Gluteal Compartment Syndrome following bariatric surgery: A rare but important complication

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Bernadette Pereira

2015-03-01

Full Text Available Gluteal Compartment Syndrome is a rare condition caused by excessive pressure within the gluteal compartments which leads to a number of potentially serious sequelae including rhabdomyolysis, nerve damage, renal failure and death. As bariatric patients are heavy and during prolonged bariatric procedures lie in one position for extended periods of time, they are especially susceptible to developing this complication. It is therefore essential that bariatric surgeons are aware of this complication and how to minimise the chances of it occurring and how to diagnose it. We describe a case of Gluteal Compartment Syndrome in a patient following a gastric bypass and review the aetiology, pathophysiology, treatment and prevention of this complication.

Anatomical basis of the lateral superior gluteal artery perforator (LSGAP) flap and role in bilateral breast reconstruction.

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Fade, Geraldine; Gobel, Fabienne; Pele, Eric; Chaput, Benoit; Garrido, Ignacio; Pinsolle, Vincent; Pelissier, Philippe; Sinna, Raphael

2013-06-01

Deep inferior epigastric perforator (DIEP) flap is one of the gold standards in autologous breast reconstruction. When the abdominal tissue is not available, the superior gluteal artery perforator (SGAP) is often a second option with its drawback, especially the donor-site deformity. Reports have highlighted that a higher and more lateral SGAP flap can be harvested to overcome several drawbacks of the classical SGAP, allowing in the same procedure a body-contouring procedure. In order to set the anatomical basis of this flap, we proposed to study the characteristics of a reliable and easily identifiable superior and lateral perforator of the superior gluteal artery (lateral SGAP (LSGAP)) situated in the region of the lower body-lift resection allowing to perform bilateral breast reconstruction at the same time. The anatomical study of 50 scans (or 100 buttocks) allows us to set forth a diagnostic assumption on the localisation of the perforator with respect to osseous landmarks (coccyx, iliac crest and great trochanter) which will be verified during the dissection of 10 cadavers (or 20 buttocks) and during the 20 colour Doppler examination (or 40 buttocks). In our computed tomography (CT) scan study, in 96% of cases, the perforator was situated in a circle with a radius≤3 cm with a 95% confidence interval and located at the junction of the proximal third-middle third of the distance summit of the posterior iliac crest (point B), most lateral point of the greater trochanter (point C). This assumption was verified by the cadaveric dissection and in vivo studies. Our study sets the anatomical landmarks of the LSGAP flap. This option allows the raising of an SGAP flap avoiding the main drawbacks of this flap and allows harvesting a flap with the tissue that is often discarded during the body-lift procedure. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Traumatic superior orbital fissure syndrome: assessment of cranial nerve recovery in 33 cases.

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Chen, Chien-Tzung; Wang, Theresa Y; Tsay, Pei-Kwei; Huang, Faye; Lai, Jui-Pin; Chen, Yu-Ray

2010-07-01

Superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. The characteristics of superior orbital fissure syndrome are attributable to a constellation of cranial nerve III, IV, and VI palsies. This is the largest series describing traumatic superior orbital fissure syndrome that assesses the recovery of individual cranial nerve function after treatment. In a review from 1988 to 2002, 33 patients with superior orbital fissure syndrome were identified from 11,284 patients (0.3 percent) with skull and facial fractures. Severity of cranial nerve injury and functional recovery were evaluated by extraocular muscle movement. Patients were evaluated on average 6 days after initial injury, and average follow-up was 11.8 months. There were 23 male patients. The average age was 31 years. The major mechanism of injury was motorcycle accident (67 percent). Twenty-two received conservative treatment, five were treated with steroids, and six patients underwent surgical decompression of the superior orbital fissure. After initial injury, cranial nerve VI suffered the most damage, whereas cranial nerve IV sustained the least. In the first 3 months, recovery was greatest in cranial nerve VI. At 9 months, function was lowest in cranial nerve VI and highest in cranial nerve IV. Eight patients (24 percent) had complete recovery of all cranial nerves. Functional recovery of all cranial nerves reached a plateau at 6 months after trauma. Cranial nerve IV suffered the least injury, whereas cranial nerve VI experienced the most neurologic deficits. Cranial nerve palsies improved to their final recovery endpoints by 6 months. Surgical decompression is considered when there is evidence of bony compression of the superior orbital fissure.

Computed tomographic measurement of gluteal subcutaneous fat thickness in reference to failure of gluteal intramuscular injections

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Burbridge, B.E. [Univ. of Saskatchewan, Royal Univ. Hospital, Academic Dept. of Medical Imaging, Saskatoon, Saskatchewan (Canada)]. E-mail: brent.burbridge@usask.ca

2007-04-15

Casual observation of gluteal region fat thickness on computed tomography (CT) of the pelvis leads to the hypothesis that, in some individuals intended intramuscular injections are not properly deposited in the gluteal muscle. We gathered and analyzed data to determine whether this hypothesis was true. CT scans of the pelvis were analyzed over an 18-day period in the tall of 2005. The thickness of gluteal region subcutaneous fat was measured in a standardized manner. Measurement of gluteal region subcutaneous fat thickness was performed for 298 pelvic CT scans. There were 150 male subjects and 148 female subjects. The average gluteal fat thickness for female subjects was 33.2 mm, whereas the average for male subjects was 23.1 mm. Analysis revealed a significant difference in gluteal region fat thickness between male and female subjects. A 37-mm needle, allowing for 6-mm penetration of the gluteal muscle, would not have entered the gluteal muscle fibres in 81 of 148 female subjects (54.7%), in 21 of 150 male subjects (14%), and in 102 of the 298 total sample (34.2%). Analysis revealed a significant difference between male and female subjects with regard to gluteal muscle needle penetration. An overall predicted failure rate of 34% was identified for intended gluteal intramuscular injections when the standard technique was used. This is important information for care providers who inject medications in the gluteal region. In a significant number of patients, the medications will be injected subcutaneously and not into the gluteal musculature, possibly altering the pharmacokinetics of the administered medication. An alternative injection site should probably be chosen to increase the success rate of intramuscular deposition of medications and vaccines in unselected adults. (author)

Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital

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Chin-Ta Lin

2014-01-01

Full Text Available Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old. Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients′ age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24. No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The

The Use of Magnetic Resonance Imaging in Planning a Pedicled Perforator Flap for Pressure Sores in the Gluteal Region.

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Park, Sun-June; Lee, Kyeong-Tae; Jeon, Byung-Joon; Woo, Kyong-Je

2018-04-01

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses. Intraoperatively, the targeted perforator was marked on the skin at the locations measured on the MRI images, and the marked location was confirmed using intraoperative handheld Doppler. Superior gluteal artery, inferior gluteal artery, or parasacral perforators were used for the PPFs. Surgical outcomes were evaluated. A total of 12 PPFs were performed in 12 patients. Superior gluteal artery perforator flaps were performed in 7 patients, inferior gluteal artery perforator flaps were performed in 3 patients, and parasacral perforator flaps were performed in 2 patients. We could identify a reliable perforator on MRI, and it was found at the predicted locations in all cases. There was only one case of partial flap necrosis. There was no recurrence of the pressure sores during the mean follow-up period of 6.7 months (range = 3-15 months). In selected patients with gluteal pressure sores, MRI is a suitable means for not only providing information about disease extent and comorbidities but also for evaluating perforators for PPF reconstructions.

Fatal Complications of Aesthetic Techniques: The Gluteal Region.

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Rapkiewicz, Amy V; Kenerson, Katherine; Hutchins, Kenneth D; Garavan, Fintan; Lew, Emma O; Shuman, Mark J

2018-02-21

Cosmetic procedures are common and utilize many techniques to obtain aesthetically good outcomes for patient satisfaction with acceptable safety standards. Cosmetic procedures that involve the gluteal region are becoming increasingly popular as various procedures can target the gluteal region such as liposuction, tumescent liposuction, cosmetic filler injections, autologous fat transfer, depot drug delivery, and implants. Complications of cosmetic gluteal procedures can be localized or systemic with systemic complications being responsible for most deaths. These reported systemic complications include sepsis, thromboembolism, fat embolism with or without fat embolism syndrome, macroscopic fat embolism, anesthesia-related and blood volume abnormalities. We herein report 10 deaths due to elective gluteal cosmetic procedures. Autologous fat transfer (fat grafting, lipoinjection) following liposuction resulted in 8 of 10 fatal outcomes of the gluteal aesthetic procedures. A comprehensive discussion of gluteal anatomy, gluteal contouring procedures, and the approach to such cases is presented along with the autopsy findings of the reported cases. © 2018 American Academy of Forensic Sciences.

[Gluteal muscle contracture release for the treatment of gluteal muscle contracture induced knee osteoarthritis: a report of 52 cases].

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Wang, Cheng-xiang; Gong, Yu-suo; Li, Sheng-hua; Liu, Hai-ping; Chai, Xi-ping

2011-07-01

To investigate clinical efficacy and significance of gluteal muscle contracture release for the treatment of gluteal muscle contracture induced knee osteoarthritis. From January 2008 to June 2010,52 patients with gluteal muscle contracture induced knee osteoarthritis were reviewed. Among the patients,15 patients were male and 37 patients were female, ranging in age from 15 to 45 years, with an average of 35 years. Eighteen patients had left knee osteoarthritis, 30 patients had right osteoarthritis, and 4 patients had double knee osteoarthritis. All the patients were treated with gluteal muscle contracture release. Lysholm knee score was used to evaluate therapeutic effects before and after operation. All the patients were followed up,and the duration ranged from 12 to 37 years,with a mean of 15 months. The Lysholm knee score improved from preoperative (68.12 +/- 0.78) points to postoperative (91.23 +/- 0.47) points at the last follow-up, the difference had statistical difference (t=31.269, Pmuscle contracture release is effective to relieve symptoms of gluteal muscles contracture and knee osteoarthritis. The patients with gluteal muscle contracture should be treated early so as to prevent effects of gluteal muscle contracture on knee joint, slow down degeneration of knee joint at early stage, and prevent occurrence of knee osteoarthritis.

Frequency of the superior rectus muscle overaction/contracture syndrome in unilateral fourth nerve palsy.

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Molinari, Andrea; Ugrin, Maria Cristina

2009-12-01

Superior oblique palsy is accompanied in most cases by overaction of the muscle's ipsilateral antagonist, the inferior oblique muscle. Overaction and contracture of the ipsilateral superior rectus muscle in patients with unilateral fourth (trochlear) nerve palsy is seldom discussed in the literature. The purpose of this study is to evaluate the frequency of superior rectus muscle overaction/contracture syndrome in patients with unilateral trochlear nerve palsy. The records of 198 patients with unilateral trochlear nerve palsy examined by the authors between July 1987 and July 2008 were reviewed retrospectively. All patients underwent complete eye examination with measurement of the deviation in the 9 positions of gaze and with the head tilted to both sides in all cooperative patients. Selection criteria for superior rectus muscle overaction/contracture syndrome in these patients were as follows: vertical deviation of 15(Delta) or larger in primary position, equal or larger hypertropia with the ipsilateral forced tilt test than with the eyes looking straight ahead, more than 5(Delta) hypertropia of the affected eye in horizontal gaze to the same side, hypertropia in all upgazes, and overaction of the contralateral superior oblique muscle. Of 198 patients, 33 (16.6%) met the selection criteria for superior rectus muscle overaction/contracture syndrome. Superior rectus muscle overaction/contracture syndrome frequently occurs in unilateral superior oblique palsy.

Changes in the frequency of swallowing during electrical stimulation of superior laryngeal nerve in rats.

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Tsuji, Kojun; Tsujimura, Takanori; Magara, Jin; Sakai, Shogo; Nakamura, Yuki; Inoue, Makoto

2015-02-01

The aim of the present study was to investigate the adaptation of the swallowing reflex in terms of reduced swallowing reflex initiation following continuous superior laryngeal nerve stimulation. Forty-four male Sprague Dawley rats were anesthetized with urethane. To identify swallowing, electromyographic activity of the left mylohyoid and thyrohyoid muscles was recorded. To evoke the swallowing response, the superior laryngeal nerve (SLN), recurrent laryngeal nerve, or cortical swallowing area was electrically stimulated. Repetitive swallowing evoked by continuous SLN stimulation was gradually reduced, and this reduction was dependent on the resting time duration between stimulations. Prior SLN stimulation also suppressed subsequent swallowing initiation. The reduction in evoked swallows induced by recurrent laryngeal nerve or cortical swallowing area stimulation was less than that following superior laryngeal nerve stimulation. Decerebration had no effect on the reduction in evoked swallows. Prior subthreshold stimulation reduced subsequent initiation of swallowing, suggesting that there was no relationship between swallowing movement evoked by prior stimulation and the subsequent reduction in swallowing initiation. Overall, these data suggest that reduced sensory afferent nerve firing and/or trans-synaptic responses, as well as part of the brainstem central pattern generator, are involved in adaptation of the swallowing reflex following continuous stimulation of swallow-inducing peripheral nerves and cortical areas. Copyright © 2014 Elsevier Inc. All rights reserved.

CT diagnosis of gluteal muscle contracture in children

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Wang Longsheng; Bao Jiaqi; Pan Zhili; Hu Kefei; Jiang Jiatan; Zhang Hongliang; Sun Jun; Yuan Yi

2004-01-01

Objective: To investigate the CT manifestations of gluteal muscle contracture (GMC) in children. Methods: Sixty-one cases of GMC diagnosed by CT and proved by surgery and pathology were studied with 20 cases of non-GMC as the control group. Results: 57 cases (93.4%) were bilateral contracture and 4 cases (6.6%) were unilateral contracture in 61 cases of GMC; The main CT manifestations were as follows: (1) gluteal muscle volume shrunk. There were 118 (100.0%) sides of gluteus maximus contracture , 16 ( 13.6 %) sides of gluteus medius contracture , 12 ( 10.2 %) sides of piriformis contracture, 4 (3.4%) sides of gluteus minimus contracture, 4 (3.4%) sides of capsula articularis contracture; (2) calcification and necrosis in injection zones. There were 95 (80.5%) sides of gluteal calcification and 24 (20.3%) sides of gluteal necrosis; (3) stripe crispation fascia. There were 81 stripes crispation fascia located outboard laterals of gluteus maximus, 36 located inboard laterals of the latter; (4) gluteal muscle clearance widened. There were 38 (32.2%) sides of light degree gluteal muscle contracture, 53 (44.9%) sides of middle degree, and 27 (22.9%) sides of heavy degree. Conclusion: CT can accurately diagnose GMC and it plays an important role in the evaluation of pathological extent and degree of GMC

Comparison of gluteal perforator flaps and gluteal fasciocutaneous rotation flaps for reconstruction of sacral pressure sores.

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Chen, Yen-Chou; Huang, Eng-Yen; Lin, Pao-Yuan

2014-03-01

The gluteus maximus myocutaneous flap was considered the workhorse that reconstructed sacral pressure sores, but was gradually replaced by fasciocutaneous flap because of several disadvantages. With the advent of the perforator flap technique, gluteal perforator (GP) flap has gained popularity nowadays. The aim of this study was to compare the complications and outcomes between GP flaps and gluteal fasciocutaneous rotation (FR) flaps in the treatment of sacral pressure sores. Between April 2007 and June 2012, 63 patients underwent sacral pressure sore reconstructions, with a GP flap used in 31 cases and an FR flap used in 32 cases. Data collected on the patients included patient age, gender, co-morbidity for being bedridden and follow-up time. Surgical details collected included the defect size, operative time and estimated blood loss. Complications recorded included re-operation, dehiscence, flap necrosis, wound infection, sinus formation, donor-site morbidity and recurrence. The complications and clinical outcomes were compared between these two groups. We found that there was no significant difference in patient demographics, surgical complications and recurrence between these two groups. In gluteal FR flap group, all recurrent cases (five) were treated by reuse of previous flaps. Both methods are comparable, good and safe in treating sacral pressure sores. Gluteal FR flap can be performed without microsurgical dissection, and re-rotation is feasible in recurrent cases. The authors suggest using gluteal FR flaps in patients with a high risk of sore recurrence. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Acetabular anteversion is associated with gluteal tendinopathy at MRI

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Moulton, Kyle M. [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada); Royal University Hospital, Department of Medical Imaging, Saskatoon, SK (Canada); Aly, Abdel-Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Rajasekaran, Sathish [Health Pointe - Pain, Spine and Sport Medicine, Edmonton, AB (Canada); Shepel, Michael; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

2015-01-15

Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy. A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test). At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4 , 95 % confidence interval (CI): 17.2 -19.6 ] compared with normal controls (mean: 15.7 , 95 % CI: 14.7 -16.8 ). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8 , 95 % CI: 16.2 -21.6 ). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903). Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition. (orig.)

Acetabular anteversion is associated with gluteal tendinopathy at MRI

International Nuclear Information System (INIS)

Moulton, Kyle M.; Aly, Abdel-Rahman; Rajasekaran, Sathish; Shepel, Michael; Obaid, Haron

2015-01-01

Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy. A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test). At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4 , 95 % confidence interval (CI): 17.2 -19.6 ] compared with normal controls (mean: 15.7 , 95 % CI: 14.7 -16.8 ). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8 , 95 % CI: 16.2 -21.6 ). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903). Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition. (orig.)

Anthropometric Study of the Piriformis Muscle and Sciatic Nerve: A Morphological Analysis in a Polish Population

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Haładaj, Robert; Pingot, Mariusz; Polguj, Michał; Wysiadecki, Grzegorz; Topol, Mirosław

2015-01-01

Background The aim of this study was to determine relationships between piriformis muscle (PM) and sciatic nerve (SN) with reference to sex and anatomical variations. Material/Methods Deep dissection of the gluteal region was performed on 30 randomized, formalin-fixed human lower limbs of adults of both sexes of the Polish population. Anthropometric measurements were taken and then statistically analyzed. Results The conducted research revealed that, apart from the typical structure of the piriformis muscle, the most common variation was division of the piriformis muscle into two heads, with the common peroneal nerve running between them (20%). The group with anatomical variations of the sciatic nerve course displayed greater diversity of morphometric measurement results. There was a statistically significant correlation between the lower limb length and the distance from the sciatic nerve to the greater trochanter in the male specimens. On the other hand, in the female specimens, a statistically significant correlation was observed between the lower limb length and the distance from the sciatic nerve to the ischial tuberosity. The shortest distance from the sciatic nerve to the greater trochanter measured at the level of the inferior edge of the piriformis was 21 mm, while the shortest distance to the ischial tuberosity was 63 mm. Such correlations should be taken into account during invasive medical procedures performed in the gluteal region. Conclusions It is possible to distinguish several anatomical variations of the sciatic nerve course within the deep gluteal region. The statistically significant correlations between some anthropometric measurements were only present within particular groups of male and female limbs. PMID:26629744

Levels of Bifurcation of the Sciatic Nerve among Ugandans at ...

African Journals Online (AJOL)

Background: The sciatic nerve is derived from the lumbo-sacral plexus, It is the thickest nerve in the whole body, it exits the gluteal region through the lower part of the greater sciatic foramen, it is the main innervator of the posterior thigh, the leg and foot, it usually ends halfway down the back of the thigh by dividing into the ...

Sciatic nerve palsy associated with intramuscular quinine injections ...

African Journals Online (AJOL)

Sct?ior ikfeclical O[ficcr. Department of Orthopaeclics, Mulago Hospital, Makerere University, Kampala, Uganda. Key Words: Sciatic nerve palsy, intramuscular injections, children, quinine dil~ydrochloride. The purpose of this paper is to show that, in children, gluteal injection of quinine dihydrochloride (QDH) may result in ...

[Diagnosis and treatment of unilateral gluteal muscle contracture].

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Chen, Xiaoliang; Tang, Xueyang; Jiang, Xin; Wang, Daoxi; Peng, Mingxing; Liu, Lijun

2011-05-01

To investigate the pathogenesis, diagnosis, and treatment of unilateral gluteal muscle contracture. Between January 1990 and September 2009, 41 patients with unilateral gluteal muscle contracture were treated and the clinical data were retrospectively analysed. Among them, 24 were male and 17 were female with an age range from 6 to 29 years (mean, 12 years). Thirty-nine patients had a definite history of repeat intragluteal injection. The locations were the left side in 9 cases and the right side in 32 cases. The main clinical manifestations included lameness and abnormal gait. The medical examination showed pelvic oblique and relative inequality of lower limbs with a mean difference of 2.1 cm (range, 1.2-3.8 cm) in the distance form navel to malleolus medials. The X-ray films of pelvis showed outpouching trochanter of femur and pelvic oblique. The CT scans showed no abnormal finding except pelvic oblique and gluteal muscle contracture. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, followed by the skin traction of both legs and rehabilitation exercise. All incisions healed by first intention. Forty-one patients were followed up 1-20 years (mean, 5 years), and the signs of gluteal muscle contracture disappeared. After 1 year of operation, 34 patients had equal leg length, 5 patients had mild pelvic oblique, and 2 patients had obvious pelvic oblique. According to LIU Guohui et al. evaluation standard, the results were excellent in 33 cases, good in 6 cases, and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation. Unilateral gluteal muscle contracture leads to pelvic oblique and inequality of lower limbs, and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and

Gluteal muscle fibrosis with abduction contracture of the hip.

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Al Bayati, Mohammed Ali; Kraidy, Bakir Kadhum

2016-03-01

Gluteal muscle fibrosis with hip contracture is a rare condition and causes major disability; literature reports are sparse. The aim of this study is to present, for the first time in Iraq and the region, a case series of gluteal fibrosis and the results of surgical treatment. Seven children--six boys and one girl--diagnosed as having gluteal muscle fibrosis with hip contracture, were investigated and treated by open surgical release of fibrotic bands and physiotherapy. All patients improved dramatically over the subsequent weeks, and were able to sit and squat in the normal position. Gluteal muscle fibrosis with hip contracture is present in Iraq and more awareness is needed for early diagnosis. Surgical treatment provided excellent results. More studies are needed to delineate the aetiology of the condition.

MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome

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Kong, Andrew; Van der Vliet, Andrew [Regional Imaging Border, Albury, NSW (Australia); Zadow, Steven [Dr Jones and Partners Medical Imaging, Adelaide, SA (Australia)

2007-07-15

Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed. (orig.)

Which level is responsible for gluteal pain in lumbar disc hernia?

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Fang, Guofang; Zhou, Jianhe; Liu, Yutan; Sang, Hongxun; Xu, Xiangyang; Ding, Zihai

2016-08-22

There are many different reasons why patients could be experiencing pain in the gluteal area. Previous studies have shown an association between radicular low back pain (LBP) and gluteal pain (GP). Studies locating the specific level responsible for gluteal pain in lumbar disc hernias have rarely been reported. All patients with lumbar disc herniation (LDH) in the Kanghua hospital from 2010 to 2014 were recruited. All patients underwent a lumbar spine MRI to clarify their LDH diagnosis, and patients were allocated to a GP group and a non-GP group. To determine the cause and effect relationship between LDH and GP, all of the patients were subjected to percutaneous endoscopic lumbar discectomy (PELD). A total of 286 cases were included according to the inclusive criteria, with 168 cases in the GP group and 118 cases in the non-GP group. Of these, in the GP group, 159 cases involved the L4/5 level and 9 cases involved the L5/S1 level, while in the non-GP group, 43 cases involved the L4/5 level and 48 cases involved the L5/S1 level. PELD was performed in both groups. Gluteal pain gradually disappeared after surgery in all of the patients. Gluteal pain recrudesced in a patient with recurrent disc herniation (L4/5). As a clinical finding, gluteal pain is related to low lumbar disc hernia. The L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. No patients with gluteal pain exhibited involvement at the L3/4 level.

A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area.

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Taha, Ahmad Muhammad

2012-03-01

The purpose of this study was to describe detailed sonographic anatomy of the parasacral area for rapid and successful identification of the sciatic nerve. Fifty patients scheduled for knee surgery were included in this observational study. An ultrasound-guided parasacral sciatic nerve block was performed in all patients. The ultrasound probe was placed on an axial plane 8 cm lateral to the uppermost point of the gluteal cleft. Usually, at this level the posterior border of the ischium (PBI), a characteristically curved hyperechoic line, could be identified. The sciatic nerve appeared as a hyperechoic structure just medial to the PBI. The nerve lies deep to the piriformis muscle lateral to the inferior gluteal vessels, and if followed caudally, it rests directly on the back of the ischium. After confirmation with electrical stimulation, a 20-mL mixture of 1% ropivacaine and 1% lidocaine with epinephrine was injected. The sciatic nerve was identified successfully in 48 patients (96%). In those patients, the median time required for its ultrasonographic identification was ten seconds [interquartile range, 8-13.7 sec], and the block success rate was 100%. The described sonographic details of the parasacral area allowed for rapid and successful identification of the sciatic nerve.

Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy

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Muhsin Eraslan

2015-01-01

Full Text Available Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD (interquartile range [IQR] 57.5–70 and vertical deviation was 13.5 PD (IQR 10–20. The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16, and the vertical deviation was 0 PD (IQR 0–4. The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16. All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.

Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome.

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Natsis, Konstantinos; Totlis, Trifon; Konstantinidis, George A; Paraskevas, George; Piagkou, Maria; Koebke, Juergen

2014-04-01

To detect the variable relationship between sciatic nerve and piriformis muscle and make surgeons aware of certain anatomical features of each variation that may be useful for the surgical treatment of the piriformis syndrome. The gluteal region of 147 Caucasian cadavers (294 limbs) was dissected. The anatomical relationship between the sciatic nerve and the piriformis muscle was recorded and classified according to the Beaton and Anson classification. The literature was reviewed to summarize the incidence of each variation. The sciatic nerve and piriformis muscle relationship followed the typical anatomical pattern in 275 limbs (93.6 %). In 12 limbs (4.1 %) the common peroneal nerve passed through and the tibial nerve below a double piriformis. In one limb (0.3 %) the common peroneal nerve coursed superior and the tibial nerve below the piriformis. In one limb (0.3 %) both nerves penetrated the piriformis. In one limb (0.3 %) both nerves passed above the piriformis. Four limbs (1.4 %) presented non-classified anatomical variations. When a double piriformis muscle was present, two different arrangements of the two heads were observed. Anatomical variations of the sciatic nerve around the piriformis muscle were present in 6.4 % of the limbs examined. When dissection of the entire piriformis is necessary for adequate sciatic nerve decompression, the surgeon should explore for the possible existence of a second tendon, which may be found either inferior or deep to the first one. Some rare, unclassified variations of the sciatic nerve should be expected during surgical intervention of the region.

