.结果 2组置管时阻滞成功率均为100%.与A组比较,Ⅰ组置管时间缩短,置管时中重度疼痛和高度置管阻力的发生率降低,置管过程中神经异感及血管损伤的发生率降低,术后24 h功能锻炼时的NRS评分降低,肘关节活动范围完全改善率升高(P<0.05),肘关节活动范围改善程度和改善满意率差异无统计学意义(P>0.05).结论 自控锁骨下臂丛神经阻滞可安全、有效地用于患者肘关节松解术后镇痛,其效果优于自控腋路臂丛神经阻滞.%Objective To evaluate the efficacy of patient-controlled infraclavicular brachial plexus block for analgesia after elbow arthrolysis.Methods Eighty

  10. Ecrg4 expression and its product augurin in the choroid plexus: impact on fetal brain development, cerebrospinal fluid homeostasis and neuroprogenitor cell response to CNS injury

    Directory of Open Access Journals (Sweden)

    Gonzalez Ana

    2011-01-01

    Full Text Available Abstract Background The content and composition of cerebrospinal fluid (CSF is determined in large part by the choroid plexus (CP and specifically, a specialized epithelial cell (CPe layer that responds to, synthesizes, and transports peptide hormones into and out of CSF. Together with ventricular ependymal cells, these CPe relay homeostatic signals throughout the central nervous system (CNS and regulate CSF hydrodynamics. One new candidate signal is augurin, a newly recognized 14 kDa protein that is encoded by esophageal cancer related gene-4 (Ecrg4, a putative tumor suppressor gene whose presence and function in normal tissues remains unexplored and enigmatic. The aim of this study was to explore whether Ecrg4 and its product augurin, can be implicated in CNS development and the response to CNS injury. Methods Ecrg4 gene expression in CNS and peripheral tissues was studied by in situ hybridization and quantitative RT-PCR. Augurin, the protein encoded by Ecrg4, was detected by immunoblotting, immunohistochemistry and ELISA. The biological consequence of augurin over-expression was studied in a cortical stab model of rat CNS injury by intra-cerebro-ventricular injection of an adenovirus vector containing the Ecrg4 cDNA. The biological consequences of reduced augurin expression were evaluated by characterizing the CNS phenotype caused by Ecrg4 gene knockdown in developing zebrafish embryos. Results Gene expression and immunohistochemical analyses revealed that, the CP is a major source of Ecrg4 in the CNS and that Ecrg4 mRNA is predominantly localized to choroid plexus epithelial (CPe, ventricular and central canal cells of the spinal cord. After a stab injury into the brain however, both augurin staining and Ecrg4 gene expression decreased precipitously. If the loss of augurin was circumvented by over-expressing Ecrg4 in vivo, BrdU incorporation by cells in the subependymal zone decreased. Inversely, gene knockdown of Ecrg4 in developing

  11. Comparison of dexmedetomidine and epinephrine as the adjuvant to local anesthetic agents for brachial plexus block%右美托咪定与肾上腺素作为局部麻醉药佐剂对臂丛神经阻滞效果的对比

    Institute of Scientific and Technical Information of China (English)

    李凯; 赵国庆; 李旭洋; 朱志华

    2016-01-01

    Objective To compare the effect of dexmedetomidine (Dex) with epinephrine as adjuvant to ropivacaine in supraclavicular brachial plexus block.Methods Sixty patients,ASA Ⅰ or Ⅱ,44-68 years old,weight 50-75 kg,scheduled for fixation of Colle's fracture under ultrasound-guided supraclavicular brachial plexus block were divided randomly into three groups (n=20) with random number table,double-blinded fashion.In group C,1 ml normal saline was used.In group D,0.75 μg/kg Dex was diluted into 1 ml.In group E,epinephrine(100 μg) was diluted into 1 ml.The adjuvant was added to local anesthetic drug composed by 10 ml 1% hydrochloride ropivacaine and 10 ml normal saline.Onset time of sensory and motor block,duration of analgesia,onset time of postoperative analgesia was recorded in three groups.MAP,HR,SpO2,BIS and anesthetic complications were recorded in time points of before (T0) and 10 min (T1),20 min (T2),30 min (T3),40 min (T4),50 min (T5),60 min (T6) after administration.Results The onset of sensory and motor block in group D are earlier than group C and E (P<0.05).Duration of sensory block and motor block in group D and E were significantly longer than group C (P<0.05).The needs for postoperative analgesia in D and E were postponed.The MAP in group D is lower than group C at T4-T5 and E at T3-T5 (P<0.05).The MAP in group E is higher than group C at T3 (P< 0.05).Group D had lower HR than group C and E from T3 to T6 (P<0.05).The HR in group E is higher than group C from T3 to T5.Group D had significantly lower BIS score than group C and E since T2 (P<0.05).Conclusions Perineural 0.75 μg/kg of Dex has similarly ability of 100 μg epinephrine to enhance the quality and duration of analgesia in supraclavicular brachial plexus block.Dex has the ability to decrease cardiovascular stress and sedation,and should be a better adjuvant to local anesthesia in patients who are cautioned against epinephrine.%目的 对比常用剂量的右美托咪

  12. Clinical Comparison of Different Concentration of Ropivacaine for Brachial Plexus Block Anesthesia in Elderly Patients%不同浓度罗派卡因用于老年患者臂丛神经阻滞麻醉的临床比较研究

    Institute of Scientific and Technical Information of China (English)

    邓继红; 丰亮; 黄杰锋; 周志军; 杨艳

    2011-01-01

    目的:比较不同浓度的罗派卡因对老年患者臂丛神经感觉、运动神经阻滞起效和维持时间的影响.方法:选择60例行择期上肢手术老年患者.男38例,女21例,年龄65-78岁.ASA Ⅰ-Ⅲ级.随机分为两组.定时记录感觉、运动神经完全阻滞起效时间和维持时间,观察并记录术中生命体征的变化和有无并发症发生.结果:两组患者感觉和运动神经阻滞的起效时间和维持时间有极显著性差异(P<0.05),术中生命体征和并发症发生率无显著性差异.结论:0.37%相较0.25%罗哌卡因用于老年患者臂丛神经阻滞麻醉起效更快,维持时间更长,副作用风险未见增加,可常规用于老年患者的上肢手术麻醉.%Objective: To compare the blockage effect in sense and motive nerves on getting effect time and maintenance time of brachial plexus with different concentration of ropivacaine in old patients. Methods: Select 60 elderly patients (aged 65-78 years old), who underwent upper extremity surgery, record the time when their sense and motive nerves were completely blocked and the blockage maintenance, and record their changes of vital signs and complications. Results: The blockage effect demonstrated obviously significant difference of two groups on the time of getting effect and the effect maintenance, but no difference was observed between two groups on vital signs and complications. Conclusion: Compared with 0.25% ropivacaine, 0.37% ropivacaine has quickly effective time, longer maintenance time and safety, which can be used as regular anaesthesia of upper extremity surgery in elderly patients.

  13. 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)

    Mônica Vicky Bahr Arias

    1997-03-01

    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.

  14. A lesão do trato de Lissauer e do corno posterior da substância cinzenta da medula espinal e a estimulação elétrica do sistema nervoso central para o tratamento da dor por avulsão de raízes do plexo braquial DREZ lesions and electrical stimulation of the central nervous system for treatment of brachial plexus avulsion pain

    Directory of Open Access Journals (Sweden)

    MANOEL JACOBSON TEIXEIRA

    1999-03-01

    Full Text Available Descrevemos os resultados do tratamento operatório de 10 doentes com dor resultante de avulsão de raízes do plexo braquial. Sete foram tratados pela técnica de lesão do trato de Lissauer (TL e do corno posterior da medula espinal (CPME, 4 pela técnica de estimulação elétrica da medula espinal (EM e 2 pela técnica de estimulação talâmica (ET. Três doentes foram tratados por ambos os procedimentos. Foi observada melhora imediata em 50% dos doentes com a técnica de estimulação medular e em apenas 25% dos casos, a longo prazo. Ocorreu melhora imediata, mas recorrência tardia da dor nos 2 doentes tratados pela ET. Houve melhora imediata de todos os doentes tratados pela técnica da lesão e recidiva parcial da dor em 23% dos casos, a longo prazo. Complicações temporárias foram observadas em 28,6% dos casos tratados pela técnica de lesão. Conclui-se que a lesão do TL e do CPME proporcionam resultados mais satisfatórios a longo prazo que a técnica de estimulação (p = 0,0046; entretanto, esta última é mais segura.We analyze the effectiveness of the treatment of 10 patients of brachial plexus avulsion pain. Seven underwent dorsal root entry zone lesions (DREZ, 3, dorsal column stimulation (DCS and, 2 thalamic stimulation (TS. DCS resulted in immediate improvement of pain in 50% of the patients. After a long term follow up period, just 25% of the patients were still better. TS resulted the in temporary improvement of 2 patients. Both had full recurrence few months after the operation. Immediate improvement of the symptoms occurred in all patients treated by DREZ. After a long term follow up period, excellent results were observed in 71.4% of the patients and good results in the remainder. The complication rate was higher among DREZ patients. It is concluded that DREZ is a better procedure for treatment of brachial plexus avulsion pain than DCS and TS (p = 0,0046; however, DCS and TS are safer.

  15. Bupivacaine 0,25% versus ropivacaine 0,25% in brachial plexus block in dogs of beagle breedBupivacaína 0,25% versus ropivacaína 0,25% no bloqueio do plexo braquial em cães da raça beagle

    Directory of Open Access Journals (Sweden)

    Thiago Ignácio Wakoff

    2013-06-01

    Full Text Available The brachial plexus block (BPB is a regional anesthesia technique which enables the attainment of surgical procedures distal scapulohumeral articulation. This study aimed to compare the efficacy of ropivacaine and bupivacaine 0.25% without vasoconstrictor in BPB guided by electrical stimulation in dogs. Thirteen male and female beagle dogs underwent a BPB using bupivacaine and ropivacaine 0.25% (4mg/kg, both alone and in different times. The anesthesic block was performed in the right forelimb and as control group the block proceeded in the left forelimb using a solution of sodium chloride 0.9% in volume corresponding to the drug in the contralateral limb. The block was performed after the localization of the radial nerve with the aid of eletrical stimulation, which was infiltrated half the volume of anesthetic calculated and subsequently the remaining solution was administered on the median nerve. We evaluated sensitive and motor latencies and sensitive and motor block total time by clamping technique. In the present study, a technique for electrical stimulation was effective in 100% of animals. Bupivacaine had lower motor latency period, however, the sensitive latency between the two groups showed no statistically significant differences. In the block total time, bupivacaine obtained time significantly higher. Clinical signs characteristic of Horner’s syndrome were present in 15% of animals treated with bupivacaine. Furthermore, two animals presented signs of cardiotoxicity in bupivacaine group. The use of bupivacaine (4mg/kg without vasoconstrictor in dogs brachial plexus block provided longer analgesia and motor blockade, however, ropivacaine at the same dose and concentration was found to be free of deleterious effects associated of cardiovascular instability, hemodynamic and respiratory. O bloqueio do plexo braquial (BPB é uma técnica de anestesia regional que possibilita a realização de procedimentos cirúrgicos distais a articula

  16. Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2% Prevalencia de parálisis diafragmática después del bloqueo del plexo braquial por la vía posterior con ropivacaína a 0,2% Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2006-10-01

    consecuencias es la parálisis diafragmática. En pacientes con algún grado de disfunción pulmonar previa, esa parálisis puede conllevar a la insuficiencia respiratoria. El abordaje del plexo braquial por vía posterior ha conquistado espacio. El objetivo de este estudio fue el de determinar la prevalencia de parálisis diafragmática, después del bloqueo de plexo braquial interescalénico por vía posterior con el uso de ropivacaína a 0,2%. MÉTODO: Veinte y dos pacientes sometidos al bloqueo del plexo braquial interescalénico por vía posterior con ropivacaína a 0,2% fueron evaluados en el postoperatorio con el objetivo de identificar señales radiológicas de elevación de la cúpula diafragmática sugestivas de parálisis hemidiafragmática. En 20 pacientes se utilizó 40 mL de ropivacaína a 0,2%, en ellos fue realizada la radiografía de tórax en inspiración. En dos fueron utilizados 20 mL de ropivacaína a 0,2%, con la siguiente evaluación fluoroscópica. RESULTADOS: No hubo complicaciones relacionadas con la realización del bloqueo. En todos los pacientes, el bloqueo fue efectivo y proporcionó una buena analgesia postoperatoria. Se observó una elevación de la cúpula diafragmática compatible con la parálisis hemidiafragmática en todos los casos estudiados. CONCLUSIONES: En las condiciones de este estudio se pudo observar que el bloqueo del plexo braquial por vía posterior es una técnica que está asociada a la alta prevalencia de parálisis diafragmática, incluso cuando se utilizan bajas concentraciones de anestésico local.BACKGROUND AND OBJECTIVES: Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become

  17. PHRENIC NERVE PALSY AFTER SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Gupta A K

    2009-09-01

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

  18. Brachial plexus morphology and vascular supply in the wistar rat.

    Science.gov (United States)

    Angélica-Almeida, Maria; Casal, Diogo; Mafra, Manuela; Mascarenhas-Lemos, Luís; Martins-Ferreira, José; Ferraz-Oliveira, Mário; Amarante, José; Goyri-O'Neill, João

    2013-01-01

    Introdução: O rato é provavelmente a espécie animal mais utilizada em estudos experimentais de reparação nervosa. Com este trabalho pretendeu-se aprofundar o conhecimento da morfologia e da vascularização do plexo braquial do rato.Material e Métodos: Trinta ratos adultos foram estudados relativamente à morfologia e vascularização do plexo braquial. As técnicas usadas foram a injecção intravascular e dissecção sob microscópio operatório, bem como técnicas de microscopia óptica e microscopia electrónica de varrimento.Resultados: Morfologicamente, o plexo braquial do rato é um pouco diferente do plexo braquial humano. O suprimento arterial e venoso do plexo braquial do rato deriva direta ou indiretamente dos vasos vizinhos. Estes vasos formam plexos vasculares densos e interconectados no epinervo, perinervo e endonervo. Vários componentes do plexo braquial do rato são acompanhados durante um trajecto relativamente longo por vasos sanguíneos relativamente calibrosos e constantes que fornecem o seu plexo epineural, tornando o seu levantamento como retalhos nervosos possível.Discussão: A vascularização do plexo braquial do rato não é muito diferente da reportada na espécie humana, tornando o rato um modelo animal útil para o estudo experimental da fisiopatologia e tratamento da patologia do nervo periférico.Conclusão: Os nossos resultados apoiam a homologia entre o rato e o Homem em termos de morfologia e vascularização do plexo braquial. Este trabalho sugere que vários componentes do plexo braquial do rato podem ser utilizados como retalhos nervosos, incluindo fibras predominantemente motoras, sensitivas ou fibras mistas.

  19. 臂丛神经与星状神经节阻滞对上肢(指)血流影响的临床观察%THE EFFECTS OF BRACHIAL PLEXUS BLOCK AND SATELLITE GANGLION BLOCK ON THE BLOOD FLOW OF UPPER LIMB,A CLINICAL STUDY

    Institute of Scientific and Technical Information of China (English)

    牛金柱; 徐志勇; 张宝玉

    2001-01-01

    To investigate the effects of brachial plexus block(BPB) and satellite ganglion block(SGB) on the blood flow of upper limb, 22 patients were randomly divided into two groups,and given BPB(group A,n=11) or SGB(group B,n=11) with 1% lidocaine 10 ml every other day for 5 times. Ulnar-radial artery blood flow was measured by using a TCD 30 minutes before and after the block. Finger pulse amplitude was measured by pulse oximeter 5,10,15,20,30 minutes after the block.The average increase in ulnar-radial artery blood flow was 13 cm/s in group A and 5 cm/s in group B. Finger pulse amplitude increased by (9.04±2.12)mm in group A and(3.54±1.42)mm in group B.A significant difference was observed between the two groups (P<0.01).It suggested that BPB could induce more increase in blood flow of the upper limb than SGB.%通过对臂丛神经与星状神经节阻滞病人(SGB)前后上肢(指)血流变化的对比观察,为临床治疗提供参考依据。将22例病人随机分为A组和B组,每组11例。A组为臂丛神经阻滞,B组为SGB,两组用药相同,1%利多卡因10ml,隔日一次,5次为一个疗程。彩色三维经颅多普勒仪监测阻滞前和阻滞后30min尺、桡动脉血流速度(cm/s),脉搏血氧饱和度仪连续监测阻滞前和阻滞后拇、示、中指5、10、15、20和30min的脉搏波幅的变化。结果显示:A组治疗后尺、桡动脉血流平均增快13cm/s,脉搏波幅平均增高(9.04±2.12)mm;B组治疗后尺、桡动脉血流平均增快5cm/s,脉搏波幅平均增高(3.54±1.42)mm。两组间比较有显著差异(P<0.01)。提示臂丛神经阻滞对上肢(指)血流的增加较星状神经节阻滞显著。

  20. Bloqueio do plexo braquial por via interescalênica: efeitos sobre a função pulmonar Bloqueo del plexo braquial por vía interescalénica: efectos sobre la función pulmonar Interscalene brachial plexus block: effects on pulmonary function

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    Alexandre Hortense

    2010-04-01

    demostrado una asociación de esa técnica con el bloqueo del nervio frénico ipsilateral. La disfunción diafragmática de resultas de esa asociación, provoca alteraciones en la mecánica pulmonar, potencialmente perjudiciales en pacientes con una limitación de la reserva ventilatoria. El objetivo del estudio fue evaluar la repercusión del bloqueo interescalénico sobre la función pulmonar por medio de la medida de la capacidad vital forzada (CVF. MÉTODO: Estudio doble ciego, con 30 pacientes, estado físico I o II (ASA, distribuidos aleatoriamente en dos grupos de 15. Se administró solución a 0,5% de ropivacaína (Grupo Ropi o bupivacaína a 0,5% con epinefrina (Grupo Bupi. El bloqueo fue realizado utilizando estimulador de nervio periférico e inyectando 30 mL de anestésico local. Cuatro espirometrías se hicieron en cada paciente: antes del bloqueo, 30 minutos, 4 y 6 horas después. Los pacientes no recibieron sedación. RESULTADOS: Un paciente del Grupo Ropi y tres pacientes del Grupo Bupi, quedaron excluidos del estudio por fallos de bloqueo. La reducción de la CVF en el Grupo Ropi se hizo máxima a los 30 minutos (25,1% y a partir de entonces, hubo una tendencia progresiva a la recuperación. Ya con la bupivacaína, la reducción de la CVF pareció ser menos acentuada en los diversos momentos estudiados; se observó una reducción adicional entre 30 minutos (15,8% y 4 horas (17,3%, siendo esa sin diferencia estadística. A partir de 4 horas, se notó una tendencia a la recuperación. En los dos grupos, después de 6 horas de bloqueo, la CVF todavía estaba por debajo de los valores previos. CONCLUSIONES: El bloqueo interescalénico reduce la CVF en la mayoría de los casos; las alteraciones fueron más acentuadas en el Grupo Ropivacaína.BACKGROUND AND OBJECTIVES: The interscalene is one of the most common approaches used in brachial plexus block. However, the association of this approach with the ipsilateral blockade of the phrenic nerve has been

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

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    Luis Henrique Cangiani

    2008-04-01

    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

  2. Bipolar physeal injuries of the clavicle in a child

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    Vrisha Madhuri

    2012-01-01

    Full Text Available This article reports a type II Salter and Harris injury at either ends of the clavicle in a 13-year-old child with postero-inferior displacement at the lateral and antero-superior displacement at the medial end of the clavicle shaft. He was treated in a shoulder immobilizer. The mechanism of injury is postulated as pivoting of the clavicle on the first rib with shearing at either ends leading to a bipolar injury. The brachial plexus and subclavian vessels are at a risk of damage at the pivot as they lie in close vicinity to the first rib. In view of the intact periosteal sleeve as well as joint articulation at both ends, the fracture healed with no functional loss.