A clear map of the lower cranial nerves at the superior carotid triangle.

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Cavalcanti, Daniel D; Garcia-Gonzalez, Ulises; Agrawal, Abhishek; Tavares, Paulo L M S; Spetzler, Robert F; Preul, Mark C

2010-07-01

The lower cranial nerves must be identified to avoid iatrogenic injury during skull base and high cervical approaches. Prompt recognition of these structures using basic landmarks could reduce surgical time and morbidity. The anterior triangle of the neck was dissected in 30 cadaveric head sides. The most superficial segments of the glossopharyngeal, vagus and its superior laryngeal nerves, accessory, and hypoglossal nerves were exposed and designated into smaller anatomic triangles. The midpoint of each nerve segment inside the triangles was correlated to the angle of the mandible (AM), mastoid tip (MT), and bifurcation of the common carotid artery. A triangle bounded by the styloglossus muscle, external carotid artery, and facial artery housed the glossopharyngeal nerve. This nerve segment was 0.06 ± 0.71 cm posterior to the AM and 2.50 ± 0.59 cm inferior to the MT. The vagus nerve ran inside the carotid sheath posterior to internal carotid artery and common carotid artery bifurcation in 48.3% of specimens. A triangle formed by the posterior belly of digastric muscle, sternocleidomastoid muscle, and internal jugular vein housed the accessory nerve, 1.90 ± 0.60 cm posterior to the AM and 2.30 ± 0.57 cm inferior to the MT. A triangle outlined by the posterior belly of digastric muscle, internal jugular vein, and common facial vein housed the hypoglossal nerve, which was 0.82 ± 0.84 cm posterior to the AM and 3.64 ± 0.70 cm inferior to the MT. Comprehensible landmarks can be defined to help expose the lower cranial nerves to avoid injury to this complex region. Copyright © 2010 Elsevier Inc. All rights reserved.

Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling.

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Rüegg, Eva; Cheretakis, Alexandre; Modarressi, Ali; Harbarth, Stephan; Pittet-Cuénod, Brigitte

2015-01-01

Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM) occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal liposuction, and gluteal lipofilling in Mexico. Three months postoperatively, implants were removed for NTM-infection in Switzerland. Adequate antibiotic treatment was stopped after seven days for drug-related hepatitis. At entrance, gluteal puncture for bacterial analysis was performed. MRI showed large subcutaneous collection. Debridement under general anaesthesia was followed by open wound management. Total antibiotic treatment was 20 weeks. Methods. Bacterial analysis of periprosthetic and gluteal liquids included Gram-stain plus acid-fast stain, and aerobic, anaerobic and mycobacterial cultures.  Results. In periprosthetic fluid, Mycobacterium abscessus, Propionibacterium, and Staphylococcus epidermidis were identified. The same M. abscessus strain was found gluteally. The gluteal wound healed within six weeks. At ten months' follow-up, gluteal asymmetry persists for deep scarring. Conclusion. This case presents major complications of multisite aesthetic surgery. Surgical-site infections in context of medical tourism need appropriate bacteriological investigations, considering potential NTM-infections.

Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

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John E. Lawrence

2016-01-01

Full Text Available A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.

The application of MRI in gluteal muscle contracture

International Nuclear Information System (INIS)

Zhao Tao; You Yuhua; Sun Jing; Cheng Kebin; Liu Wei; Qu Hui

2003-01-01

Objective: To evaluate the MRI findings and its diagnostic value in gluteal muscle contracture (GMC). Methods: Eleven clinic or operation confirmed GMC patients were examined by plain X-ray and MRI. Conventional T 1 WI and T 2 WI MR imaging were performed and FFE-T 2 WI (fast field echo-T 2 WI) was also scanned. CT scan was conducted in 5 cases. Results: 11 GMC patients were all diagnosed by MRI. Conventional T 1 WI and T 2 WI could only show the atrophy of gluteal muscles, while FFE-T 2 WI could directly show the fibrous band of gluteal muscle and its fascia, and the fibrous band appeared as low signal intensity on FFE-T 2 WI sequence. Conclusions: MRI is the efficient modality in imaging the fibrous band for GMC patients, and FFE-T 2 WI is the most valuable sequence. MRI is very helpful in the diagnosis and treatment of GMC

[Characteristics and role of the gluteal herpes in a female population].

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Suárez, M; Saavedra, T; Briones, H

1989-01-01

Based on the fact that the gluteal herpes may constitute the clinical expression of the reactivation of a Herpes simplex virus latent at the sacral lymph node, we investigated a group of women who were carriers of gluteal herpetic infection, the characteristics of the infection, the virus type principally associated to it, and its possible relation with the genital herpes. Forty one women with gluteal herpes verified by virologic laboratory were studied. 75.7% of these women had had in addition to this herpetic infection in other places, mainly genital, with an average of 7.2 of recurrent episodes per year, (range: 1 to 18 episodes yearly). 78% of the isolated virus was typified as HSV-2 by the use of monoclonal antibodies. It is stand out the importance of considering the background of gluteal herpes as causative of classification of herpetic high risk.

Anatomical etiology of “pseudo-sciatica” from superior cluneal nerve entrapment: a laboratory investigation

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Konno T

2017-11-01

Full Text Available Tomoyuki Konno,1 Yoichi Aota,2 Hiroshi Kuniya,1 Tomoyuki Saito,1 Ning Qu,3 Shogo Hayashi,3 Shinichi Kawata,3 Masahiro Itoh3 1Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, 2Department of Spine & Spinal Cord Surgery, Yokohama Brain and Spine Center, Yokohama, 3Department of Anatomy, Tokyo Medical University, Tokyo, Japan Objective: The superior cluneal nerve (SCN may become entrapped where it pierces the thoracolumbar fascia over the iliac crest; this can cause low back pain (LBP and referred pain radiating into the posterior thigh, calf, and occasionally the foot, producing the condition known as “pseudo-sciatica.” Because the SCN was thought to be a cutaneous branch of the lumbar dorsal rami, originating from the dorsal roots of L1–L3, previous anatomical studies failed to explain why SCN causes “pseudo-sciatica”. The purpose of the present anatomical study was to better elucidate the anatomy and improve the understanding of “pseudo-sciatica” from SCN entrapment. Materials and methods: SCN branches were dissected from their origin to termination in subcutaneous tissue in 16 cadavers (5 male and 11 female with a mean death age of 88 years (range 81–101 years. Special attention was paid to identify SCNs from their emergence from nerve roots and passage through the fascial attachment to the iliac crest. Results: Eighty-one SCN branches were identified originating from T12 to L5 nerve roots with 13 branches passing through the osteofibrous tunnel. These 13 branches originated from L3 (two sides, L4 (six sides, and L5 (five sides. Ten of the 13 branches showed macroscopic entrapment in the tunnel. Conclusion: The majority of SCNs at risk of nerve entrapment originated from the lower lumbar nerve. These anatomical results may explain why patients with SCN entrapment often evince leg pain or tingling that mimics sciatica. Keywords: superior cluneal nerve, entrapment neuropathy, dorsal rami

Morphological and radiological study of ossified superior transverse scapular ligament as potential risk factor of suprascapular nerve entrapment.

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Polguj, Michał; Sibiński, Marcin; Grzegorzewski, Andrzej; Waszczykowski, Michał; Majos, Agata; Topol, Mirosław

2014-01-01

The suprascapular notch is covered superiorly by the superior transverse scapular ligament. This region is the most common place of suprascapular nerve entrapment formation. The study was performed on 812 specimens: 86 dry scapulae, 104 formalin-fixed cadaveric shoulders, and 622 computer topography scans of scapulae. In the cases with completely ossified superior transverse scapular ligament, the following measurements were performed: proximal and distal width of the bony bridge, middle transverse and vertical diameter of the suprascapular foramen, and area of the suprascapular foramen. An ossified superior transverse scapular ligament was observed more often in men and in the right scapula. The mean age of the subjects with a completely ossified superior transverse scapular ligament was found to be similar than in those without ossification. The ossified band-shaped type of superior transverse scapular ligament was more common than the fan-shaped type and reduced the space below the ligament to a significantly greater degree. The ossified band-shaped type should be taken into consideration as a potential risk factor in the formation of suprascapular nerve entrapment. It could explain the comparable frequency of neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified superior transverse scapular ligament.

Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery.

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Ijichi, Kei; Sasano, Hiroshi; Harima, Megumi; Murakami, Shingo

2017-10-01

In thyroid surgery, intraoperative identification and preservation of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) are crucial. Several reports have proposed that electromyography (EMG) monitoring is an acceptable adjunct for identification and preservation of the RLN. However, a limited number of hospitals have access to an EMG monitoring system. Therefore, the development of another viable monitoring method is required. The aim of the present study was to design a new RLN and SLNEB monitoring method combining an Airwayscope™ (AWS) and a facial nerve stimulator. The facial nerve-stimulating electrode stimulates the RLN or SLNEB, so that the movement of the vocal cord may be observed with an AWS. This monitoring method was performed on 10 patients with a thyroid tumor. In all the cases, RLN and SLNEB were identified and vocal cord function was preserved. All the patients exhibited normal vocal cord function following surgery. Thus, the new RLN and SLNEB monitoring method using an AWS and a facial nerve stimulator is useful in thyroid surgery, and this method may be used as a reliable and available alternative to EMG monitoring to ensure the normal function of the vocal cord.

Risks to the Superior Gluteal Neurovascular Bundle During Iliosacral and Transsacral Screw Fixation: A Computed Tomogram Arteriography Study.

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Maslow, Jed; Collinge, Cory A

2017-12-01

Iliosacral (IS) and transsacral (TS) screws are popular techniques to repair complicated injuries to the pelvis. The anatomy of the superior gluteal neurovasculature (SG NV bundle) is well described as running along the posterior ilium, providing innervation and perfusion to important abductor muscles. The method of pelvis fixation least likely to injure the SG NV bundle is unknown. Twenty uninjured patients with a contrasted computed tomogram of the pelvis and lower extremities (CTA) were evaluated. Starting points for an S1 IS screw and S1 and S2 TS screws were estimated on the "ghost" lateral CTA image for those pelvi with safe corridors (>9 mm diameter). The distance from the projected screw to the SG artery was measured. A distance of <3.65 mm (half of a 7.3-mm screw's diameter) was considered likely for NV bundle injury. Of 40 pelvi CTAs (single sides), 10 pelvi (25%) were determined to be inappropriate for an S1 TS screw. The average distances from the screw starting point and the artery were 25.3 mm (±9.2) for S1 IS, 12.4 mm (±9.0) for S1 TS, and 23.5 mm (±10.7) for S2 TS screws, respectively. Ten S1 TS screws (25%) and no S1 IS or S2 TS screws were projected to have caused injury to the SG NV bundle (P < 0.001). Inserting S1 IS and S2 TS screws put the SG NV anatomy at significantly less risk than S1 TS screws. This information may aid in choosing the "best" fixation option for patients with pelvic ring trauma requiring surgery.

Anterior and middle superior alveolar nerve block for anesthesia of maxillary teeth using conventional syringe

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Ignacio Velasco

2012-01-01

Full Text Available Background: Dental procedures in the maxilla typically require multiple injections and may inadvertently anesthetize facial structures and affect the smile line. To minimize these inconveniences and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures, the anterior and middle superior alveolar (AMSA nerve block, which achieves pulpal anesthesia from the central incisor to second premolar through palatal approach with a single injection. The purpose of this article is to provide background information on the anterior and middle superior alveolar nerve block and demonstrate its success rates of pulpal anesthesia using the conventional syringe. Materials and Methods: Thirty Caucasian patients (16 men and 14 women with an average age of 22 years-old, belonging to the School of Dentistry of Los Andes University, were selected. All the patients received an AMSA nerve block on one side of the maxilla using the conventional syringe, 1 ml of lidocaine 2% with epinephrine 1:100.000 was injected to all the patients. Results: The AMSA nerve block obtained a 66% anesthetic success in the second premolar, 40% in the first premolar, 60% in the canine, 23.3% in the lateral incisor, and 16.7% in the central incisor. Conclusions: Because of the unpredictable anesthetic success of the experimental teeth and variable anesthesia duration, the technique is disadvantageous for clinical application as the first choice, counting with other techniques that have greater efficacy in the maxilla. Although, anesthetizing the teeth without numbing the facial muscles may be useful in restorative dentistry.

Gluteal muscle contracture: diagnosis and management options

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Rai, Saroj; Meng, Chunqing; Wang, Xiaohong; Chaudhary, Nabin; Jin, Shengyang; Yang, Shuhua; Wang, Hong

2017-01-01

Gluteal muscle contracture (GMC), a debilitating disease, exists all over the globe but it is much more prevalent in China. Patients typically present with abduction and external rotation of the hip and are unable to bring both the knees together while squatting. Multiple etiologies have been postulated, the commonest being repeated intramuscular injection into the buttocks. The disease is diagnosed primarily by clinical features but radiological features are necessary for the exclusion of other pathological conditions. Non-operative treatment with physiotherapy can be tried before surgery is considered but it usually fails. Different surgical techniques have been described and claimed to have a better outcome of one over another but controversy still exists. Based on published literatures, the clinical outcome is exceptionally good in all established methods of surgery. However, endoscopic surgery is superior to conventional open surgery in terms of cosmetic outcome with fewer complications. Nevertheless, its use has been limited by lack of adequate knowledge, instrumentations, and some inherent limitations. Above all, post-operative rehabilitation plays a key role in better outcome, which however should be started gradually. PMID:28059055

Z-plasty for severe gluteal muscle contracture in children.

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Zha, Kun; Liu, GuoHui; Yang, Shuhua; Cao, Faqi

2016-12-01

To review the records of 363 patients with severe gluteal muscle contracture to determine its mechanism, underlying pathology, and treatment outcome. Records of 136 males and 227 females aged 5 to 18 (mean, 12.2) years who underwent Z-plasty for bilateral (n=347) or unilateral (n=16) severe gluteal muscle contracture were reviewed. Severe gluteal muscle contracture was classified as typical (n=52) or special (n=311). The typical type is associated with symptoms of positive out-toe gait, Ober sign, back-extending test, cross-leg test, squatting with knee side-by-side test, and hip dysfunction. It is further subdivided into mild (n=0), moderate (n=40), or severe (n=12). The special type is associated with additional symptoms of pelvic tilt and leg length discrepancy (4 cm in 48 hips). 311 hips had pelvic tilt and 47 hips had lumbar compensatory scoliosis. Treatment outcome was assessed at 6 months. Hip functional score was assessed at the final follow-up. The mean hospitalisation period was 11 days. After a mean follow-up of 1.5 years, the mean hip functional score improved from 8.03 to 11.69; improvement was higher in children (age 5-13 years) than in adolescents (age 14-18 years) [3.7 vs. 2.9, p4 cm, and intra-operatively the contracture band severely affected the joint capsule. The third patient did not comply with postoperative exercises. Surgical treatment for severe gluteal muscle contracture achieved good outcome.

The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction.

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Massoud Arab, Amir; Reza Nourbakhsh, Mohammad; Mohammadifar, Ali

2011-02-01

It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years participate in the study. Subjects were categorized into three groups: LBP without SIJ involvement (n = 53); back pain with SIJ dysfunction (n = 53); and no low back pain (n = 53). Hamstring muscle length and gluteal muscle strength were measured in all subjects. The number of individuals with gluteal weakness was significantly (P = 0.02) higher in subjects with SI joint dysfunction (66%) compared to those with LBP without SI joint dysfunctions (34%). In pooled data, there was no significant difference (P = 0.31) in hamstring muscle length between subjects with SI joint dysfunction and those with back pain without SI involvement. In subjects with SI joint dysfunction, however, those with gluteal muscle weakness had significantly (P = 0.02) shorter hamstring muscle length (mean = 158±11°) compared to individuals without gluteal weakness (mean = 165±10°). There was no statistically significant difference (P>0.05) in hamstring muscle length between individuals with and without gluteal muscle weakness in other groups. In conclusion, hamstring tightness in subjects with SI joint dysfunction could be related to gluteal muscle weakness. The slight difference in hamstring muscle length found in this study, although statistically significant, was not sufficient for making any definite conclusions. Further studies are needed to establish the role of hamstring muscle in SI joint stability.

An Interesting Fistula Tract Presenting with Recurrent Gluteal Abscess: Instructive Case

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Gulsum Iclal Bayhan

2015-01-01

Full Text Available A fistula extending from the gluteus to penis is an extremely rare entity. In this paper, we have highlighted novel variant of congenital penile to gluteal fistula complicated with gluteal and penoscrotal abscess in a previously healthy boy. A fistulous tract extending from the gluteus to penis has been shown by fistulogram. Bleomycin has been used in fistula tract with successful results in our patient.

External laryngeal nerve in thyroid surgery: is the nerve stimulator necessary?

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Aina, E N; Hisham, A N

2001-09-01

To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them. Prospective, non-randomised study. Teaching hospital, Malaysia. 317 patients who had 447 dissections between early January 1998 and late November 1999. Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them. The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve. Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.

[Etiological analysis and significance of anterior knee pain induced by gluteal muscles contracture].

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Zhao, Gang; Liu, Yu-jie; Wang, Jun-liang; Qi, Wei; Qu, Feng; Yuan, Bang-tuo; Wang, Jiang-tao; Shen, Xue-zhen; Liu, Yang; Zhu, Juan-li

2014-12-01

To explore causes of gluteal muscle contracture induced anterior knee pain and curative effect of arthroscopic release. From March 2002 to August 2013,36 patients with gluteal muscle contracture induced anterior knee pain were treated, including 15 males, 21 females, aged from 9 to 40 years old with an average (18.7±7.2) years old; the courses of diseases ranged from 4 to 30 years. The clinical manifestations involved limited to symmelia, positive Ober sign, buttocks touch contracture belts, knee and patella slide to lateral when doing squat activities. All patients were performed gluteal muscle contracture release under arthroscopic. Postoperative complications were observed, Kujala scoring before and after operation was used for compare curative effect. All patients were followed up with an average of 29 months. The incision were healed well, and no complications were occurred. Postoperative Kujala score were improved more than preoperative. Gluteal muscle contracture release could alleviate hypertension of lateral patella, and palys an important role in preventing patellofemoral arthritis.

Aberrant femoral torsion presenting with frog-leg squatting mimicking gluteal muscle contracture.

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Chiang, Chia-Ling; Tsai, Meng-Yuan; Chang, Wei-Ning; Chen, Clement Kuen-Huang

2012-04-01

Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture. We therefore raised the following questions: What are the imaging features of patients with frog-leg squatting? Do conditions other than gluteal muscle contracture manifest frog-leg squatting? We retrospectively reviewed the MR images of 67 patients presenting with frog-leg squatting from April 1998 to July 2010. There were four females and 63 males; their mean age was 22.2 years (range, 4-50 years). During MRI readout, we observed aberrant axes of some femoral necks and obtained additional CT to measure femoral torsion angles in 59 of the 67 patients. MR images of 27 (40%) patients had signs of gluteal muscle contracture. Twenty-two (33%) patients (40 femora) had aberrant femoral torsion, including diminished anteversion (range, 6°-0°; average, 3.9°) in 11 femora of eight patients and femoral retroversion (range, muscle contracture or aberrant femoral torsion. The observation of aberrant femoral torsion was not anticipated before imaging studies. In addition to gluteal muscle contracture, aberrant femoral torsion can be a cause of frog-leg squatting. Level II, diagnostic study. See the guidelines for Authors for a complete description of levels of evidence.

Sedentary lifestyle related exosomal release of Hotair from gluteal-femoral fat promotes intestinal cell proliferation

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Xiaozhao Lu; Danna Bai; Xiangwei Liu; Chen Zhou; Guodong Yang

2017-01-01

Pioneering epidemiological work has established strong association of sedentary lifestyle and obesity with the risk of colorectal cancer, while the detailed underlying mechanism remains unknown. Here we show that Hotair (HOX transcript antisense RNA) is a pro-adipogenic long non-coding RNA highly expressed in gluteal-femoral fat over other fat depots. Hotair knockout in adipose tissue results in gluteal-femoral fat defect. Squeeze of the gluteal-femoral fat induces intestinal proliferation in...

Bilateral gluteal abscesses and myofibrosis complicating ...

African Journals Online (AJOL)

BACKGROUND: There is paucity of reports on the musculoskeletal complications of pentazocine abuse in Nigeria.The aim was to report a case of bilateral gluteal abscesses and myofibrosis as a consequence of parenteral pentazocine abuse. CASE SUMMARY: We report a case of a 39 year old housewife who presented ...

Sedentary lifestyle related exosomal release of Hotair from gluteal-femoral fat promotes intestinal cell proliferation.

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Lu, Xiaozhao; Bai, Danna; Liu, Xiangwei; Zhou, Chen; Yang, Guodong

2017-03-31

Pioneering epidemiological work has established strong association of sedentary lifestyle and obesity with the risk of colorectal cancer, while the detailed underlying mechanism remains unknown. Here we show that Hotair (HOX transcript antisense RNA) is a pro-adipogenic long non-coding RNA highly expressed in gluteal-femoral fat over other fat depots. Hotair knockout in adipose tissue results in gluteal-femoral fat defect. Squeeze of the gluteal-femoral fat induces intestinal proliferation in wildtype mice, while not in Hotair knockout mice. Mechanistically, squeeze of the gluteal-femoral fat induces exosomal Hotair secretion mainly by transcriptional upregulation of Hotair via NFκB. And increased exosomal Hotair in turn circulates in the blood and is partially endocytosed by the intestine, finally promoting the stemness and proliferation of intestinal stem/progenitor cells via Wnt activation. Clinically, obese subjects with sedentary lifestyle have much higher exosomal HOTAIR expression in the serum. These findings establish that sedentary lifestyle promotes exosomal Hotair release from the gluteal-femoral fat, which in turn facilitates intestinal stem and/or progenitor proliferation, raising a possible link between sedentary lifestyle with colorectal tumorigenesis.

Comparison of gluteal and hamstring activation during five commonly used plyometric exercises.

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Struminger, Aaron H; Lewek, Michael D; Goto, Shiho; Hibberd, Elizabeth; Blackburn, J Troy

2013-08-01

Anterior cruciate ligament injuries occur frequently in athletics, and anterior cruciate ligament injury prevention programs may decrease injury risk. However, previous prevention programs that include plyometrics use a variety of exercises with little justification of exercise inclusion. Because gluteal and hamstring activation is thought to be important for preventing knee injuries, the purpose of this study was to determine which commonly used plyometric exercises produce the greatest activation of the gluteals and hamstrings. EMG (Electromyography) amplitudes of the hamstring and gluteal muscles during preparatory and loading phases of landing were recorded in 41 subjects during 5 commonly used plyometric exercises. Repeated measures ANOVAs (Analysis of Variance) were used on 36 subjects to examine differences in muscle activation. Differences in hamstring (Pplyometric exercises, their removal from injury prevention programs may be warranted without affecting program efficacy. © 2013.

Roles of TGF-β/Smad signaling pathway in pathogenesis and development of gluteal muscle contracture.

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Zhang, Xintao; Ma, Yukun; You, Tian; Tian, Xiaopeng; Zhang, Honglei; Zhu, Qi; Zhang, Wentao

2015-02-01

Gluteal muscle contracture (GMC) is a chronic fibrotic disease of gluteal muscles which is characterized by excessive deposition of collagen in the extracellular matrix. Transforming growth factor (TGF)-βs have been shown to play an important role in the progression of GMC. However, the underlying mechanisms are not entirely clear. We sought to explore the expression of TGF-β/Smad pathway proteins and their downstream targets in gluteal muscle contracture disease. The expression levels of collagens type I/III, TGF-β1, Smad2/3/4/7 and PAI-1 (plasminogen activator inhibitor type 1) in gluteal muscle contraction (GMC) patients were measured using immunohistochemistry, reverse transcription and polymerase chain reaction (RT-PCR) and western blot assays. The expressions of collagens type I/III and TGF-β1 were significantly increased in the contraction band compared with unaffected muscle. In addition, R-Smad phosphorylation and Smad4 protein expression in the contraction band were also elevated, while the expression of Smad7 was significantly decreased in the fibrotic muscle of the GMC patients compared to the unaffected adjacent muscle. The protein and mRNA levels of PAI-1 were also remarkably increased in the contraction band compared with adjacent muscle. Immunohistochemical analysis also demonstrated that the expression levels of TGF-β1 and PAI-1 were higher in contraction band than those in the adjacent muscle. Our data confirm the stimulating effects of the TGF-β/Smad pathway in gluteal muscle contracture disease and reveal the internal changes of TGF-β/Smad pathway proteins and their corresponding targets in gluteal muscle contracture patients.

New minimally invasive option for the treatment of gluteal muscle contracture.

Science.gov (United States)

Ye, Bin; Zhou, Panyu; Xia, Yan; Chen, Youyan; Yu, Jun; Xu, Shuogui

2012-12-01

Gluteal muscle contracture is a clinical syndrome that involves contracture and distortion of the gluteal muscles and fascia fibers due to multiple causes. Physical examination demonstrates a characteristic gait due to hip adduction and internal thigh rotation. This study introduces a new minimally invasive method for surgical release of gluteal muscle contracture. Patients with gluteal muscle contracture were assigned to 4 categories: type A, contracture occurred mainly in the iliotibial tract; type B, contracture occurred in the Iliotibial tract and gluteus maximus; type C1, movement of the contraction band was palpable and a snapping sound was audible during squatting; and type C2, movement of the contraction band was not palpable or almost absent and a snapping sound was audible during squatting. This classification method allowed prediction of the anatomic location of these pathological contractures and determination of the type of surgery required. Four critical points were used to define the operative field and served as points to mark a surgical incision smaller than 4 mm. The contracture was easily released in this carefully marked operative field without causing significant neurovascular damage. Over a period of 5 years, between March 2003 and June 2008, the authors treated 1059 patients with this method and achieved excellent outcomes. Most patients were fully active within 12 weeks, with the assistance of an early postoperative rehabilitation program. The most significant complication was a postoperative periarticular hematoma, which occurred in 3 patients within 10 days postoperatively and required surgical ligation of the bleeding vessel. Copyright 2012, SLACK Incorporated.

Digital subtraction angiography of inferior gluteal artery through the infusion catheter of chemotherapy for bladder cancer

International Nuclear Information System (INIS)

Ishikawa, Satoru; Noguchi, Ryosuke; Kanoh, Shori; Shimazui, Toru; Uchida, Katsunori; Nemoto, Ryosuke; Koiso, Kenkichi

1987-01-01

More than fifty patients of invasive bladder cancer had been treated by selective intra-arterial chemotherapy through the inferior or superior gluteal arteries. The distribution of infused drugs had been evaluated by RI-angiography through a thin arterial infusion catheter. This time we performed digital subtraction angiography (DSA) through an infusion catheter in order to know the precise distribution of infused materials in seven patients with locally advanced bladder cancer. Pharmaco-DSA with norepinephrine was also done in four patients. Satisfactory spatial and contrast resolution were gained in four patients and pharmaco-DSA showed better quality. In our experience DSA through intra-arterial infusion catheter was a useful procedure in the evaluation of distribution of infused drugs. (author)

Prospective Evaluation of Electromyography-Guided Phrenic Nerve Monitoring During Superior Vena Cava Isolation to Anticipate Phrenic Nerve Injury.

Science.gov (United States)

Miyazaki, Shinsuke; Ichihara, Noboru; Nakamura, Hiroaki; Taniguchi, Hiroshi; Hachiya, Hitoshi; Araki, Makoto; Takagi, Takamitsu; Iwasawa, Jin; Kuroi, Akio; Hirao, Kenzo; Iesaka, Yoshito

2016-04-01

Right phrenic nerve injury (PNI) is a major concern during superior vena cava (SVC) isolation due to the anatomical close proximity. The functional and histological severity of PNI parallels the degree of the reduction in the compound motor action potential (CMAP) amplitude. This study aimed to evaluate the feasibility of monitoring CMAPs during SVC isolation to anticipate PNI during atrial fibrillation (AF) ablation. Thirty-nine paroxysmal AF patients were prospectively enrolled. Radiofrequency energy was delivered point-by-point for 30 seconds with 20 W until eliminating all SVC potentials after the pulmonary vein isolation. Right diaphragmatic CMAPs were obtained from modified surface electrodes by pacing from the right subclavian vein. Radiofrequency applications were applied without fluoroscopy under CMAP monitoring at sites with phrenic nerve capture by high output pacing. Electrical SVC isolation was successfully achieved with a mean of 9.4 ± 3.3 applications in all patients. In 3 (7.5%) patients, the SVC was isolated without radiofrequency delivery at phrenic nerve capture sites. Among a total of 346 applications in the remaining 36 patients, 71 (20.5%) were delivered while monitoring CMAPs. In 1 (1.4%) application, the RF application was interrupted due to a decrease in the CMAP amplitude. However, no PNI was detected on fluoroscopy, and the decreased amplitude recovered spontaneously. The remaining 70 (98.6%) applications exhibited no significant changes in the CMAP amplitude throughout the applications (from 1.01 ± 0.47 to 0.98 ± 0.45 mV, P = 0.383). Stable right diaphragmatic CMAPs could be obtained, and monitoring CMAPs might be useful for anticipating right PNI during SVC isolation. © 2016 Wiley Periodicals, Inc.

Anatomical basis for sciatic nerve block at the knee level.

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Barbosa, Fabiano Timbó; Barbosa, Tatiana Rosa Bezerra Wanderley; da Cunha, Rafael Martins; Rodrigues, Amanda Karine Barros; Ramos, Fernando Wagner da Silva; de Sousa-Rodrigues, Célio Fernando

2015-01-01

Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. The study was conducted by dissection of human cadavers' popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Anatomical basis for sciatic nerve block at the knee level].

Science.gov (United States)

Barbosa, Fabiano Timbó; Barbosa, Tatiana Rosa Bezerra Wanderley; Cunha, Rafael Martins da; Rodrigues, Amanda Karine Barros; Ramos, Fernando Wagner da Silva; Sousa-Rodrigues, Célio Fernando de

2015-01-01

Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. The study was conducted by dissection of human cadavers' popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

BUILDING A BETTER GLUTEAL BRIDGE: ELECTROMYOGRAPHIC ANALYSIS OF HIP MUSCLE ACTIVITY DURING MODIFIED SINGLE-LEG BRIDGES.

Science.gov (United States)

Lehecka, B J; Edwards, Michael; Haverkamp, Ryan; Martin, Lani; Porter, Kambry; Thach, Kailey; Sack, Richard J; Hakansson, Nils A

2017-08-01

Gluteal strength plays a role in injury prevention, normal gait patterns, eliminating pain, and enhancing athletic performance. Research shows high gluteal muscle activity during a single-leg bridge compared to other gluteal strengthening exercises; however, prior studies have primarily measured muscle activity with the active lower extremity starting in 90 ° of knee flexion with an extended contralateral knee. This standard position has caused reports of hamstring cramping, which may impede optimal gluteal strengthening. The purpose of this study was to determine which modified position for the single-leg bridge is best for preferentially activating the gluteus maximus and medius. Cross-Sectional. Twenty-eight healthy males and females aged 18-30 years were tested in five different, randomized single-leg bridge positions. Electromyography (EMG) electrodes were placed on subjects' gluteus maximus, gluteus medius, rectus femoris, and biceps femoris of their bridge leg (i.e., dominant or kicking leg), as well as the rectus femoris of their contralateral leg. Subjects performed a maximal voluntary isometric contraction (MVIC) for each tested muscle prior to performing five different bridge positions in randomized order. All bridge EMG data were normalized to the corresponding muscle MVIC data. A modified bridge position with the knee of the bridge leg flexed to 135 ° versus the traditional 90 ° of knee flexion demonstrated preferential activation of the gluteus maximus and gluteus medius compared to the traditional single-leg bridge. Hamstring activation significantly decreased (p bridge by flexing the active knee to 135 ° instead of 90 ° minimizes hamstring activity while maintaining high levels of gluteal activation, effectively building a bridge better suited for preferential gluteal activation. 3.

Targeted Ultrasound-Guided Perineural Hydrodissection of the Sciatic Nerve for the Treatment of Piriformis Syndrome.

Science.gov (United States)

Burke, Christopher J; Walter, William R; Adler, Ronald S

2018-05-01

Piriformis syndrome is a common cause of lumbar, gluteal, and thigh pain, frequently associated with sciatic nerve symptoms. Potential etiologies include muscle injury or chronic muscle stretching associated with gait disturbances. There is a common pathological end pathway involving hypertrophy, spasm, contracture, inflammation, and scarring of the piriformis muscle, leading to impingement of the sciatic nerve. Ultrasound-guided piriformis injections are frequently used in the treatment of these pain syndromes, with most of the published literature describing injection of the muscle. We describe a safe, effective ultrasound-guided injection technique for the treatment of piriformis syndrome using targeted sciatic perineural hydrodissection followed by therapeutic corticosteroid injection.

Performance Effects of Repetition Specific Gluteal Activation Protocols on Acceleration in Male Rugby Union Players

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Barry Lorna

2016-12-01

Full Text Available Warm-up protocols have the potential to cause an acute enhancement of dynamic sprinting performance. The purpose of this study was to evaluate the effects of three repetition specific gluteal activation warm-up protocols on acceleration performance in male rugby union players. Forty male academy rugby union players were randomly assigned to one of 4 groups (control, 5, 10 or 15 repetition gluteal activation group and performed 10 m sprints at baseline and 30 s, 2, 4, 6 and 8 min after their specific intervention protocol. Five and ten meter sprint times were the dependent variable and dual-beam timing gates were used to record all sprint times. Repeated measures analysis of variance found no significant improvement in 5 and 10 m sprint times between baseline and post warm-up scores (p ≥ 0.05 for all groups. There were no reported significant differences between groups at any of the rest interval time points (p ≥ 0.05. However, when individual responses to the warm-up protocols were analyzed, the 15 repetition gluteal activation group had faster 10 m times post-intervention and this improvement was significant (p = 0.021. These results would indicate that there is no specific rest interval for any of the gluteal interventions that results in a potentiation effect on acceleration performance. However, the individual response analysis would seem to indicate that a 15 repetition gluteal activation warm-up protocol has a potentiating effect on acceleration performance provided that the rest interval is adequately and individually determined.

Effects of electrical stimulation-induced gluteal versus gluteal and hamstring muscles activation on sitting pressure distribution in persons with a spinal cord injury

NARCIS (Netherlands)

Smit, C. A. J.; Haverkamp, G. L. G.; de Groot, S.; Stolwijk-Swuste, J. M.; Janssen, T. W. J.

Study design: Ten participants underwent two electrical stimulation (ES) protocols applied using a custom-made electrode garment with built-in electrodes. Interface pressure was measured using a force-sensitive area. In one protocol, both the gluteal and hamstring (g+h) muscles were activated, in

Gluteal Black Market Silicone-induced Renal Failure: A Case Report and Literature Review.

Science.gov (United States)

Matson, Andrea; Faibisoff, Burt

2017-11-01

Very few cases of successful surgical treatment for renal failure due to gluteal silicone injections have been reported in the literature. The silicone toxicity and subsequent renal failure seem to follow repetitive silicone injections and silicone injections in large quantities. This is a case of a 31-year-old woman who developed renal failure after 6 years of gluteal silicone injections who underwent radical resection of bilateral gluteal regions in an attempt to mitigate her impending complete renal failure. A systematic review of the literature was conducted using PubMed database and with assistance from medical library staff to conduct keyword searches for "Silicone," "Renal failure," "Silicone emboli syndrome," "Silicone granuloma," and "Silicone end organ toxicity." The search results were reviewed by the authors and selected based on the relevance to the case report presented. Extensive literature relating to silicone granulomas and their systemic effects supports the use of steroids for immediate treatment and eventual surgical resection for cure of the various silicone-related end-organ toxicities including renal failure.

Child gluteal aggressive fibromatosis: a correlative study of CT findings and pathology

International Nuclear Information System (INIS)

Fan Miao; Li Ziping; Meng Quanfei; Guo Yan; Ye Bingbing; Xiao Gang

2005-01-01

Objective: To evaluate CT imaging in the diagnosis of child gluteal aggressive fibromatosis. Methods: CT manifestations of child gluteal aggressive fibromatosis were retrospectively analyzed. In total 7 males and 1 female, 2 to 11 years old, were enrolled in study. All cases had been confirmed by surgery and pathology. CT findings were correlatively studied with pathology. Results: Lesions located on the left side were noted in 7 cases, and a lesion located on right side was seen in the rest 1 cam The lesions were elliptical or lobulated on CT images. Three tumors originated from solitary muscle and multiple muscles were involved in other 5 cases. Tumors were well demarcated. Invasion to the adjacent structure was shown in 7 cases. All tumors were homogeneous in density in non-enhanced scan. Compared to the muscles in the same section, 5 tumors were iso -density and 3 tumors were hypo-density. Inside the lesions no hemorrhage, necrosis, cystic degeneration and calcification was revealed. After contrast medium was administrated, iso-dense and homogeneous enhancement as the adjacent muscles was seen in 1 tumor and apparent enhancement were demonstrated in 7 tumors. Seven tumors tended to grow along the longitudinal axis of muscles and infiltrated into fascial space. Atrophy resulting from compression was shown in the adjacent muscles in 6 cases. The major clinical manifestation was limp. Gluteal aggressive fibromatosis was confirmed by pathology in all cases. Conclusion: There are characteristics of child gluteal aggressive fibromatosis in age of onset, gender of the patients, site of the lesion and CT findings as well. CT manifestations were consistent with pathology. CT imaging is helpful in initial diagnosis and differential diagnosis, as well as in assessing the expansion of the tumor and involvement of the adjacent structures. (authors)

The relationship between gluteal muscle activation and throwing kinematics in baseball and softball catchers.

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Plummer, Hillary A; Oliver, Gretchen D

2014-01-01

The purpose of this study was to determine the relationship between gluteal muscle activation and pelvis and trunk kinematics when catchers throw to second base. Forty-two baseball and softball catchers (14.74 ± 4.07 years; 161.85 ± 15.24 cm; 63.38 ± 19.98 kg) participated in this study. Muscle activity of the bilateral gluteus maximus and medius as well as pelvis and trunk kinematics throughout the throwing motion were analyzed. It was discovered that at foot contact, there were 2 significant inverse relationships between stride leg gluteus maximus activity and pelvis axial rotation (r = -0.31, r2 = 0.10, p = 0.05), and between trunk axial rotation and pelvis lateral flexion (r = -0.34, r2= 0.12, p = 0.03). In addition, at foot contact, a significant positive relationship between the drive leg (throwing arm side) and trunk flexion (r = 0.33, r2 = 0.11, p = 0.04) was present. The results of this study provide evidence of gluteal activation both concentrically and eccentrically, in attempt to control the pelvis and trunk during the throwing motion of catchers. The gluteal muscles play a direct role in maintaining the stability of the pelvis, and catchers should incorporate strengthening of the entire lumbopelvic-hip complex into their training regimen. Incorporating concentric and eccentric gluteal exercises will help to improve musculoskeletal core stability, thereby assisting in upper extremity injury prevention.

The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction

OpenAIRE

Massoud Arab, Amir; Reza Nourbakhsh, Mohammad; Mohammadifar, Ali

2011-01-01

It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years parti...

Acellular Nerve Allografts in Peripheral Nerve Regeneration: A Comparative Study

Science.gov (United States)

Moore, Amy M.; MacEwan, Matthew; Santosa, Katherine B.; Chenard, Kristofer E.; Ray, Wilson Z.; Hunter, Daniel A.; Mackinnon, Susan E.; Johnson, Philip J.

2011-01-01

Background Processed nerve allografts offer a promising alternative to nerve autografts in the surgical management of peripheral nerve injuries where short deficits exist. Methods Three established models of acellular nerve allograft (cold-preserved, detergent-processed, and AxoGen® -processed nerve allografts) were compared to nerve isografts and silicone nerve guidance conduits in a 14 mm rat sciatic nerve defect. Results All acellular nerve grafts were superior to silicone nerve conduits in support of nerve regeneration. Detergent-processed allografts were similar to isografts at 6 weeks post-operatively, while AxoGen®-processed and cold-preserved allografts supported significantly fewer regenerating nerve fibers. Measurement of muscle force confirmed that detergent-processed allografts promoted isograft-equivalent levels of motor recovery 16 weeks post-operatively. All acellular allografts promoted greater amounts of motor recovery compared to silicone conduits. Conclusions These findings provide evidence that differential processing for removal of cellular constituents in preparing acellular nerve allografts affects recovery in vivo. PMID:21660979

Gluteal Augmentation With Intramuscular Implants in Patients With Human Immunodeficiency Virus With Lipoatrophy Related to the Use of Antiretroviral Therapy.

Science.gov (United States)

Andrade, Guilherme Augusto; Coltro, Pedro Soler; Barros, Mário Eduardo; Müller Neto, Bruno Francisco; Lima, Renan Victor; Farina, Jayme Adriano

2017-11-01

Lipodystrophy syndrome associated with highly active antiretroviral therapy (HAART) may lead to low self-esteem and poor compliance with the drug treatment on patients infected with human immunodeficiency virus (HIV), which is a matter of concern for the health system. The aim of this study was to evaluate patients with HIV submitted to gluteal augmentation with intramuscular silicone implants to correct gluteal lipoatrophy related to the use of HAART. This is a retrospective evaluation of 10 patients submitted to gluteal augmentation with intramuscular silicone implant for correction of gluteal lipoatrophy related to the use of HAART, operated between 2012 and 2015. Postoperative complications and the degree of patient's satisfaction were analyzed. There were 3 postoperative complications including 1 case of surgical wound dehiscence and 2 cases of seroma. Six months after surgery, 8 patients had an excellent degree of satisfaction, and 2 patients had a good degree of satisfaction related to the procedure. Although this intervention does not offer functional advantages, it improves the body contour, increases patients' self-esteem, and helps them to accept their body image. These advantages can lead to higher compliance with prolonged HAART. Gluteal augmentation with intramuscular silicone implant can be a viable option to treat patients with HIV with gluteal lipoatrophy related to the use of HAART. The patients were satisfied with the outcomes of the procedure, and there were only minor self-limited postoperative complications.

Gluteal Black Market Silicone–induced Renal Failure: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Andrea Matson, DO, PGY-2

2017-11-01

Full Text Available Summary:. Very few cases of successful surgical treatment for renal failure due to gluteal silicone injections have been reported in the literature. The silicone toxicity and subsequent renal failure seem to follow repetitive silicone injections and silicone injections in large quantities. This is a case of a 31-year-old woman who developed renal failure after 6 years of gluteal silicone injections who underwent radical resection of bilateral gluteal regions in an attempt to mitigate her impending complete renal failure. A systematic review of the literature was conducted using PubMed database and with assistance from medical library staff to conduct keyword searches for “Silicone,” “Renal failure,” “Silicone emboli syndrome,” “Silicone granuloma,” and “Silicone end organ toxicity.” The search results were reviewed by the authors and selected based on the relevance to the case report presented. Extensive literature relating to silicone granulomas and their systemic effects supports the use of steroids for immediate treatment and eventual surgical resection for cure of the various silicone-related end-organ toxicities including renal failure.

The vestibulocochlear nerve (VIII).

Science.gov (United States)

Benoudiba, F; Toulgoat, F; Sarrazin, J-L

2013-10-01

The vestibulocochlear nerve (8th cranial nerve) is a sensory nerve. It is made up of two nerves, the cochlear, which transmits sound and the vestibular which controls balance. It is an intracranial nerve which runs from the sensory receptors in the internal ear to the brain stem nuclei and finally to the auditory areas: the post-central gyrus and superior temporal auditory cortex. The most common lesions responsible for damage to VIII are vestibular Schwannomas. This report reviews the anatomy and various investigations of the nerve. Copyright © 2013. Published by Elsevier Masson SAS.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

Science.gov (United States)

Kaneko, Mami; Hitomi, Takefumi; Takekawa, Takashi; Tsuji, Takuya; Kishimoto, Yo; Hirano, Shigeru

2017-09-26

Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[Clinical application of modified upper gluteal rhomboid fasciocutaneous flap in repairing sacrococcygeal pressure sores].

Science.gov (United States)

Jiang, Maohua; Yang, Xiaoliang; Wei, Bangmin; Li, Yinghao

2012-03-01

To investigate the method and effectiveness of repairing sacrococcygeal pressure sores with modified upper gluteal rhomboid fasciocutaneous flap. Between January 2004 and March 2011, 43 patients with sacrococcygeal pressure sores were treated. There were 25 males and 18 females with an average age of 63 years (range, 38-95 years). The disease duration was 3 months to 2 years and 6 months (mean, 8.5 months). The size of pressure sores ranged from 6 cm x 5 cm to 18 cm x 13 cm. According to the extent and lesion degree of pressure scores, 23 pressure sores were rated as degree III and 20 pressure sores as degree IV. The modified upper gluteal rhomboid flap was designed, one-side upper gluteal fasciocutaneous flaps were transplanted to repair sacrococcygeal pressure sores in 19 cases and two-side flaps in 24 cases. The size of one side flap ranged from 6.5 cm x 4.5 cm to 18.0 cm x 11.5 cm. Fluid under flap occurred in 1 case and edge necrosis of the flaps in 3 cases at 7 days after operation, which were cured after drainage and dressing change; the other flaps survived, and incisions healed by first intention. All patients were followed up 6 months to 3 years with an average of 11 months. Two patients relapsed at 5 months and 8 months, respectively; the other patients had no recurrence. The color of the flaps was normal, and the appearance and elasticity of the flaps were good. The modified upper gluteal rhomboid fasciocutaneous flap has the advantages of simple design and operation, less injury, and reliable effect in repairing sacrococcygeal pressure sores.

Effects of transcutaneous electrical nerve stimulation on pain intensity during application of carboxytherapy in patients with cellulite: A randomized placebo-controlled trial.

Science.gov (United States)

Sadala, Adria Y; Machado, Aline F P; Liebano, Richard E

2018-01-16

Carboxytherapy may generate local pain that is considered the main limiting factor in clinical practice. Transcutaneous electric nerve stimulation (TENS) is widely used in the control of acute pain; however, the effect of TENS on pain relief during carboxytherapy has not been studied to date. To assess the effect of TENS on pain intensity during carboxytherapy in patients with cellulite in the gluteal region. This randomized clinical trial was conducted with 84 patients, 18-44 years of age, who had moderate cellulite in the gluteal region, according to Cellulite Severity Scale, but never received carboxytherapy. Patients were randomized into 3 groups: active TENS, placebo TENS, and control group. For the intervention, skin depressions with cellulite were outlined, and the gluteal area to be treated was defined. The subcutaneous injection of CO 2 was performed using 0.30 × 13 mm-needles at a 45° angle, with a controlled flow rate of 100 mL/min maintained for 1 minute at each puncture site. The parameters for TENS were as follows: frequency of 100 Hz and pulse duration of 200 μs; TENS intensity was adjusted until the patient reported strong paresthesia. The visual numeric pain rating scale was used to assess pain intensity after each puncture. The active TENS group reported lower pain intensity compared to the placebo TENS (P TENS) was effective in reducing pain intensity during carboxytherapy in patients with cellulite in the gluteal region. © 2018 Wiley Periodicals, Inc.

Non-formation of the main trunk of the sciatic nerve and unusual relationships to the piriformis muscle

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J. Stoyanov

2017-09-01

Full Text Available Background: The sciatic nerve is the largest branch of the sacral plexus. Variations of its origin, exit from the pelvis, emergence and branching in the posterior region of the thigh, especially in regards to the piriformis muscle, are an object of interest due to the possibility to be involved in the pathogenensis of clinically significant non-discogenic sciatica or piriformis syndrome. Case report: We present a case of variant anatomy of the sciatic nerve, discovered during routine dissection of the left gluteal region of an adult female cadaver. We observed a non-formation of the main trunk of the nerve; rather, the tibial nerve passed inferiorly to the piriformis muscle, while the common peroneal nerve went through the body of the bifid piriformis muscle, immediately next to its tendon. The two branches continued their course in the thigh without joining and forming a proper sciatic nerve. The medical records of the body donor did not reveal any neurological impairment which could be linked to this anatomical peculiarity. Conclusion: The anatomy of the sciatic nerve could be considered to be a factor of clinical significance. The high prevalence of similar anatomical variations should be kept in mind during the diagnostic process of clinical entities involving the sciatic nerve.

Detailed anatomy of the abducens nerve in the lateral rectus muscle.

Science.gov (United States)

Nam, Yong Seok; Kim, In-Beom; Shin, Sun Young

2017-10-01

The aims of this study were to elucidate the detailed anatomy of the abducens nerve in the lateral rectus muscle (LRM) and the intramuscular innervation pattern using Sihler staining. In this cohort study, 32 eyes of 16 cadavers were assessed. Dissection was performed from the LRM origin to its insertion. The following distances were measured: from LRM insertion to the bifurcation point of the abducens nerve, from LRM insertion to the entry site of the superior branch or inferior branch, from the upper border of the LRM to the entry site of the superior branch, from the lower border of LRM to the entry site of inferior branch, and the widths of the main trunk and superior and inferior branches. The single trunk of the abducens nerve divided into two branches 37 mm from insertion of the LRM, and 22 of 32 (68.8%) orbits showed only two superior and inferior branches with no subdivision. The superior branch entered the LRM more anteriorly (P = 0.037) and the superior branch was thinner than the inferior branch (P = 0.040). The most distally located intramuscular nerve ending was observed at 52.9 ± 3.5% of the length of each muscle. Non-overlap between the superior and inferior intramuscular arborization of the nerve was detected in 27 of 32 cases (84.4%). Five cases (15.6%) showed definite overlap of the superior and inferior zones. This study revealed the detailed anatomy of the abducens nerve in the LRM and provides helpful information to understand abducens nerve palsy. Clin. Anat. 30:873-877, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

[Insertion of gluteus maximus tendo-chilles lengthening with Z-shaped for the treatment of severe gluteal muscle contracture].

Science.gov (United States)

Chen, Huan-shi; Yang, Xiao-long

2015-06-01

To investigate clinical curative effects of gluteal muscle contracture release combined with insertion of gluteus maximus tendo-chilles lengthening with Z-shaped in treating severe gluteal muscles contracture. From 2006 May to 2011 May, 20 patients (35 sides) with severe gluteal muscle contracture were collected, including 12 males and 8 females, aged from 8 to 34 years old with an average of 13 years old; the courses of disease ranged from 3 to 21 years. All patients manifested abnormal gait at different degree, knees close together cannot squat,positive syndrome of Ober, positive test of alice leg. Gluteus contracture fascia release were performed firstly in operation, then insertion of tendo-chilles lengthening with Z-shaped were carried out. Preoperative and postoperative gait, and knee flexion hip extensor squat test, cross leg test, adduction and internal rotary activity of hip joint, stretch strength and motor ability after hip abduction were observed and compared. Twenty patients were followed up for 1 to 5 years. Gluteus maximus were released thoroughly, and snapping hip was disappeared, Ober syndrome were negative. There was significant differences in knee flexion hip extensor squat test, adduction and internal rotary activity of hip joint,stretch before and after operation (Pmuscle strength was protected,stretch strength and motor ability of hip joint were recovered well. Among them,31 cases got excellent results and 4 good. For severe gluteal muscles contracture,insertion of gluteus maximus tendo-chilles lengthening with Z-shaped performed after gluteus contracture fascia release could release gluteal muscle contracture to the greatest extent and obtain postoperative curative effect without resection of normal hip muscle fibers and destroy joint capsule.