  3. A study on diaphragm function after interscalene brachial plexus block using a fixed dose of ropivacaine with different concentrations%相同剂量不同浓度罗哌卡因行肌间沟臂丛阻滞对膈肌功能的影响

    Institute of Scientific and Technical Information of China (English)

    翟文雯; 王雪冬; 李民; 郭向阳

    2016-01-01

    Objective To compare the effect of interscalene brachial plexus block (ISBPB) on the incidence of diaphragmatic paralysis,respiratory function and post-operative pain control using same dosage of local anesthetics diluted into two different volume and concentrations.Methods Approved by the Peking University Third Hospital ethics committee,sixty patients undergoing elective arthroscopic shoulder surgery in Peking University Third Hospital from November 2013 to April 2014 were randomly allocated into two groups according to random number table method:before induction of general anesthesia,ultrasound-guided ISBPB was performed using 0.5% ropivacaine 10 ml (Group A) or 0.25% ropivacaine 20 ml (Group B).The incidence of diaphragmatic paralysis,respiratory function and reduction of pulse oxygen saturation at 30 min post-block were recorded and analyzed.Patients were interviewed at 4,8 and 24 h after block for numerical rating pain score,rescue analgesics requirement and sleep quality.Results There were no statistically differences between group A and group B for the incidence of diaphragmatic paralysis at 30 min after block (67% vs 70%,x2 =0.077,P >0.05).The change of forced vital capacity ((78 ± 16)% vs (80 ± 18) %,t =0.435,P > 0.05),the change of forced expiratory volume in 1 second ((85 ± 16) % vs (78±22)%,t =1.472,P>0.05) and the reduction of pulse oxygen saturation (1(0-3)% vs 2 (0-3)%,Z =-0.538,P > 0.05) showed no significant differences between the two groups at 30 min after block.There were no statistically differences in terms of the numerical rating pain score,rescue analgesics requirement and sleep quality at 4,8 and 24 h after block (all P > 0.05).Conclusions The use of 0.5% and 0.25% ropivacaine 50 mg for interscalene block provides similar effect on the incidence of diaphragmatic paralysis,changes in respiratory function and postoperative analgesia.%目的 比较相同剂量局麻药稀释成两种不同浓度容量行

  4. Curva de aprendizado da sonoanatomia do plexo braquial na região axilar Curva de aprendizaje de la sonoanatomía del plexo braquial en la región axilar Learning curve for the ultrasound anatomy of the brachial plexus in the axillary region

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    Pablo Escovedo Helayel

    2009-04-01

    : Proficiency in ultrasound-guided blocks demands four skills: recognition of the ultrasound anatomy, capacity to generate images, aligning the needle with the ultrasound beam, and recognizing the dispersion of the local anesthetic. The objective of this study was to construct and evaluate learning curves for image generation and ultrasound identification of the neurovascular structures in the axilla. METHODS: Seven Anesthesiology residents received theoretical and practical notions on the basic principles of ultrasound and the ultrasound anatomy of the axillary region with the objective to identify the terminal branches of the brachial plexus and axillary vessels. Each resident performed six exams. The accuracy and the time to identify the structures were evaluated. The success rate of each exam was calculated. Simple linear regression evaluated the time necessary to identify each structure in relation to the number of the exam. RESULTS: The axillary vessels were identified in 100% of the exams. The median nerve was identified in 83% of the cases from the first to the fifth exams. The radial nerve was identified in 100% of the exams. The ulnar nerve was identified in 67% of the cases in the first exam, and in 83% of the cases from the second to the fifth exams. The musculocutaneous nerve was identified in 50% of the cases in the first exam and in 83% of the cases in the fourth and fifth exams. All structures were identified correctly on the sixth exam. The mean time for the correct identification of the structures decreased considerably from the first to the sixth exam (r = - 0.37. CONCLUSIONS: Learning progression required the memorization of the ultrasound anatomy of the axillary region and acquisition of manual ability, and increasing success rates were associated with a significant reduction in the time to identify the structures.

  5. The advantages of laryngeal mask airway inspiration anesthesia combined with brachial plexus blockage in upper limb orthopaedic surgeries%喉罩通气全身麻醉辅助臂丛神经阻滞在上肢手术中的应用

    Institute of Scientific and Technical Information of China (English)

    徐明; 周懿之; 何绍旋

    2011-01-01

    目的 探讨喉罩通气全身麻醉辅助臂丛神经阻滞在上肢手术中的应用.方法 择期行上肢骨折手术患者30例,完全随机分为2组,各15例:喉罩通气全麻辅助臂丛神经阻滞组(A组)和单纯喉罩通气全麻组(B组).A组先予1.6%利多卡因20~25 ml注入患侧肌间沟行臂丛神经阻滞.2组皆以芬太尼1μg/kg、异丙酚2.5 mg/kg诱导后置入喉罩.术中根据患者自主呼吸频率、心率和无创血压以及体动反应调整异氟醚吸人浓度.观察入室(T0)、诱导前(T1)、喉罩置入后3 min(T2)、切皮后1 min(T3)各时点心率、血压、血氧饱和度(SpO2)变化.比较术中潮气量、呼吸频率、呼气末二氧化碳分压(PETCO2)、异氟醚呼气末浓度(ET)、异氟醚最低肺泡有效浓度(MAC)及维持芬太尼用量.记录术后疼痛程度.结果 T2和T3时点A组潮气量[(443.83±52.98)和(450.25±53.92)ml]明显高于B组[(219.00±53.24)和(301.44±60.48)ml,均P<0.01].T3时点A组呼吸频率值[(12.00±0.74)次/min]明显低于B组[(15.11±3.76)次/min,P<0.01],A组PETCO2[(41.5±4.34)mm Hg]低于B组[(46.22±5.73)mm Hg(P<0.05)].T2时点A组异氟醚ET[(1.04±0.37)%]和异氟醚MAC[(0.97±0.33)%]显著低于B组(1.53±0.21)%和(1.44±0.14)%(P<0.01).T3时点A组异氟醚ET[(1.12±0.24)%]和异氟醚MAC[(0.98±0.21)%]低于B组[(1.29±0.15)%和(1.13±0.12)%,P<0.05].A组术后镇痛优于B组(P<0.01).B组拔罩时有3例躁动、1例反流.结论 喉罩通气全麻辅助臂丛神经阻滞在上肢手术麻醉中能有效降低术中吸入麻醉剂浓度,减少术后并发症发生.%Objective To evaluate the advantage of laryngeal mask airway(LMA) inspiration anesthesia combined with brachial plexus blockage (BPB) in upper limb orthopaedic surgeries. Methods Thirty patients were divided randomly into two groups (n = 15). In group A,LMA combined with BPB was adopted,while LMA was used only in group B. In group A,a dosage of 20-25 ml 1.6% lydocaine was adopted in BPB

  6. Ultrasound guidance improves the success rate of axillary plexus block: a meta-analysis

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    Qin Qin

    2016-04-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the value of real-time ultrasound (US guidance for axillary brachial plexus block (AXB through the success rate and the onset time. METHODS: The meta-analysis was carried out in the Anesthesiology Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China. A literature search of Medline, EMBASE, Cochrane database from the years 2004 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text word: "axilla", "axillary", "brachial plexus", "ultrasonography", "ultrasound", "ultrasonics". Two different reviewers carried out the search and evaluated studies independently. RESULTS: Seven randomized controlled trials, one cohort study and three retrospective studies were included. A total of 2042 patients were identified. 1157 patients underwent AXB using US guidance (US group and the controlled group included 885 patients (246 patients using traditional approach (TRAD and 639 patients using nerve stimulation (NS. Our analysis showed that the success rate was higher in the US group compared to the controlled group (90.64% vs. 82.21%, p < 0.00001. The average time to perform the block and the onset of sensory time were shorter in the US group than the controlled group. CONCLUSION: The present study demonstrated that the real-time ultrasound guidance for axillary brachial plexus block improves the success rate and reduce the mean time to onset of anesthesia and the time of block performance.

  7. The odontoid synchondrotic slip: an injury unique to young children

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    Connolly, B. [Dept. of Diagnostic Imaging, The Hospital for Sick Children, Univ. of Toronto, ON (Canada); Emery, D. [Dept. of Diagnostic Imaging, The Hospital for Sick Children, Univ. of Toronto, ON (Canada); Armstrong, D. [Dept. of Diagnostic Imaging, The Hospital for Sick Children, Univ. of Toronto, ON (Canada)

    1995-11-01

    We report seven children (three female, four male) diagnosed with traumatic synchrondrotic slip of the odontoid. The clinical records, plain films, and CT scans were evaluated retrospectively. The patients ranged in age between 3 and 5 years. Their injuries resulted from a motor vehicle accident in four cases and from a fall from a height in three. The injury was isolated in five; it was associated with a closed head injury in one and with facial and brachial plexus trauma in another. Radiographs showed anterior angulation with or without displacement in all seven cases. Axial CT with sagittal reformation and 3D reconstructions were performed in six cases. This confirmed the synchrondrotic slip and, in addition, identified a rotary component to the injury in three cases, with compromise of the canal in two. Other additional injuries were also noted. All cases were treated conservatively and the injuries healed. Only one child had a neurological deficit attributable to her head injury rather than to her cervical injury (MR of the cervical cord was normal). The presence of the synchondrosis between the dens and the body of C-2 makes this injury unique to children under 7 years of age; by the age of 7 the synchrondrosis has fused. (orig.)

  8. SUPERFICIAL CERVICAL PLEXUS BLOCK

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    Komang Mega Puspadisari

    2014-01-01

    Full Text Available Superficial cervical plexus block is one of the regional anesthesia in  neck were limited to thesuperficial fascia. Anesthesia is used to relieve pain caused either during or after the surgery iscompleted. This technique can be done by landmark or with ultrasound guiding. The midpointof posterior border of the Sternocleidomastoid was identified and the prosedure done on thatplace or on the level of cartilage cricoid.

  9. Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery

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    Ding Zi-hai

    2011-04-01

    Full Text Available Abstract Background Exposure of the anterior or lateral lumbar via the retroperitoneal approach easily causes injuries to the lumbar plexus. Lumbar plexus injuries which occur during anterior or transpsoas lumbar spine exposure and placement of instruments have been reported. This study aims is to provide more anatomical data and surgical landmarks in operations concerning the lumbar plexus in order to prevent lumbar plexus injuries and to increase the possibility of safety in anterior approach lumbar surgery. Methods To study the applied anatomy related to the lumbar plexus of fifteen formaldehyde-preserved cadavers, Five sets of Virtual Human (VH data set were prepared and used in the study. Three-dimensional (3D computerized reconstructions of the lumbar plexus and their adjacent structures were conducted from the VH female data set. Results The order of lumbar nerves is regular. From the anterior view, lumbar plexus nerves are arranged from medial at L5 to lateral at L2. From the lateral view, lumbar nerves are arranged from ventral at L2 to dorsal at L5. The angle of each nerve root exiting outward to the corresponding intervertebral foramen increases from L1 to L5. The lumbar plexus nerves are observed to be in close contact with transverse processes (TP. All parts of the lumbar plexus were located by sectional anatomy in the dorsal third of the psoas muscle. Thus, access to the psoas major muscle at the ventral 2/3 region can safely prevent nerve injuries. 3D reconstruction of the lumbar plexus based on VCH data can clearly show the relationships between the lumbar plexus and the blood vessels, vertebral body, kidney, and psoas muscle. Conclusion The psoas muscle can be considered as a surgical landmark since incision at the ventral 2/3 of the region can prevent lumbar plexus injuries for procedures requiring exposure of the lateral anterior of the lumbar. The transverse process can be considered as a landmark and reference in surgical

  10. Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1% no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20 mL de ropivacaina a 0,5, 0,75 ó 1% en el bloqueo de plexo braquial por la vía posterior Comparative study for the postoperative analgesic efficacy of 20 mL at 0.5, 0.75, and 1% ropivacaine in posterior brachial plexus block

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    Marcos Guilherme Cunha Cruvinel

    2008-10-01

    ía posterior se dividieron aleatoriamente en tres grupos de 30. Grupo 1: 20 mL de ropivacaina a 0,5%; Grupo 2: 20 mL de ropivacaina a 0,75%; Grupo 3: 20 mL de ropivacaina a 1%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó según una escala numérico verbal (ENV en las primeras 48 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor medio, tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve una analgesia eficaz para intervenciones quirúrgicas en el hombro. Utilizando 20 mL de ropivacaina, las tres diferentes concentraciones estudiadas promueven analgesia similar.BACKGROUND AND OBJECTIVES: Arthroscopic shoulder surgeries are associated with severe postoperative pain. Among the analgesic techniques available, brachial plexus block has the best results. The objective of this study was to determine which concentration of local analgesic used in the posterior brachial plexus block provides longer postoperative analgesia. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided into three groups of 30 patients each. Group I: 20 mL of 0.5% ropivacaine; Group 2: 20 mL of 0.75% ropivacaine; and Group 3: 20 mL of 1% ropivacaine. The blockade was evaluated by assessing the thermal sensitivity using a cotton pad with alcohol and postoperative pain was evaluated according to a Verbal Numeric Scale (VNS in the first 48 hours. RESULTS: Postoperative analgesia was similar in all three groups according to the parameters evaluated: mean VNS, time until the first complaint of pain, and postoperative opioid consumption. CONCLUSIONS: This study demonstrated that posterior brachial plexus block provides effective analgesia for shoulder surgeries

  11. Application of Oram theory on improving self-care ability of patients with brachial plexus injury%应用Oram自理学说提高全臂丛神经损伤患者自理能力

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    孙家芝; 马宁; 张经文

    2010-01-01

    @@ 美国护理学家(Dorothea Elizabeth Oram)提出了自理理论,自理是人们以特定的方式维持自身结构完整和功能正常的进行维持正常生长发育的过程,她将患者定为自理缺陷的人.全臂从神经损伤是指C5-T1脊神经根的损伤,临床表现为上肢肌肉瘫痪及感觉消失,伸屈肘及腕桡反射消失[1].

  12. Survival and Pathway of Regenerative Motoneurons after Brachial Plexus Root Injury%臂丛根性伤后运动神经元的存活及再生路径研究

    Institute of Scientific and Technical Information of China (English)

    郑玲玲; 肖波

    2010-01-01

    目的 观察臂丛神经不同损伤后脊髓前角运动神经元的存活及再生轴突的路径选择,探讨其与运动功能恢复的关系.方法 选用48只健康成年雄性SD大鼠,随机分为挫伤组、切断组、撕脱组和对照组.术后2个月进行Grooming实验.处死前3 d肌皮神经肌支或皮支注射荧光金逆行追踪标记,处死后取脊髓C5-8节段标本,计数再生脊髓运动神经元数;中性红复染计数存活神经元数.结果 各组存活神经元数撕脱组(881±76)<切断组(1005±89)<挫伤组(1126±25)<对照组(1900±39);各组皮支均标记到10~20个神经元,而肌支标记到大量的神经元.Grooming实验,挫伤组(3.42级)明显好于撕脱组(1.75级)及切断组(1.75级).结论 臂丛神经根性损伤后脊髓前角运动神经元的再生路径为肌支路径,不同损伤后存活的神经元数不同,功能恢复的程度也不同.

  13. Ankle Brachial Index

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

    2008-03-15

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

  14. Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20, 30 o 40 mL de ropivacaína en el bloqueo de plexo braquial por la vía posterior A comparative study on the postoperative analgesic efficacy of 20, 30, or 40 mL of ropivacaine in posterior brachial plexus block

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    Marcos Guilherme Cunha Cruvinel

    2007-10-01

    fue determinar cuál volumen de anestésico local en el bloqueo de plexo braquial por la vía posterior propicia analgesia postoperatoria para esas operaciones de manera más eficiente. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por vía posterior fueron divididos aleatoriamente en tres grupos de 30. Grupo 1 - volumen de 20 mL; Grupo 2 - volumen de 30 mL; Grupo 3 - volumen de 40 mL. En todos los grupos, el anestésico usado fue la ropivacaína a 0,375%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó secundando una escala numérica verbal (ENV en las primeras 24 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor promedio,tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. En el grupo de 20 mL hubo un mayor consumo de analgésicos no opioides después de la 12ª hora de postoperatorio. En los grupos de 30 y 40 mL la extensión del bloqueo fue significativamente mayor. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve analgesia eficaz para intervenciones quirúrgicas en el hombro. Los tres diferentes volúmenes estudiados promovieron analgesia similar. La mayor extensión del bloqueo con volúmenes mayores no se tradujo en una mejor analgesia.BACKGROUND AND OBJECTIVES: Arthroscopic surgeries of the shoulder are accompanied by severe postoperative pain. Among the analgesic techniques, brachial plexus block offers the best results. The objective of this study was to determine which volume of local anesthetic in the posterior brachial plexus block offers more adequate analgesia for those procedures. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided in three groups of 30 patients: Group 1 – volume of 20 mL; Groups 2 – volume of 30 m

  15. DOES THE ADDITION OF DEXAMETHASON TO LOCAL ANESTHETIC PROLONG THE ANALGESIA OF INTERSCALEN PLEXUS BRACHIALIS BLOCK IN PATIENTS WITH SHOULDER SURGERY?