Does Endoscopic Piriformis Tenotomy Provide Safe and Complete Tendon Release? A Cadaver Study.

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Coulomb, Rémy; Khelifi, Anis; Bertrand, Martin; Mares, Olivier; May, Olivier; Marchand, Philippe; Kouyoumdjian, Pascal

2018-05-28

Endoscopic piriformis release (EPR) is among the available treatments for piriformis syndrome. This procedure typically involves dividing the muscle near the sciatic nerve in the sub-gluteal space, which contains numerous blood vessels and nerves. The objectives of this prospective cadaver study were: 1) to assess the reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter; 2) to detect iatrogenic injuries to the lateral hip rotators, nerves, and vessels; 3) and to define the surgical safety margins relative to the sciatic nerve and inferior gluteal bundle. EPR at the greater trochanter ensures full release of the muscle with a limited risk of neuro-vascular injury. EPR was performed via two portals on 10 cadaver hips preserved in zinc chloride and placed in the prone position. A third, ancillary portal was required in 7 cases. The area was then dissected with the Kocher-Langenbeck approach to allow an assessment of the tenotomy, detect iatrogenic injuries, and measure the distances separating the tenotomy site from the sciatic nerve and inferior gluteal artery. Complete tenotomy was achieved in 9 (90%) cases. The tendon adhered to the capsule in 2 (20%) cases and showed acquired avulsion in 1 case. No injuries to the sciatic nerve or inferior gluteal artery occurred. Mean distances from the tenotomy site were 5.21±0.59cm (range, 4.5-6.6cm) for the sciatic nerve and 7.1±0.89cm (range, 5.4-8.5cm) for the inferior gluteal artery. EPR by a tenotomy at the greater trochanter without sciatic nerve release provides full release of the muscle with satisfactory safety margins and a short learning curve. III, prospective cadaver case-control study. Copyright © 2018. Published by Elsevier Masson SAS.

The role of ultrasonography in the diagnosis of gluteal muscle contracture.

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Li, Qiu; Lingyan, Zhang; Yan, Luo; Yulan, Peng

2011-02-01

To evaluate the use of ultrasonography (US) in the diagnosis of gluteal muscle contracture (GMC) by analysis of its imaging characteristics. Thirty-nine patients suspected of having GMC due to abnormal gait underwent pre-operative US. The diagnosis of GMC was confirmed by surgery in 27 patients. Six patients were diagnosed with congenital hip dysplasia, and the remaining six patients were diagnosed with sciatic nerve damage, post-poliomyelitis sequelae, and myasthenia gravis. For the patients with GMC, US showed muscle thinning and hyperechoic strips (specific for muscular contracture) in the muscles involved. In three patients with GMC, the strips were integrated into muscle bundles, demonstrating both strong and weak sonographic echoes. The sensitivity and specificity of the diagnosis of GMC using the presence of strips were 88.9% and 83.3%, respectively, and using muscle thinning, the sensitivity and specificity were 92.6% and 50%, respectively. The contracture strips, as measured by US, were significantly smaller than the actual measurements at the time of surgery, but there was a significant correlation between the two measurements (r = 0.814, P muscle (91.8%), and the lowest rate was found in the piriformis muscle (52.9%). Ultrasonography is a valuable tool for the diagnosis of GMC, especially for the detection of specific contracture strips in involved muscles. Its role in the pre-operative diagnosis of GMC also provides surgical planning that can guide subsequent treatment.

Successful Treatment of Gluteal Pain from Obturator Internus Tendinitis and Bursitis with Ultrasound-Guided Injection.

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Chen, Boqing; Rispoli, Leia; Stitik, Todd; Leong, Michelle

2017-10-01

This case report describes what the authors believe is the first case of a patient with obturator internus tendinitis and bursitis successfully treated with a corticosteroid injection using a trans-tendinous lateral to medial approach. The patient presented with right gluteal pain not relieved by physical therapy or right hip and ischial bursa corticosteroid injections. Pelvic and lumbar spine MRIs and EMG/NCS findings were unremarkable. Physical examination demonstrated tenderness to palpation at the right middle lower gluteal region. Ultrasound imaging with sonopalpation identified the maximal local tender point as the right obturator internus muscle and/or its underlying bursa. A 22-gauge 3.5-inch needle was inserted in-plane to the transducer and longitudinal to the obturator internus from a lateral to medial direction, an approach previously described in cadavers. The obturator internus tendon sheath and bursa were injected with 2.5 ml of 0.5% lidocaine combined with 10 mg of triamcinolone. The patient reported immediate complete relief of pain with continued relief at 2 and 6 months post-injection. This case report demonstrates an injection of the obturator internus tendon sheath and bursa using a trans-tendinous approach, which may be successful for treatment of patients presenting with persistent gluteal pain from obturator internus tendinitis and bursitis.

Acquired myospherulosis secondary to gluteal augmentation on fine needle aspiration cytology: A diagnostic challenge.

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Alperstein, Susan; Dilcher, Thomas; Viswanathan, Kartik; Rao, Rema A; Siddiqui, Momin T; Giorgadze, Tamara

2018-05-01

A 30-year-old female presented with a three-month history of a multilocular cystic lesion over the lumbosacral spine. Fine-needle aspiration biopsy (FNA) of the lesion was performed at an outside institution, and a cytologic diagnosis, suspicious for chordoma, was rendered. The patient presented for surgical consultation at our institution. Repeat FNA demonstrated an unusual fat-like material. Upon further inquiry, the patient provided a recent history of gluteal contour improvement with fibroadipose tissue implants. A diagnosis of myospherulosis was made with a concurrent surgical pathology correlation. No evidence of chordoma was identified. To date, this is the first reported case of acquired myospherulosis in the context of gluteal contour enhancement and represents an important diagnostic pitfall to consider on cytology preparations. © 2017 Wiley Periodicals, Inc.

Congenital heart disease in adolescents with gluteal muscle contracture.

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You, Tian; Zhang, Xin-tao; Zha, Zhen-gang; Zhang, Wen-tao

2015-02-01

Gluteal muscle contracture (GMC), presented with hip abduction and external rotation when crouching, is common in several ethnicities, particularly in Chinese. It remains unclear that the reasons why these children are weak and have no choice to accept repeated intramuscular injection. Here, we found some unique cases which may be useful to explain this question. We describe a series of special GMC patients, who are accompanied with congenital heart disease (CHD). These cases were first observed in preoperative examinations of a patient with atrial septal defect (ASD), which was proved by chest X-ray and cardiac ultrasound. From then on, we gradually identified additional 3 GMC patients with CHD. The original patient with ASD was sent to cardiosurgery department to repair atrial septal first and received arthroscopic surgery later. While the other 3 were cured postoperative of ventricular septal defect (VSD), tetralogy of fallot (TOF), patent ductus arteriosus (PDA), respectively, and had surgery directly. The study gives us 3 proposals: (1) as to CHD children, it is essential to decrease the use of intramuscular injection, (2) paying more attention to cardiac examination especially cardiac ultrasound in perioperative period, and (3) taking 3D-CT to reconstruct gluteal muscles for observing contracture bands clearly in preoperation. However, more larger series of patients are called for to confirm these findings.

Origem e distribuição do nervo isquiático no veado-catingueiro (Mazama gouazoubira Origin and distribution of the sciatic nerve in catingueiro-deer (Mazama gouazoubira

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Tracy Martina M. Martins

2013-02-01

úteo superficial, gluteobíceps, bíceps da coxa, semitendinoso, semimembranoso, adutor e gastrocnêmio. Distalmente o nervo isquiático bifurca-se Em nervo tibial e fibular comum, os quais inervam a porção distal do membro pélvico.This study aimed to describe the origin and distribution of the sciatic nerve in catingueiro-deer (Mazama gouazoubira. Two animals of the species, obtained post mortem by trampling on the highway, were used for the study meeting the requirements of the Governing Law (1.153/95. By dissection the skin was completely removed and the animals were fixed in aqueous 10% formaldehyde solution. Through dorsolateral access, superficial gluteal muscle, biceps femoris muscle and gluteus medius muscle were cut at their insertion and folded, to view the origin and distribution of the sciatic nerve on both sides of the animals. Images were recorded with a digital camera (Sony a200 Camera, 10.2mpx and results were described based on Veterinary Anatomical Nomina. The source data of the sciatic nerve in both specimens showed that the nerve originates from the ventral branches of S1 and L6, and could have contribution from S2. After its emergence through the greater sciatic foramen on both the sides, the sciatic nerve supplies branches to gluteus medius muscle, gluteus deep muscle, superficial gluteal muscle, gluteobiceps muscle, biceps femoris muscle, semimembranosus muscle, semitendinosus muscle and gastrocnemius muscle. Near the mid-thigh the sciatic nerve divides into the tibial nerve and common peroneal nerve which innervate the muscles of the distal hind limb. Moreover, the cutaneous nerve flow can cause the common peroneal nerve or tibial nerve. In conclusion, in Mazama gouazoubira specimens studied, the sciatic nerve originated from the ventral branch of spinal L6 and S1, which may or may not have the contribution from S2. In its distribution stem originate the gluteal nerve, the caudal femoral cutaneous nerve and muscular branches, which together innervate the

Assessment of nerve regeneration across nerve allografts treated with tacrolimus.

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Haisheng, Han; Songjie, Zuo; Xin, Li

2008-01-01

Although regeneration of nerve allotransplant is a major concern in the clinic, there have been few papers quantitatively assessing functional recovery of animals' nerve allografts in the long term. In this study, functional recovery, histopathological study, and immunohistochemistry changes of rat nerve allograft with FK506 were investigated up to 12 weeks without slaughtering. C57 and SD rats were used for transplantation. The donor's nerve was sliced and transplanted into the recipient. The sciatic nerve was epineurally sutured with 10-0 nylon. In total, 30 models of transplantation were performed and divided into 3 groups that were either treated with FK506 or not. Functional recovery of the grafted nerve was serially assessed by the pin click test, walking track analysis and electrophysiological evaluations. A histopathological study and immunohistochemistry study were done in the all of the models. Nerve allografts treated with FK506 have no immune rejection through 12 weeks. Sensibility had similarly improved in both isografts and allografts. There has been no difference in each graft. Walk track analysis demonstrates significant recovery of motor function of the nerve graft. No histological results of difference were found up to 12 weeks in each graft. In the rodent nerve graft model, FK506 prevented nerve allograft rejection across a major histocompatibility barrier. Sensory recovery seems to be superior to motor function. Nerve isograft and allograft treated with FK506 have no significant difference in function recovery, histopathological result, and immunohistochemistry changes.

Effects of electrical stimulation-induced gluteal versus gluteal and hamstring muscles activation on sitting pressure distribution in persons with a spinal cord injury.

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Smit, C A J; Haverkamp, G L G; de Groot, S; Stolwijk-Swuste, J M; Janssen, T W J

2012-08-01

Ten participants underwent two electrical stimulation (ES) protocols applied using a custom-made electrode garment with built-in electrodes. Interface pressure was measured using a force-sensitive area. In one protocol, both the gluteal and hamstring (g+h) muscles were activated, in the other gluteal (g) muscles only. To study and compare the effects of electrically induced activation of g+h muscles versus g muscles only on sitting pressure distribution in individuals with a spinal cord injury (SCI). Ischial tuberosities interface pressure (ITs pressure) and pressure gradient. In all participants, both protocols of g and g+h ES-induced activation caused a significant decrease in IT pressure. IT pressure after g+h muscles activation was reduced significantly by 34.5% compared with rest pressure, whereas a significant reduction of 10.2% after activation of g muscles only was found. Pressure gradient reduced significantly only after stimulation of g+h muscles (49.3%). g+h muscles activation showed a decrease in pressure relief (Δ IT) over time compared with g muscles only. Both protocols of surface ES-induced of g and g+h activation gave pressure relief from the ITs. Activation of both g+h muscles in SCI resulted in better IT pressure reduction in sitting individuals with a SCI than activation of g muscles only. ES might be a promising method in preventing pressure ulcers (PUs) on the ITs in people with SCI. Further research needs to show which pressure reduction is sufficient in preventing PUs.

Movement anatomy of the gluteal region and thigh of the giant anteater Myrmecophaga tridactyla (Myrmecophagidae: Pilosa

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Priscilla Rosa Queiroz Ribeiro

2016-06-01

Full Text Available Abstract: Locomotion reveals the displacement and behavior manner of the species in their daily needs. According to different needs of the several species, different locomotor patterns are adopted. The shapes and attachment points of muscles are important determinants of the movements performed and consequently, the locomotion and motion patterns of living beings. It was aimed to associate anatomical, kinesiology and biomechanics aspects of the gluteal region and thigh of the giant anteater to its moving characteristics and locomotor habits. It was used three specimens of Myrmecophaga tridactyla, settled in formaldehyde aqueous solution at 10% and subsequently, dissected using usual techniques in gross anatomy. The morphological characteristics of the gluteal region and thigh that influence the patterns of movement and locomotion of animals, were analyzed and discussed in light of literature. All muscles of the gluteal region and thigh of giant anteater show parallel arrangement of the muscular fibers, being flat or fusiform. These muscles are formed in the joint which the interpotent type biolever act. These morphological characteristics indicate a greater predominance of amplitude and movement speed at the expense of strength. On the other hand, features such as osteometric index and the observation of giant anteater motion indicate the opposite, what reflects this animal lack of expertise in locomotor habits and shows the need of future realization of more detailed studies in this subject.

Percutaneous Fascia Release for Treating Chronic Recurrent Gluteal Myofascial Pain—A Pilot Study of a New Technique

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Hsin-Shui Chen

2015-01-01

Full Text Available Objective To investigate the therapeutic effectiveness of percutaneous fascia release to treat chronic recurrent gluteal myofascial pain related to recurrent tendonitis or bursitis at the attachment sites. Methods Five patients (three males, two females; aged 48.6 ± 8.9 years with myofascial trigger points in the gluteus medius muscle were treated. Outcome measures, including pain intensity, pressure pain threshold, and the relative strength of hip abduction, were assessed before, immediately after, and six months after the treatment. The data measured before and after treatment (different times on visual analog scale, pressure pain threshold, and relative hip abduction strength were analyzed by Wilcoxon signed-rank test and paired t -test, respectively, for the comparisons between time points. Results Reduction in pain intensity and increase in the pressure pain threshold and the relative hip abduction strength were found in all five patients after treatment when compared with those of before treatment ( P 0.05. Conclusions Percutaneous fascia release of gluteal muscle insertion sites can be used to treat chronic gluteal pain related to subtrochanteric bursitis to avoid recurrence, if other treatment cannot control the recurrence, although this was demonstrated only on a small sample size without control and blind assessment in the pilot study.

Gluteal fat thickness in pelvic CT

International Nuclear Information System (INIS)

Park, Jeong Mi; Jung, Se Young; Lee, Jae Mun; Park, Seog Hee; Kim, Choon Yul; Bahk, Yong Whee

1986-01-01

Many calcifications due to fat necrosis in the buttocks detected on the pelvis roentgenograms suggest that the majority of injections intended to be intramuscular actually are delivered into fat. We measured thickness of adult gluteal fat to decide whether the injection using needle of usual length is done into fat or muscle. We measured the vertical thickness of the subcutaneous fat at a point of 2-3cm above the femoral head cut slice with randomly collected 116 cases of adults in the department of Radiology, St. Mary's Hospital, Catholic Medical College. We found that 32% female cases might actually receive on intra adipose injection when a needle of maximum 3.8cm length is inserted into the buttock. If deposition into muscle is desirable, we need to choose needle whose length is appropriate for the site of injection and the patient's deposits of fat.

Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity.

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Schreiber, Alberto; Mattavelli, Davide; Ferrari, Marco; Rampinelli, Vittorio; Lancini, Davide; Ravanelli, Marco; Bertazzoni, Giacomo; Rodella, Luigi Fabrizio; Buffoli, Barbara; Doglietto, Francesco; Nicolai, Piero

2017-10-01

Endoscopic medial maxillectomies (EMMs) are used to optimize exposure of the maxillary sinus and retromaxillary areas. Although in type D EMM (Sturmann-Canfield procedure) the anterior superior alveolar nerve (ASAN) is always at risk of injury, only 29% of patients complained of alveolar process and dental anesthesia. The purpose of this anatomical study is to assess the neural anastomotic network of the ASAN (ASAN-NAN) and describe different extensions of type D EMMs in a preclinical setting. The ASAN and its medial anastomotic branches (MABs) and lateral anastomotic branches (LABs) were evaluated by cone-beam computerized tomography (CBCT). Five different extensions of type D (D1 to D5) EMMs were identified and nerves at risk of injury in each type were assessed by CBCT. Moreover, quantification of surgical corridors was performed on cadaver heads with a neuronavigation system. Fifty-seven CBCT scans were analyzed. The ASAN would be spared in 16.3% of cases with a type D1 EMM, while it would be injured in the majority of type D2 to D5 resections. At least 1 nerve of the ASAN-NAN was spared in 96.6%, 93%, 74.6%, 0%, and 65.8% of type D1 to D5 EMMs, respectively. Two cadaver heads were dissected and the incremental volume and number of maxillary subsites exposed was assessed in type D1 to D5 EMMs. ASAN function impairment is probably compensated by LABs and MABs. If this hypothesis will be validated in a prospective study on patients, preoperative CBCT evaluation could predict neurological morbidity after type D EMM, and allow tailoring the procedure to minimize impairment of the ASAN-NAN. © 2017 ARS-AAOA, LLC.

Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration.

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Ho, Bryant; Khan, Zubair; Switaj, Paul J; Ochenjele, George; Fuchs, Daniel; Dahl, William; Cederna, Paul; Kung, Theodore A; Kadakia, Anish R

2014-08-06

Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer. We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer. Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength. The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.

A novel conduit-based coaptation device for primary nerve repair.

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Bamba, Ravinder; Riley, D Colton; Kelm, Nathaniel D; Cardwell, Nancy; Pollins, Alonda C; Afshari, Ashkan; Nguyen, Lyly; Dortch, Richard D; Thayer, Wesley P

2018-06-01

Conduit-based nerve repairs are commonly used for small nerve gaps, whereas primary repair may be performed if there is no tension on nerve endings. We hypothesize that a conduit-based nerve coaptation device will improve nerve repair outcomes by avoiding sutures at the nerve repair site and utilizing the advantages of a conduit-based repair. The left sciatic nerves of female Sprague-Dawley rats were transected and repaired using a novel conduit-based device. The conduit-based device group was compared to a control group of rats that underwent a standard end-to-end microsurgical repair of the sciatic nerve. Animals underwent behavioral assessments at weekly intervals post-operatively using the sciatic functional index (SFI) test. Animals were sacrificed at four weeks to obtain motor axon counts from immunohistochemistry. A sub-group of animals were sacrificed immediately post repair to obtain MRI images. SFI scores were superior in rats which received conduit-based repairs compared to the control group. Motor axon counts distal to the injury in the device group at four weeks were statistically superior to the control group. MRI tractography was used to demonstrate repair of two nerves using the novel conduit device. A conduit-based nerve coaptation device avoids sutures at the nerve repair site and leads to improved outcomes in a rat model. Conduit-based nerve repair devices have the potential to standardize nerve repairs while improving outcomes.

Estudo das relações anatômicas e suas variações entre o nervo ciático e o músculo piriforme Study on anatomical relationships and variations between the sciatic nerve and piriform muscle

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EJD Vicente

2007-06-01

Full Text Available CONTEXTO: A síndrome do músculo piriforme pode ter como causa a passagem anormal do nervo ciático ou de uma de suas partes pelo ventre do músculo piriforme. OBJETIVO: Analisar as relações anatômicas e métricas entre o músculo piriforme e o nervo ciático, contribuindo com o conhecimento anátomo-clínico da região glútea. MÉTODO: Foram utilizados 20 cadáveres adultos de ambos os sexos. O nervo ciático e o músculo piriforme foram dissecados, medidos e fotodocumentados. RESULTADOS: Observou-se que 85% das 40 regiões glúteas apresentaram o nervo como tronco único, passando pela borda inferior do músculo piriforme, e 15% mostraram uma variação bilateral, caracterizada pela passagem do nervo fibular comum através do músculo piriforme. Os dados obtidos não revelaram diferenças estatisticamente significantes.CONTEXT: Piriform muscle syndrome can be caused by abnormal passage of the sciatic nerve or one of its parts through the belly of the piriform muscle. OBJECTIVE: To analyze the anatomical and measurement relationships between the piriform muscle and the sciatic nerve in order to contribute towards better anatomoclinical understanding of the gluteal region. METHOD: Twenty adult cadavers of both sexes were used. The sciatic nerve and piriform muscle were dissected, measured and photodocumented. RESULTS: The sciatic nerve was seen to be a single trunk passing through the lower margin of the piriform muscle in 85% of the 40 gluteal regions, and 15% showed bilateral variation characterized by the passage of the common fibular nerve through the piriform muscle. The data obtained did not show any statistically significant differences.

Diagnostic capability of optic nerve head rim width and retinal nerve fiber thickness in open-angle glaucoma.

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Di Staso, Silvio; Agnifili, Luca; Di Staso, Federico; Climastone, Hilary; Ciancaglini, Marco; Scuderi, Gian Luca

2018-03-01

This study was performed to test the diagnostic capability of the minimum rim width compared to peripapillary retinal nerve fiber layer thickness in patients with glaucoma. A case control, observer masked study, was conducted. Minimum rim width and retinal nerve fiber layer thickness were assessed using the patient-specific axis traced between fovea-to-Bruch's membrane opening center axis. For both minimum rim width and retinal nerve fiber layer thickness, the regionalization in six sectors (nasal, superior-nasal, superior-temporal, temporal, inferior-temporal, and inferior-nasal) was analyzed. Eyes with at least one sector with value below the 5% or 1% normative limit of the optical coherence tomography normative database were classified as glaucomatous. The area under the receiver operator characteristic curve, the accuracy, sensitivity, specificity, and predictive positive and negative values were calculated for both minimum rim width and retinal nerve fiber layer thickness. A total of 118 eyes of 118 Caucasian subjects (80 eyes with open-angle glaucoma and 38 control eyes) were enrolled in the study. Accuracy, sensitivity, and specificity were 79.7%, 77.5%, and 84.2%, respectively, for minimum rim width and 84.7%, 82.5%, and 89.5% for retinal nerve fiber layer thickness. The positive predictive values were 0.91% and 0.94% for minimum rim width and retinal nerve fiber layer thickness, respectively, whereas the negative predictive values were 0.64% and 0.70%. The area under the receiver operator characteristic curve was 0.892 for minimum rim width and 0.938 for retinal nerve fiber layer thickness. Our results indicated that the sector analysis based on Bruch's membrane opening and fovea to disk alignment is able to detect glaucomatous defects, and that Bruch's membrane opening minimum rim width and retinal nerve fiber layer thickness showed equivalent diagnostic ability.

Neurological complications in thyroid surgery: a surgical point of view on laryngeal nerves.

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EMANUELA eVARALDO

2014-07-01

Full Text Available The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified,the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a

Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness.

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Guzman, Marco; Rubin, Adam; Cox, Paul; Landini, Fernando; Jackson-Menaldi, Cristina

2014-03-01

In this retrospective case study, we report the apparent clinical effectiveness of neuromuscular electrical stimulation (NMES) in combination with voice therapy (VT) for rehabilitating dysphonia secondary to suspected superior laryngeal nerve (SLN) weakness in two female patients. Both patients failed or plateaued with traditional VT but had significant improvement with the addition of NMES of the cricothyroid muscle and SLN using a VitalStim unit. Stimulation was provided simultaneously with voice exercises based on musical phonatory tasks. Both acoustic analysis and endoscopic evaluation demonstrated important improvements after treatment. In the first patient, the major change was obtained within the primo passaggio region; specifically, a decrease in voice breaks was demonstrated. In the second patient, an improvement in voice quality (less breathiness) and vocal range were the most important findings. Additionally, each patient reported a significant improvement in their voice complaints. Neuromuscular laryngeal electrical stimulation in combination with vocal exercises might be a useful tool to improve voice quality in patients with SLN injury. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.

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Balik, Emre; Eren, Tunc; Bulut, Türker; Büyükuncu, Yilmaz; Bugra, Dursun; Yamaner, Sümer

2009-03-01

Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed. Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks. Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic

An update-tissue engineered nerve grafts for the repair of peripheral nerve injuries.

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Patel, Nitesh P; Lyon, Kristopher A; Huang, Jason H

2018-05-01

Peripheral nerve injuries (PNI) are caused by a range of etiologies and result in a broad spectrum of disability. While nerve autografts are the current gold standard for the reconstruction of extensive nerve damage, the limited supply of autologous nerve and complications associated with harvesting nerve from a second surgical site has driven groups from multiple disciplines, including biomedical engineering, neurosurgery, plastic surgery, and orthopedic surgery, to develop a suitable or superior alternative to autografting. Over the last couple of decades, various types of scaffolds, such as acellular nerve grafts (ANGs), nerve guidance conduits, and non-nervous tissues, have been filled with Schwann cells, stem cells, and/or neurotrophic factors to develop tissue engineered nerve grafts (TENGs). Although these have shown promising effects on peripheral nerve regeneration in experimental models, the autograft has remained the gold standard for large nerve gaps. This review provides a discussion of recent advances in the development of TENGs and their efficacy in experimental models. Specifically, TENGs have been enhanced via incorporation of genetically engineered cells, methods to improve stem cell survival and differentiation, optimized delivery of neurotrophic factors via drug delivery systems (DDS), co-administration of platelet-rich plasma (PRP), and pretreatment with chondroitinase ABC (Ch-ABC). Other notable advancements include conduits that have been bioengineered to mimic native nerve structure via cell-derived extracellular matrix (ECM) deposition, and the development of transplantable living nervous tissue constructs from rat and human dorsal root ganglia (DRG) neurons. Grafts composed of non-nervous tissues, such as vein, artery, and muscle, will be briefly discussed.

After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study.

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Choi, D; Raisman, G

2004-02-01

After facial nerve trauma, aberrant regeneration is associated with synkinesis. Animal models of mechanical nerve guides or reparative cell transplants at the site of a lesion have not been shown to improve disorganized regeneration. We examined whether this is because regenerating axons become disorganized throughout the length of the nerve and not only at the site of the lesion. In rats (n = 12), retrograde fluorescent tracer techniques were used to establish that most of the temporal branch fibres were carried in the superior half of the facial nerve trunk. In two further groups of rats (n = 24) a complete proximal facial nerve lesion was made, and the nerve immediately repaired by suture. After 4 weeks, at a second operation, the superior half of the facial nerve trunk was cut, either proximal or distal to the original lesion, and retrograde tracers were applied to distal branches of the nerve. It was possible to localize the points at which regenerating fibres became aberrant in their course by studying the number of labelled motoneurons in the facial nucleus after application of the tracer to the temporal branch of the nerve: this was similar in the distal and proximal hemisection groups, suggesting that aberrant axonal development occurred throughout the length of the nerve. Future strategies aimed at improving the organization of regeneration need to provide guidance cues not only at the site of the lesion as previously thought, but also throughout the length of the nerve.

Morphology of the lumbosacral plexus of the ocelot (Leopardus pardalis

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Jessica Albuquerque Lopes

2012-11-01

Full Text Available Popularly known as the ocelot, Leopardus pardalis occurs throughout Brazil in all ecosystems, but prefers riparian regions and forests. The objective of this study was to learn more about the macroscopic, anatomical aspects of the plexus lumbossacral of this species. Three specimens were studied, two males and one female, from the region near the Bauxite Mine in Paragominas, PA. The specimens were donated to the Laboratório de Pesquisa Morfológica Animal (LaPMA at UFRA after being run over (authorization numbers 485/2009 and 522/2009. The animals were fixed in an aqueous solution of 10% formaldehyde and then the hind limb was dissected by removing some muscles to expose the nerves. In two animals, the femoral nerve originated in the fourth lumbar nerve (L4 and transformed into the saphenous nerve. The obturator nerve and sciatic nerve originated in the last lumbar nerve (L5, and the latter was divided into branches that formed the tibial and common peroneal nerves, which dorsally formed the cranial gluteal and caudal gluteal nerves.

Histopathology of cryoballoon ablation-induced phrenic nerve injury.

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Andrade, Jason G; Dubuc, Marc; Ferreira, Jose; Guerra, Peter G; Landry, Evelyn; Coulombe, Nicolas; Rivard, Lena; Macle, Laurent; Thibault, Bernard; Talajic, Mario; Roy, Denis; Khairy, Paul

2014-02-01

Hemi-diaphragmatic paralysis is the most common complication associated with cryoballoon ablation for atrial fibrillation, yet the histopathology of phrenic nerve injury has not been well described. A preclinical randomized study was conducted to characterize the histopathology of phrenic nerve injury induced by cryoballoon ablation and assess the potential for electromyographic (EMG) monitoring to limit phrenic nerve damage. Thirty-two dogs underwent cryoballoon ablation of the right superior pulmonary vein with the objective of inducing phrenic nerve injury. Animals were randomized 1:1 to standard monitoring (i.e., interruption of ablation upon reduction in diaphragmatic motion) versus EMG guidance (i.e., cessation of ablation upon a 30% reduction in the diaphragmatic compound motor action potential [CMAP] amplitude). The acute procedural endpoint was achieved in all dogs. Phrenic nerve injury was characterized by Wallerian degeneration, with subperineural injury to large myelinated axons and evidence of axonal regeneration. The degree of phrenic nerve injury paralleled the reduction in CMAP amplitude (P = 0.007). Animals randomized to EMG guidance had a lower incidence of acute hemi-diaphragmatic paralysis (50% vs 100%; P = 0.001), persistent paralysis at 30 days (21% vs 75%; multivariate odds ratio 0.12, 95% confidence interval [0.02, 0.69], P = 0.017), and a lesser severity of histologic injury (P = 0.001). Mature pulmonary vein ablation lesion characteristics, including circumferentiality and transmurality, were similar in both groups. Phrenic nerve injury induced by cryoballoon ablation is axonal in nature and characterized by Wallerian degeneration, with potential for recovery. An EMG-guided approach is superior to standard monitoring in limiting phrenic nerve damage. © 2013 Wiley Periodicals, Inc.

Microsurgical anatomy of the abducens nerve.

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Joo, Wonil; Yoshioka, Fumitaka; Funaki, Takeshi; Rhoton, Albert L

2012-11-01

The aim of this study is to demonstrate and review the detailed microsurgical anatomy of the abducens nerve and surrounding structures along its entire course and to provide its topographic measurements. Ten cadaveric heads were examined using ×3 to ×40 magnification after the arteries and veins were injected with colored silicone. Both sides of each cadaveric head were dissected using different skull base approaches to demonstrate the entire course of the abducens nerve from the pontomedullary sulcus to the lateral rectus muscle. The anatomy of the petroclival area and the cavernous sinus through which the abducens nerve passes are complex due to the high density of critically important neural and vascular structures. The abducens nerve has angulations and fixation points along its course that put the nerve at risk in many clinical situations. From a surgical viewpoint, the petrous tubercle of the petrous apex is an intraoperative landmark to avoid damage to the abducens nerve. The abducens nerve is quite different from the other nerves. No other cranial nerve has a long intradural path with angulations and fixations such as the abducens nerve in petroclival venous confluence. A precise knowledge of the relationship between the abducens nerve and surrounding structures has allowed neurosurgeon to approach the clivus, petroclival area, cavernous sinus, and superior orbital fissure without surgical complications. Copyright © 2012 Wiley Periodicals, Inc.

Gluteal Hydatid Cyst: Report of a Case from Iran

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Behzad NEMATI HONA

2017-06-01

Full Text Available Hydatid cyst involves both hard and soft tissues even without the evidence of the disease in liver or lungs; however, this manifestation is very rare, particularly in musculoskeletal regions. The current report describes a case with primary diagnose of cystic gluteal swelling leading to diagnose of hydatid cyst after surgical exploration in an 80-yr-old woman the Surgical Outpatient Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. During surgery, the cavity was washed by silver nitrate and the cyst content was appropriately evacuated. The patient had completed a   short course of albendazole postoperatively. Early postoperative complications were not appeared. The patient was followed for 6 months with no evidence of recurrence or complications. 

Imaging of neuropathies about the hip

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Martinoli, Carlo, E-mail: carlo.martinoli@unige.it [Radiologia – DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Miguel-Perez, Maribel [Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapy, Faculty of Medicine (C Bellvitge), University of Barcelona, Barcelona (Spain); Padua, Luca [Fondazione Don Gnocchi Onlus and Department of Neurology, Policlinico “A. Gemelli”, Università Cattolica del Sacro Cuore, Rome (Italy); Gandolfo, Nicola [IM2S – Institut Monégasque de Médecine and Chirurgie Sportive, Montecarlo (Monaco); Zicca, Anna [Radiologia – DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Tagliafico, Alberto [Radiologia – National Institute for Cancer Research, Genoa (Italy)

2013-01-15

Neuropathies about the hip may be cause of chronic pain and disability. In most cases, these conditions derive from mechanical or dynamic compression of a segment of a nerve within a narrow osteofibrous tunnel, an opening in a fibrous structure, or a passageway close to a ligament or a muscle. Although the evaluation of nerve disorders primarily relies on neurological examination and electrophysiology, diagnostic imaging is currently used as a complement to help define the site and aetiology of nerve compression and exclude other disease possibly underlying the patient’ symptoms. Diagnosis of entrapment neuropathies about the hip with US and MR imaging requires an in-depth knowledge of the normal imaging anatomy and awareness of the anatomic and pathologic factors that may predispose or cause a nerve injury. Accordingly, the aim of this article is to provide a comprehensive review of hip neuropathies with an emphasis on the relevant anatomy, aetiology, clinical presentation, and their imaging appearance. The lateral femoral cutaneous neuropathy (meiralgia paresthetica), femoral neuropathy, sciatic neuropathy, obturator neuropathy, superior and inferior gluteal neuropathies and pudendal neuropathy will be discussed.

High-Frequency Electrical Modulation of the Superior Ovarian Nerve as a Treatment of Polycystic Ovary Syndrome in the Rat.

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Pikov, Victor; Sridhar, Arun; Lara, Hernan E

2018-01-01

The polycystic ovary syndrome (PCOS) is the most prevalent ovarian pathology in women, with excessive sympathetic activity in the superior ovarian nerve (SON) playing an important role in inducing the PCOS symptoms in the rats and humans. Our previous studies have shown that surgical transection of the SON can reverse the disease progression, prompting us to explore the effect of the kilohertz frequency alternating current (KHFAC) modulation as a method of reversible non-surgical suppression of the nerve activity in the rodent model of PCOS. 56 animals were randomly allocated to three groups: the Control group ( n = 18), the PCOS group ( n = 15), and the PCOS + KHFAC group ( n = 23). The physiological, anatomical, and biochemical parameters of ovarian function were evaluated during the progression of the experimentally-induced PCOS and during long-term KHFAC modulation applied for 2-3 weeks. The KHFAC modulation has been able to reverse the pathological changes in assessed PCOS parameters, namely the irregular or absent estrous cycling, formation of ovarian cysts, reduction in the number of corpora lutea, and ovarian norepinephrine concentration. The fertility capacity was similar in the PCOS and the PCOS + KHFAC groups, indicating the safety of KHFAC modulation approach. In summary, these results suggest that the KHFAC modulation approach of suppressing the SON activity could become a useful treatment modality for PCOS and potentially other pathological ovarian conditions.

High-Frequency Electrical Modulation of the Superior Ovarian Nerve as a Treatment of Polycystic Ovary Syndrome in the Rat

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Victor Pikov

2018-05-01

Full Text Available The polycystic ovary syndrome (PCOS is the most prevalent ovarian pathology in women, with excessive sympathetic activity in the superior ovarian nerve (SON playing an important role in inducing the PCOS symptoms in the rats and humans. Our previous studies have shown that surgical transection of the SON can reverse the disease progression, prompting us to explore the effect of the kilohertz frequency alternating current (KHFAC modulation as a method of reversible non-surgical suppression of the nerve activity in the rodent model of PCOS. 56 animals were randomly allocated to three groups: the Control group (n = 18, the PCOS group (n = 15, and the PCOS + KHFAC group (n = 23. The physiological, anatomical, and biochemical parameters of ovarian function were evaluated during the progression of the experimentally-induced PCOS and during long-term KHFAC modulation applied for 2–3 weeks. The KHFAC modulation has been able to reverse the pathological changes in assessed PCOS parameters, namely the irregular or absent estrous cycling, formation of ovarian cysts, reduction in the number of corpora lutea, and ovarian norepinephrine concentration. The fertility capacity was similar in the PCOS and the PCOS + KHFAC groups, indicating the safety of KHFAC modulation approach. In summary, these results suggest that the KHFAC modulation approach of suppressing the SON activity could become a useful treatment modality for PCOS and potentially other pathological ovarian conditions.

Organization of the auditory brainstem in a lizard, Gekko gecko. I. Auditory nerve, cochlear nuclei, and superior olivary nuclei.

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Tang, Yezhong; Christensen-Dalsgaard, Jakob; Carr, Catherine E

2012-06-01

We used tract tracing to reveal the connections of the auditory brainstem in the Tokay gecko (Gekko gecko). The auditory nerve has two divisions, a rostroventrally directed projection of mid- to high best-frequency fibers to the nucleus angularis (NA) and a more dorsal and caudal projection of low to middle best-frequency fibers that bifurcate to project to both the NA and the nucleus magnocellularis (NM). The projection to NM formed large somatic terminals and bouton terminals. NM projected bilaterally to the second-order nucleus laminaris (NL), such that the ipsilateral projection innervated the dorsal NL neuropil, whereas the contralateral projection crossed the midline and innervated the ventral dendrites of NL neurons. Neurons in NL were generally bitufted, with dorsoventrally oriented dendrites. NL projected to the contralateral torus semicircularis and to the contralateral ventral superior olive (SOv). NA projected to ipsilateral dorsal superior olive (SOd), sent a major projection to the contralateral SOv, and projected to torus semicircularis. The SOd projected to the contralateral SOv, which projected back to the ipsilateral NM, NL, and NA. These results suggest homologous patterns of auditory connections in lizards and archosaurs but also different processing of low- and high-frequency information in the brainstem. Copyright © 2011 Wiley Periodicals, Inc.

Nerve canals at the fundus of the internal auditory canal on high-resolution temporal bone CT

International Nuclear Information System (INIS)

Ji, Yoon Ha; Youn, Eun Kyung; Kim, Seung Chul

2001-01-01

To identify and evaluate the normal anatomy of nerve canals in the fundus of the internal auditory canal which can be visualized on high-resolution temporal bone CT. We retrospectively reviewed high-resolution (1 mm thickness and interval contiguous scan) temporal bone CT images of 253 ears in 150 patients who had not suffered trauma or undergone surgery. Those with a history of uncomplicated inflammatory disease were included, but those with symptoms of vertigo, sensorineural hearing loss, or facial nerve palsy were excluded. Three radiologists determined the detectability and location of canals for the labyrinthine segment of the facial, superior vestibular and cochlear nerve, and the saccular branch and posterior ampullary nerve of the inferior vestibular nerve. Five bony canals in the fundus of the internal auditory canal were identified as nerve canals. Four canals were identified on axial CT images in 100% of cases; the so-called singular canal was identified in only 68%. On coronal CT images, canals for the labyrinthine segment of the facial and superior vestibular nerve were seen in 100% of cases, but those for the cochlear nerve, the saccular branch of the inferior vestibular nerve, and the singular canal were seen in 90.1%, 87.4% and 78% of cases, respectiveIy. In all detectable cases, the canal for the labyrinthine segment of the facial nerve was revealed as one which traversed anterolateralIy, from the anterosuperior portion of the fundus of the internal auditory canal. The canal for the cochlear nerve was located just below that for the labyrinthine segment of the facial nerve, while that canal for the superior vestibular nerve was seen at the posterior aspect of these two canals. The canal for the saccular branch of the inferior vestibular nerve was located just below the canal for the superior vestibular nerve, and that for the posterior ampullary nerve, the so-called singular canal, ran laterally or posteolateralIy from the posteroinferior aspect of

Nerve canals at the fundus of the internal auditory canal on high-resolution temporal bone CT

Energy Technology Data Exchange (ETDEWEB)

Ji, Yoon Ha; Youn, Eun Kyung; Kim, Seung Chul [Sungkyunkwan Univ., School of Medicine, Seoul (Korea, Republic of)

2001-12-01

To identify and evaluate the normal anatomy of nerve canals in the fundus of the internal auditory canal which can be visualized on high-resolution temporal bone CT. We retrospectively reviewed high-resolution (1 mm thickness and interval contiguous scan) temporal bone CT images of 253 ears in 150 patients who had not suffered trauma or undergone surgery. Those with a history of uncomplicated inflammatory disease were included, but those with symptoms of vertigo, sensorineural hearing loss, or facial nerve palsy were excluded. Three radiologists determined the detectability and location of canals for the labyrinthine segment of the facial, superior vestibular and cochlear nerve, and the saccular branch and posterior ampullary nerve of the inferior vestibular nerve. Five bony canals in the fundus of the internal auditory canal were identified as nerve canals. Four canals were identified on axial CT images in 100% of cases; the so-called singular canal was identified in only 68%. On coronal CT images, canals for the labyrinthine segment of the facial and superior vestibular nerve were seen in 100% of cases, but those for the cochlear nerve, the saccular branch of the inferior vestibular nerve, and the singular canal were seen in 90.1%, 87.4% and 78% of cases, respectiveIy. In all detectable cases, the canal for the labyrinthine segment of the facial nerve was revealed as one which traversed anterolateralIy, from the anterosuperior portion of the fundus of the internal auditory canal. The canal for the cochlear nerve was located just below that for the labyrinthine segment of the facial nerve, while that canal for the superior vestibular nerve was seen at the posterior aspect of these two canals. The canal for the saccular branch of the inferior vestibular nerve was located just below the canal for the superior vestibular nerve, and that for the posterior ampullary nerve, the so-called singular canal, ran laterally or posteolateralIy from the posteroinferior aspect of

Experimental study of vascularized nerve graft: evaluation of nerve regeneration using choline acetyltransferase activity.

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Iwai, M; Tamai, S; Yajima, H; Kawanishi, K

2001-01-01

A comparative study of nerve regeneration was performed on vascularized nerve graft (VNG) and free nerve graft (FNG) in Fischer strain rats. A segment of the sciatic nerve with vascular pedicle of the femoral artery and vein was harvested from syngeneic donor rat for the VNG group and the sciatic nerve in the same length without vascular pedicle was harvested for the FNG group. They were transplanted to a nerve defect in the sciatic nerve of syngeneic recipient rats. At 2, 4, 6, 8, 12, 16, and 24 weeks after operation, the sciatic nerves were biopsied and processed for evaluation of choline acetyltransferase (CAT) activity, histological studies, and measurement of wet weight of the muscle innervated by the sciatic nerve. Electrophysiological evaluation of the grafted nerve was also performed before sacrifice. The average CAT activity in the distal to the distal suture site was 383 cpm in VNG and 361 cpm in FNG at 2 weeks; 6,189 cpm in VNG and 2,264 cpm in FNG at 4 weeks; and 11,299 cpm in VNG and 9,424 cpm in FNG at 6 weeks postoperatively. The value of the VNG group was statistically higher than that of the FNG group at 4 weeks postoperatively. Electrophysiological and histological findings also suggested that nerve regeneration in the VNG group was superior to that in the FNG group during the same period. However, there was no significant difference between the two groups after 6 weeks postoperatively in any of the evaluations. The CAT measurement was useful in the experiments, because it was highly sensitive and reproducible. Copyright 2001 Wiley-Liss, Inc.

Surgical management of third nerve palsy

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Anupam Singh

2016-01-01

Full Text Available Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell′s phenomenon, superior oblique (SO overaction, and lateral rectus (LR contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%, trauma (20%, inflammation (13%, aneurysm (7%, and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension, aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles.

Surgical management of third nerve palsy

Science.gov (United States)

Singh, Anupam; Bahuguna, Chirag; Nagpal, Ritu; Kumar, Barun

2016-01-01

Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles. PMID:27433033

Clinical anatomy of the superior cluneal nerve in relation to easily ...

African Journals Online (AJOL)

The diagnostic criteria for SCN entrapment include anaesthesia of the area supplied by the SCN ... (PSIS) to the SCN and from the midline lumbar spinous processes to the nerve. ... The most widely accepted and first-line treatment for SCN.

Iliopsoas and Gluteal Muscles Are Asymmetric in Tennis Players but Not in Soccer Players

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Sanchis-Moysi, Joaquin; Idoate, Fernando; Izquierdo, Mikel; Calbet, Jose A. L.; Dorado, Cecilia

2011-01-01

Purpose To determine the volume and degree of asymmetry of iliopsoas (IL) and gluteal muscles (GL) in tennis and soccer players. Methods IL and GL volumes were determined using magnetic resonance imaging (MRI) in male professional tennis (TP) and soccer players (SP), and in non-active control subjects (CG) (n = 8, 15 and 6, respectively). Results The dominant and non-dominant IL were hypertrophied in TP (24 and 36%, respectively, Psoccer players had similar volumes in both sides (P = 0.87). The degree of side-to-side asymmetry decreased linearly from the first lumbar disc to the pubic symphysis in TP (r = −0.97, PSoccer and CG had similar GL volumes in both sides (P = 0.11 and P = 0.19, for the dominant and contralateral GL, respectively). GL was asymmetrically hypertrophied in TP. The non-dominant GL volume was 20% greater in TP than in CG (Psoccer is associated to a symmetric hypertrophy of IL. Gluteal muscles are asymmetrically hypertrophied in TP, while SP display a similar size to that observed in controls. It remains to be determined whether the different patterns of IL and GL hypertrophy may influence the risk of injury. PMID:21829539

Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

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Bareka, Metaxia; Hantes, Michael; Arnaoutoglou, Eleni; Vretzakis, George

2018-02-01

The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. I.

臀下动脉穿支蒂复合组织瓣修复骶尾部巨大褥疮的解剖与临床应用%Anatomy study and clinical applications of complex tissue flap pedicled with inferior gluteal artery perforator for repairing giant sacrococcygeal pressure sore

Institute of Scientific and Technical Information of China (English)

谢昀; 林建华; 叶君健; 郑和平

2014-01-01

Objective To discuss the technical feasibility and clinical effectiveness of using complex tissue flap pedicled with inferior gluteal artery perforator for repair giant sacrococcygeal pressure sore.Methods Thirty embalmed lower limbs of adult cadavers perfused with red latex were used for anatomical study,and the followings were observed:①The course,branche and distribution of gluteal artery.②The course and distribution of the posterior femoral cutaneous nerve.③Anastomosis between the posterior cutaneous branch of gluteal artery and nutrient vessels of the posterior femoral cutaneous nerve.8 cases aging from 17 years to 56 years were completed during May 2007 to July 2013,6 cases were males and 2 cases were females.The sizes of pressure sore with the depth to Ⅳ degree were ranged from 16 cm × 9 cm to 22 cm × 10 cm.The sizes of flaps were harvested from 32 cm × 10 cm to 25 cm × 9 cm.Results The gluteal artery crossed the edge of the piriformis,the main stem was (3.1 ± 0.4) mm in diameter and gave out 2-5 muscular branches to supply the gluteus maximus.The posterior femoral cutaneous nerve crossed the edge of gluteus maximus and descended between biceps femoris and semitendinosus.Perforating deep fascia point located was (5.9 ± 0.8) cm above the line between medial and lateral femoral epicondyle.The constant anastomosis were formed by the posterior cutaneous branch of gluteal artery,the obturator artery perforator and the direct popliteal artery perforator around the posterior femoral cutaneous nerve.The complex flap survived successfully in all patients.Sutures were removed at 14 days postoperatively and the wounds healed well.All supplied areas were closed by directly suturing.Recurrent sacrococcygeal pressure sore was not observed in all cases with satisfied appearance and normal color during the outpatient follow-up period from 5 months to 5 years.Conclusion The united flap of gluteal myocutaneous flap and the posterior femoral cutaneous

Non-small-cell lung cancer: unusual presentation in the gluteal muscle.

LENUS (Irish Health Repository)

Al-Alao, Bassel Suffian

2011-05-01

Lung cancer is one of the most commonly diagnosed cancers in both men and women worldwide. It is also one of the most common forms of cancer in Ireland, accounting for about 20% of all deaths from cancer each year. Early detection of lung cancer is infrequent, and most cases are not diagnosed and treated until they are at an advanced stage. Distant metastases in lung cancer commonly involve the adrenal glands, liver, bones, and central nervous system; they are only rarely seen in the skeletal system. We report a rare case of metastasis to the gluteal muscle as the initial presentation of lung cancer.

Optic Nerve Injury in a Patient with Chronic Allergic Conjunctivitis

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Ribhi Hazin

2014-01-01

Full Text Available Manipulation of the optic nerve can lead to irreversible vision changes. We present a patient with a past medical history of skin allergy and allergic conjunctivitis (AC who presented with insidious unexplained unilateral vision loss. Physical exam revealed significant blepharospasm, mild lid edema, bulbar conjunctival hyperemia, afferent pupillary defect, and slight papillary hypertrophy. Slit lamp examination demonstrated superior and inferior conjunctival scarring as well as superior corneal scarring but no signs of external trauma or neurological damage were noted. Conjunctival cultures and cytologic evaluation demonstrated significant eosinophilic infiltration. Subsequent ophthalmoscopic examination revealed optic nerve atrophy. Upon further questioning, the patient admitted to vigorous itching of the affected eye for many months. Given the presenting symptoms, history, and negative ophthalmological workup, it was determined that the optic nerve atrophy was likely secondary to digital pressure from vigorous itching. Although AC can be a significant source of decreased vision via corneal ulceration, no reported cases have ever described AC-induced vision loss of this degree from vigorous itching and chronic pressure leading to optic nerve damage. Despite being self-limiting in nature, allergic conjunctivitis should be properly managed as extreme cases can result in mechanical compression of the optic nerve and compromise vision.

Combined Ipsilateral Oculomotor Nerve Palsy and Contralateral Downbeat Nystagmus in a Case of Cerebral Infarction

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Kosuke Matsuzono

2014-04-01

Full Text Available We report a patient with acute cerebral infarction of the left paramedian thalamus, upper mesencephalon and cerebellum who exhibited ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus. The site of the infarction was considered to be the paramedian thalamopeduncular and cerebellar regions, which are supplied by the superior cerebellar artery containing direct perforating branches or both the superior cerebellar artery and the superior mesencephalic and posterior thalamosubthalamic arteries. Contralateral and monocular downbeat nystagmus is very rare. Our case suggests that the present downbeat nystagmus was due to dysfunction of cerebellar-modulated crossed oculovestibular fibers of the superior cerebellar peduncle or bilateral downbeat nystagmus with one-sided oculomotor nerve palsy.