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    Nancheva Jasminka

    2016-07-01

    Full Text Available Abstract: Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of plexus brachialis block as much as supraclavicular and infraclavicular provide reliable, safe, effective, low cost and most complete anesthesia with satisfactory postoperative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study. Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analgesia in patients under the shoulder surgery. Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASA I-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach and mixture of 2% lidocaine (12ml and 0.5% bupivacaine (22 ml either alone or combined with dexamethasone (4 mg. The block was performed by using double technique neurostimulator/ultrasound technique. Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2 (with dexamethasone as compared to Group G1 patients (p < 0.01. Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthroscopy. Moreover, it is a remarkably safe and costeffective method of providing

  16. True aneurysm of brachial artery.

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    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms.

  17. Medical Rehabilitation and Occupational Therapy in Patients with Lesion of Plexus Brachialis

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    Vacheva D.

    2015-05-01

    Full Text Available Causes for plexus brachialis damage are versatile, and in some cases remain unknown, but mostly result from degenerative and inflammatory processes. Treatment of brachial plexus dysfunction is often conservative and is subject to a team of specialists - neurologists, traumatologists, rehabilitation physicians, kinesitherapists and occupational therapists. The objective of the research is to report the recovery of patients with lesion of plexus brachialis after a complex physiotherapy and rehabilitation treatment program that includes electrostimulation, remedial massage, kinesitherapy, electrotherapy and occupational therapy. A total of 159 patients, treated at the Clinic of Physical Therapy, University Hospital of Pleven, were included in the study. Improvement of measured indexes: pain assessment, centimetry, assessment of upper limb muscle weakness, dynamometry and functional test of activities of daily living, was registered in all patients under observation. In order to achieve good results in the rehabilitation of patients with injured plexus brachialis, timely diagnosis, good medication therapy and early start of complex physiotherapy and rehabilitation are of crucial importance, so that performance of daily living activities improves. The good results come slowly and with difficulties, but the quality of life of patients and the quality of labor performed by them, improves significantly.

  18. Cervical spine injuries in American football.

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    Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R

    2009-01-01

    American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of

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

    Science.gov (United States)

    Haninec, Pavel; Mencl, Libor; Bačinský, Peter; Kaiser, Radek

    2013-12-01

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

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

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    Nagarjuna Reddy

    2015-09-01

    Full Text Available BACKGROUND : The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral ner ve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of tru nks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adju vants to the local anesthetics. AIM : To compare the efficacy of Ropivacaine and Ropivacaine with Magnesium Sulphate for Brachial Plexus Block by Supraclavicular technique, for upper limb orthopedic surgeries. DESIGN : A Prospective randomized comparative st udy . METHODS : Sixty adult patients of both sexes in the age group of 20 - 60 years belonging to ASA I/II category posted for various types of upper limb surgeries. The patients were randomly allocated into two groups. Supraclavicular brachial plexus block wa s performed. Group – I (Ropivacaine alone – 30 patients received 29ml of 0.75% Ropiva caine with 1ml of normal saline .Group – II (Ropivacaine+Magnesium – 30 patients received 29ml of 0.75% Ropivacaine with Magnesium Sulphate 250mg (1ml of 500mg drug diluted wi th 1ml of distilled water. The following parameters were observed after performing Supraclavicular Brachial Plexus block in both the groups: 1. Time of onset of block (Sensory and Motor 2. Total Duration of Analgesia 3. Total Duration of Motor Blockade 4 . Dermatomes/Nerves blocked 5. Complications if any. RESULTS : There was no significant difference in onset of sensory blockade between Group I ( 4

  1. COMPARATIVE STUDY OF BUPIVACAINE V/S BUPIVACAINE WITH CLONIDINE FOR BRACHIAL PLUXUS BLOCK

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    Praveen Kumar

    2015-10-01

    Full Text Available BACKGROUND : The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral ne rve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of tr unks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adj uvants to the local anesthetics. This study is intended to determine the effects of adding Clonidine to Bupivacaine in brachial plexus blockade by Nerve locator assisted supraclavicular approach, with regard to the onset, intensity and duration of blockade along with its analgesic efficacy. METHODS : Forty adult patients of both sexes in the age group of 20 - 60 years of weight ranging from 50 - 70kg belonging to ASA I/II category posted for various types of upper limb surgeries the patients were randomly alloca ted into two groups,. Supraclavicular brachial plexus block was performed via peripheral nerve locator assisted subclavian perivascular technique. Group – B ( B upivacaine alone – 20 patients received 30 ml of 0.375%Bupivacaine with 2ml of 0.9% sodium chloride solution. Group – BC ( B upivacaine + C lonidine – 20 patients received 30ml of 0.375%Bupivacaine with Clonidine hydrochloride 100μg (1ml of 150μg diluted with 2ml 0.9% Na C l solution. From that 2ml used fo r study. ( T he following parameters are assessed Onset of blockade, Duration of blockade, Intensity of blockade, Sedation, Quality of analgesia, Haemodynamic changes & Complications if any RESULTS

  2. Ganglion block. Celiac plexus neurolysis; Ganglienblockade. Neurolyse des Plexus coeliacus

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Seifarth, H. [Klinikum Esslingen gGmbH, Klinik fuer diagnostische und interventionelle Radiologie und Nuklearmedizin, Esslingen (Germany); Meier, R. [Universitaetsklinikum Ulm, Klinik fuer diagnostische und interventionelle Radiologie, Ulm (Germany)

    2015-06-15

    Pain originating from the organs of the upper abdomen, especially in patients suffering from inoperable carcinoma of the pancreas or advanced inflammatory conditions, is difficult to treat in a significant number of patients. Computed tomography (CT) guided neurolysis is the most commonly used technique for neurolysis of the celiac plexus. Ethanol is used to destroy the nociceptive fibers passing through the plexus and provides an effective means of diminishing pain arising from the upper abdomen. Using either an anterior or posterior approach, a 22 G Chiba needle is advanced to the antecrural space and neurolysis is achieved by injecting a volume of 20-50 ml of ethanol together with a local anesthetic and contrast medium. In up to 80 % of patients suffering from tumors of the upper abdomen, CT-guided celiac plexus neurolysis diminishes pain or allows a reduction of analgesic medication; however, in some patients the effect may only be temporary necessitating a second intervention. In inflammatory conditions, celiac neurolysis is often less effective in reducing abdominal pain. The CT-guided procedure for neurolysis of the celiac plexus is safe and effective in diminishing pain especially in patients suffering from tumors of the upper abdomen. The procedure can be repeated if the effect is only temporary. (orig.) [German] Therapierefraktaere und schwere rezidivierende Schmerzen im Oberbauch stellen insbesondere beim nicht operablen Pankreaskarzinom, aber auch bei fortgeschrittenen entzuendlichen Erkrankungen eine Herausforderung dar. Die CT-gesteuerte Neurolyse/Blockade des Plexus coeliacus schaltet durch eine gezielte Zerstoerung der afferenten und efferenten Nervenfasern mit Alkohol die Schmerzweiterleitung aus. Mittels unterschiedlicher Zugaenge von ventral oder dorsal wird eine 22-G-Chiba-Nadel CT-durchleuchtungsgesteuert nach prae- und/oder paraaortal auf Hoehe des Truncus coeliacus vorgebracht. An der entsprechenden Lokalisation erfolgt die Injektion von 20

  3. Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume

    Energy Technology Data Exchange (ETDEWEB)

    Lundstedt, Dan, E-mail: dan.lundstedt@gu.se [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Gustafsson, Magnus [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Steineck, Gunnar [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Sundberg, Agnetha [Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Wilderäng, Ulrica [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden); Holmberg, Erik [Regional Cancer Center, Sahlgrenska University Hospital, Gothenburg (Sweden); Johansson, Karl-Axel [Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg (Sweden); Karlsson, Per [Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg (Sweden)

    2015-06-01

    Purpose: To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. Methods and Materials: The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. Results: After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V{sub 40} {sub Gy} ≥ 13.5 cm{sup 3}, compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). Conclusion: Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer.

  4. Delayed olfactory ensheathing cell transplants reduce nociception after dorsal root injury.

    Science.gov (United States)

    Wu, Ann; Lauschke, Jenny L; Gorrie, Catherine A; Cameron, Nicholas; Hayward, Ian; Mackay-Sim, Alan; Waite, Phil M E

    2011-05-01

    Injury to cervical dorsal roots mimics the deafferentation component of brachial plexus injury in humans, with intractable neuropathic pain in the deafferented limb being a common consequence. Such lesions are generally not amenable to surgical repair. The use of olfactory ensheathing cells (OECs) for dorsal root repair, via acute transplantation, has been successful in several studies. From a clinical point of view, delayed transplantation of OECs would provide a more realistic timeframe for repair. In this study we investigated the effect of delayed OEC transplantation on functional recovery of skilled forepaw movements and amelioration of neuropathic pain, using a C7 and C8 dorsal root injury rat model previously established in our lab. We found that OEC transplantation to the dorsal horn 1 week after root injury effectively attenuated neuropathic disturbances associated with dorsal root injury, including spontaneous pain behavior, tactile allodynia and thermal hyperalgesia. The sensory controls of complex, goal-oriented skilled reaching and ladder walking, however, were not improved by delayed OEC transplantation. We did not detect any significant influence of transplanted OECs on injury-induced central reorganisation and afferent sprouting. The anti-nociceptive effect mediated by OEC transplants may therefore be explained by alternative mechanisms such as modification of inflammation and astrogliosis. The significant effect of OEC transplants in mitigating neuropathic pain may be clinically useful in intractable pain syndromes arising from deafferentation. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.

  5. Parche de lidocaína al 5% para el tratamiento del SDRC de extremidad superior por bloqueo transcutáneo del plexo braquial: Caso Clínico Licodocaíne patch for the treatment of CRPS in the arm by transcutaneous block of the brachial plexus: Clinical case

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    M. A. Vidal

    2007-06-01

    convencional y únicamente el parche de lidocaína al 5% consiguió un alivio importante del dolor y mejoría de la funcionalidad de la extremidad. El bajo riesgo de interacciones farmacológicas hacen del parche de lidocaína al 5% una atractiva opción como terapia analgésica adyuvante. Resultando especialmente beneficiosa en pacientes plurimedicados y en aquellos que reciben medicación analgésica sistémica.The complex regional pain syndrome (SDRC it is characterized by pain, functional impotence, and tróphics alterations. The cause is a primary injury or a dysfunction of the Nervous System. SDRC-I that replaces term SRD and the SDRC-II instead of the term causalgia. Clinical case: A man of 37 years of age, that after being put under a shoulder arthroscopy began to display pain in the shoulder and important functional limitation, as well as vasomotor changes of the same extremity, reason why was diagnosed of SDRC. The patient followed several analgesic treatment by oral route, was put under numerous, sympathetic blockades and physiotherapy treatment. During these months the clinical evolution was poor, reappearing the pain in all the occasions and without displaying improvement of mobility. It was decided to initiate treatment with lidocaine patches, with this treatment the patient was able to control the pain and restaure a complete mobilization of the shoulder. Lidocaine patch is a topic analgesic developed for the treatment of neuropathic pain. It is approved in the U.S.A. for the treatment of the postherpetic neuralgia. Nevertheless, its use in other forms of neuropathic pain is being proven, like the neuropathic diabetes, chronic back pain and the miofascial pain. The SDRC is associate with an abnormal activity of the nervous system, reason why the blockade likeable by means of the anaesthetic premises widely is used. This case is similar to which we described by others authors, in patints refractary to conventional treatment and the lidocaine patch solely obtained

  6. ULTRASOUND GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK WITH AND WITHOUT MAGNESIUM SULPHATE: A COMPARATIVE STUDY

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    Narmatha

    2016-05-01

    Full Text Available BACKGROUND Many drugs have been used as adjuvants to local anaesthetics to prolong the duration of analgesia after a peripheral nerve block. In this study, we evaluate the effects of adding MgSO4 to local anaesthetics in supraclavicular block to prolong the duration of analgesia. AIM AND OBJECTIVES To compare the effect of addition of MgSO4 to local anaesthetics in supraclavicular block and study the onset of sensory blockade, motor blockade, duration of motor blockade and duration of analgesia. MATERIALS AND METHOD This study was conducted in 60 patients of ASA Grade 1 and 2, undergoing upper limb orthopaedic procedures using ultrasoundguided supraclavicular block after getting Ethical Committee approval. They were divided into two groups of 30 each. Group 1 received 1.5% adrenalized lignocaine 13 mL + 0.5% bupivacaine 13 mL and 2 mL of 10% MgSO4. Group 2 received 1.5% adrenalized lignocaine 13 mL + 0.5% bupivacaine 13 mL and 2 mL of 0.9% normal saline. Following data were recorded for 24 hrs. after surgeryOnset and duration of sensory and motor blockade, analgesic duration using VAS pain score and side effects. RESULTS The duration of analgesia was significantly longer in MgSO4 group than in saline group. In MgSO4 group, duration was 834 minutes Vs 276 minutes in normal saline group. The p value was <0.0001, which was significant. But onset times of sensory and motor blockade were not significantly different between the two groups. Also there was no significant difference observed in the side effects between the groups. CONCLUSION The addition of 10% MgSO4 2 mL (200 mg as adjuvant to local anaesthetic for supraclavicular block prolongs the duration of analgesia.

  7. [Macrosomia, shoulder dystocia and elongation of the brachial plexus: what is the role of caesarean section?

    Science.gov (United States)

    Kehila, Mehdi; Derouich, Sadok; Touhami, Omar; Belghith, Sirine; Abouda, Hassine Saber; Cheour, Mariem; Chanoufi, Mohamed Badis

    2016-01-01

    The delivery of a macrosomic infant is associated with a higher risk for maternofoetal complications. Shoulder dystocia is the most feared fetal complication, leading sometimes to a disproportionate use of caesarean section. This study aims to evaluate the interest of preventive caesarean section. We conducted a retrospective study of 400 macrosomic births between February 2010 and December 2012. We also identified cases of infants with shoulder dystocia occurred in 2012 as well as their respective birthweight. Macrosomic infants weighed between 4000g and 4500g in 86.25% of cases and between 4500 and 5000 in 12.25% of cases. Vaginal delivery was performed in 68% of cases. Out of 400 macrosomic births, 9 cases with shoulder dystocia were recorded (2.25%). All of these cases occurred during vaginal delivery. The risk for shoulder dystocia invaginal delivery has increased significantly with the increase in birth weight (p dystocia affectd macrosoic infants in 58% of cases. Shoulder dystocia is not a complication exclusively associated with macrosomia. Screening for risky deliveries and increasing training of obstetricians on maneuvers in shoulder dystocia seem to be the best way to avoid complications.

  8. Letter to Editor : Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

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    Hemendra KA

    2014-01-01

    Full Text Available Dear sir, I would like to raise these following points: 1. Illustration of case report in abstract was somehow different from illustration in the description as the case was explained as a 2 month old clavicle fracture in abstract & it was explained as 4 months old in description and different other time intervals also. 2. Itrogenic compartment syndrome manifestating a week after surgery would not happen,as there was no compartment at clavicle bone,and if any local hematoma would present,that might manifest as a wound dehiscence rather that a isolated neurological symptoms. 3. lateral costo-clavicular space cannot be altered by fixing the fracture as the lateral space is maintained by coraco-clavicular ligaments which were intact in this case. 4. There was no indication for implant removal at 70 days for unstabilising the fracture site as practically it will not increase lateral costo-clavicular space. 5. Why the fracture was fixd again after a year as although the fracture fixation had created the problem. these points indicate unreliability of facts explained in the article. Warm regards Hemendra Agrawal Central Institute Of Orthopaedics, V.M.M.C. & Safdarjung Hospital, Newdelhi-110029, INDIA.

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

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    K.E. Joubert

    2002-07-01

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

  10. Obturator nerve transfer to repair Iumbosacral plexus nerve root avulsion injuries: anatomic study and clinical application%闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用

    Institute of Scientific and Technical Information of China (English)

    王树锋; 薛云浩; 刘佳勇; 栗鹏程; 褚寅; 熊革; 孙燕琨

    2009-01-01

    Objective To provide an effective and safe motor donor nerve for the treatment of lumbosacral plexus nerve root avulsion injuries. Methods The obturator nerve, lumbar plexus and sacral plexus on both sides were exposed on 15 cadaver specimens. The length of obturator nerve was measured from its origin to entrance of the foramen obturatum. The transverse diameter and thickness of the obturator nerve and femoral nerve on both sides were measured individually. The obturator nerve and femoral nerve of each specimen was cut into histological slice, and the amount of myelinated nerve fiber was counted respectively. There were five patients including 4 patients with traumatic lumbosacral plexus nerve root avulsion injuries and 1 patient with lumbar plexus nerve root injuries. The contralateral obturator nerve as motor donor nerve transferred through the retroperitoneal route and direct coaptation with the femoral nerve was performed in 4 cases, and ipsilateral obturator nerve was transferred to the S1 nerve root in 1 case. Results The length, transverse diameter and thickness of the obturator nerve was (10.5±0.9) cm, (2.03±0.37) mm and (2.78±0.29) mm individually. The transverse diameter and thickness of femoral nerve were (3.79±0.58) mm, (6.53±0.61) mm individually. The obturator nerve contained 5974±1996 myelinated nerve fibers and the femoral nerve contained 15 860±4350 myelinated nerve fibers. In 3-7 d after the operation, the muscle strength of adduction on the donor lower limber was decreased to grade 2-3. The functional recovery of muscle strength of quadriceps reconstructed by contralateral obturator nerve transfer recovered to grade 4 in 2 cases, grade 2 in 1 case and grade 1 in 1 case between 8 months to 5 years postoperatively. The muscle strength of triceps surae and finger flexor reconstructed by ipsilateral obturator nerve transferring to S1 nerve root recovered to grade 3 after 11 months postoperatively. Conclusion The contralateral or ipsilateral

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

    Science.gov (United States)

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

    2010-06-01

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

  12. Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease

    Directory of Open Access Journals (Sweden)

    Meera Subash BS

    2014-05-01

    Full Text Available Background. Brachial neuritis (BN is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. “Sniff” test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis.

  13. Hippocampal plasticity after a vagus nerve injury in the rat

    Institute of Scientific and Technical Information of China (English)

    Giulia Ronchi; Vitaly Ryu; ong ling; Krzysztof Czaja

    2012-01-01

    Stimulation of the vagus nerve has been previously reported to promote neural plasticity and neurogenesis in the brain. Several studies also revealed plastic changes in the spinal cord after injuries to somatosensory nerves originating from both the brachial and lumbo-sacral plexuses. However, the neurogenic responses of the brain to the injury of the viscerosensory innervation are not as yet well understood. In the present study, we investigated whether cells in the dentate gyrus of the hippocampus respond to a chemical and physical damage to the vagus nerve in the adult rat. Intraperitoneal capsaicin administration was used to damage non-myelinated vagal afferents while subdiaphragmatic vagotomy was used to damage both the myelinated and non-myelinated vagal afferents. The 5-bromo-2-deoxyuridine (BrdU) incorporation together with cell-specific markers was used to study neural proliferation in subgranular zone, granule cell layer, molecular layer and hilus of the dentate gyrus. Microglia activation was determined by quantifying changes in the intensity of fluorescent staining with a primary antibody against ionizing calcium adapter-binding molecule 1. Results revealed that vagotomy decreased BrdU incorporation in the hilus 15 days after injury compared to the capsaicin group. Capsaicin administration decreased BrdU incorporation in the granular cell layer 60 days after the treatment. Capsaicin decreased the number of doublecortin-expressing cells in the dentate gyrus, whereas vagotomy did not alter the expression of doublecortin in the hippocampus. Both the capsaicin- and the vagotomy-induced damage to the vagus nerve decreased microglia activation in the hippocampus at 15 days after the injury. At 30 days post injury, capsaicin-treated and vagotomized rats revealed significantly more activated microglia. Our findings show that damage to the subdiaphragmatic vagus in adult rats is followed by microglia activation and long-lasting changes in the dentate gyrus

  14. Treatment of Combined Injuries of the Axillary and Suprascapular Nerves with Scapulothoracic Dissociation.

    Science.gov (United States)

    Sano, Kazufumi; Ozeki, Satoru

    2015-12-01

    A 20-year-old man suffered the combined axillary and suprascapular nerve palsies associated with scapulothoracic dissociation by motorcycle accident. The dislocated shoulder girdle was reduced and stabilized with osteosynthesis of the fractured clavicle and reattachment of the trapezius avulsed from the scapular spine for removal of continuous traction force to these damaged nerves. Because of no evidence of recovery on manual muscle test and electromyogram, exploration for these nerves was administered 6 weeks after injury. Although neurolysis of both nerves revealed neural continuity, excessive tension still existed on the suprascapular nerve. It was thought that previous operation in which the shoulder girdle had been reduced and stabilized as much as possible could not achieve complete anatomical reduction of the scapula. As an additional treatment, medial walls of the suprascapular and spinoglenoid notches were shaven to relax the suprascapular nerve. After a year, complete recovery of both the axillary and suprascapular nerve was identified. Although scapulothoracic dissociation is commonly recognized as massive injury of the shoulder girdle with poor prognosis because of existence of accompanied severe neurovascular injuries, there are more than a few cases in which partial damage on the infraclavicular brachial plexus is only accompanied. In case of them, there is the possibility of lesions in continuity of the nerves in which good prognosis might be expected with surgical intervention including early reduction of the shoulder girdle for removal of excessive tension to the damaged nerve.

  15. [Percutaneous brachial access: a few simple considerations].

    Science.gov (United States)

    Marcy, P Y; Ianessi, A; Ben Taarit, I

    2009-01-01

    This letter is with regards to the recently published article by Vidal et al. in the Journal Français de Radiologie Médicale. A clarification of US and venographic techniques of brachial venous catheterization and related complications are presented. The main indications for PICC line and subcutaneous port placement are described.

  16. Effects of Neurolytic Celiac Plexus Block on Liver Regeneration in Rats with Partial Hepatectomy

    OpenAIRE

    Jun Li; Hong-Tao Yan; Jian-Xiang Che; Shu-Rong Bai; Qing-Ming Qiu; Ling Ren; Fan Pan; Xiao-Qin Sun; Fu-Zhou Tian; Dong-Xuan Li; Li-Jun Tang

    2013-01-01

    Liver regeneration is the basic physiological process after partial hepatectomy (PH), and is important for the functional rehabilitation of the liver after acute hepatic injury. This study was designed to explore the effects of neurolytic celiac plexus block (NCPB) on liver regeneration after PH. We established a model of PH in rats, assessing hepatic blood flow, liver function, and serum CRP, TNF-α, IL-1β and IL-6 concentrations of the residuary liver after PH. Additionally, histopathologica...

  17. Brachial Approach to NOGA-Guided Procedures

    Science.gov (United States)

    Banovic, Marko; Ostojic, Miodrag C.; Bartunek, Jozef; Nedeljkovic, Milan; Beleslin, Branko; Terzic, Andre

    2011-01-01

    Several methods are available for delivering stem cells to the heart. Recent studies have highlighted the advantages of injecting the cells directly into the myocardium in order to increase myocardial retention of cells. A particular focus has been on percutaneous transendocardial injection, facilitated by electromechanical mapping. The NOGA® XP Cardiac Navigation System has a multicomponent catheter that is designed to guide and deliver transendocardial injections via a transfemoral approach, without a guidewire. However, this method may not be feasible in some patients who have peripheral vascular disease. Herein, we describe the case of a 68-year-old man whose tortuous, sharply angled iliac arteries precluded a femoral approach to transendocardial injection. To overcome the anatomic and mechanical challenges, we used a brachial approach. We believe that this is the 1st report of using the brachial route for transendocardial injection, and that it can be a viable alternative to the transfemoral approach in selected patients. PMID:21494532

  18. Complex anatomic variation in the brachial region.

    Science.gov (United States)

    Troupis, Th; Michalinos, A; Protogerou, V; Mazarakis, A; Skandalakis, P

    2015-01-01

    Authors describe a case of a complex anatomic variation discovered during dissection of the humeral region. On the right side, brachial artery followed a superficial course. Musculocutaneous nerve did not pierce coracobrachialis muscle but instead passed below the muscle before continuing in the forearm. On the left side, a communication between musculocutaneous and median nerve was dissected. Those variations are analytically presented with a brief review on their anatomic and clinical implications. Considerations on their embryological origin are attempted.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-03-15

    referred for magnetic resonance imaging (MRI) to demonstrate the brachial plexus involvement. Coronal diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) revealed a mass in the right axilla, with a b value of 1,000, infiltrating the cord and branches of the right brachial plexus visualised as linear hyperintensities (Fig. 1c, arrow). Brachial plexopathy in breast cancer patients can be metastatic (because major lymph drainage routes for the breast course through the axilla) or radiation induced, the former being the commoner of the two. Differentiation between the two pathologies is important for appropriate treatment planning. {sup 18}F-FDG PET/CT is a useful tool in the evaluation of patients with recurrent or metastatic breast cancer. Recognition of the pattern of brachial plexus involvement is thus essential for accurate interpretation of the {sup 18}F-FDG PET/CT study. To date, two case reports and one small case series have demonstrated the feasibility of PET for confirming metastatic brachial plexopathy when MRI was suspicious of the same or when the patient was symptomatic for the same. This case highlights the possibility of metastatic brachial plexopathy even when the patient may not be overtly symptomatic for the same. The typical pattern as seen on MIP and coronal images is linear, extending from the superomedial aspect (supra/infraclavicular) to the lateral aspect of axilla closely related to the subclavian/axillary vessels). The commonest finding on computed tomography (CT) is that of an axillary mass, but may range from no remarkable abnormality to minimal thickening. Moreover, CT would not be able to differentiate metastatic from radiation plexopathy. MRI is the first-line imaging modality for evaluating brachial plexopathy and can delineate both normal and abnormal anatomy of the brachial plexus, with the ability to differentiate nerves from the surrounding vessels and soft tissue with greater detail than CT. In this case

  20. Physical and psychological factors predict outcome following whiplash injury.

    Science.gov (United States)

    Sterling, Michele; Jull, Gwendolen; Vicenzino, Bill; Kenardy, Justin; Darnell, Ross

    2005-03-01

    Predictors of outcome following whiplash injury are limited to socio-demographic and symptomatic factors, which are not readily amenable to secondary and tertiary intervention. This prospective study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK, IES) were measured in 76 acute whiplash participants. The outcome measure was Neck Disability Index scores at 6 months. Stepwise regression analysis was used to predict the final NDI score. Logistic regression analyses predicted membership to one of the three groups based on final NDI scores (pain and disability, >30 moderate/severe pain and disability). Higher initial NDI score (1.007-1.12), older age (1.03-1.23), cold hyperalgesia (1.05-1.58), and acute post-traumatic stress (1.03-1.2) predicted membership to the moderate/severe group. Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were: ROM loss and diminished sympathetic reactivity. Higher initial NDI score (1.03-1.28), greater psychological distress (GHQ-28) (1.04-1.28) and decreased ROM (1.03-1.25) predicted subjects with persistent milder symptoms from those who fully recovered. These results demonstrate that both physical and psychological factors play a role in recovery or non-recovery from whiplash injury. This may assist in the development of more relevant treatment methods for acute whiplash.

  1. Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

    Directory of Open Access Journals (Sweden)

    Cantekin Iskender

    Full Text Available PURPOSE: To describe the risk factors and labor characteristics of Clavicular fracture (CF and brachial plexus injury (BPI; and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. METHODS: This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300 was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. RESULTS: During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2% sustained permanent injury, whereas one neonate (4.5% with BPI following shoulder dystocia sustained permanent injury (p = 0.34. CONCLUSION: BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

  2. A comparison between brachial and echocardiographic systolic time intervals.

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    Full Text Available Systolic time interval (STI is an established noninvasive technique for the assessment of cardiac function. Brachial STIs can be automatically determined by an ankle-brachial index (ABI-form device. The aims of this study are to evaluate whether the STIs measured from ABI-form device can represent those measured from echocardiography and to compare the diagnostic values of brachial and echocardiographic STIs in the prediction of left ventricular ejection fraction (LVEF <50%. A total of 849 patients were included in the study. Brachial pre-ejection period (bPEP and brachial ejection time (bET were measured using an ABI-form device and pre-ejection period (PEP and ejection time (ET were measured from echocardiography. Agreement was assessed by correlation coefficient and Bland-Altman plot. Brachial STIs had a significant correlation with echocardiographic STIs (r = 0.644, P<0.001 for bPEP and PEP; r  = 0.850, P<0.001 for bET and ET; r = 0.708, P<0.001 for bPEP/bET and PEP/ET. The disagreement between brachial and echocardiographic STIs (brachial STIs minus echocardiographic STIs was 28.55 ms for bPEP and PEP, -4.15 ms for bET and ET and -0.11 for bPEP/bET and PEP/ET. The areas under the curve for bPEP/bET and PEP/ET in the prediction of LVEF <50% were 0.771 and 0.765, respectively. Brachial STIs were good alternatives to STIs obtained from echocardiography and also helpful in prediction of LVEF <50%. Brachial STIs automatically obtained from an ABI-form device may be helpful for evaluation of left ventricular systolic dysfunction.

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

    OpenAIRE

    López, C.; JU Carmona; Samudio, I

    2010-01-01

    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 au...

  4. 体感诱发电位对强直性脊柱炎胸腰椎后凸矫形术中体位性臂丛神经损伤的监测作用%The application of somatosensory evoked potentials in monitoring the occurrence of postural brachial plexus injury in ankylosing spondylitis with thoracolumbar kyphosis following pedicle subtraction osteotomy

    Institute of Scientific and Technical Information of China (English)

    刘兴勇; 钱邦平; 邱勇; 王斌; 俞杨; 朱泽章; 王岩; 张永刚

    2015-01-01

    目的:探讨体感诱发电位(somatosensory evoked potentials,SEP)对强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形患者经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)中体位性臂丛神经损伤的监测作用.方法:选取2013年10月~2014年6月行单节段PSO治疗并有完整术中SEP监测数据及术前、术后临床资料的AS胸腰椎后凸畸形患者28例,其中男27例,女1例.术中均行双上肢正中神经SEP监测,SEP阳性改变标准为波幅降低超过50%和/或潜伏期延长超过10%.结果:PSO术中闭合截骨面复位后,上肢正中神经SEP监测及时发现了3例体位性单侧臂丛神经损伤,SEP波幅降低分别为100%、65%及90%.经体位垫调整后5min,2例SEP波幅降低分别为100%及65%的患者上肢正中神经SEP恢复正常,术后未出现臂丛神经损伤症状;SEP波幅降低90%的患者虽经体位调节,SEP波幅稍有好转,但仍降低70%,术后出现单侧上肢疼痛、乏力的臂丛神经损伤症状,经康复训练及药物治疗后3个月神经功能完全恢复.术中无手术操作引起的神经系统并发症.结论:术中双上肢正中神经SEP监测能及时发现AS胸腰椎后凸畸形PSO术中体位性臂丛神经损伤,经及时处理能有效减轻臂丛神经损伤程度.

  5. 不同年龄大鼠臂丛损伤后Horner征发生机制差异的动物模型建立%The establishment of animal Horner models with different mechanisms following the brachial plexus injury in rats at various ages

    Institute of Scientific and Technical Information of China (English)

    黄轶刚; 陈亮; 顾玉东; 俞光荣

    2007-01-01

    目的 采用不同年龄大鼠模拟产瘫和成人臂丛撕脱伤后Horner征阳性的临床现象,为进一步研究Horner征在产瘫诊治中的价值提供较理想的实验模型.方法 (1)观察幼年及成年大鼠颈交感神经节与C5~T1神经根的解剖关系.(2)取14 d和成年大鼠各56只,平均分为7组,分别行C7、C8、T1、C7+C8、C8+T1神经根撕脱、颈上神经节尾侧节间支切断及星状神经节尾侧节间支切断,术后观察动物是否出现Horner征.结果 (1)所有14 d和成年大鼠星状神经节可见到发自C7、C8和T1神经根的白交通支.(2)C7和C8神经根联合撕脱组幼年和成年大鼠分别有有6只和2只出现Horner征,该组幼年大鼠Horner征在阳性率高于成年大鼠(P<0.05).结论 不同年龄大鼠臂丛损伤后Horner征的发生规律与人类相似--即幼年大鼠Horner征的发生与C7撕脱有关,因而大鼠是进行相关基础研究理想的实验动物.

  6. Patrones de lesión en parálisis obstétricas del plexo braquial. Hallazgos morfológicos en 27 exploraciones microquirúrgicas. [Obstetrical brachial plexus palsy: Patterns of injuries. Morphological findings in 27 cases

    Directory of Open Access Journals (Sweden)

    Sebastian Valbuena

    2013-01-01

    Full Text Available Objetivo Evaluar los patrones morfológicos lesiónales en parálisis obstétricas del plexo braquial encontrados en 27 casos. Materiales y Métodos Se evaluó retrospectivamente los datos de las historias clínicas de 27 exploraciones microquirúrgicas realizadas durante el periodo de los años 2009-2012. Se usó la clasificación clínica de Narakas. Se comparó los hallazgos operatorios con el patrón clínico de lesión. Resultados Se observaron 17 patrones diferentes de lesión. Las parálisis totales mostraban el mayor tipo de diversidad lesional, presentando en general roturas de raíces altas con avulsiones de raíces bajas. El compromiso clínico de la raíz de C7 no siempre se correlaciono con los hallazgos quirúrgicos. Conclusión Las parálisis obstétricas del plexo braquial muestran una gran diversidad de lesiones. La cirugía es altamente demandante, requiriendo el manejo de todas las estrategias de reconstrucción para poder ser usadas dependiendo de acuerdo a los hallazgos quirúrgicos.

  7. Notch receptors in human choroid plexus tumors.

    Science.gov (United States)

    Beschorner, R; Waidelich, J; Trautmann, K; Psaras, T; Schittenhelm, J

    2013-08-01

    Notch signaling plays a role in development and formation of the normal choroid plexus (nCP), and in formation of various tumors in humans. Activation of Notch3 has been reported to promote tumor growth in invasive gliomas and to initiate formation of choroid plexus tumors (CPT) in mice. We investigated the expression of all currently known Notch receptors (Notch 1-4) in 55 samples of nCP and 88 CPT, including 61 choroid plexus papillomas (CPP), 22 atypical CPP and 5 choroid plexus carcinomas by immunohistochemistry. Notch expression was semiquantitatively evaluated separately for membranous/cytoplasmic and for nuclear staining. In addition, we examined Her2 expression (EGFR2, Her2/neu, ErbB2, CD340) because of its functional link to Notch signaling. All samples were negative for Notch3. Membranous/cytoplasmic expression of Notch1 (pnCP compared to CPT. Nuclear expression of Notch1, -2 and -4 was significantly higher in CPT compared to nCP (pnCP to a predominant nuclear expression in CPT. Her2 was weakly expressed in 42/84 CPT but only in 2/53 nCP (p=0.0001) and positively correlated with nuclear expression of Notch1, -2 and 4 in CPT. In summary, a shift between membranous/cytoplasmic (non-canonical signaling pathway) and nuclear expression (canonical signaling pathway) of Notch1, -2 and -4 and upregulation of Her2 indicate neoplastic transformation in human CP and may reveal new therapeutic approaches.

  8. Accessory brachialis muscle associated with high division of brachial artery

    Directory of Open Access Journals (Sweden)

    Krishnamurthy A

    2010-10-01

    Full Text Available During routine dissection for the undergraduate students in the Department of Anatomy, Kasturba Medical College, Mangalore, of a male cadaver aged 73 years, we encountered an additional slip of brachialis muscle taking origin in the flexor compartment of left arm and inserting into the forearm. The origin of the additional muscle belly was from the anteromedial surface of shaft and medial supracondylar ridge of lower end of humerus. The additional muscle slip merged with the tendon of pronator teres before inserting on the lateral surface of the shaft of radius. The median nerve pierced the muscle at a distance of 6 cm from the medial epicondyle of humerus, supplied it and had a routine course later. Associated with the muscular abnormality was the high division of brachial artery into radial and ulnar arteries 17.5 cm from the medial epicondyle. The ulnar artery passed beneath the accessory brachialis muscle along with the median nerve. The role of additional muscles in compression syndrome is a well known phenomenon. The altered anatomy of the blood vessels may make them more vulnerable to trauma and to hemorrhage but at the same time more accessible for cannulation. Medical fraternity including orthopedicians and neurologists need to be aware of such variations when dealing with upper limb injuries or operations around the elbow joint.

  9. Generation of New Neurons in Dorsal Root Ganglia in Adult Rats after Peripheral Nerve Crush Injury

    Directory of Open Access Journals (Sweden)

    Luisa Muratori

    2015-01-01

    Full Text Available The evidence of neurons generated ex novo in sensory ganglia of adult animals is still debated. In the present study, we investigated, using high resolution light microscopy and stereological analysis, the changes in the number of neurons in dorsal root ganglia after 30 days from a crush lesion of the rat brachial plexus terminal branches. Results showed, as expected, a relevant hypertrophy of dorsal root ganglion neurons. In addition, we reported, for the first time in the literature, that neuronal hypertrophy was accompanied by massive neuronal hyperplasia leading to a 42% increase of the number of primary sensory neurons. Moreover, ultrastructural analyses on sensory neurons showed that there was not a relevant neuronal loss as a consequence of the nerve injury. The evidence of BrdU-immunopositive neurons and neural progenitors labeled with Ki67, nanog, nestin, and sox-2 confirmed the stereological evidence of posttraumatic neurogenesis in dorsal root ganglia. Analysis of morphological changes following axonal damage in addition to immunofluorescence characterization of cell phenotype suggested that the neuronal precursors which give rise to the newly generated neurons could be represented by satellite glial cells that actively proliferate after the lesion and are able to differentiate toward the neuronal lineage.