Asymmetry of Peak Thicknesses between the Superior and Inferior Retinal Nerve Fiber Layers for Early Glaucoma Detection: A Simple Screening Method.

Science.gov (United States)

Bae, Hyoung Won; Lee, Sang Yeop; Kim, Sangah; Park, Chan Keum; Lee, Kwanghyun; Kim, Chan Yun; Seong, Gong Je

2018-01-01

To assess whether the asymmetry in the peripapillary retinal nerve fiber layer (pRNFL) thickness between superior and inferior hemispheres on optical coherence tomography (OCT) is useful for early detection of glaucoma. The patient population consisted of Training set (a total of 60 subjects with early glaucoma and 59 normal subjects) and Validation set (30 subjects with early glaucoma and 30 normal subjects). Two kinds of ratios were employed to measure the asymmetry between the superior and inferior pRNFL thickness using OCT. One was the ratio of the superior to inferior peak thicknesses (peak pRNFL thickness ratio; PTR), and the other was the ratio of the superior to inferior average thickness (average pRNFL thickness ratio; ATR). The diagnostic abilities of the PTR and ATR were compared to the color code classification in OCT. Using the optimal cut-off values of the PTR and ATR obtained from the Training set, the two ratios were independently validated for diagnostic capability. For the Training set, the sensitivities/specificities of the PTR, ATR, quadrants color code classification, and clock-hour color code classification were 81.7%/93.2%, 71.7%/74.6%, 75.0%/93.2%, and 75.0%/79.7%, respectively. The PTR showed a better diagnostic performance for early glaucoma detection than the ATR and the clock-hour color code classification in terms of areas under the receiver operating characteristic curves (AUCs) (0.898, 0.765, and 0.773, respectively). For the Validation set, the PTR also showed the best sensitivity and AUC. The PTR is a simple method with considerable diagnostic ability for early glaucoma detection. It can, therefore, be widely used as a new screening method for early glaucoma. © Copyright: Yonsei University College of Medicine 2018

Brief reports: ultrasound-guided obturator nerve block: a proximal interfascial technique.

Science.gov (United States)

Taha, Ahmad Muhammad

2012-01-01

In this report, I describe and evaluate a proximal ultrasound (US)-guided obturator nerve block technique using an interfascial local anesthetic (LA) injection deep to the pectineus muscle. The pectineus muscle was identified and followed, while the US probe was tilted cranially until the superior pubic ramus was visualized. In this plane, LA was injected interfascially between the pectineus and obturator externus. The median time required to identify the injection site was 4 seconds (95% confidence interval, 3-5 seconds). The median motor block onset was 4 minutes (95% confidence interval, 3-5 minutes). Both obturator nerve branches were blocked successfully in all patients (100%). The US-guided obturator nerve block using interfascial LA injection inferior to the superior pubic ramus, between the pectineus and obturator externus muscles, was shown to be a simple and successful technique.

Ultrasound of the lateral femoral cutaneous nerve in asymptomatic adults

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Zhu Jiaan

2012-11-01

Full Text Available Abstract Background To define the sites where the lateral femoral cutaneous nerve (LFCN is more easily visualized and to describe the anatomical variations of the LFCN. Methods A total of 240 LFCNs in 120 volunteers were evaluated with 18 MHz ultrasound; the intermuscular space between the tensor fasciae latae muscle and the sartorius was used as an initial sonographic landmark. The time taken to identify the nerve was recorded. The number of nerve branches at the level of the inguinal ligament (IL and the relationship between the LFCN and the IL was assessed. The nerve cross-sectional area (CSA of the LFCN and the distance between the LFCN and the anterior superior iliac spine was measured. Results Each nerve was identified using ultrasound in all participants. The mean time for identifying the nerve was 7s for unilateral LFCNs. The nerve passed under the IL in 198 cases, whereas in 44 cases, it passed through to the IL. The LFCN consisted of 1–4 branches just after its passage under or through the IL. The CSA of the LFCN was 1.04±0.44 mm2, and the mean distance between the LFCN and the anterior superior iliac spine was 15.6 ± 4.2 mm. Conclusions It is easier to identify the LFCN if the intermuscular space between the tensor fasciae latae muscle and the sartorius is used as an initial sonographic landmark. The anatomical variation of the LFCN can be viewed with high-frequency ultrasound.

Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve.

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Prades, J M; Gavid, M; Asanau, A; Timoshenko, A P; Richard, C; Martin, C H

2014-03-01

The purpose of the study was to determine the relationships between the extracranial glossopharyngeal (IX) nerve and the muscles of the styloid diaphragm. In humans, the IX nerve is a hidden retrostyloid nerve which plays a critical role notably in swallowing and has to be preserved during infratemporal fossa and parapharyngeal spaces surgical procedures. In ten adult heads from cadavers (20 sides) fixed in formalin, dissection of the extracranial IX nerve was performed under operating microscope with special attention given to the relationships between this nerve and the styloid muscles of the styloid diaphragm. The three styloid muscles delimit three triangular intermuscular intervals which were each thoroughly explored. Different osseous landmarks were investigated for easy nerve location. The styloid process (SP) is the main superior osseous landmark for the three muscles of the styloid diaphragm. The stylohyoid muscle (SHM) is anteromedially located to the posterior belly of the digastric muscle. The styloglossus muscle (SGM) is medial and anterior to the SHM. The stylopharyngeal muscle (SPM) is the most vertical and medial of the three styloid muscles. It courses from the medial surface of the SP in a deep plane hidden between the SHM and the SGM. The extracranial IX nerve turns around the SPM superiorly with a vertical segment posterior to the SPM and inferiorly with a horizontal segment lateral to the SPM. The meeting point of the two segments of the IX nerve is about 10 mm anteriorly located from the transverse process of the atlas. The external carotid artery and some of its branches lie in contact with the lateral side of the IX nerve. Such relationships between the extracranial IX nerve, the styloid muscles and the transverse process of the atlas should be appreciated by clinician who treats patients with stylohyoid complex syndromes and by the surgeon for the parapharyngeal spaces approach.

Electrical stimulation-induced Gluteal and Hamstring muscle activation can reduce sitting pressure in individuals with a spinal cord injury

NARCIS (Netherlands)

Janssen, T. W J; De Koning, A.; Legemate, K. J A; Smit, C. A J

2010-01-01

Individuals with spinal cord injury (SCI) are at high risk of developing pressure sores, in part due to high sitting pressures under the buttocks. PURPOSE: To evaluate the effect of ES-induced activation of the gluteal and hamstring muscles on the sitting pressure in individuals with SCI. METHODS:

An artery accompanying the sciatic nerve (arteria comitans nervi ischiadici) and the position of the hip joint: a comparative histological study using chick, mouse, and human foetal specimens.

Science.gov (United States)

Ishizawa, A; Hayashi, S; Nasu, H; Abe, H; Rodríguez-Vázquez, J F; Murakami, G

2013-02-01

Birds and reptiles always carry a long and thick artery accompanying the sciatic nerve (i.e., the sciatic artery), whereas mammals do not. We attempted to demonstrate a difference in courses of the nerve and artery in fetuses in relation with the hip joint posture. Eight mid-term human fetuses (15-18 weeks), five mouse fetuses (E18) and five chick embryos (11 days after incubation) were examined histologically. Thin feeding arteries in the sciatic nerve were consistently observed in human fetuses in spite of the long, inferiorly curved course of the nerve around the ischium. The tissue around the human sciatic nerve was not so tight because of the medial and inferior shift of the nerve away from the hip joint. The fetal hip joint position differed among the species, being highly flexed in humans and almost at right angle flexion in mice and chicks. Because of deep adduction of the hip joint in the mouse, the knee was located near the midline of the body. The mouse sciatic nerve ran through the tight tissue along the head of the femur, whereas the chick nerve ran through the loose space even in the gluteal region. In birds, evolution of the pelvis including the hip joint without adduction seemed to make the arterial development possible. In mammals, highly flexed or adducted hip joint seemed to be one of the disturbing factors against development of the long and thick artery. A slight change in posture may cause significant arterial variation.

Characteristics of vertigo and the affected vestibular nerve systems in idiopathic bilateral vestibulopathy.

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Fujimoto, Chisato; Kinoshita, Makoto; Kamogashira, Teru; Egami, Naoya; Sugasawa, Keiko; Yamasoba, Tatsuya; Iwasaki, Shinichi

2016-01-01

Vertigo attacks in IBV patients involving both the superior and inferior vestibular nerve systems were significantly more severe than vertigo attacks in patients with selective involvement of the inferior vestibular nerve system alone. To investigate the relationship between the frequency and duration of vertigo and the affected vestibular nerve system in idiopathic bilateral vestibulopathy (IBV). This study categorized 44 IBV patients into the following three sub-groups according to the affected vestibular nerve system: superior, inferior, and mixed type. These patients were also categorized into the following three sub-groups according to their clinical time course: progressive type showing no episodes of vertigo, sequential type showing recurrent vertigo attacks and single-attack type showing a single episode of vertigo. Ten, 11 and 23 patients were classified as the superior, the inferior, and the mixed type, respectively. Seventeen, 23, and four patients were classified as the progressive, the sequential, and the single-attack type, respectively. For the patients having one or more vertigo attacks, the duration of the vertigo attack was longer than 24 h in 69% of the mixed type, and the duration of vertigo in the mixed type was significantly longer than that in the inferior type (p < 0.05).

Parkinson disease affects peripheral sensory nerves in the pharynx.

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Mu, Liancai; Sobotka, Stanislaw; Chen, Jingming; Su, Hungxi; Sanders, Ira; Nyirenda, Themba; Adler, Charles H; Shill, Holly A; Caviness, John N; Samanta, Johan E; Sue, Lucia I; Beach, Thomas G

2013-07-01

Dysphagia is very common in patients with Parkinson disease (PD) and often leads to aspiration pneumonia, the most common cause of death in PD. Current therapies are largely ineffective for dysphagia. Because pharyngeal sensation normally triggers the swallowing reflex, we examined pharyngeal sensory nerves in PD patients for Lewy pathology.Sensory nerves supplying the pharynx were excised from autopsied pharynges obtained from patients with clinically diagnosed and neuropathologically confirmed PD (n = 10) and healthy age-matched controls (n = 4). We examined the glossopharyngeal nerve (cranial nerve IX), the pharyngeal sensory branch of the vagus nerve (PSB-X), and the internal superior laryngeal nerve (ISLN) innervating the laryngopharynx. Immunohistochemistry for phosphorylated α-synuclein was used to detect Lewy pathology. Axonal α-synuclein aggregates in the pharyngeal sensory nerves were identified in all of the PD subjects but not in the controls. The density of α-synuclein-positive lesions was greater in PD patients with dysphagia versus those without dysphagia. In addition, α-synuclein-immunoreactive nerve fibers in the ISLN were much more abundant than those in cranial nerve IX and PSB-X. These findings suggest that pharyngeal sensory nerves are directly affected by pathologic processes in PD. These abnormalities may decrease pharyngeal sensation, thereby impairing swallowing and airway protective reflexes and contributing to dysphagia and aspiration.

Prolonged electrical stimulation-induced gluteal and hamstring muscle activation and sitting pressure in spinal cord injury: Effect of duty cycle

NARCIS (Netherlands)

MSc Karin J.A. Legemate; MD Christof A. J. Smit; MSc Anja de Koning; PhD Sonja de Groot; MD, PhD Janneke M. Stolwijk-Swuste; PhD Thomas W.H. Janssen

2013-01-01

Abstract—Pressure ulcers (PUs) are highly prevalent in people with spinal cord injury (SCI). Electrical stimulation (ES) activates muscles and might reduce risk factors. Our objectives were to study and compare the effects of two duty cycles during 3 h of ES-induced gluteal and hamstring activation

Prolonged electrical stimulation-induced gluteal and hamstring muscle activation and sitting pressure in spinal cord injury : Effect of duty cycle

NARCIS (Netherlands)

Smit, Christof A. J.; Legemate, Karin J. A.; de Koning, Anja; de Groot, Sonja; Stolwijk-Swuste, Janneke M.; Janssen, Thomas W. J.

2013-01-01

Pressure ulcers (PUs) are highly prevalent in people with spinal cord injury (SCI). Electrical stimulation (ES) activates muscles and might reduce risk factors. Our objectives were to study and compare the effects of two duty cycles during 3 h of ES-induced gluteal and hamstring activation on

Survey of Nerve Fiber Layer Thickness in Anisometropic and Strabismic Amblyopia

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Reza Soltani Moghaddam

2017-02-01

Full Text Available . To investigate the effect of anisometropic and strabismic amblyopia on the nerve fiber layer thickness. This cross-sectional study was done on 54 amblyopic subjects, equally in both strabismic and anisometropic groups. The thickness otonerve fiber layer measured in superior, inferior, nasal, temporal quadrants and as a whole in both eyes of both groups. The means of thickness were compared in amblyopic and sound eyes. In strabismus group, the average nerve fiber layer thickness of the sound eye , in superior, inferior, nasal and temporal quadrants and as a whole were 113.23±14, 117.37±25, 68.96±6, 69.55±14 and 93.40±8 microns respectively. In amblyopic eyes of the same group, these measurements were 103.11±18, 67.74±11, and 69.59±16 and 89.59±12 microns in superior, inferior, nasal, temporal quadrants and as whole respectively. In anisometropic groups, the sound eye measurements were as 130.96±22, 129.07±29, 80.62±12, and 83.88±20 and 107.7±13 microns in superior, inferior, nasal and temporal quadrants and as a whole orderly. In amblyopic eyes of this group the mean thicknesses were 115.63±29, 133.15±25, 78.8±15, 80.2±16 and 109.17±21 microns in superior, inferior, nasal, temporal quadrants and as a whole respectively. Statistically, there were no significant differences between amblyopic and sound eyes (P>0.5. Our study did not support any significant change in a nerve fiber layer thickness of amblyopic patients; however, decreased thickness in superior and nasal quadrants of strabismic amblyopia and except inferior quadrant and as a whole. These measurements may be a clue for management and prognosis of amblyopia in old age.

Effect of nerve activity on transport of nerve growth factor and dopamine β-hydroxylase antibodies in sympathetic neurones

International Nuclear Information System (INIS)

Lees, G.; Chubb, I.; Freeman, C.; Geffen, L.; Rush, R.

1981-01-01

The effect of nerve activity on the uptake and retrograde transport of nerve growth factor (NGF) and dopamine β-hydroxylase (DBH) antibodies was studied by injecting 125 I-labelled NGF and anti-DBH into the anterior eye chamber of guinea-pigs. Decentralization of the ipsilateral superior cervical ganglion (SCG) had no significant effect on the retrograde transport of either NGF or anti-DBH. Phenoxybenzamine produced a 50% increase in anti-DBH but not NGF accumulation and this effect was prevented by prior decentralization. This demonstrates that NGF is taken up independently of the retrieval of synaptic vesicle components. (Auth.)

Correlation among ultrasound, cross-sectional anatomy, and histology of the sciatic nerve: a review.

Science.gov (United States)

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

2010-01-01

Efficient identification of the sciatic nerve (SN) requires a thorough knowledge of its topography in relation to the surrounding structures. Anatomic cross sections in similar oblique planes as observed during SN ultrasonography are lacking. A survey of sonoanatomy matched with ultrasound views of the major SN block sites will be helpful in pattern recognition, especially when combined with images that show the internal architecture of the nerve. From 1 cadaver, consecutive parts of the upper leg corresponding to the 4 major blocks sites were sectioned and deeply frozen. Using cryomicrotomy, consecutive transverse sections were acquired and photographed at 78-microm intervals, along with histologic sections at 5-mm intervals. Multiplanar reformatting was done to reconstruct the optimal planes for an accurate comparison of ultrasonography and gross anatomy. The anatomic and histologic images were matched with ultrasound images that were obtained from 2 healthy volunteers. By simulating the exact position and angulation as in the ultrasonographic images, detailed anatomic overviews of SN and adjacent structures were reconstructed in the gluteal, subgluteal, midfemoral, and popliteal regions. Throughout its trajectory, SN contains numerous fascicles with connective and adipose tissues. In this study, we provide an optimal matching between histology, anatomic cross sections, and short-axis ultrasound images of SN. Reconstructing ultrasonographic planes with this high-resolution digitized anatomy not only enables an overview but also shows detailed views of the architecture of internal SN. The undulating course of the nerve fascicles within SN may explain its varying echogenic appearance during probe manipulation.

Gluteal mass in a bodybuilder: radiological depiction of a complication of anabolic steroid use

Energy Technology Data Exchange (ETDEWEB)

Al-Ismail, Khalid; Torreggiani, William C; Munk, Peter L; Nicolaou, Savvas [Department of Radiology, Vancouver General Hospital and the University of British Columbia, Vancouver, BC (Canada)

2002-06-01

The use of anabolic steroids by bodybuilders is relatively common and associated with many side effects. Local side effects include tissue necrosis and soft tissue infection at the injection site. Systemic effects may be early epiphyseal closure in the immature skeleton, testicular atrophy, sterility, acne, gynaecomastia and liver disorders such as hepatitis. We report an unusual case of a bodybuilder who developed a large painful inflammatory soft tissue mass in his gluteal area. Multi-modality imaging showed direct evidence revealing the underlying cause of the mass being depot steroid injections. (orig.)

Gluteal mass in a bodybuilder: radiological depiction of a complication of anabolic steroid use

International Nuclear Information System (INIS)

Al-Ismail, Khalid; Torreggiani, William C.; Munk, Peter L.; Nicolaou, Savvas

2002-01-01

The use of anabolic steroids by bodybuilders is relatively common and associated with many side effects. Local side effects include tissue necrosis and soft tissue infection at the injection site. Systemic effects may be early epiphyseal closure in the immature skeleton, testicular atrophy, sterility, acne, gynaecomastia and liver disorders such as hepatitis. We report an unusual case of a bodybuilder who developed a large painful inflammatory soft tissue mass in his gluteal area. Multi-modality imaging showed direct evidence revealing the underlying cause of the mass being depot steroid injections. (orig.)

Movement anatomy of the gluteal region and thigh of the giant anteater Myrmecophaga tridactyla (Myrmecophagidae: Pilosa)

OpenAIRE

Priscilla Rosa Queiroz Ribeiro; André Luiz Quagliatto Santos; Lucas de Assis Ribeiro; Tharlianne Alici Martins de Souza; Daniela Cristina Silva Borges; Rogério Rodrigues de Souza; Saulo Gonçalves Pereira

2016-01-01

Abstract: Locomotion reveals the displacement and behavior manner of the species in their daily needs. According to different needs of the several species, different locomotor patterns are adopted. The shapes and attachment points of muscles are important determinants of the movements performed and consequently, the locomotion and motion patterns of living beings. It was aimed to associate anatomical, kinesiology and biomechanics aspects of the gluteal region and thigh of the giant anteater t...

Cannabinoids facilitate the swallowing reflex elicited by the superior laryngeal nerve stimulation in rats.

Science.gov (United States)

Mostafeezur, Rahman Md; Zakir, Hossain Md; Takatsuji, Hanako; Yamada, Yoshiaki; Yamamura, Kensuke; Kitagawa, Junichi

2012-01-01

Cannabinoids have been reported to be involved in affecting various biological functions through binding with cannabinoid receptors type 1 (CB1) and 2 (CB2). The present study was designed to investigate whether swallowing, an essential component of feeding behavior, is modulated after the administration of cannabinoid. The swallowing reflex evoked by the repetitive electrical stimulation of the superior laryngeal nerve in rats was recorded before and after the administration of the cannabinoid receptor agonist, WIN 55-212-2 (WIN), with or without CB1 or CB2 antagonist. The onset latency of the first swallow and the time intervals between swallows were analyzed. The onset latency and the intervals between swallows were shorter after the intravenous administration of WIN, and the strength of effect of WIN was dose-dependent. Although the intravenous administration of CB1 antagonist prior to intravenous administration of WIN blocked the effect of WIN, the administration of CB2 antagonist did not block the effect of WIN. The microinjection of the CB1 receptor antagonist directly into the nucleus tractus solitarius (NTS) prior to intravenous administration of WIN also blocked the effect of WIN. Immunofluorescence histochemistry was conducted to assess the co-localization of CB1 receptor immunoreactivity to glutamic acid decarboxylase 67 (GAD67) or glutamate in the NTS. CB1 receptor was co-localized more with GAD67 than glutamate in the NTS. These findings suggest that cannabinoids facilitate the swallowing reflex via CB1 receptors. Cannabinoids may attenuate the tonic inhibitory effect of GABA (gamma-aminobuteric acid) neurons in the central pattern generator for swallowing.

Relationship between the Ulnar Nerve and the Branches of the Radial Nerve to the Medial Head of the Triceps Brachii Muscle.

Science.gov (United States)

Sh, Cho; Ih, Chung; Uy, Lee

2018-05-17

One branch of the radial nerve to the medial head of the triceps brachii muscle (MHN) has been described as accompanying or joining the ulnar nerve. Mostly two MHN branches have been reported, with some reports of one; however, the topographical anatomy is not well documented. We dissected 52 upper limbs from adult cadavers and found one, two, and three MHN branches in 9.6%, 80.8%, and 9.6% of cases, respectively. The MHN accompanying the ulnar nerve was always the superior MHN. The relationship between the ulnar nerve and the MHN was classified into four types according to whether the MHN was enveloped along with the ulnar nerve in the connective tissue sheath and whether it was in contact with the ulnar nerve. It contacted the ulnar nerve in 75.0% of cases and accompanied it over a mean distance of 73.6 mm (range 36-116 mm). In all cases in which the connective tissue sheath enveloped the branch of the MHN and the ulnar nerve, removing the sheath confirmed that the MHN branch originated from the radial nerve. The detailed findings and anatomical measurements of the MHN in this study will help in identifying its branches during surgical procedures. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery.

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Tempel, Zachary J; Smith, Justin S; Shaffrey, Christopher; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel; Kanter, Adam S

2017-04-01

A retrospective multicenter case-series study; case report and review of the literature. The anatomy and function of the superior laryngeal nerve (SLN) are well described; however, the consequences of SLN injury remain variable and poorly defined. The prevalence of SLN injury as a consequence of cervical spine surgery is difficult to discern as its clinical manifestations are often inconstant and frequently of a subclinical degree. A multicenter study was performed to better delineate the risk factors, prevalence, and outcomes of SLN injury. A retrospective multicenter case-series study involving 21 high-volume surgical centers from the AO Spine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. A retrospective review of the neurosurgical literature on SLN injury was also performed. A total of 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened, and 1 case of SLN palsy was identified. The prevalence ranged from 0% to 1.25% across all centers. The patient identified underwent a C4 corpectomy. The SLN injury was identified after the patient demonstrated difficulty swallowing postoperatively. He underwent placement of a percutaneous gastrostomy tube and his SLN palsy resolved by 6 weeks. This multicenter study demonstrates that identification of SLN injury occurs very infrequently. Symptomatic SLN injury is an exceedingly rare complication of anterior cervical spine surgery. The SLN is particularly vulnerable when exposing the more rostral levels of the cervical spine. Careful dissection and retraction of the longus coli may decrease the risk of SLN injury during anterior cervical surgery.

Fibrin matrices with affinity-based delivery systems and neurotrophic factors promote functional nerve regeneration.

Science.gov (United States)

Wood, Matthew D; MacEwan, Matthew R; French, Alexander R; Moore, Amy M; Hunter, Daniel A; Mackinnon, Susan E; Moran, Daniel W; Borschel, Gregory H; Sakiyama-Elbert, Shelly E

2010-08-15

Glial-derived neurotrophic factor (GDNF) and nerve growth factor (NGF) have both been shown to enhance peripheral nerve regeneration following injury and target different neuronal populations. The delivery of either growth factor at the site of injury may, therefore, result in quantitative differences in motor nerve regeneration and functional recovery. In this study we evaluated the effect of affinity-based delivery of GDNF or NGF from fibrin-filled nerve guidance conduits (NGCs) on motor nerve regeneration and functional recovery in a 13 mm rat sciatic nerve defect. Seven experimental groups were evaluated consisting of GDNF or NGF and the affinity-based delivery system (DS) within NGCs, control groups excluding the DS and/or growth factor, and nerve isografts. Groups with growth factor in the conduit demonstrated equivalent or superior performance in behavioral tests and relative muscle mass measurements compared to isografts at 12 weeks. Additionally, groups with GDNF demonstrated greater specific twitch and tetanic force production in extensor digitorum longus (EDL) muscle than the isograft control, while groups with NGF produced demonstrated similar force production compared to the isograft control. Assessment of motor axon regeneration by retrograde labeling further revealed that the number of ventral horn neurons regenerating across NGCs containing GDNF and NGF DS was similar to the isograft group and these counts were greater than the groups without growth factor. Overall, the GDNF DS group demonstrated superior functional recovery and equivalent motor nerve regeneration compared to the isograft control, suggesting it has potential as a treatment for motor nerve injury.