  10. Brachial access technique for aortoiliac stenting revisited

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a modified technique to perform iliac artery stenting through the brachial artery access. A 6F Brite tip sheath (Cordis, Jonhson & Jonhson Medical, Miami Lakes, FL, USA) is inserted into either brachial artery and a standard 4F Judkins Right diagnostic catheter was inserted over a 260 cm 0.038" Terumo Stiff wire (Terumo Corp, Tokyo, Japan) through the sheath. The catheter is navigated down to the aortic bifurcation, and after selecting the common iliac artery ostium, the wire is navigated through the lesion and advanced to the ipsilateral superficial femoral arteries. The catheter should be then moved forward over the wires beyond the lesion and the Terumo guidewire is replaced by two 0.038" 260 cm Supracor wires (Boston Scientific Corporation, San Jose, CA, USA). In order to facilitate advancement of the stent without risk of dislodgement as well as to check the position with low contrast dose injection, a 6 F (or 7F if large stent is selected) 90cm Shuttle Flexor introducer long sheath (Cook Group, Bloomington, IN, USA) should be advanced over the Supracor wire until it reaches the common iliac artery ostium. A road-map technique can be used to check the ostium position in order to properly deploy the selected stent. This technique promises to be safe and effective offering more support than guiding catheter technique; moreover it reduces the stress on the arterial vessel at the subclavian site and enables a stiff balloon or stent catheter to be advanced even through a very elongated and calcified aorta without the risk of stent dislodgement.

  11. 经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的临床疗效%Lateral-rectus approach for treatment of pelvic and sacral fracture complicated with lumbosacral plexus injury

    Institute of Scientific and Technical Information of China (English)

    谷诚; 杨晓东; 夏广; 麦奇光; 王华; 谭新宇; 黄海; 廖坚文; 樊仕才

    2016-01-01

    目的 探讨经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的手术方法及临床疗效.方法 回顾性分析2013年1月至2015年1月,采用经腹直肌外侧切口治疗9例骨盆、骶骨骨折合并腰骶丛损伤患者资料,男4例,女5例;年龄21~61岁,平均38岁;伤后至手术时间:6例为7~20 d,3例为21~59 d.骨盆骨折Tile分型:B2型2例,B3型1例,C1型2例,C2型1例,C3型3例;骶骨骨折Denis分型:Ⅰ型3例,Ⅱ型6例;神经损伤分级:完全损伤1例,部分损伤8例;其中3例合并髋臼骨折,3例合并同侧股骨中段骨折,2例合并胫骨骨折,其他脏器损伤5例.术前通过3D打印制作1:1骨折模型,并在电脑上进行骨折模拟复位;5例患者术前1h在血管造影下行患侧髂内动脉栓塞术.手术经腹直肌外侧切口进入,于腰骶干外侧显露骶髂关节,在骶正中血管与腰骶干、髂内血管间分离显露S1椎体前方,复位骶骨骨折并松解腰骶丛,紧贴骨面放置钢板跨骶髂关节固定,而后再处理合并的耻骨支及髋臼骨折.结果 9例患者均顺利完成手术,手术时间125~224 min,平均183 min;术中出血440~2 760 ml,平均1 150 ml.术后影像学检查示骨折复位固定良好,无一例发生手术相关并发症,骶骨骨折均愈合,愈合时间8~12周,陈旧骨折与新鲜骨折愈合时间无明显差异;术后3个月,6例新鲜骨折中5例腰骶丛损伤症状完全恢复,1例恢复良好;3例陈旧骨折患者,其中2例于术后6个月神经症状大部分恢复,1例无恢复.结论 采用经腹直肌外侧切口入路能较好显露骶髂关节周围,松解骨折压迫的腰骶丛神经根,通过腰骶干下方跨骶髂关节钢板固定能达到较好的固定效果,是治疗骶骨骨折合并腰骶丛损伤的一种可行性手术方法.%Objective To explore the lateral-rectus approach for surgical treatment of pelvic and sacral fracture with lumbosacral plexus injury and its effect.Methods From January 2013

  12. Telocytes in meninges and choroid plexus.

    Science.gov (United States)

    Popescu, B O; Gherghiceanu, M; Kostin, S; Ceafalan, L; Popescu, L M

    2012-05-16

    Telocytes (TCs) are a recently identified type of interstitial cells present in a wide variety of organs in humans and mammals (www.telocytes.com). They are characterized by a small cell body, but extremely long cell processes - telopodes (Tp), and a specific phenotype. TCs establish close contacts with blood capillaries, nerve fibers and stem cells. We report here identification of TCs by electron microscopy and immunofluorescence in rat meninges and choroid plexus/subventricular zone, in the vicinity of putative stem cells. The presence of TCs in brain areas involved in adult neurogenesis might indicate that they have a role in modulation of neural stem cell fate.

  13. Monitoring of celiac plexus block in chronic pancreatitis

    DEFF Research Database (Denmark)

    Myhre, John Gabriel; Hilsted, J; Tronier, B

    1989-01-01

    Pharmacological, percutaneous celiac plexus blockade is often inefficient in the treatment of pain in chronic pancreatitis. Lack of efficiency could be due to incomplete denervation of the plexus; however, a method for measuring the completeness of celiac plexus blockade is not yet available. We...... have, therefore, monitored the physiological completeness of pharmacological percutaneous celiac blockade with 40 ml 25% ethanol by measuring the effect of posture on heart rate, blood pressure, hepato-splanchnic vascular resistance, and pancreatic hormone concentrations before and after celiac plexus...... regarding pain after 1 week. In conclusion, pancreatic hormone concentrations in response to standing are not useful for monitoring celiac plexus block, whereas heart rate, blood pressure and hepato-splanchnic blood flow may yield useful information. From such measurements it was concluded that permanent...

  14. Sonographic assessment of predictors of depth of the corner pocket for ultrasound-guided supraclavicular brachial plexus block

    Directory of Open Access Journals (Sweden)

    Naveen Yadav

    2016-01-01

    Conclusion: Prescanning of supraclavicular region for estimating depth of corner pocket should be done before choosing an appropriate size needle. Furthermore, the needle should not be advanced more than the predicted corner pocket depth.

  15. Computerized tomographic analyses of interscalene brachial plexus block%肌间沟臂丛阻滞的CT分析

    Institute of Scientific and Technical Information of China (English)

    徐华强; 袁新平; 何绍明; 周宁; 邵艳波; 曹波

    2010-01-01

    目的 臂丛麻醉时将麻醉药注入臂丛鞘内有时不能得到满意的麻醉效果,因此,有必要深入研究臂丛神经阻滞效果与臂丛鞘的关系.文中应用CT观察局麻药在臂丛鞘内的分布与扩散,探讨肌间沟臂丛神经阻滞的效果.方法 60例拟行上肢手术的患者,随机分为非异感(non-paresthesia,NPAR)组和神经刺激器定位(peripheral nerve stimulator,PNS)2组,每组30例,评估感觉和运动神经的阻滞程度、手术过程中的麻醉效果,每组随机选择8例行CT检查,扫描范围自C3至T3平面,并行注药侧的冠、矢状面CT重组成像,测量臂丛上、中、下干周围局麻药物的扩散范围.结果 局麻药局限性分布于臂丛鞘内,肌间沟水平为完整的鞘样结构,其下方有明显的分隔,局麻药的分布范围在臂丛上干、中干2组间无明显差异,下干PNS组麻醉药分布高于NPAR组(P<0.05).2组患者中腋神经、肌皮神经、正中神经、桡神经的感觉及运动评分均无统计学意义差异;前臂内侧皮神经的感觉评分和尺神经的感觉及运动评分NPAR组明显高于PNS组(P<0.05).结论 臂丛鞘是多腔结构,局麻药物注射的位置和深度直接影响阻滞效果,偏向尺侧的手术采用PNS定位效果更好.

  16. Real-Time 3-Dimensional Ultrasound-Assisted Infraclavicular Brachial Plexus Catheter Placement: Implications of a New Technology

    Directory of Open Access Journals (Sweden)

    Steven R. Clendenen

    2010-01-01

    Full Text Available Background. There are a variety of techniques for targeting placement of an infraclavicular blockade; these include eliciting paresthesias, nerve stimulation, and 2-dimensional (2D ultrasound (US guidance. Current 2D US allows direct visualization of a “flat” image of the advancing needle and neurovascular structures but without the ability to extensively analyze multidimensional data and allow for real-time manipulation. Three-dimensional (3D ultrasonography has gained popularity and usefulness in many clinical specialties such as obstetrics and cardiology. We describe some of the potential clinical applications of 3D US in regional anesthesia. Methods. This case represents an infraclavicular catheter placement facilitated by 3D US, which demonstrates 360-degree spatial relationships of the entire anatomic region. Results. The block needle, peripheral nerve catheter, and local anesthetic diffusion were observed in multiple planes of view without manipulation of the US probe. Conclusion. Advantages of 3D US may include the ability to confirm correct needle and catheter placement prior to the injection of local anesthetic. The spread of local anesthetic along the length of the nerve can be easily observed while manipulating the 3D images in real-time by simply rotating the trackball on the US machine to provide additional information that cannot be identified with 2D US alone.

  17. A modeling approach to compute modification of net joint forces caused by coping movements in obstetric brachial plexus palsy

    OpenAIRE

    2013-01-01

    Background Many disorders of the musculoskeletal system are caused by modified net joint forces resulting from individual coping movement strategies of patients suffering from neuromuscular diseases. Purpose of this work is to introduce a personalized biomechanical model which allows the calculation of individual net joint forces via inverse dynamics based on anthropometry and kinematics of the upper extremity measured by 3D optoelectronical motion analysis. Methods The determined resulting n...

  18. Low-concentration, continuous brachial plexus block in the management of Purple Glove Syndrome: a case report

    OpenAIRE

    2010-01-01

    Abstract Introduction Purple Glove Syndrome is a devastating complication of intravenous phenytoin administration. Adequate analgesia and preservation of limb movement for physiotherapy are the two essential components of management. Case presentation A 26-year-old Tamil woman from India developed Purple Glove Syndrome after intravenous administration of phenytoin. She was managed conservatively by limb elevation, physiotherapy and oral antibiotics. A 20G intravenous cannula was inserted into...

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

    Directory of Open Access Journals (Sweden)

    Kawamura Kenji

    2006-09-01

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

  20. A case of Lewis-Sumner syndrome with conduction abnormalities only in the brachial plexus and roots.

    Science.gov (United States)

    Dionne, Annie; Brunet, Denis

    2006-10-01

    We present a case of subacute weakness of one hand with unusual sensory involvement including the upper thorax. Despite normal distal conduction studies, a clinical diagnosis of Lewis-Sumner syndrome was made and the patient responded well to intravenous immunoglobulins. Repeated studies after clinical exacerbation finally proved the demyelinating nature of the neuropathy using proximal magnetic nerve stimulation. This case underlies the importance of seeking proximal conduction blocks in patients with suspected demyelinating neuropathy.

  1. Outcome following nerve repair of high isolated clean sharp injuries of the ulnar nerve.

    Directory of Open Access Journals (Sweden)

    René Post

    Full Text Available OBJECTIVE: The detailed outcome of surgical repair of high isolated clean sharp (HICS ulnar nerve lesions has become relevant in view of the recent development of distal nerve transfer. Our goal was to determine the outcome of HICS ulnar nerve repair in order to create a basis for the optimal management of these lesions. METHODS: High ulnar nerve lesions are defined as localized in the area ranging from the proximal forearm to the axilla just distal to the branching of the medial cord of the brachial plexus. A meta-analysis of the literature concerning high ulnar nerve injuries was performed. Additionally, a retrospective study of the outcome of nerve repair of HICS ulnar nerve injuries at our institution was performed. The Rotterdam Intrinsic Hand Myometer and the Rosén-Lundborg protocol were used. RESULTS: The literature review identified 46 papers. Many articles presented outcomes of mixed lesion groups consisting of combined ulnar and median nerves, or the outcome of high and low level injuries was pooled. In addition, outcome was expressed using different scoring systems. 40 patients with HICS ulnar nerve lesions were found with sufficient data for further analysis. In our institution, 15 patients had nerve repair with a median interval between trauma and reconstruction of 17 days (range 0-516. The mean score of the motor and sensory domain of the Rosen's Scale instrument was 58% and 38% of the unaffected arm, respectively. Two-point discrimination never reached less then 12 mm. CONCLUSION: From the literature, it was not possible to draw a definitive conclusion on outcome of surgical repair of HICS ulnar nerve lesions. Detailed neurological function assessment of our own patients showed that some ulnar nerve function returned. Intrinsic muscle strength recovery was generally poor. Based on this study, one might cautiously argue that repair strategies of HICS ulnar nerve lesions need to be improved.

  2. Celiac plexus block: an anatomical study and simulation using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Gabriela Augusta Mateus; Lopes, Paulo Tadeu Campos; Santos, Ana Maria Pujol Vieira dos, E-mail: pclopes@ulbra.br [Universidade Luterana do Brasil (Ulbra), Canoas, RS (Brazil); Pozzobon, Adriane [Centro Universitario Univates, Lajeado, RS (Brazil); Duarte, Rodrigo Dias; Cima, Alexandre da Silveira; Massignan, Angela [Fundacao Serdil/Saint Pastous, Porto Alegre, RS (Brazil)

    2014-09-15

    Objective: to analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: one hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject. (author)

  3. Celiac plexus block: an anatomical study and simulation using computed tomography

    Directory of Open Access Journals (Sweden)

    Gabriela Augusta Mateus Pereira

    2014-10-01

    Full Text Available Objective: To analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: One hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: Aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: Considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject.

  4. Bupivacaína racêmica a 0,5% e mistura com excesso enantiomérico de 50% (S75-R25 a 0,5% no bloqueio do plexo braquial para cirurgia ortopédica. Estudo comparativo Bupivacaína racémica a 0,5% y mezcla con exceso enantiomérico del 50% (S75-R25 a 0,5% en el bloqueo del plexo braquial para cirugía ortopédica. Estudio comparativo Comparative study of 0.5% racemic bupivacaine versus enantiomeric mixture (S75-R25 of 0.5% bupivacaine in brachial plexus block for orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Roberto Tsuneo Cervato Sato

    2005-04-01

    segura y efectiva para el bloqueo del plexo braquial para cirugía ortopédica de miembro superior.BACKGROUND AND OBJECTIVES: Several studies were performed with bupivacaine isomers in the attempt to find a safer drug than racemic bupivacaine. This study aimed at evaluating the efficacy of 0.5% bupivacaine enantiomeric mixture (MEE50% as compared to 0.5% racemic bupivacaine in brachial plexus block for upper limb orthopedic surgery. METHODS: Participated of this randomized double-blind study 40 patients aged 18 to 90 years, physical status ASA I and II, submitted to upper limb orthopedic surgeries, who were divided in two groups: Group R received 0.5% racemic bupivacaine; and Group L received 0.5% enantiomeric mixture (S75-R25 of bupivacaine both with 1:200,000 epinephrine, in a volume of 0.6 mL.kg-1 (3 mg.kg-1, limited to 40 mL. Motor and/or sensory characteristics of each nerve involved (musculocutaneous, radial, median, ulnar and medial cutaneous nerve of forearm, as well as the incidence of side effects were evaluated. RESULTS: There were no statistical differences in demographics. Hemodynamic parameters were similar between groups but systolic pressure was higher for Group R. There were no statistically significant differences in time to reach the greatest intensity of sensory and motor blocks. With one exception, the onset of motor block within the muscles innervated by the ulnar nerve was longer for Group L (10.75 versus 14.25 minutes. CONCLUSIONS: There were adequate sensory and motor blocks in both groups, with few side effects, suggesting that the 0.5% enantiomeric mixture (S75-R25 of bupivacaine with epinephrine is safe and effective for brachial plexus block of upper limb orthopedic surgeries.

  5. Pulmonary embolism following celiac plexus block and neurolysis

    Science.gov (United States)

    Raizada, Miles S.; Kelly, Seth M.

    2016-01-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

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

    LENUS (Irish Health Repository)

    Mullins, G M

    2012-02-03

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

  7. Symptomatic third ventricular choroid plexus cysts

    Energy Technology Data Exchange (ETDEWEB)

    Lam, A.H. (Children' s Hospital, Sydney (Australia). Dept. of Radiology); Villanueva, A.C. (Jose Reyes Memorial Medical Center, Manila (Philippines))

    1992-10-01

    We describe the imaging findings in 3 children with choroid plexus cysts (CPC) at the foramen of Monro. All CPC measured less than 2 cm and produced symptoms of raised intracranial pressure when located at the foramen of Monro where there was obstruction to the cerebrospinal fluid (CSF) flow. Two of our patients had relief of symptoms after resection of the cyst. One patient with inoperable cardiac defects died and had no surgery performed. Cranial sonography and CT-ventriculography are the modalities of choice in evaluating ventriculomegaly when the diagnosis of occult obstructive CPC is entertained in children. Cranial sonography is indicated in infants with an open fontanelle and CT-ventriculography is reserved for older children with hydrocephalus which is not responding to shunting. (orig./GDG).

  8. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    Science.gov (United States)

    ... Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults ... on Screening for Peripheral Artery Disease (PAD) and Cardiovascular Disease (CVD) Risk Assessment with Ankle Brachial Index (ABI) ...

  9. Screening for gestational diabetes mellitus : US preventive services task force recommendation statement

    NARCIS (Netherlands)

    Calonge, Ned; Petitti, Diana B.; DeWitt, Thomas G.; Gordis, Leon; Gregory, Kimberly D.; Harris, Russell; Isham, George; LeFevre, Michael L.; Loveland-Cherry, Carol; Marion, Lucy N.; Moyer, Virginia A.; Ockene, Judith K.; Sawaya, George F.; Siu, Albert L.; Teutsch, Steven M.; Yawn, Barbara P.