Contorno de la región glútea: Conceptos actuales y propuesta de clasificación Contouring of gluteal region: Current concepts and proposal for classification

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G. Avendaño-Valenzuela

2010-09-01

Full Text Available La mejora del contorno glúteo y de las regiones paraglúteas es un requerimiento frecuente por parte de las pacientes. Algunos autores han hecho contribuciones múltiples a este tema: cruroplastias, levantamiento glúteo, implantes de glúteo, flancoplastias, liposucción y lipoinyección, técnicas que logran mejoría del contorno glúteo, pero que generalmente requieren una combinación de procedimientos. Sugerimos una clasificación para facilitar la elección del tratamiento quirúrgico más adecuado para la remodelación de la región glútea. Esta clasificación se basa principalmente en la anatomía músculo-esquelética de la región glútea, la cadera y las zonas de deformidad o lipodistrofia. Analizamos un total de 800 mujeres entre 16 y 54 años de edad, a lo largo de un período de 7 años. A todas se les realizó estudio anatómico y fotográfico de la cadera. Analizamos las estructuras músculo-esqueléticas y las zonas con lipodistrofia o deformidad; éstas últimas fueron clasificadas según su frecuencia como zona I, II, III, IV y V. Las deformidades aparecieron con la frecuencia siguiente: tipo I: 5%. Tipo II: 30%. Tipo III: 40%. Tipo IV: 20%. Tipo V: 5%. El propósito de esta nueva clasificación de deformidades de la cadera y su tratamiento es actualizar los conceptos y evolucionar en el tratamiento estético de la cadera con un concepto global. Permite también obtener resultados estéticos más relevantes. La clasificación, aplicable a las mujeres latinas y anglosajonas, ofrece una guía para el estudio preoperatorio de los glúteos y evitar así secuelas tras la cirugía.An improvement in the contouring of gluteal and paragluteal regions has been frequently required by the patients. Some authors have made multiple contributions like cruroplasty, gluteal lift, gluteal implants, flancoplasty, liposuction and lipoinjection, because the improvement of the gluteal contouring requires a combination of procedures. We are

Optic Nerve Head and Retinal Nerve Fiber Layer Differences Between Caribbean Black and African American Patients as Measured by Spectral Domain OCT.

Science.gov (United States)

Rao, Rohini; Dhrami-Gavazi, Elona; Al-Aswad, Lama; Ciarleglio, Adam; Cioffi, George A; Blumberg, Dana M

2015-01-01

There are well-established differences in optic nerve morphology between patients of African and European descent. Spectral domain optical coherence tomography (OCT) scanning has demonstrated these differences with respect to optic disc area (DA), average cup-disc ratio, cup volume, and nerve fiber layer thickness. However, the term "African descent" describes a heterogenous group with considerable variability. This study evaluates differences in optic nerve and retinal nerve fiber layer (RNFL) parameters as measured by Cirrus HD-OCT between Caribbean black and African American patients. A total of 25 African American subjects and 25 Caribbean black subjects with normal ocular examinations were consecutively recruited to this study. All patients received imaging of the optic nerve and nerve fiber layer with Cirrus HD-OCT. Optic nerve and RNFL parameters were evaluated for statistically significant differences using a t test. A mixed effect model for correlated data was then created to adjust outcome variables for (1) repeated measures and (2) optic nerve size. Two one-sided t tests were then utilized to determine equivalence. After adjustment for DA, RNFL thickness, cup volume, DA, inferior nerve fiber layer, and vertical cup-disc ratio demonstrated statistically significant equivalence between the 2 groups (P value fiber layer quadrant was significantly different between the 2 groups and may merit further investigation. Findings of this study suggest that optic nerve and RNFL morphology is markedly similar between Caribbean blacks and African Americans once adjusted for optic nerve size but cannot be considered equivalent in all measures, particularly in the superior nerve fiber layer.

MR imaging of nerve root impingement in the lumbar spine

International Nuclear Information System (INIS)

Teresi, L.M.; Bradley, W.G. Jr.; Bloze, A.E.; Davis, S.J.; Amster, J.; Berger, P.E.

1990-01-01

This paper determines the relationship between MR imaging findings of nerve root impingement, presenting symptoms, and physical examination findings, and physiologic data (DSEP and EMG) in a population of patients presented with classic radicular symptoms. Fifty-eight patients presenting with classic radicular pain were studied with MR imaging, DSER, and EMG, MR imaging was performed with a GE Signa imaging system with use of T1- and T2-weighted sequences and 5-mm-thick sections. Nerve root impingement in the subarticular recess (the root exiting the next lowest level) was distinguished from nerve root impingement in the superior intervertebral foramen (the root exiting the same level)

Gluteal blood flow and oxygenation during electrical stimulation-induced muscle activation versus pressure relief movements in wheelchair users with a spinal cord injury

NARCIS (Netherlands)

Smit, C. A. J.; Zwinkels, M.; van Dijk, T.; de Groot, S.; Stolwijk-Swuste, J. M.; Janssen, T. W. J.

Background: Prolonged high ischial tuberosities pressure (IT pressure), decreased regional blood flow (BF) and oxygenation (%SO2) are risk factors for developing pressure ulcers (PUs) in patients with spinal cord injury (SCI). Electrical stimulation (ES)-induced gluteal and hamstring muscle

Cannabinoids facilitate the swallowing reflex elicited by the superior laryngeal nerve stimulation in rats.

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Rahman Md Mostafeezur

Full Text Available Cannabinoids have been reported to be involved in affecting various biological functions through binding with cannabinoid receptors type 1 (CB1 and 2 (CB2. The present study was designed to investigate whether swallowing, an essential component of feeding behavior, is modulated after the administration of cannabinoid. The swallowing reflex evoked by the repetitive electrical stimulation of the superior laryngeal nerve in rats was recorded before and after the administration of the cannabinoid receptor agonist, WIN 55-212-2 (WIN, with or without CB1 or CB2 antagonist. The onset latency of the first swallow and the time intervals between swallows were analyzed. The onset latency and the intervals between swallows were shorter after the intravenous administration of WIN, and the strength of effect of WIN was dose-dependent. Although the intravenous administration of CB1 antagonist prior to intravenous administration of WIN blocked the effect of WIN, the administration of CB2 antagonist did not block the effect of WIN. The microinjection of the CB1 receptor antagonist directly into the nucleus tractus solitarius (NTS prior to intravenous administration of WIN also blocked the effect of WIN. Immunofluorescence histochemistry was conducted to assess the co-localization of CB1 receptor immunoreactivity to glutamic acid decarboxylase 67 (GAD67 or glutamate in the NTS. CB1 receptor was co-localized more with GAD67 than glutamate in the NTS. These findings suggest that cannabinoids facilitate the swallowing reflex via CB1 receptors. Cannabinoids may attenuate the tonic inhibitory effect of GABA (gamma-aminobuteric acid neurons in the central pattern generator for swallowing.

The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study.

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Bernardo, Antonio; Evins, Alexander I; Visca, Anna; Stieg, Phillip E

2013-06-01

The facial nerve has a short intracranial course but crosses critical and frequently accessed surgical structures during cranial base surgery. When performing approaches to complex intracranial regions, it is essential to understand the nerve's conventional and topographic anatomy from different surgical perspectives as well as its relationship with surrounding structures. To describe the entire intracranial course of the facial nerve as observed via different neurosurgical approaches and to provide an analytical evaluation of the degree of nerve exposure achieved with each approach. Anterior petrosectomies (middle fossa, extended middle fossa), posterior petrosectomies (translabyrinthine, retrolabyrinthine, transcochlear), a retrosigmoid, a far lateral, and anterior transfacial (extended maxillectomy, mandibular swing) approaches were performed on 10 adult cadaveric heads (20 sides). The degree of facial nerve exposure achieved per segment for each approach was assessed and graded independently by 3 surgeons. The anterior petrosal approaches offered good visualization of the nerve in the cerebellopontine angle and intracanalicular portion superiorly, whereas the posterior petrosectomies provided more direct visualization without the need for cerebellar retraction. The far lateral approach exposed part of the posterior and the entire inferior quadrants, whereas the retrosigmoid approach exposed parts of the superior and inferior quadrants and the entire posterior quadrant. Anterior and anteroinferior exposure of the facial nerve was achieved via the transfacial approaches. The surgical route used must rely on the size, nature, and general location of the lesion, as well as on the capability of the particular approach to better expose the appropriate segment of the facial nerve.

The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations.

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Chim, Harvey; Okada, Haruko C; Brown, Matthew S; Alleyne, Brendan; Liu, Mengyuan T; Zwiebel, Samantha; Guyuron, Bahman

2012-08-01

The auriculotemporal nerve has been identified as one of the peripheral trigger sites for migraine headaches. However, its distal course is poorly mapped following emergence from the parotid gland. In addition, a reliable anatomical landmark for locating the potential compression points along the course of the nerve during surgery has not been sufficiently described. Twenty hemifaces on 10 fresh cadavers were dissected to trace the course of the auriculotemporal nerve from the inferior border of the zygomatic arch to its termination in the temporal scalp. The compression points were mapped and the distances were measured from the most anterosuperior point of the external auditory meatus, which was used as a fixed anatomical landmark. Three potential compression points along the course of the auriculotemporal nerve were identified. Compression points 1 and 2 corresponded to preauricular fascial bands. Compression point 1 was centered 13.1±5.9 mm anterior and 5.0±7.0 mm superior to the most anterosuperior point of the external auditory meatus, whereas compression point 2 was centered at 11.9±6.0 mm anterior and 17.2±10.4 mm superior to the most anterosuperior point of the external auditory meatus. A significant relationship was found between the auriculotemporal nerve and superficial temporal artery (compression point 3) in 80 percent of hemifaces, with three patterns of interaction: a single site of artery crossing over the nerve (62.5 percent), a helical intertwining relationship (18.8 percent), and nerve crossing over the artery (18.8 percent). Findings from this cadaver study provide information relevant to the operative localization of potential compression points along the auriculotemporal nerve.

Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma.

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Marinelli, John P; Van Gompel, Jamie J; Link, Michael J; Carlson, Matthew L

2018-05-01

Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN. A 51-year-old woman presented with abrupt-onset TN of the V2 and V3 nerve divisions with hypesthesia. She denied changes in hearing, balance, or facial nerve dysfunction. Magnetic resonance imaging revealed a 1.6-cm contrast-enhancing cerebellopontine angle tumor that effaced the trigeminal nerve, consistent with a vestibular schwannoma. In addition, a branch of the superior cerebellar artery abutted the cisternal segment of the trigeminal nerve on T2-weighted thin-slice magnetic resonance imaging. Intraoperative electrical stimulation of the tumor elicited a response from the facial nerve at low threshold over the entire accessible tumor surface, indicating that the tumor was a facial nerve schwannoma. Considering the patient's lack of facial nerve deficit and that the tumor exhibited no safe entry point for intracapsular debulking, tumor resection was not performed. Working between the tumor and tentorium, a branch of the superior cerebellar artery was identified and decompressed with a Teflon pad. At last follow-up, the patient exhibited resolution of her TN. Her hearing and facial nerve function remained intact. Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered. Copyright © 2018 Elsevier Inc. All rights reserved.

Vascularized nerve grafts: an experimental study.

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Donzelli, Renato; Capone, Crescenzo; Sgulò, Francesco Giovanni; Mariniello, Giuseppe; Maiuri, Francesco

2016-08-01

The aim of this study is to define an experimental model in order to promote the functional recovery of the nerves using grafts with vascular support (Vascular Nerve Grafts - VNG). The aim of this study is to define, on an experimental model in normal recipient bed, whether the functional recovery with VNG is superior to that obtained non-vascularized graft (NNG). Twenty male rabbits, which underwent dissection of sciatic nerve, were later treated by reinnervation through an autograft. In 10 animals the reconstruction of sciatic nerve was realized with VNG; in 10 control animals the reconstruction of sciatic nerve was realized with NNG. The VNG group showed a better axonal organization and a significantly higher number of regenerated axons in the early phases (after 30 days) than the NNG group, whereas the difference in the axonal number at day 90 was less significant; besides, the axon diameter and the myelin thickness were not significantly improved by VNG group. Our data suggests that the use of VNG leads to a faster regeneration process and a better functional recovery, although the final results are comparable to those of the NNG. VNG improve the quality of the axonal regeneration (axonal diameter and Schwann cells), although the increase in the axonal number is not significant and does not improve the long-term functional outcome.

Adrenergic nerve fibres and mast cells: correlation in rat thymus.

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Artico, Marco; Cavallotti, Carlo; Cavallotti, Daniela

2002-10-21

The interactions between adrenergic nerve fibres and mast cells (MCs) were studied in the thymus of adult and old rats by morphological methods and by quantitative analysis of images (QAIs). The whole thymus was drawn in adult (12 months old) rats: normal, sympathectomized or electrostimulated. Thymuses from the above-mentioned animals were weighed, measured and dissected. Thymic slices were stained with eosin orange for detection of microanatomical details and with Bodian's method for identification of the whole nerve fibres. Thymic MCs were stained with Astrablau. Histofluorescence microscopy was used for staining of adrenergic nerve fibres. Finally, all morphological results were submitted to the QAIs and statistical analysis of data. Our results suggest that after surgical sympathectomy, the greater part of adrenergic nerve fibres disappear while related MCs appear to show less evident fluorescence and few granules. On the contrary, electrostimulation of the cervical superior ganglion induced an increase in the fluorescence of adrenergic nerve fibres and of related MCs.

Prevalence of Split Nerve Fiber Layer Bundles in Healthy People Imaged with Spectral Domain Optical Coherence Tomography

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Sirel Gür Güngör

2016-12-01

Full Text Available Objectives: The presence of retinal nerve fiber layer (RNFL split bundles was recently described in normal eyes scanned using scanning laser polarimetry and by histologic studies. Split bundles may resemble RNFL loss in healthy eyes. The aim of our study was to determine the prevalence of nerve fiber layer split bundles in healthy people. Materials and Methods: We imaged 718 eyes of 359 healthy persons with the spectral domain optical coherence tomography in this cross-sectional study. All eyes had intraocular pressure of 21 mmHg or less, normal appearance of the optic nerve head, and normal visual fields (Humphrey Field Analyzer 24-2 full threshold program. In our study, a bundle was defined as ‘split’ when there is localized defect not resembling a wedge defect in the RNFL deviation map with a symmetrically divided RNFL appearance on the RNFL thickness map. The classification was performed by two independent observers who used an identical set of reference examples to standardize the classification. Results: Inter-observer consensus was reached in all cases. Bilateral superior split bundles were seen in 19 cases (5.29% and unilateral superior split was observed in 15 cases (4.16%. In 325 cases (90.52% there was no split bundle. Conclusion: Split nerve fiber layer bundles, in contrast to single nerve fiber layer bundles, are not common findings in healthy eyes. In eyes with normal optic disc appearance, especially when a superior RNFL defect is observed in RNFL deviation map, the RNLF thickness map and graphs should also be examined for split nerve fiber layer bundles.

Visualization of the lower cranial nerves by 3D-FIESTA

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Okumura, Yusuke; Suzuki, Masayuki; Takemura, Akihiro; Tsujii, Hideo; Kawahara, Kazuhiro; Matsuura, Yukihiro; Takada, Tadanori

2005-01-01

MR cisternography has been introduced for use in neuroradiology. This method is capable of visualizing tiny structures such as blood vessels and cranial nerves in the cerebrospinal fluid (CSF) space because of its superior contrast resolution. The cranial nerves and small vessels are shown as structures of low intensity surrounded by marked hyperintensity of the CSF. In the present study, we evaluated visualization of the lower cranial nerves (glossopharyngeal, vagus, and accessory) by the three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequence and multiplanar reformation (MPR) technique. The subjects were 8 men and 3 women, ranging in age from 21 to 76 years (average, 54 yeas). We examined the visualization of a total of 66 nerves in 11 subjects by 3D-FIESTA. The results were classified into four categories ranging from good visualization to non-visualization. In all cases, all glossopharyngeal and vagus nerves were identified to some extent, while accessory nerves were visualized either partially or entirely in only 16 cases. The total visualization rate was about 91%. In conclusion, 3D-FIESTA may be a useful method for visualization of the lower cranial nerves. (author)

Hydrogel derived from porcine decellularized nerve tissue as a promising biomaterial for repairing peripheral nerve defects.

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Lin, Tao; Liu, Sheng; Chen, Shihao; Qiu, Shuai; Rao, Zilong; Liu, Jianghui; Zhu, Shuang; Yan, Liwei; Mao, Haiquan; Zhu, Qingtang; Quan, Daping; Liu, Xiaolin

2018-06-01

Decellularized matrix hydrogels derived from tissues or organs have been used for tissue repair due to their biocompatibility, tunability, and tissue-specific extracellular matrix (ECM) components. However, the preparation of decellularized peripheral nerve matrix hydrogels and their use to repair nerve defects have not been reported. Here, we developed a hydrogel from porcine decellularized nerve matrix (pDNM-G), which was confirmed to have minimal DNA content and retain collagen and glycosaminoglycans content, thereby allowing gelatinization. The pDNM-G exhibited a nanofibrous structure similar to that of natural ECM, and a ∼280-Pa storage modulus at 10 mg/mL similar to that of native neural tissues. Western blot and liquid chromatography tandem mass spectrometry analysis revealed that the pDNM-G consisted mostly of ECM proteins and contained primary ECM-related proteins, including fibronectin and collagen I and IV). In vitro experiments showed that pDNM-G supported Schwann cell proliferation and preserved cell morphology. Additionally, in a 15-mm rat sciatic nerve defect model, pDNM-G was combined with electrospun poly(lactic-acid)-co-poly(trimethylene-carbonate)conduits to bridge the defect, which did not elicit an adverse immune response and promoted the activation of M2 macrophages associated with a constructive remodeling response. Morphological analyses and electrophysiological and functional examinations revealed that the regenerative outcomes achieved by pDNM-G were superior to those by empty conduits and closed to those using rat decellularized nerve matrix allograft scaffolds. These findings indicated that pDNM-G, with its preserved ECM composition and nanofibrous structure, represents a promising biomaterial for peripheral nerve regeneration. Decellularized nerve allografts have been widely used to treat peripheral nerve injury. However, given their limited availability and lack of bioactive factors, efforts have been made to improve the efficacy

Subclavian vein pacing and venous pressure waveform measurement for phrenic nerve monitoring during cryoballoon ablation of atrial fibrillation.

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Ghosh, Justin; Singarayar, Suresh; Kabunga, Peter; McGuire, Mark A

2015-06-01

The phrenic nerves may be damaged during catheter ablation of atrial fibrillation. Phrenic nerve function is routinely monitored during ablation by stimulating the right phrenic nerve from a site in the superior vena cava (SVC) and manually assessing the strength of diaphragmatic contraction. However the optimal stimulation site, method of assessing diaphragmatic contraction, and techniques for monitoring the left phrenic nerve have not been established. We assessed novel techniques to monitor phrenic nerve function during cryoablation procedures. Pacing threshold and stability of phrenic nerve capture were assessed when pacing from the SVC, left and right subclavian veins. Femoral venous pressure waveforms were used to monitor the strength of diaphragmatic contraction. Stable capture of the left phrenic nerve by stimulation in the left subclavian vein was achieved in 96 of 100 patients, with a median capture threshold of 2.5 mA [inter-quartile range (IQR) 1.4-5.0 mA]. Stimulation of the right phrenic nerve from the subclavian vein was superior to stimulation from the SVC with lower pacing thresholds (1.8 mA IQR 1.4-3.3 vs. 6.0 mA IQR 3.4-8.0, P phrenic nerve palsy. The left phrenic nerve can be stimulated from the left subclavian vein. The subclavian veins are the optimal sites for phrenic nerve stimulation. Monitoring the femoral venous pressure waveform is a novel technique for detecting impending phrenic nerve damage. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Tullio phenomenon in superior semicircular canal dehiscence syndrome.

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Basura, Gregory J; Cronin, Scott J; Heidenreich, Katherine D

2014-03-18

Tullio phenomenon refers to eye movements induced by sound.(1) This unusual examination finding may be seen in superior semicircular canal dehiscence (SSCD) syndrome.(2) This disorder is due to absent bone over the superior semicircular canal (figure). Patients complain of dizziness triggered by loud sound, aural fullness, autophony, and pulsatile tinnitus. When Tullio phenomenon exists in SSCD syndrome, the patient develops a mixed vertical-torsional nystagmus in which the slow phase rotates up and away from the affected ear (video on the Neurology® Web site at Neurology.org). This pattern of nystagmus aligns in the plane of the dehiscent semicircular canal and is due to excitation of its afferent nerves.

Estrogen receptor protein content is different in abdominal than gluteal subcutaneous adipose tissue of overweight-to-obese premenopausal women.

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Gavin, Kathleen M; Cooper, Elizabeth E; Hickner, Robert C

2013-08-01

Premenopausal women demonstrate a distinctive gynoid body fat distribution and circulating estrogen status is associated with the maintenance of this adiposity patterning. Estrogen's role in modulation of regional adiposity may occur through estrogen receptors (ERs), which are present in human adipose tissue. The purpose of this study was to determine regional differences in the protein content of ERα, ERβ, and the G protein-coupled estrogen receptor (GPER) between the abdominal (AB) and gluteal (GL) subcutaneous adipose tissue of overweight-to-obese premenopausal women. Biopsies of the subcutaneous AB and GL adipose tissue were performed in 15 premenopausal women (7 Caucasian/8 African American, 25.1 ± 1.8 years, BMI 29.5 ± 0.5kg/m(2)). Adipose tissue protein content was measured by western blot analysis and correlation analyses were conducted to assess the relationship between ER protein content and anthropometric indices/body composition measurements. We found that ERα protein was higher in AB than GL (AB 1.0 ± 0.2 vs GL 0.67 ± 0.1 arbitrary units [AU], P=0.02), ERβ protein was higher in GL than AB (AB 0.78 ± 0.12 vs GL 1.3 ± 0.2 AU, P=0.002), ERα/ERβ ratio was higher in AB than GL (AB 1.9 ± 0.4 vs GL 0.58 ± 0.08 AU, P=0.007), and GPER protein content was similar in AB and GL (P=0.80) subcutaneous adipose tissue. Waist-to-hip ratio was inversely related to gluteal ERβ (r(2)=0.315, P=0.03) and positively related to gluteal ERα/ERβ ratio (r(2)=0.406, P=0.01). These results indicate that depot specific ER content may be an important underlying determinant of regional effects of estrogen in upper and lower body adipose tissue of overweight-to-obese premenopausal women. Copyright © 2013 Elsevier Inc. All rights reserved.

Schwannoma of the Recurrent Laryngeal Nerve : A Rare Entity

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de Heer, Linda M; Teding van Berkhout, F; Priesterbach, Loudy; Buijsrogge, Marc P

Neurogenic tumors are the most common posterior mediastinal tumors in adults. Schwannomas originating from the recurrent laryngeal nerve are rare. The present study describes a 46-year-old man with a tumor in the left superior mediastinum. Because of the narrow relationship with the aorta and the

Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis.

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Jacobson, Jon A; Yablon, Corrie M; Henning, P Troy; Kazmers, Irene S; Urquhart, Andrew; Hallstrom, Brian; Bedi, Asheesh; Parameswaran, Aishwarya

2016-11-01

The purpose of this study was to compare ultrasound-guided percutaneous tendon fenestration to platelet-rich plasma (PRP) injection for treatment of greater trochanteric pain syndrome. After Institutional Review Board approval was obtained, patients with symptoms of greater trochanteric pain syndrome and ultrasound findings of gluteal tendinosis or a partial tear (Pain scores were recorded at baseline, week 1, and week 2 after treatment. Retrospective clinic record review assessed patient symptoms. The study group consisted of 30 patients (24 female), of whom 50% were treated with fenestration and 50% were treated with PRP. The gluteus medius was treated in 73% and 67% in the fenestration and PRP groups, respectively. Tendinosis was present in all patients. In the fenestration group, mean pain scores were 32.4 at baseline, 16.8 at time point 1, and 15.2 at time point 2. In the PRP group, mean pain scores were 31.4 at baseline, 25.5 at time point 1, and 19.4 at time point 2. Retrospective follow-up showed significant pain score improvement from baseline to time points 1 and 2 (P.99). Our study shows that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups. © 2016 by the American Institute of Ultrasound in Medicine.

Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation

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Jacques Clementy

2007-01-01

Full Text Available Phrenic Nerve Injury (PNI has been well studied by cardiac surgeons. More recently it has been recognized as a potential complication of catheter ablation with a prevalence of 0.11 to 0.48 % after atrial fibrillation (AF ablation. This review will focus on PNI after AF ablation. Anatomical studies have shown a close relationship between the right phrenic nerve and it's proximity to the superior vena cava (SVC, and the antero-inferior part of the right superior pulmonary vein (RSPV. In addition, the proximity of the left phrenic nerve to the left atrial appendage has been well established. Independent of the type of ablation catheter (4mm, 8 mm, irrigated tip, balloon or energy source used (radiofrequency (RF, ultrasound, cryothermia, and laser; the risk of PNI exists during ablation at the critical areas listed above. Although up to thirty-one percent of patients with PNI after AF ablation remain asymptomatic, dyspnea remain the cardinal symptom and is present in all symptomatic patients. Despite the theoretical risk for significant adverse effect on functional status and quality of life, short-term outcomes from published studies appear favorable with 81% of patients with PNI having a complete recovery after 7 ± 7 months.Conclusion: Existing studies have described PNI as an uncommon but avoidable complication in patients undergoing pulmonary vein isolation for AF. Prior to ablation at the SVC, antero-inferior RSPV ostium or the left atrial appendage, pacing should be performed before energy delivery. If phrenic nerve capture is documented, energy delivery should be avoided at this site. Electrophysiologist's vigilance as well as pacing prior to ablation at high risk sites in close proximity to the phrenic nerve are the currently available tools to avoid the complication of PNI.

Effect of neurotrophic factor, MDP, on rats’ nerve regeneration

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A.A. Fornazari

2011-04-01

Full Text Available Our objective was to determine the immune-modulating effects of the neurotrophic factor N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP on median nerve regeneration in rats. We used male Wistar rats (120-140 days of age, weighing 250-332 g and compared the results of three different techniques of nerve repair: 1 epineural neurorrhaphy using sutures alone (group S - 10 rats, 2 epineural neurorrhaphy using sutures plus fibrin tissue adhesive (FTA; group SF - 20 rats, and 3 sutures plus FTA, with MDP added to the FTA (group SFM - 20 rats. Functional assessments using the grasp test were performed weekly for 12 weeks to identify recovery of flexor muscle function in the fingers secondary to median nerve regeneration. Histological analysis was also utilized. The total number and diameter of myelinated fibers were determined in each proximal and distal nerve segment. Two indices, reported as percentage, were calculated from these parameters, namely, the regeneration index and the diameter change index. By the 8th week, superiority of group SFM over group S became apparent in the grasping test (P = 0.005. By the 12th week, rats that had received MDP were superior in the grasping test compared to both group S (P < 0.001 and group SF (P = 0.001. Moreover, group SF was better in the grasping test than group S (P = 0.014. However, no significant differences between groups were identified by histological analysis. In the present study, rats that had received MDP obtained better function, in the absence of any significant histological differences.