    2008-01-01

    Description: Update of 2003 U. S. Preventive Services Task Force (USPSTF) recommendation about screening for gestational diabetes. Methods: The USPSTF weighed the evidence on maternal and neonatal benefits (reduction in preeclampsia, mortality, brachial plexus injury, clavicular fractures, admission

  10. Assessment of differential gene expression in human peripheral nerve injury

    Directory of Open Access Journals (Sweden)

    Sangameswaran Lakshmi

    2002-09-01

    Full Text Available Abstract Background Microarray technology is a powerful methodology for identifying differentially expressed genes. However, when thousands of genes in a microarray data set are evaluated simultaneously by fold changes and significance tests, the probability of detecting false positives rises sharply. In this first microarray study of brachial plexus injury, we applied and compared the performance of two recently proposed algorithms for tackling this multiple testing problem, Significance Analysis of Microarrays (SAM and Westfall and Young step down adjusted p values, as well as t-statistics and Welch statistics, in specifying differential gene expression under different biological states. Results Using SAM based on t statistics, we identified 73 significant genes, which fall into different functional categories, such as cytokines / neurotrophin, myelin function and signal transduction. Interestingly, all but one gene were down-regulated in the patients. Using Welch statistics in conjunction with SAM, we identified an additional set of up-regulated genes, several of which are engaged in transcription and translation regulation. In contrast, the Westfall and Young algorithm identified only one gene using a conventional significance level of 0.05. Conclusion In coping with multiple testing problems, Family-wise type I error rate (FWER and false discovery rate (FDR are different expressions of Type I error rates. The Westfall and Young algorithm controls FWER. In the context of this microarray study, it is, seemingly, too conservative. In contrast, SAM, by controlling FDR, provides a promising alternative. In this instance, genes selected by SAM were shown to be biologically meaningful.

  11. Prognostic value of thumb pain sensation in birth brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Carlos O. Heise

    2012-08-01

    Full Text Available OBJECTIVE: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. METHODS: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6. The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. RESULTS: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. CONCLUSION: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.

  12. Central motor conduction in brachial monomelic amyotrophy

    Directory of Open Access Journals (Sweden)

    Pal Pramod

    2008-01-01

    Full Text Available Background: Prevalence of subclinical involvement of motor pathways in clinically diagnosed Brachial Monomelic Amyotrophy (BMMA is unknown. Aims: To determine the prevalence of subclinical involvement of central motor pathways in BMMA using transcranial magnetic stimulation. Setting and Design: Prospective case-control study. Materials and Methods: Central motor conduction time (CMCT was determined by ′F′ wave method using figure-of-eight coil attached to Magstim 200 stimulator, in 17 patients with BMMA. Motor evoked potentials were recorded from first dorsal interosseous of the affected (AFF and unaffected upper limbs (UNAFF at rest and during partial contraction. Comparison was made with data from 10 healthy controls (CTRL. Statistical Analysis: Descriptive analysis and Analysis of Variance (ANOVA. Results: Compared to controls, the mean CMCT of AFF was significantly prolonged, both at rest and contraction: (a Rest: AFF-6.68±1.78 ms, UNAFF-6.36±1.16 ms, CTRL-5.71±1.02 ms; Fisher′s PLSD for AFF vs. CTRL: P =0.037, (b Contraction: AFF-5.78±1.62 ms, UAFF - 4.86±1.38 ms, CTRL-4.06±0.80 ms; Fisher′s PLSD for AFF vs. CTRL; P =0.0002, AFF vs. UNAFF- P =0.044. Prolonged CMCT (>mean+2SD of controls was observed in 29.4% of AFF and 6.25% of UNAFF at rest, and in 47.1% and 23.5% respectively during contraction. Conclusions: Dysfunction of central motor pathways was observed in both affected and unaffected upper limbs of some patients with BMMA of upper limbs. The dysfunction was more pronounced during voluntary contraction. A larger study is needed to validate the significance of these findings.

  13. Electrodiagnosis of plexopathy.

    Science.gov (United States)

    Strakowski, Jeffrey A

    2013-05-01

    Electrodiagnostic evaluation of the brachial and lumbosacral plexus can be challenging even to an experienced practitioner. Detailed attention to anatomy and correlation with the history and physical examination results are needed to have a comprehensive differential diagnosis and to develop reliable conclusions. Electrophysiologic techniques, when applied appropriately, provide invaluable functional information after a plexus injury. Electrodiagnostic evaluation of a plexus injury should be systematic and comprehensive to provide the maximum precision for localization, extent of involvement, and severity of injury.

  14. Effect of low-frequency pulse percutaneous electric stimulation on peripheral nerve injuries at different sites

    Institute of Scientific and Technical Information of China (English)

    Jinwu Wang; Liye Chen; Qi Li; Weifeng Ni; Min Zhang; Shangchun Guo; Bingfang Zeng

    2006-01-01

    BACKGROUND: The postoperative recovery of nerve function in patients with peripheral nerve injury is always an important problem to solve after treatment. The electric stimulation induced electromagnetic field can nourish nerve, postpone muscular atrophy, and help the postoperative neuromuscular function.OBJECTIVE: To observe the effects of low-frequency pulse percutaneous electric stimulation on the functional recovery of postoperative patients with peripheral nerve injury, and quantitatively evaluate the results of electromyogram (EMG) examination before and after treatment.DESIGN: A retrospective case analysis.SETTING: The Sixth People's Hospital affiliated to Shanghai Jiaotong University.PARTICIPANTS: Nineteen postoperative inpatients with peripheral nerve injury were selected from the Department of Orthopaedics, the Sixth People's Hospital affiliated to Shanghai Jiaotong University from June 2005 to January 2006, including 13 males and 6 females aged 24-62 years with an average of 36 years old.There were 3 cases of brachial plexus nerve injury, 3 of median nerve injury, 7 of radial nerve injury, 3 of ulnar nerve injury and 3 of common peroneal nerve injury, and all the patients received probing nerve fiber restoration. Their main preoperative manifestations were dennervation, pain in limbs, motor and sensory disturbances. All the 19 patients were informed with the therapeutic program and items for evaluation.METHODS : ① Low-frequency pulse percutaneous electric stimulation apparatus: The patients were given electric stimulation with the TERESA cantata instrument (TERESA-0, Shanghai Teresa Health Technology, Co.,Ltd.). The patients were stimulated with symmetric square waves of 1-111 Hz, and the intensity was 1.2-5.0 mA, and it was gradually adjusted according to the recovered conditions of neural regeneration following the principle that the intensity was strong enough and the patients felt no obvious upset. They were treated for 4-24 weeks, 10-30 minutes

  15. Brachial versus central blood pressure and vascular stiffness

    DEFF Research Database (Denmark)

    Rasmussen, Susanne; Hansen, Tine; Frimodt-Møller, Marie

    2009-01-01

    Central blood pressure (BP) estimates the true load imposed on the left ventricle to a higher degree than does brachial BP. Increased aortic pulse wave velocity (aPWV) and central BP are risk markers for cardiovascular disease. Both can be measured by simple and noninvasive methods. Guidelines re...

  16. Brachial versus central blood pressure and vascular stiffness

    DEFF Research Database (Denmark)

    Rasmussen, Susanne; Hansen, Tine; Frimodt-Møller, Marie

    2010-01-01

    Central blood pressure (BP) estimates the true load imposed on the left ventricle to a higher degree than does brachial BP. Increased aortic pulse wave velocity (aPWV) and central BP are risk markers for cardiovascular disease. Both can be measured by simple and noninvasive methods. Guidelines re...

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

    DEFF Research Database (Denmark)

    Bogert, Lysander W J; Harms, Mark P M; Pott, Frank;

    2004-01-01

    In patients with recurrent syncope, monitoring of intra-arterial pressure during orthostatic stress testing is recommended because of the potentially sudden and rapid development of hypotension. Replacing brachial arterial pressure (BAP) by the non-invasively obtained finger arterial pressure (Fin...

  18. Genetic determinants of the ankle-brachial index

    DEFF Research Database (Denmark)

    Wassel, Christina L; Lamina, Claudia; Nambi, Vijay

    2012-01-01

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

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

    DEFF Research Database (Denmark)

    Bogert, Lysander W J; Harms, Mark P M; Pott, Frank

    2004-01-01

    In patients with recurrent syncope, monitoring of intra-arterial pressure during orthostatic stress testing is recommended because of the potentially sudden and rapid development of hypotension. Replacing brachial arterial pressure (BAP) by the non-invasively obtained finger arterial pressure (Fi...

  20. VARIATIONS IN ORIGIN OF FEMORAL NERVE FROM THE LUMBER PLEXUS (A CADAVERIC STUDY

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    Dr. Gurbachan Singh Gindha

    2015-04-01

    Full Text Available The variations in origin of femoral nerve from lumbar plexuses is very much common. The normal root value of origin of femoral nerve is L2, L2 and L4. It can be prefixed or postfixed. Mostly the femoral nerve is used for the nerve block in several surgeries and is vulnerable to compression in tight ilio-psoas compartment. The knowledge of origin and variations of femoral nerve in iliac fossa is important for anatomists, anaesthetists and surgeons to prevent iatrogenic femoral nerve injuries.3 0 embalmed with 10% formal in and fixed cadavers were dissecte donboth sides and 60 lumbar plexuses with their branches formed the mat e r i a l f o r t h e study. The p s oas major muscle was dissected to see the formation of femoral nerve from theroots and to observe the variations in the formation of femoral nerve. The aim of this study was to look for the variations in origin and branching pattern of the femoral nerve in the iliac fossa and proper exposure of the femoral nerve in the femoral triangle.

  1. Ultrasound localization of the sacral plexus using a parasacral approach.

    Science.gov (United States)

    Ben-Ari, Alon Y; Joshi, Rama; Uskova, Anna; Chelly, Jacques E

    2009-06-01

    In this report, we describe the feasibility of locating the sacral plexus nerve using a parasacral approach and an ultrasound-guided technique. The parasacral region using a curved probe (2-5 MHz) was scanned in 17 patients in search of the medial border of the ischial bone and the lateral border of the sacrum, which represent the limit of the greater sciatic foramen. In addition, attempts were made to identify the piriformis muscles and the gluteal arteries. The sacral plexus was identified at the level of the sciatic foramen as a round hyperechoic structure. The gluteal arteries were identified in 10 of 17 patients, but we failed to positively identify the piriformis muscle in any patient. To confirm localization of the sacral plexus, an insulated needle attached to a nerve stimulator was advanced and, in each case, a sacral plexus motor response was elicited (plantar flexion-12, dorsal flexion-1, hamstring muscle stimulation-3, gastrocnemius muscle stimulation-1-not recorded) at a current between 0.2 and 0.5 mA. No complications were observed. This report confirms the feasibility of using ultrasound to locate the sacral plexus using a parasacral approach.

  2. Diagnostik proximaler Läsionen des Plexus brachialis: Eine Übersicht

    Directory of Open Access Journals (Sweden)

    Claus D

    2011-01-01

    Full Text Available Die funktionelle Anatomie des Plexus brachialis wird beschrieben. Daraus leiten sich klinische und neurophysiologische Untersuchungen bei Schäden des Plexus sowie einzelner Armnerven ab. Auf die distalen Nervenläsionen wird nicht eingegangen.

  3. Choroid plexus failure in the Kearns-Sayre syndrome

    Directory of Open Access Journals (Sweden)

    Spector Reynold

    2010-08-01

    Full Text Available Abstract The Kearns-Sayre syndrome is a mitochondrial disorder (generally due to mitochondrial DNA deletions that causes ophthalmoplegia, retinopathy, ataxia and brain abnormalities such as leukoencephalopathy. In this syndrome, the choroid plexus epithelial cells, unlike brain cells, are greatly enlarged and granular, consistent with their inability to adequately transport folate from blood into cerebrospinal fluid (CSF, and homovanillic acid (a dopamine metabolite from CSF into blood. This inability to transport folates from blood into CSF (and brain adequately, causes cerebral folate deficiency that can be partially reversed by very high doses of reduced folates. The Kearns-Sayre syndrome is a disease that interferes with key choroid plexus functions and is a cause of generalized choroid plexus failure.

  4. The sub-peritoneal arterial plexus of Sir William Turner.

    Science.gov (United States)

    Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marious; Shokouhi, Ghaffar; Ghabili, Kamyar; Agutter, Paul S

    2010-08-20

    Sir William Turner (1832-1916) was Professor of Anatomy at the University of Edinburgh. His classic paper of 1863 on the anastomoses between the parietal and visceral branches of the abdominal aorta, later known as the sub-peritoneal arterial plexus of Turner, has mostly been forgotten. Located in the retroperitoneum and surrounding the kidneys and other adjacent structures, this plexus is an important route of collateral circulation. In the current paper, we discuss the sub-peritoneal arterial plexus as described by Turner in 1863 and review the literature concerning its potential clinical significance in the kidney, emphasizing its probable role in the metastatic spread of various tumors of abdominal organs and in the continuing viability of the kidney after renal artery occlusion. A biographical sketch of Sir William Turner is also presented.

  5. The effect of severing a normal S1 nerve root to use for reconstruction of an avulsed contralateral lumbosacral plexus: a pilot study.

    Science.gov (United States)

    Zhu, L; F Zhang; Yang, D; Chen, A

    2015-03-01

    The aim of this study was to evaluate the feasibility of using the intact S1 nerve root as a donor nerve to repair an avulsion of the contralateral lumbosacral plexus. Two cohorts of patients were recruited. In cohort 1, the L4-S4 nerve roots of 15 patients with a unilateral fracture of the sacrum and sacral nerve injury were stimulated during surgery to establish the precise functional distribution of the S1 nerve root and its proportional contribution to individual muscles. In cohort 2, the contralateral uninjured S1 nerve root of six patients with a unilateral lumbosacral plexus avulsion was transected extradurally and used with a 25 cm segment of the common peroneal nerve from the injured leg to reconstruct the avulsed plexus. The results from cohort 1 showed that the innervation of S1 in each muscle can be compensated for by L4, L5, S2 and S3. Numbness in the toes and a reduction in strength were found after surgery in cohort 2, but these symptoms gradually disappeared and strength recovered. The results of electrophysiological studies of the donor limb were generally normal. Severing the S1 nerve root does not appear to damage the healthy limb as far as clinical assessment and electrophysiological testing can determine. Consequently, the S1 nerve can be considered to be a suitable donor nerve for reconstruction of an avulsed contralateral lumbosacral plexus.

  6. Investigating Choroid Plexus Volume and Capillaries Length in 15.5 Day Foetus of Diabetic Mothers Compared to Normal Foetus in Rats

    Directory of Open Access Journals (Sweden)

    S Mohammadi

    2012-07-01

    Full Text Available Introduction: Diabetes mellitus is a metabolic disorder with systemic complications. Children of diabetic mothers are at risk of many disorders such as major and minor vascular injuries, retinopathy, and atherosclerosis. The present study aimed to investigate the effects of maternal diabetes on changes in choroid plexus volume and capillaries length in 15.5 day foetus. Methods: in this experimental study which was conducted on 30 male wistar rats, animals were divided into two groups; an experimental and a control group (n=10. Streptotosin was injected (55 mg/kg in experimental group to induce diabetes while in control group intra-peritoneal injection of buffer citrate was done for four weeks. In the last day of the fourth week, mating was done and zero day of pregnancy was determined with vaginal plug observation. on 15th day of pregnancy, rats were anatomized and a foetus was chosen from each mother. After foetal head fixation and tissue processing, serial horizontal sections were prepared and stained with haematoxylin-eosin. Choroid plexus volume was measured by stereological techniques and the results were analysed using ANOVA statistical test. Results: Results showed a significant difference between Choroid plexus volume and capillaries length in experimental and control groups, so that Choroid plexus volume and capillaries length were increased significantly in foetus of diabetic mothers(P<0.05. Conclusion: It is likely that maternal hyper-glycaemia induces a kind of angiogenesis in foetus that can cause many brain disorders.

  7. Delayed presentation of a traumatic brachial artery pseudoaneurysm.

    LENUS (Irish Health Repository)

    Forde, James C

    2009-09-01

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

  8. The Macroanatomy of the Sacral Plexus and Its Nerves in Eurasian Eagle Owls (Bubo bubo).

    Science.gov (United States)

    Akbulut, Y; Demiraslan, Y; Aslan, K; Coban, A

    2016-10-01

    This study was carried out to reveal the formation of the sacral plexus in the Eurasian Eagle Owls (Bubo bubo) and the nerves originating from this plexus. Five EEOs, three of them were male and two were female, were provided from Wildlife Rescue and Rehabilitation Center of Kafkas University and used as materials. Following the euthanizing of the animals, abdominal cavity was opened. The nerves of plexus sacrales were dissected and photographed. It was detected that the sacral plexus was formed by the ventral ramus of five synsacral nerves. Moreover, it was determined that the roots of the sacral plexus formed three trunks: the truncus cranialis, the truncus medius and the truncus caudalis in fossa renalis. The availability of the n. ischiofemoralis and the availability of n. parafibularis were detected in the EEOs. Five branches were specified as having segregated from the sacral plexus: the n. cutaneus femoralis caudalis, the mutual root of n. fibularis with n. tibialis (n. ischiadicus), the rami musculares, the n. coxalis caudalis and the ramus muscularis. It was observed that the sacral plexus was linked to the lumbar plexus by the n. furcalis, to the pudendus plexus via the n. bigeminus. Consequently, the anatomic structure of the EEO's sacral plexus, the participating synsacral nerves to plexus and the innervation areas of these nerves were revealed.

  9. Occult radiological effects of lipomatosis of the lumbosacral plexus

    Energy Technology Data Exchange (ETDEWEB)

    Mahan, Mark A. [Barrow Neurological Institute, Phoenix, AZ (United States); Howe, B.M.; Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Spinner, Robert J. [Mayo Clinic, Department of Neurosurgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States)

    2014-07-15

    Lipomatosis of nerve (LN) is a condition of massive peripheral nerve enlargement frequently associated with hypertrophy within the distribution of the nerve, and most commonly affecting the distal limbs. We sought to understand if LN of the lumbosacral plexus would be associated with the trophic effects of LN on surrounding tissue within the pelvis, which may be clinically occult, but present on MRI. Fifty-one cases of LN, confirmed by pathology or pathognomonic appearance on MRI, were reviewed. Patients with LN of the sciatic nerve were investigated for radiological signs suggestive of overgrowth. Five patients had involvement of the sciatic nerve, 4 of whom had MR imaging of the pelvis. Three patients had LN involving the lumbosacral plexus, and one patient had isolated involvement of the sciatic nerve. All patients with involvement of the lumbosacral plexus demonstrated previously unrecognized evidence of nerve territory overgrowth in the pelvis, including: LN, profound adipose proliferation, muscle atrophy and fatty infiltration, and bone hypertrophy and ankylosis. The patient with LN involving the intrapelvic sciatic nerve, but not the lumbosacral plexus did not demonstrate any radiological evidence of pelvic overgrowth. LN is broader in anatomical reach than previously understood. Proximal plexal innervation may be involved, with a consequent effect on axial skeleton and intrapelvic structures. (orig.)

  10. Influx mechanisms in the embryonic and adult rat choroid plexus

    DEFF Research Database (Denmark)

    Saunders, Norman R; Dziegielewska, Katarzyna M; Møllgård, Kjeld

    2015-01-01

    The transcriptome of embryonic and adult rat lateral ventricular choroid plexus, using a combination of RNA-Sequencing and microarray data, was analyzed by functional groups of influx transporters, particularly solute carrier (SLC) transporters. RNA-Seq was performed at embryonic day (E) 15 and a...

  11. Repeated upper limb salvage in a case of severe traumatic soft-tissue and brachial artery defect.

    Science.gov (United States)

    Noaman, Hassan Hamdy; Shiha, Anis Elsayed

    2002-01-01

    We present the case of a 9-year-old male patient who suffered a gunshot injury to the right arm. The patient arrived in shock, his right arm severely traumatized, with soft-tissue loss involving the anterior surface and both sides of the right arm. The humerus was exposed. There was brachial artery defect and damage to the lateral fibers of the median nerve. The mangled extremity severity score (MESS) was 8 points. The patient was treated with general resuscitation, blood transfusion, and debridement. A venous graft, 12 cm in length, to bridge the brachial artery defect, and tendon transfer, triceps to the biceps, was performed in one step. Postoperatively, there was a normal radial pulse, normal skin color, normal temperature, and normal movement of the fingers without pain. Unfortunately, the patient then sustained a second trauma to the right arm 3 weeks later, rupturing the graft. This time he lost 1,500 cc of blood. After another blood transfusion, we performed a second reverse saphenous vein graft. The patient stayed at the hospital for 3 weeks. At follow-up 12 months later, the limb has good function and, except for the presence of a scar and skin graft, is equal in appearance to the left side.

  12. Fractures of the clavicle and injuries of the sub-clavian artery. Report of 10 cases.

    Science.gov (United States)

    Natali, J; Maraval, M; Kieffer, E; Petrovic, P

    1975-01-01

    During four years, the authors have observed ten lesions of the sub-clavian artery associated with a fracture of the clavicle. The clinical picture in one case out of two was that of an acute ischemia of the upper limb. The surgical repair has been performed in 8 cases. The thoracic approach was necessary three times. The clavicle was resected in most cases. The prognosis of these lesions depends on the rapidity of their recognition, and of their treatment, and on the fact whether the brachial plexus is involved or not

  13. Diffuse choroid plexus hyperplasia: an under-diagnosed cause of hydrocephalus in children?

    Energy Technology Data Exchange (ETDEWEB)

    Aziz, Azian Abd.; Coleman, Lee [Royal Children' s Hospital Melbourne, Department of Medical Imaging, Parkville, Victoria (Australia); Morokoff, Andrew; Maixner, Wirginia [Royal Children' s Hospital Melbourne, Department of Neurosurgery, Parkville (Australia)

    2005-08-01

    Hydrocephalus is a common neurological disorder in children and the result of a variety of causes. However, with the advancement of imaging modalities, particularly MRI, previously reported rarer causes of hydrocephalus in children are now being more readily appreciated. We report an 11-year-old boy with diffuse villous hyperplasia of the choroid plexus. He had a ventriculo-peritoneal (VP) shunt in-situ and a prior diagnosis from infancy of congenital aqueduct stenosis as the cause of his hydrocephalus. His current presentation was with further shunt dysfunction. CT and MRI demonstrated enlarged choroid plexuses but did not confirm aqueduct stenosis. CSF overproduction was demonstrated from the externalized ventricular drain. The enlarged choroid plexuses were surgically resected and histology confirmed choroid plexus hyperplasia. Identification of choroid plexus hyperplasia is important since the neurosurgical management of hydrocephalus is not VP shunt insertion, but resection of the hyperplastic choroid plexus. (orig.)

  14. Altered choroid plexus gene expression in major depressive disorder

    Directory of Open Access Journals (Sweden)

    Cortney Ann Turner

    2014-04-01

    Full Text Available Given the emergent interest in biomarkers for mood disorders, we assessed gene expression in the choroid plexus, the region that produces cerebrospinal fluid (CSF, in individuals with major depressive disorder (MDD. Genes that are expressed in the choroid plexus (CP can be secreted into the CSF and may be potential biomarker candidates. Given that we have previously shown that fibroblast growth factor family members are differentially expressed in post-mortem brain of subjects with MDD and the CP is a known source of growth factors in the brain, we posed the question whether growth factor dysregulation would be found in the CP of subjects with MDD. We performed laser capture microscopy of the choroid plexus at the level of the hippocampus in subjects with MDD and psychiatrically normal controls. We then extracted, amplified, labeled and hybridized the cRNA to Illumina BeadChips to assess gene expression. In controls, the most highly abundant known transcript was transthyretin. Moreover, half of the 14 most highly expressed transcripts in controls encode ribosomal proteins. Using BeadStudio software, we identified 169 transcripts differentially expressed (p< 0.05 between control and MDD samples. Using pathway analysis we noted that the top network altered in subjects with MDD included multiple members of the transforming growth factor-beta (TGFβ pathway. Quantitative real-time PCR (qRT-PCR confirmed downregulation of several transcripts that interact with the extracellular matrix in subjects with MDD. These results suggest that there may be an altered cytoskeleton in the choroid plexus in MDD subjects that may lead to a disrupted blood-CSF-brain barrier.

  15. Development and Notch signaling requirements of the zebrafish choroid plexus.

    Directory of Open Access Journals (Sweden)

    Brent R Bill

    Full Text Available BACKGROUND: The choroid plexus (CP is an epithelial and vascular structure in the ventricular system of the brain that is a critical part of the blood-brain barrier. The CP has two primary functions, 1 to produce and regulate components of the cerebral spinal fluid, and 2 to inhibit entry into the brain of exogenous substances. Despite its importance in neurobiology, little is known about how this structure forms. METHODOLOGY AND PRINCIPAL FINDINGS: Here we show that the transposon-mediated enhancer trap zebrafish line Et(Mn16 expresses green fluorescent protein within a population of cells that migrate toward the midline and coalesce to form the definitive CP. We further demonstrate the development of the integral vascular network of the definitive CP. Utilizing pharmacologic pan-notch inhibition and specific morpholino-mediated knockdown, we demonstrate a requirement for Notch signaling in choroid plexus development. We identify three Notch signaling pathway members as mediating this effect, notch1b, deltaA, and deltaD. CONCLUSIONS AND SIGNIFICANCE: This work is the first to identify the zebrafish choroid plexus and to characterize its epithelial and vasculature integration. This study, in the context of other comparative anatomical studies, strongly indicates a conserved mechanism for development of the CP. Finally, we characterize a requirement for Notch signaling in the developing CP. This establishes the zebrafish CP as an important new system for the determination of key signaling pathways in the formation of this essential component of the vertebrate brain.

  16. Inflammatory Neuropathy of the Lumbosacral Plexus following Periacetabular Osteotomy

    Directory of Open Access Journals (Sweden)

    Stijn Ghijselings

    2016-01-01

    Full Text Available Introduction. During periacetabular osteotomy (PAO, the sciatic, femoral, and obturator nerves are at risk. Most frequently nerve lesions can be attributed to a mechanical cause; however, in the absence of a clear mechanical cause surgeons are faced with a diagnostic problem and in many cases no diagnosis will be established. We report a case of inflammatory neuropathy of the lumbosacral plexus following a PAO. Case Presentation. A 31-year-old female developed weakness of ankle and knee flexion and extension 6 months after a PAO. Electrophysiological studies revealed damage to the obturator, femoral, and sciatic nerve consistent with an inflammatory lumbosacral plexopathy. MRI of the lumbosacral plexus was normal. The patient was treated with multimodal pain therapy and prolonged physiotherapy; nevertheless, symptoms worsened over time. At 2-year follow-up, there were no signs of recovery. Discussion. Inflammatory neuropathy of the lumbosacral plexus is a potential cause of pain and weakness after ipsilateral orthopaedic procedures. It should be distinguished from more frequently encountered mechanical causes of postsurgical neuropathy based on clinical suspicion, electrophysiological studies, MRI, and nerve biopsy. It is important that the orthopaedic community is aware of this complication since there is some evidence that early recognition and initiation of immunosuppressive therapy can lead to improved clinical outcome.

  17. Prejunctional Muscarinic Receptors in the Deep Muscular Plexus of Canine Ileum: Comparison with Smooth Muscle Receptors

    Science.gov (United States)

    1992-01-01

    myenteric and submucosal plexuses. activity with axonal varicosities of deep muscular plexus was that is, the negative control of neurotransmitter...from synaptosomes of the myenteric plextis. .J. Neuriochem. 38: MAN. TF. WV.: Interaction of agonists aInd selective antagonists with gastric 501-508...population associated with the deep muscular plexus synaptosomal fraction was linked to the inhibition of adenylate cyclase activity , as demonstrated by a

  18. [Percutaneous exclusion of traumatic abdominal aortic pseudoaneurysm from a brachial approach].

    Science.gov (United States)

    Gamboa, Ricardo; Ríos-Méndez, Raúl E; Solernó, Raúl; Giachello, Federico; Videla-Lynch, Ángeles; Sarmiento, Ricardo A

    2012-01-01

    Abdominal aortic pseudoaneurysm (AAP) is a rare lesion, although traumatic aortic injury is described as one of the main causes; both the rupture as the surgical treatment of the defect has high morbidity and mortality. Therefore, endovascular treatment either by chemical embolization or exclusion of defect with devices has emerged as an alternative treatment. However, there are risks such as occlusion of visceral vessels near the neck of the defect, embolization material or aortic rupture. Therefore, the choice of material and method of approach should be planned carefully in each case. We report a patient who ten years after abdominal wound firearm was diagnosed with AAP 17 x 13 cm, with short neck originated close to the ostium of the celiac trunk at an acute angle with the aortic axis. We perform the exclusion of the defect with a device designed for closing atrial septal defect from the left brachial access due to the angulation of the neck defect. There were no complications. At 72 hours was granted discharge. A month later, CT scan control showed the false aneurysm of equal size and no residual flow. The monitoring to date is five months and the patient remained asymptomatic.

  19. Hypothermic oxygenated machine perfusion prevents arteriolonecrosis of the peribiliary plexus in pig livers donated after circulatory death.

    Directory of Open Access Journals (Sweden)

    Sanna Op den Dries

    Full Text Available BACKGROUND: Livers derived from donation after circulatory death (DCD are increasingly accepted for transplantation. However, DCD livers suffer additional donor warm ischemia, leading to biliary injury and more biliary complications after transplantation. It is unknown whether oxygenated machine perfusion results in better preservation of biliary epithelium and the peribiliary vasculature. We compared oxygenated hypothermic machine perfusion (HMP with static cold storage (SCS in a porcine DCD model. METHODS: After 30 min of cardiac arrest, livers were perfused in situ with HTK solution (4°C and preserved for 4 h by either SCS (n = 9 or oxygenated HMP (10°C; n = 9, using pressure-controlled arterial and portal venous perfusion. To simulate transplantation, livers were reperfused ex vivo at 37°C with oxygenated autologous blood. Bile duct injury and function were determined by biochemical and molecular markers, and a systematic histological scoring system. RESULTS: After reperfusion, arterial flow was higher in the HMP group, compared to SCS (251±28 vs 166±28 mL/min, respectively, after 1 hour of reperfusion; p = 0.003. Release of hepatocellular enzymes was significantly higher in the SCS group. Markers of biliary epithelial injury (biliary LDH, gamma-GT and function (biliary pH and bicarbonate, and biliary transporter expression were similar in the two groups. However, histology of bile ducts revealed significantly less arteriolonecrosis of the peribiliary vascular plexus in HMP preserved livers (>50% arteriolonecrosis was observed in 7 bile ducts of the SCS preserved livers versus only 1 bile duct of the HMP preserved livers; p = 0.024. CONCLUSIONS: Oxygenated HMP prevents arteriolonecrosis of the peribiliary vascular plexus of the bile ducts of DCD pig livers and results in higher arterial flow after reperfusion. Together this may contribute to better perfusion of the bile ducts, providing a potential advantage in the post

  20. Use of StarClose for brachial artery closure after percutaneous endovascular interventions.

    Science.gov (United States)

    Puggioni, Alessandra; Boesmans, Evelyne; Deloose, Koen; Peeters, Patrick; Bosiers, Marc

    2008-01-01

    The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5+/-7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08+/-0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge.

  1. RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

    Institute of Scientific and Technical Information of China (English)

    孙寅光; 沈卫峰; 施仲伟; 张大东

    2003-01-01

    Objective To determine the relations between endothelium dependent vasodilator function and blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease.MethodsTwenty eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high resolution B mode ultrasound before coronary angiography (CAG) and coronary flow reserve (CFR) test by using intracoronary Doppler technique. The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow mediated dilatation (FMD) following reactive hyperemia was evaluated. The relation between the change of brachial artery blood flow and CFR was also studied.ResultsThere was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion (12.50%±9.35% vs 11.38%±7.55%, r=0.425,P=0.02). There was also a weak negative relation between brachial flow change following reactive hyperemia and CFR (r=0.397, P=0.04).ConclusionThere is a correlation between the coronary endothelial function and the CFR by ultrasonic determination of brachial flow changes following reactive hyperemia.

  2. Effect of black tea consumption on brachial artery flow-mediated dilation and ischaemia-reperfusion in humans.

    Science.gov (United States)

    Schreuder, Tim H A; Eijsvogels, Thijs M H; Greyling, Arno; Draijer, Richard; Hopman, Maria T E; Thijssen, Dick H J

    2014-02-01

    Tea consumption is associated with reduced cardiovascular risk. Previous studies found that tea flavonoids work through direct effects on the vasculature, leading to dose-dependent improvements in endothelial function. Cardioprotective effects of regular tea consumption may relate to the prevention of endothelial ischaemia-reperfusion (IR) injury. Therefore, we examined the effect of black tea consumption on endothelial function and the ability of tea to prevent IR injury. In a randomized, crossover study, 20 healthy subjects underwent 7 days of tea consumption (3 cups per day) or abstinence from tea. We examined brachial artery (BA) endothelial function via flow-mediated dilation (FMD), using high resolution echo-Doppler, before and 90 min after tea or hot water consumption. Subsequently, we followed a 20-min ischaemia and 20-min reperfusion protocol of the BA after which we measured FMD to examine the potential of tea consumption to protect against IR injury. Tea consumption resulted in an immediate increase in FMD% (pre-consumption: 5.8 ± 2.5; post-consumption: 7.2 ± 3.2; p tea consumption (p tea ingestion improves BA FMD. However, the impact of the IR protocol on FMD was not influenced by tea consumption. Therefore, the cardioprotective association of tea ingestion relates to a direct effect of tea on the endothelium in humans in vivo.

  3. Interstitial cells of Cajal and Auerbach's plexus. A scanning electron microscopical study of guinea-pig small intestine

    DEFF Research Database (Denmark)

    Jessen, Harry; Thuneberg, Lars

    1991-01-01

    Anatomy, interstitial cells of Cajal, myenteric plexus, small intestine, guinea-pig, scanning electron microscopy......Anatomy, interstitial cells of Cajal, myenteric plexus, small intestine, guinea-pig, scanning electron microscopy...

  4. Choroid plexus papillomas: advances in molecular biology and understanding of tumorigenesis.

    Science.gov (United States)

    Safaee, Michael; Oh, Michael C; Bloch, Orin; Sun, Matthew Z; Kaur, Gurvinder; Auguste, Kurtis I; Tihan, Tarik; Parsa, Andrew T

    2013-03-01

    Choroid plexus papillomas are rare, benign tumors originating from the choroid plexus. Although generally found within the ventricular system, they can arise ectopically in the brain parenchyma or disseminate throughout the neuraxis. We sought to review recent advances in our understanding of the molecular biology and oncogenic pathways associated with this disease. A comprehensive PubMed literature review was conducted to identify manuscripts discussing the clinical, molecular, and genetic features of choroid plexus papillomas. Articles concerning diagnosis, treatment, and long-term patient outcomes were also reviewed. The introduction of atypical choroid plexus papilloma as a distinct entity has increased the need for accurate histopathologic diagnosis. Advances in immunohistochemical staining have improved our ability to differentiate choroid plexus papillomas from other intracranial tumors or metastatic lesions using combinations of key markers and mitotic indices. Recent findings have implicated Notch3 signaling, the transcription factor TWIST1, platelet-derived growth factor receptor, and the tumor necrosis factor-related apoptosis-inducing ligand pathway in choroid plexus papilloma tumorigenesis. A combination of commonly occurring chromosomal duplications and deletions has also been identified. Surgical resection remains the standard of care, although chemotherapy and radiotherapy may be considered for recurrent or metastatic lesions. While generally considered benign, these tumors possess a complex biology that sheds insight into other choroid plexus tumors, particularly malignant choroid plexus carcinomas. Improving our understanding of the molecular biology, genetics, and oncogenic pathways associated with this tumor will allow for the development of targeted therapies and improved outcomes for patients with this disease.

  5. Crohn's disease: ultrastructure of interstitial cells in colonic myenteric plexus

    DEFF Research Database (Denmark)

    Rumessen, Jüri J; Vanderwinden, Jean-Marie; Horn, Thomas

    2011-01-01

    The role of the interstitial cells of Cajal (ICC) in chronic inflammatory bowel disease, i.e., ulcerative colitis (UC) and Crohn's disease (CD), remains unclear. Ultrastructural alterations in ICC in the colonic myenteric plexus (ICC-MP) have been reported previously in UC, but descriptions of ICC...... were dilated and appeared to be empty. Lipid droplets and lipofuscin-bodies were prominent in glial cells and neurons. ICC-MP were scanty but, as in controls, had caveolae, prominent intermediate filaments, cytoplasmic dense bodies, and membrane-associated dense bands with a patchy basal lamina. ICC...

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

    Directory of Open Access Journals (Sweden)

    Su T

    2011-08-01

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

  7. The analgesic effect of plexus anesthesia with buprenorphine in patients%丁丙诺啡在臂丛麻醉患者中的镇痛作用

    Institute of Scientific and Technical Information of China (English)

    李斌; 陈学丽; 孙翠翠; 吕国义

    2011-01-01

    目的 研究对行臂神经丛阻滞的患者丁丙诺啡加入局麻药中与肌肉注射两种镇痛方式对麻醉效果、麻醉维持时间、术后镇痛等方面的作用.方法 选择2009年9月至2009年12月天津市天津医院60例拟行上肢、手部手术的患者,数字随机法分为3组.A组(局麻药中无丁丙诺啡组,n=20);B组(局麻药中加丁丙诺啡2μg/kg组,n=20);C组(麻醉前肌肉注射丁丙诺啡2 μg/kg组,n=20).用B/BRAMN-STIMMPLEX-DIG神经刺激仪引导定位行腋路臂神经丛阻滞.3组患者记录(1)麻醉起效时间;(2)麻醉维持时间;(3)手术时间;(4)术后4、8、12、24、36、48、72 h各时间点的疼痛评分;(5)恶心、呕吐的发生率;(6)观察其他副作用.结果 3组患者年龄、体重、性别、手术时间之间比较,差异无统计学意义(P>0.05);麻醉起效时间3组之间比较差异无统计学意义(P>0.05).麻醉维持时间:A、C组明显短于B组(P<0.01);疼痛评分4 h时A与B、C组之间差异无统计学意义(P>0.05);8、12、24 h时A组极显著高于B、C组(P<0.01),36、48、72 h时A组与B、C组之间差异无统计学意义(P>0.05);恶心发生率A组为10%,B组20%,C组20%.呕吐发生率A、B组为0,C组30%.结论 丁丙诺啡加入局麻药中进行臂神经丛阻滞或阻滞前肌肉注射丁丙诺啡都可以取得满意的术后镇痛效果,丁丙诺啡加入局麻药中进行臂神经丛阻滞麻醉可延长麻醉维持时间、对术后镇痛有明显疗效,且不良反应较少.%Objective To study the anesthetic effect of brachial plexus block by adding buprenorphine in local anesthetics and patients with intramuscular injection , and observe the anesthesia effects, the anesthesia maintenance time, postoperative analgesia effects. Methods 60 cases of upper limb to line, hand surgery patients from Sep. 2009 to Dec. 2009 in Tianjin Hospital were randomly divided into 3groups. A (local anesthetics without buprenorphine, n = 20); B group (plus 2

  8. VARIATIONS IN ORIGIN OF FEMORAL NERVE FROM THE LUMBER PLEXUS (A CADAVERIC STUDY (ORIGINAL ARTICLE

    Directory of Open Access Journals (Sweden)

    Dr. Gurbachan Singh Gindha

    2015-03-01

    Full Text Available The variations in origin of femoral nerve from lumbar plexus is very much common. The normal root value of origin of femoral nerve is L2, L3 and L4. It can be prefixed or postfixed. Mostly the femoral nerve is used for the nerve block in several surgeries and is vulnerable to compression in tight ilio-psoascompartment. The knowledge of origin and variations of femoral nerve in iliac fossa is important for anatomists, anesthetists and surgeons to prevent iatrogenic femoral nerve injuries. 3 0 embalmed and 10% forma l in f i x e d c a d ave r s w e r e d is s e c ted on b o th s ides and 60 lumba r pl exus e s with their branches formed the material for the study. Thepsoas major muscle was dissected to see the formation of femoral nerve from theroots and to observe the variations in formation of femoral nerve. The aim of this study was to look for the variations in origin and branching pattern of the femoral nerve in the iliac fossa.

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

    Directory of Open Access Journals (Sweden)

    Perrin Byron M

    2010-12-01

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

  10. INTERSCALENE BRACHIAL PLEXUS BLOCK: COMPARISON OF EFFICACY OF VARYING DOSES OF DEXAMETHASONE COMBINED WITH LEVOBUPIVACAINE: A DOUBLE-BLIND RANDOMISED TRAIL.

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2014-06-01

    Full Text Available INTRODUCTION: To compare the effects of adding two different doses of dexamethasone on the duration and quality of interscalene block in patients undergoing shoulder surgery. METHODOLOGY: A total of 90 patients(age 18-65years undergoing shoulder surgery under interscalene block were assigned randomly to one of three groups: Control Group-C received injection levobupivacaine (0.5%, 35ml plus 2 ml normal saline Group-L received injection levobupivacaine (0.5% 35 ml plus dexamethasone 4 mg plus 1 ml normal saline and; Group H received injection levobupivacaine (0.5% 35 ml plus dexamethasone 8 mg. 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 the end of surgery. Postoperative analgesia was assessed using the numeric rating scores [NRS]. RESULTS: The duration of analgesia was significantly prolonged in both Group L (19.2 ± 2.6 h and Group H (21.3 ± 1.7 h compared with Group C (11.6 ± 1.1 h (p<0.05. Similarly, the duration of motor block was longer in both Group L (26.6 ± 2.8 h, and Group H (28.4 ± 2.2 h compared to Group C (18.6 ± 3.1 h (p<0.05. Postoperative analgesic consumption for the first 48 hours was significantly lower in Group L (6.5 [4–8] tabs and in Group H (5.5 [4–7] tabs vs. 9.5 [8–12] tabs in Group C (p<0.01. CONCLUSION: The addition of dexamethasone to levobupivacaine significantly prolonged the duration of the motor block and improved the quality of analgesia following interscalene block. There was no difference in the duration of analgesia and motor block between low-dose and high-dose dexamethasone.

  11. Incidence of shoulder dystocia and its relation to brachial plexus palsy: a 10 year retrospective review at King Abdulaziz University Hospital

    Directory of Open Access Journals (Sweden)

    Ayman A. Bukhari

    2016-12-01

    Conclusions: Most of clinically diagnosed SD cases did not give the consequence of BPP. However, this complication in addition to other complications of SD mandates extra caution in cases with risk factors. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000: 4415-4418

  12. The Latest Study of Nerval Root of Brachial Plexus in Clinical Application%臂丛神经根临床应用研究及进展

    Institute of Scientific and Technical Information of China (English)

    欧阳铭; 戴冀斌

    2008-01-01

    从解剖角度上阐述临床上对臂丛神经根的应用研究的进展:臂丛神经根在麻醉术及影像学诊断中的应用,选择性臂丛神经根切断治疗脑性上肢痉挛,臂丛神经损伤后的神经移位和移植治疗.随着臂丛神经根的显微解剖和分子生物学的深入研究,对麻醉学、上肢的神经源性疾病的治疗也有很好的指导作用.

  13. Applied Anatomy of Anesthesia for Nerval Root of Brachial Plexus%臂丛神经根麻醉术的应用解剖

    Institute of Scientific and Technical Information of China (English)

    欧阳铭; 冯丹

    2000-01-01

    在20具成人干尸标本上解剖,观测了臂丛神经根的毗邻关系、第7颈神经根的深度.结果表明:臂丛神经根C5,C6合干多位于前斜角肌外侧缘,C7为单干,C8,T1合干多为前斜角肌所掩盖;皮肤至7颈神经根的深度为(3.26±0.59)cm;臂丛神经的C5,C6,C8,T1根距C7根的距离分别为:(1.81±0.15)cm,(0.70±0.10)cm,(0.63±0.05)cm,(1.82±0.10)cm膈神经经前斜角肌表面由外上斜向内下,颈部血管神经鞘位于前斜角肌前内方,C8,T1与胸膜顶关系密切.这为臂丛神经根麻醉术提供了解剖学依据.

  14. A NEW METHOD TO SHORTEN THE LENGTH OF NERVE GRAFT AND TO SECURE THE NERVE REPAIR (AN INTRAOPERATIVE EXPERIENCE BASED ON 30 CASES OF OBSTETRICAL BRACHIAL PLEXUS PALSY)

    OpenAIRE

    2012-01-01

    Purpose: to compare the result of using a stay stitch to bridge the nerve gaps with repair the nerve gap without using a stay stitch, to compare both ways on the length of graft, number of grafts and number of cables per graft. Methods: a comparative study between 2 groups of babies with OBPP in which each group consists of 15 infants. In all the patients in both groups, neuroma excision and nerve grafting was indicated. In group (A) the defects were measured directly after neuroma excision w...

  15. Schwannoma de plexo braquial en el diagnóstico diferencial del hombro doloroso: Diferential diagnostic in the shoulder pain Brachial plexus schwannoma

    OpenAIRE

    S. Cortés; A. Orts; R. García-Rayo; F. Pérez-Cerdá; J. Gómez de Tojeiro

    2006-01-01

    Los schwannomas son tumores derivados de las células de Schwann, infrecuentes y generalmente de comportamiento benigno. El dolor y la radiculopatía son los síntomas iniciales más frecuentes. El diagnóstico se realiza mediante resonancia magnética y la resección quirúrgica es el tratamiento de elección. Presentamos el caso de una paciente de 50 años con omalgia atraumática izquierda de 5 años de evolución, durante los cuáles fue valorada por diferentes especialistas que incluían traumatólogos,...

  16. Rapid, automated mosaicking of the human corneal subbasal nerve plexus.

    Science.gov (United States)

    Vaishnav, Yash J; Rucker, Stuart A; Saharia, Keshav; McNamara, Nancy A

    2017-03-04

    Corneal confocal microscopy (CCM) is an in vivo technique used to study corneal nerve morphology. The largest proportion of nerves innervating the cornea lie within the subbasal nerve plexus, where their morphology is altered by refractive surgery, diabetes and dry eye. The main limitations to clinical use of CCM as a diagnostic tool are the small field of view of CCM images and the lengthy time needed to quantify nerves in collected images. Here, we present a novel, rapid, fully automated technique to mosaic individual CCM images into wide-field maps of corneal nerves. We implemented an OpenCV image stitcher that accounts for corneal deformation and uses feature detection to stitch CCM images into a montage. The method takes 3-5 min to process and stitch 40-100 frames on an Amazon EC2 Micro instance. The speed, automation and ease of use conferred by this technique is the first step toward point of care evaluation of wide-field subbasal plexus (SBP) maps in a clinical setting.

  17. Choroid plexus tumors: An institutional series of 25 patients

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    Menon Girish

    2010-01-01

    Full Text Available Purpose : Choroid plexus tumors (CPT are rare neoplasms that pose considerable treatment challenges. This study reviews a single institute′s experience with 25 patients of CPT and attempts to contribute to the general body of knowledge on CPT. Materials and Methods : A retrospective analysis of the case records of 25 patients operated for CPT since January 1998 and having a minimum of 1 year follow-up. Results : The study group included 12 (48% cases of choroid plexus papilloma (CPP, 09 (36% cases of choroid plexus carcinoma (CPC and 4 cases of atypical CPP. The mean age at presentation was 18.6 years (range, 6 months to 54 years; SD, 18.7 and a male preponderance was noted (17:8. Raised intracranial pressure was the commonest presenting symptom (72%. The tumors were distributed as follows: lateral ventricle (16; 64%, fourth ventricle (5; 20%, fourth ventricle with cerebellopontine angle extension (3; 12%, and third ventricle (1; 4%. A complete surgical excision was achieved in 11 cases of CPP and 8 cases of CPC. Operative complications include pneumocephalus (40%, focal deficits (36%, subdural effusion (32%, and persistent hydrocephalus requiring shunt (24%. All patients with CPP had a good outcome at the end of a mean follow-up of 5.4 years, whereas the median survival for patients with CPCs who underwent a subtotal resection with adjuvant therapy was 36 months. Conclusion : CPTs include a spectra ranging from CPP to CPC. Radiologic and histologic characterization of these tumors is difficult and newer immunohistochemical and genetic studies should be done to differentiate them from each other. Total excision offers a good prognosis and should be attempted for all forms of CPTs. CPPs carry a good prognosis, and adjuvant therapy is not indicated even after partial excision. CPCs and atypical CPCs carry a poor prognosis, and adjuvant therapy improves survival marginally after total excision. Spinal drop metastases are common for CPC and

  18. Choroid plexus papilloma originating in the sella turcica--case report.

    Science.gov (United States)

    Sameshima, Tetsuro; Tanikawa, Rokuya; Sugimura, Toshihide; Izumi, Naoto; Seki, Toshitaka; Maeda, Takahiro; Tsuboi, Toshiyuki; Hashimoto, Masaaki; Kimura, Teruo; Nabeshima, Kazuki

    2010-01-01

    A 51-year-old female presented with a rare case of choroid plexus papilloma originating in the sella turcica manifesting as headaches that was not readily distinguishable preoperatively from pituitary adenoma. Head magnetic resonance imaging revealed a tumor extending from the sella turcica to the suprasellar cistern. The tumor was removed via an endonasal transsphenoidal approach. Histological examination indicated a papillary structure covered with a layer of columnar epithelial cells that resembled normal choroid plexus. These findings, together with immunohistochemistry, led to a diagnosis of choroid plexus papilloma.

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

    Science.gov (United States)

    Wakerley, Benjamin R; Yuki, Nobuhiro

    2014-03-01

    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.

  20. [Continuous lumbar plexus block sets in France. Our experience].

    Science.gov (United States)

    Lascurain, P; Breining, T; Labbani, L; Le Gourrier, L; Lupescu, R; Gaertner, E

    2003-12-01

    The undeniable postoperative analgesia brought by the lumbar plexus block among patients scheduled for major surgery of the hip or knee justifies, the setting of a catheter to allow a continues analgesia more durable. Having drawn aside the difficulties of the daily practice (in allusion to the number of blocks carried out per day) and anatomical variations, the failure of the perineural catheter setting is in direct relationship with the material used by the anaesthesiologists for neurostimulation. The presentation of a case report describes a failure of catheter introduction due to the canula in deep continuous blocks, and the advantages and disadvantages of the various sets of neurostimulation. The authors conclude that the sets with the "catheter through the needle" are to be recommended, particularly the stimulating Tuohy needle.

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

    Science.gov (United States)

    Gupta, N; Anshu, A; Dada, R

    2014-01-01

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

  2. Neurological Disorder

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    13.1 Neurophysiology 2006115 Regional modulation of primary motor cortex after peripheral nerve injury: a functional magnetic resonance imaging study CAO Ge - jun (高歌军 ), et al. Dept Radiol, Huashan Hosp Shanghai 200040. Natl Med J China 2005 ;85(25) : 1752 -1756. Objective:To map dynamic changes of primary motor cortex after total brachial plexus traction injury by using functional magnetic resonance imaging, and to explore underlying probable mechanisms. Methods:Five patients with total traumatic root avulsions of the brachial plexus underwent varied kinds of nerve transfer to restore partial-

  3. Nicotinic receptor mediates nitric oxide synthase expression in the rat gastric myenteric plexus.

    OpenAIRE

    1998-01-01

    The mechanism that regulates the synthesis of nitric oxide synthase (NOS), a key enzyme responsible for NO production in the myenteric plexus, remains unknown. We investigated the roles of the vagal nerve and nicotinic synapses in the mediation of NOS synthesis in the gastric myenteric plexus in rats. Truncal vagotomy and administration of hexamethonium significantly reduced nonadrenergic, noncholinergic relaxation, the catalytic activity of NOS, the number of NOS-immunoreactive cells, and th...

  4. Unusual case of extradural choroid plexus papilloma of the sacral canal. Case report.

    Science.gov (United States)

    Kurtkaya-Yapicier, Ozlem; Scheithauer, Bernd W; Van Peteghem, Karl Peter; Sawicki, John E

    2002-07-01

    An unusual case of a sacral, extradural choroid plexus papilloma involving the S1-3 level is described. This 50-year-old woman presented with a 4-month history of pain involving her right buttock, perineum, and leg. Contrast-enhanced magnetic resonance (MR) imaging of the spine revealed a well-defined, mildly enhancing sacral canal mass at the S1-3 level; its appearance was consistent with that of a benign tumor. Intraoperatively, the lesion was found to be extradural in location and was entwined among nerve roots in the sacral canal. Microscopic examination of the gross totally resected tumor revealed typical features of a choroid plexus papilloma. Despite performing a thorough neuroimaging workup (craniospinal contrast-enhanced MR imaging) for an intracranial or spinal primary mass, none was found. The choroid plexus appeared entirely normal; however, both a cavum septum pellucidum and a cavum vergae were noted. Extraneural choroid plexus papilloma, specifically intrasacral, extradural choroid plexus papilloma has not been previously reported. The present example is thought to have arisen either from ectopic choroid plexus tissue or perhaps by metaplasia from ependymal rests.

  5. A DTC niche plexus surrounds the germline stem cell pool in Caenorhabditis elegans.

    Science.gov (United States)

    Byrd, Dana T; Knobel, Karla; Affeldt, Katharyn; Crittenden, Sarah L; Kimble, Judith

    2014-01-01

    The mesenchymal distal tip cell (DTC) provides the niche for Caenorhabditis elegans germline stem cells (GSCs). The DTC has a complex cellular architecture: its cell body caps the distal gonadal end and contacts germ cells extensively, but it also includes multiple cellular processes that extend along the germline tube and intercalate between germ cells. Here we use the lag-2 DTC promoter to drive expression of myristoylated GFP, which highlights DTC membranes and permits a more detailed view of DTC architecture. We find that short processes intercalating between germ cells contact more germ cells than seen previously. We define this region of extensive niche contact with germ cells as the DTC plexus. The extent of the DTC plexus corresponds well with the previously determined extent of the GSC pool. Moreover, expression of a differentiation marker increases as germ cells move out of the plexus. Maintenance of this DTC plexus depends on the presence of undifferentiated germ cells, suggesting that germ cell state can influence niche architecture. The roles of this DTC architecture remain an open question. One idea is that the DTC plexus delivers Notch signaling to the cluster of germ cells comprising the GSC pool; another idea is that the plexus anchors GSCs at the distal end.

  6. Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders

    Directory of Open Access Journals (Sweden)

    Danielius Serapinas

    2014-06-01

    Full Text Available Introduction: C horoid plexus cysts are one of the foetus ultrasonography findings that raise parents’ concerns about their child’s health. Usually cysts are found in an estimated 1% all performed ultrasonographies. Aim of the research: To evaluate the risk of Down syndrome, Edward’s syndrome and neural tube defect when choroid plexus cysts are found. Material and methods : The risks of Down syndrome, Edward’s syndrome and neural tube defect were calculated by using second-trimester biomarkers (a-fetoprotein, human choriongonadotropin, unconjugated estriol for patients with choroid plexus cysts. A control group was selected randomly with calculated risks and without any abnormal ultrasonography findings. These risks were compared between the two groups. Results: Twelve pregnancies with diagnosed choroid plexus cysts were included in this study during the year 2012. Choroid plexus cyst findings during this case/control study have shown that only one case from the test group had progressed to more serious foetal aberrations (Edward’s syndrome; nonetheless, this progression did not influence statistically significant changes in the test and control groups. No statistically significant changes between the risks of disorders according the PRISCA method were observed in the appearance of Down syndrome or neural tube defect.  Conclusions : There is no data that choroid plexus cysts increase the risk of Down syndrome, Edward’s syndrome and neural tube defect.

  7. Choroid plexus of the fourth ventricle: Review and anatomic study highlighting anatomical variations.

    Science.gov (United States)

    Tubbs, R Shane; Shoja, Mohammadali M; Aggarwal, Anjali; Gupta, Tulika; Loukas, Marios; Sahni, Daisy; Ansari, Shaheryar F; Cohen-Gadol, Aaron A

    2016-04-01

    Relatively few studies have been performed that analyze the morphology of the choroid plexus of the fourth ventricle. Due to the importance of this tissue as a landmark on imaging and during sur