The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

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Spinner, Robert J. [Mayo Clinic, Department of Neurologic Surgery, Rochester, Minnesota (United States); Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota (United States); Mayo Clinic, Department of Anatomy, Rochester, Minnesota (United States); Mokhtarzadeh, Ali; Schiefer, Terry K. [Mayo Clinic College of Medicine, Rochester, Minnesota (United States); Krishnan, Kartik G. [Carl Gustav Carus University Hospital, Department of Neurological Surgery, Dresden (Germany); Kliot, Michel [University of Washington, Department of Neurosurgery, Seattle, Washington (United States); Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, Minnesota (United States)

2007-04-15

To demonstrate that tibial intraneural ganglia in the popliteal fossa are derived from the posterior portion of the superior tibiofibular joint, in a mechanism similar to that of peroneal intraneural ganglia, which have recently been shown to arise from the anterior portion of the same joint. Retrospective clinical study and prospective anatomic study. The clinical records and MRI findings of three patients with tibial intraneural ganglion cysts were analyzed and compared with those of one patient with a tibial extraneural ganglion cyst and one volunteer. Seven cadaveric limbs were dissected to define the articular anatomy of the posterior aspect of the superior tibiofibular joint. The condition of the three patients with intraneural ganglia recurred because their joint connections were not identified initially. In two patients there was no cyst recurrence when the joint connection was treated at revision surgery; the third patient did not wish to undergo additional surgery. The one patient with an extraneural ganglion had the joint connection identified at initial assessment and had successful surgery addressing the cyst and the joint connection. Retrospective evaluation of the tibial intraneural ganglion cysts revealed stereotypic features, which allowed their accurate diagnosis and distinction from extraneural cases. The intraneural cysts had tubular (rather than globular) appearances. They derived from the postero-inferior portion of the superior tibiofibular joint and followed the expected course of the articular branch on the posterior surface of the popliteus muscle. The cysts then extended intra-epineurially into the parent tibial nerves, where they contained displaced nerve fascicles. The extraneural cyst extrinsically compressed the tibial nerve but did not directly involve it. All cadaveric specimens demonstrated a small single articular branch, which derived from the tibial nerve to the popliteus. The branch coursed obliquely across the posterior

CT and MR imaging of the normal and pathologic conditions of the facial nerve

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Jaeger, Lorenz E-mail: jaeger@ikra.med.uni-muenchen.de; Reiser, Maximilian

2001-11-01

Computed tomography (CT) and magnetic resonance imaging (MRI) are well established imaging modalities to examine the facial nerve as well as the course of the facial nerve itself. High spatial resolution is guaranteed not only in the x- and y-axis, but also in the z-axis using multislice spiral CT. With this technique, reformatted multiplanar images in oblique planes, avoiding additional examinations in the coronal plane, facilitate the delineation of the facial nerve canal. This is beneficial in patients with temporal bone trauma, malformation or osseous changes. MR has a superior soft-tissue contrast to CT that enables imaging of the facial nerve itself. Therefore the normal facial nerve as well as pathologic changes of the facial nerve is readily visualized from the brain stem to the parotid gland. This review article presents anatomy, pathology and imaging strategies in the diagnostics of the facial nerve.

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy.

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Thorsen, Y; Stimec, B; Andersen, S N; Lindstrom, J C; Pfeffer, F; Oresland, T; Ignjatovic, D

2016-07-01

The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography" in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed. Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews. Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores. Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.

Intratemporal facial nerve neuromas and their mimics: CT and MR findings

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Han, Moon Hee; Chang, Kee Hyun; Lee, Kyung Hwan; Cha, Sang Hoon; Kim, Chong Sun [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Sang Joon [Chungang Gil General Hospital, Seoul (Korea, Republic of)

1992-05-15

CT and MR findings of nine cases with intra temporal facial nerve neuromas were described and compared with CT findings of 3 cases with facial nerve palsy and facial nerve canal erosion which may mimic facial nerve neuroma. The tympanic segment of the facial nerve was involved in 8 cases, mastoid segment in 7 cases and labyrinthine segment in 5 cases. The lesions were easily diagnosed with high resolution CT with bone algorithms by showing the expansion of bony structures along the course of the facial nerves. In 4 cases with large vertical segment tumors, extensive destruction of mastoid air cells and external auditory canals posed difficulty in making a diagnosis. Two out of 5 cases with labyrinthine segment involvement were presented as middle cranial fossa masses. MRI with enhancement was performed in 4 cases and was useful in characterizing the lesion as a tumor with its superior sensitivity to enhancement. Three cases of facial neuroma-mimicking lesion including post-inflammatory peri neural thickening, peri neural extension from parotid adenoid cystic carcinoma, and congenita; cholesteatoma showed irregular erosion or mild expansion of the facial nerve canal which may be helpful for differential diagnosis from neuromas.

Acute optic nerve sheath fenestration with the free-electron laser

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Shen, Jin-Hui; Casagrande, Vivien A.; Joos, Karen M.; Shetlar, Debra J.; Robinson, Richard D.; Head, William S.; Mavity-Hudson, Julia A.; Nunnally, Amy H.

1999-06-01

Purpose: To determine if the free electron laser (FEL) energy can be delivered to a small space to perform optic nerve sheath fenestration with minimal acute nerve damage. Methods: A 530 mm hollow waveguide probe was designed. Optic nerve sheath fenestration (1.0 mm diameter) was performed in 8 rabbits using either the FEL (4 eyes, 6.45mm, 10 Hz, 2 mJ) or a knife (4 eyes). Within 2 hours following surgery, the animals were perfused with aldehyde fixative. The integrity of the optic nerve and glial response at the site of fenestration were evaluated on tissue selections with H&E, and antibodies to S100β or GFAP. Results: Surgery using the FEL probe was found to be technically superior to the knife. The glial reaction was limited to a zone adjacent to the fenestration and was similar in both the FEL and knife incisions. Conclusions: The FEL appears capable of efficiently performing an optic nerve sheath fenestration in a small space with minimal acute damage. Both the FEL and knife incisions result in a rapid glial response at the site of fenestration even when optic nerve integrity is not compromised.

Surgical Anatomy of the Cervical Part of the Hypoglossal Nerve.

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Kariuki, Brian Ngure; Butt, Fawzia; Mandela, Pamela; Odula, Paul

2018-03-01

Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (±5.99) mm and 15.19 (±6.68) mm, respectively. The point where it crossed the ICA was 12.24 (±3.71) mm superior to the greater horn of hyoid, 17.16 (±4.40) mm inferior to the angle of the mandible, and 39.08 (±5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study population. Caution should be exercised during surgical procedures in the neck. The study also revealed that the mastoid process is a reliable fixed landmark to locate the hypoglossal nerve.

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

DEFF Research Database (Denmark)

Rothe, C; Steen-Hansen, C; Lund, J

2014-01-01

BACKGROUND: The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block the suprascapu......BACKGROUND: The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block...... the suprascapular nerve in a more superficial and proximal location. METHODS: Twelve healthy volunteers were included. We located the brachial plexus in transverse section with ultrasound, and by longitudinal slide, we identified the departure of the suprascapular nerve from the superior trunk. The suprascapular...

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

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J.R. Martínez-Méndez

2008-09-01

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

Right-sided vagus nerve stimulation inhibits induced spinal cord seizures.

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Tubbs, R Shane; Salter, E George; Killingsworth, Cheryl; Rollins, Dennis L; Smith, William M; Ideker, Raymond E; Wellons, John C; Blount, Jeffrey P; Oakes, W Jerry

2007-01-01

We have previously shown that left-sided vagus nerve stimulation results in cessation of induced spinal cord seizures. To test our hypothesis that right-sided vagus nerve stimulation will also abort seizure activity, we have initiated seizures in the spinal cord and then performed right-sided vagus nerve stimulation in an animal model. Four pigs were anesthetized and placed in the lateral position and a small laminectomy performed in the lumbar region. Topical penicillin, a known epileptogenic drug to the cerebral cortex and spinal cord, was next applied to the dorsal surface of the exposed cord. With the exception of the control animal, once seizure activity was discernible via motor convulsion or increased electrical activity, the right vagus nerve previously isolated in the neck was stimulated. Following multiple stimulations of the vagus nerve and with seizure activity confirmed, the cord was transected in the midthoracic region and vagus nerve stimulation performed. Right-sided vagus nerve stimulation resulted in cessation of spinal cord seizure activity in all animals. Transection of the spinal cord superior to the site of seizure induction resulted in the ineffectiveness of vagus nerve stimulation in causing cessation of seizure activity in all study animals. As with left-sided vagus nerve stimulation, right-sided vagus nerve stimulation results in cessation of induced spinal cord seizures. Additionally, the effects of right-sided vagus nerve stimulation on induced spinal cord seizures involve descending spinal pathways. These data may aid in the development of alternative mechanisms for electrical stimulation for patients with medically intractable seizures and add to our knowledge regarding the mechanism for seizure cessation following peripheral nerve stimulation.

Schwann cell seeded guidance tubes restore erectile function after ablation of cavernous nerves in rats.

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

2004-07-01

Dissection of the cavernous nerves eliminates spontaneous erections. We evaluated the ability of Schwann cell seeded nerve guidance tubes to restore erections after bilateral cavernous nerve resection in rats. Sections (5 mm) of the cavernous nerve were excised bilaterally, followed by immediate bilateral microsurgical reconstruction. In 10 animals per group (20 study nerves) reconstruction was performed by genitofemoral nerve interposition, interposition of silicone tubes or interposition of silicone tubes seeded with homologous Schwann cells. As the control 10 animals (20 study nerves) underwent sham operation (positive control) and bilateral nerve ablation (without reconstruction) was performed in a further 10 (negative control). Erectile function was evaluated 3 months postoperatively by relaparotomy, electrical nerve stimulation and intracavernous pressure recording. After 3 months neurostimulation resulted in an intact erectile response in 90% (18 of 20) of Schwann cell grafts, while treatment with autologous nerves (30% or 6 of 20) or tubes only (50% or 10 of 20) was less successful (p Schwann cell grafts compared to results in the other treatment groups (p Schwann cell grafts. Schwann cell seeded guidance tubes restore erectile function after the ablation of cavernous nerves in rats and they are superior to autologous nerve grafts.

Terminal nerve: cranial nerve zero

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Jorge Eduardo Duque Parra

2006-12-01

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

Selective angiography of the avascular necrosis of the femoral head

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Choi, Joong Chan; Park, Cheong Hee; Rho, Tae Jin; Yune, Seung Ho; Rhee, Byung Chull [Chung Nam National University College of Medicine, Deajeon (Korea, Republic of)

1988-10-15

The diagnosis of the avascular of the femoral head (AVN) has advanced. RI scan, intraosseous pressure monitoring, intramedullary venography, CT, MRI, and selective femoral angiography are used in diagnosis. Among these methods, selective or superselective angiography is necessary to study the change of the vessels of the hip, because the vascular insufficiency could be a major etiology of AVN. Selective femoral angiography was performed for 23 hips of 22 patients who were suspected as AVN by simple rediographs and RI scans in order to estimate the change of vascularity of the femoral head. The results were as follow. 1. The alteration of vasculature appeared in 21 cases among all 23 cases (91%), which included 100% in the traumatic group (4/4 cases) and 90% in nontraumatic group (17/19 cases). 2. The affected vessles in nontraumatic group were the proximal portion of the posterior branch of the medical circumflex artery in 2 cases, the modportion of posterior branch in 2 cases, the distal portion of the posterior branch in 11 cases, and superior capsular branch in 2 cases. 3. The affected vessels in traumatic group were proximal portion in 1 cases, midportion in 1 case, and superior capsular artrey in 2 cases. 4. The obstruction of inferior casular artery was noted in 6 cases of nontraumatic group. 5. The retrograde filling of the posterior branch of medial circumflex artery were noted in 1 case from superior gluteal artery, in 1 case from inferior gluteal artery, in 1 case form superior and inferior gluteal artery and retrograde filling of inferior gluteal artery from medial circumflex artery was in 6 cases.

Selective angiography of the avascular necrosis of the femoral head

International Nuclear Information System (INIS)

Choi, Joong Chan; Park, Cheong Hee; Rho, Tae Jin; Yune, Seung Ho; Rhee, Byung Chull

1988-01-01

The diagnosis of the avascular of the femoral head (AVN) has advanced. RI scan, intraosseous pressure monitoring, intramedullary venography, CT, MRI, and selective femoral angiography are used in diagnosis. Among these methods, selective or superselective angiography is necessary to study the change of the vessels of the hip, because the vascular insufficiency could be a major etiology of AVN. Selective femoral angiography was performed for 23 hips of 22 patients who were suspected as AVN by simple rediographs and RI scans in order to estimate the change of vascularity of the femoral head. The results were as follow. 1. The alteration of vasculature appeared in 21 cases among all 23 cases (91%), which included 100% in the traumatic group (4/4 cases) and 90% in nontraumatic group (17/19 cases). 2. The affected vessles in nontraumatic group were the proximal portion of the posterior branch of the medical circumflex artery in 2 cases, the modportion of posterior branch in 2 cases, the distal portion of the posterior branch in 11 cases, and superior capsular branch in 2 cases. 3. The affected vessels in traumatic group were proximal portion in 1 cases, midportion in 1 case, and superior capsular artrey in 2 cases. 4. The obstruction of inferior casular artery was noted in 6 cases of nontraumatic group. 5. The retrograde filling of the posterior branch of medial circumflex artery were noted in 1 case from superior gluteal artery, in 1 case from inferior gluteal artery, in 1 case form superior and inferior gluteal artery and retrograde filling of inferior gluteal artery from medial circumflex artery was in 6 cases.

Anatomical basis for sciatic nerve block at the knee level

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Fabiano Timbó Barbosa

2015-05-01

Full Text Available Background and objectives: Recently, administration of sciatic nerve block has been revised due to the potential benefit for postoperative analgesia and patient satisfaction after the advent of ultrasound. The aim of this study was to describe the anatomical relations of the sciatic nerve in the popliteal fossa to determine the optimal distance the needle must be positioned in order to realize the sciatic nerve block anterior to its bifurcation into the tibial and common fibular nerve. Method: The study was conducted by dissection of human cadavers’ popliteal fossa, fixed in 10% formalin, from the Laboratory of Human Anatomy and Morphology Departments of the Universidade Federal de Alagoas and Universidade de Ciências da Saúde de Alagoas. Access to the sciatic nerve was obtained. Results: 44 popliteal fossa were analyzed. The bifurcation of the sciatic nerve in relation to the apex of the fossa was observed. There was bifurcation in: 67.96% below the apex, 15.90% above the apex, 11.36% near the apex, and 4.78% in the gluteal region. Conclusions: The sciatic nerve bifurcation to its branches occurs at various levels, and the chance to succeed when the needle is placed between 5 and 7 cm above the popliteal is 95.22%. Resumo: Justificativa e objetivos: Recentemente a feitura de bloqueio do nervo isquiático tem sido revista devido ao potencial benéfico para analgesia pós-operatória e satisfação dos pacientes após o advento da ultrassonografia. O objetivo deste estudo foi descrever as relações anatômicas do nervo isquiático na fossa poplítea para determinar a distância ideal em que a agulha deve ser posicionada para a feitura do bloqueio anestésico do nervo isquiático anterior a sua bifurcação em nervo tibial e fibular comum. Método: O trabalho foi feito por meio de dissecção de fossa poplítea de cadáveres humanos, fixados em formol a 10%, provenientes do Laboratório de Anatomia Humana dos departamentos de Morfologia da

Fluoroscopic position of the second-generation cryoballoon during ablation in the right superior pulmonary vein as a predictor of phrenic nerve injury.

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Saitoh, Yukio; Ströker, Erwin; Irfan, Ghazala; Mugnai, Giacomo; Ciconte, Giuseppe; Hünük, Burak; Velagić, Vedran; Overeinder, Ingrid; Tanaka, Kaoru; Brugada, Pedro; de Asmundis, Carlo; Chierchia, Gian-Battista

2016-08-01

Phrenic nerve injury (PNI) is the most frequently observed complication during pulmonary vein isolation procedure using the second-generation cryoballoon (CB). Our objective was to analyse the correlation between the fluoroscopic position of the 28 mm CB during ablation in the right superior pulmonary vein (RSPV) and the occurrence of PNI. A total of 165 patients having undergone the large 28 mm CB ablation were retrospectively reviewed. Positioning of the CB relative to the cardiac silhouette was classified under fluoroscopic guidance in antero-posterior projection during RSPV ablation. Regarding the lower half of the balloon, CB positioning was defined as follows: (A) completely inside the cardiac shadow; (B1) Phrenic nerve injury occurred in 9.7% (16/165) during ablation in the RSPV. The occurrence of PNI was 0.9, 10.6, and 90.1% in positions A, B1, and B2, respectively (A vs. B1, P = 0.01; B1 vs. B2, P < 0.0001). Among other pre-procedural and procedural variables, the B2 position was the strongest independent determinant for predicting PNI at RSPV (P = 0.001, odds ratio: 119.9; 95% confidence interval: 11.6-1234.7) after multivariable analysis. The incidence of PNI at the RSPV significantly increased in case of more distal positioning of the CB relative to the cardiac shadow. This simple and straightforward intra-procedural indicator might prone the operators to attempt occluding the RPSV more proximally in order to avoid PNI. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Anatomical study of phrenic nerve course in relation to neck dissection.

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Hamada, Tomohiro; Usami, Akinobu; Kishi, Asuka; Kon, Hideki; Takada, Satoshi

2015-04-01

The present study sought to clarify the course of the phrenic nerve and its correlation with anatomical landmarks in the neck region. We examined 17 cadavers (30 sides). In each, the phrenic nerves was dissected from the lateral side of the neck, and its position within the triangle formed by the mastoid process and sternal and acromial ends of the clavicle was determined. The point where the phrenic nerve arises in the posterior triangle was found to be similar to the point where the cutaneous blanches of the cervical plexus emerge at the middle of the posterior border of the sternocleidomastoid muscle. In the supraclavian triangle, the phrenic nerve crosses the anterior border of the anterior scalene muscle near Erb's point where the superficial point is 2-3 cm superior from the clavicle and posterior border of the sternocleidomastoid muscle. The phrenic nerve arises in the posterior triangle near the nerve point, then descends to the anterior surface of the anterior scalene muscle in the supraclavian triangle. It is necessary to be aware of the supraclavian triangle below Erb's point during neck dissection procedures.

Pathological Location of Cranial Nerves in Petroclival Lesions: How to Avoid Their Injury during Anterior Petrosal Approach.

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Borghei-Razavi, Hamid; Tomio, Ryosuke; Fereshtehnejad, Seyed-Mohammad; Shibao, Shunsuke; Schick, Uta; Toda, Masahiro; Yoshida, Kazunari; Kawase, Takeshi

2016-02-01

Objectives  Numerous surgical approaches have been developed to access the petroclival region. The Kawase approach, through the middle fossa, is a well-described option for addressing cranial base lesions of the petroclival region. Our aim was to gather data about the variation of cranial nerve locations in diverse petroclival pathologies and clarify the most common pathologic variations confirmed during the anterior petrosal approach. Method  A retrospective analysis was made of both videos and operative and histologic records of 40 petroclival tumors from January 2009 to September 2013 in which the Kawase approach was used. The anatomical variations of cranial nerves IV-VI related to the tumor were divided into several location categories: superior lateral (SL), inferior lateral (IL), superior medial (SM), inferior medial (IM), and encased (E). These data were then analyzed taking into consideration pathologic subgroups of meningioma, epidermoid, and schwannoma. Results  In 41% of meningiomas, the trigeminal nerve is encased by the tumor. In 38% of the meningiomas, the trigeminal nerve is in the SL part of the tumor, and it is in 20% of the IL portion of the tumor. In 38% of the meningiomas, the trochlear nerve is encased by the tumor. The abducens nerve is not always visible (35%). The pathologic nerve pattern differs from that of meningiomas for epidermoid and trigeminal schwannomas. Conclusion  The pattern of cranial nerves IV-VI is linked to the type of petroclival tumor. In a meningioma, tumor origin (cavernous, upper clival, tentorial, and petrous apex) is the most important predictor of the location of cranial nerves IV-VI. Classification of four subtypes of petroclival meningiomas using magnetic resonance imaging is very useful to predict the location of deviated cranial nerves IV-VI intraoperatively.

Brodie’s Abscess of Posterior Ilium with Gluteal Syndrome, an Unusual Cause of Paediatric Low Back Pain: A Case Report

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Behera G

2017-07-01

Full Text Available Brodie’s abscess is a variety of subacute osteomyelitis with a long duration of presentation and intermittent pain. It usually involves the metaphyseal region of long bones of the lower limbs. Brodie’s abscess of pelvic bone is very rare. Involvement of posterior ilium with gluteal syndrome is extremely unusual and can be easily missed or misdiagnosed. We present a 9-year old boy who reported to us with intermittent low back pain of three months duration without any other constitutional symptoms. Clinically, there was mild tenderness over the posterior ilium. Computed tomography showed a lytic lesion in the posterior ilium with a breach in the outer cortex. MRI and bone scan were suggestive of inflammatory pathology. Keeping infective, tubercular and benign bone tumors as differential diagnoses, open biopsy and curettage were done. Staphylococcus aureus was cultured and histopathology was suggestive of osteomyelitis. The patient received appropriate antibiotics for six weeks. He was asymptomatic till 18 months of follow up without any recurrence. We present this case because of its rarity and unusual presentation as gluteal syndrome and low back pain, and its resemblance to other pelvic and sacroiliac joint pathologies which are often missed or misdiagnosed in paediatric patients.

Fluoroscopy of spontaneous breathing is more sensitive than phrenic nerve stimulation for detection of right phrenic nerve injury during cryoballoon ablation of atrial fibrillation.

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Linhart, Markus; Nielson, Annika; Andrié, René P; Mittmann-Braun, Erica L; Stöckigt, Florian; Kreuz, Jens; Nickenig, Georg; Schrickel, Jan W; Lickfett, Lars M

2014-08-01

Right phrenic nerve palsy (PNP) is a typical complication of cryoballoon ablation of the right-sided pulmonary veins (PVs). Phrenic nerve function can be monitored by palpating the abdomen during phrenic nerve pacing from the superior vena cava (SVC pacing) or by fluoroscopy of spontaneous breathing. We sought to compare the sensitivity of these 2 techniques during cryoballoon ablation for detection of PNP. A total of 133 patients undergoing cryoballoon ablation were monitored with both SVC pacing and fluoroscopy of spontaneous breathing during ablation of the right superior PV. PNP occurred in 27/133 patients (20.0%). Most patients (89%) had spontaneous recovery of phrenic nerve function at the end of the procedure or on the following day. Three patients were discharged with persistent PNP. All PNP were detected first by fluoroscopic observation of diaphragm movement during spontaneous breathing, while diaphragm could still be stimulated by SVC pacing. In patients with no recovery until discharge, PNP occurred at a significantly earlier time (86 ± 34 seconds vs. 296 ± 159 seconds, P < 0.001). No recovery occurred in 2/4 patients who were ablated with a 23 mm cryoballoon as opposed to 1/23 patients with a 28 mm cryoballoon (P = 0.049). Fluoroscopic assessment of diaphragm movement during spontaneous breathing is more sensitive for detection PNP as compared to SVC pacing. PNP as assessed by fluoroscopy is frequent (20.0%) and carries a high rate of recovery (89%) until discharge. Early onset of PNP and use of 23 mm cryoballoon are associated with PNP persisting beyond hospital discharge. © 2014 Wiley Periodicals, Inc.

The gross anatomy of the renal sympathetic nerves revisited.

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Mompeo, Blanca; Maranillo, Eva; Garcia-Touchard, Arturo; Larkin, Theresa; Sanudo, Jose

2016-07-01

Catheter-based renal denervation techniques focus on reducing blood pressure in resistant hypertension. This procedure requires exact knowledge of the anatomical interrelation between the renal arteries and the targeted renal nervous plexus. The aim of this work was to build on classical anatomical studies and describe the gross anatomy and anatomical relationships of the renal arteries and nerve supply to the kidneys in a sample of human cadavers. Twelve human cadavers (six males and six females), age range 73 to 94 years, were dissected. The nervous fibers and renal arteries were dissected using a surgical microscope. The renal plexus along the hilar renal artery comprised a fiber-ganglionic ring surrounding the proximal third of the renal artery, a neural network along the middle and distal thirds, and smaller accessory ganglia along the course of the nerve fibers. The fibers of the neural network were mainly located on the superior (95.83%) and inferior (91.66%) surfaces of the renal artery and they were sparsely interconnected by diagonal fibers. Polar arteries were present in 33.33% of cases and the renal nerve pattern for these was similar to that of the hilar arteries. Effective renal denervation needs to target the superior and inferior surfaces of the hilar and polar arteries, where the fibers of the neural network are present. Clin. Anat. 29:660-664, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

End-to-side neurorrhaphy repairs peripheral nerve injury: sensory nerve induces motor nerve regeneration.

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Yu, Qing; Zhang, She-Hong; Wang, Tao; Peng, Feng; Han, Dong; Gu, Yu-Dong

2017-10-01

End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve. It involves suturing the distal stump of the disconnected nerve (recipient nerve) to the side of the intimate adjacent nerve (donor nerve). However, the motor-sensory specificity after end-to-side neurorrhaphy remains unclear. This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy. Thirty rats were randomized into three groups: (1) end-to-side neurorrhaphy using the ulnar nerve (mixed sensory and motor) as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve; (2) the sham group: ulnar nerve and cutaneous antebrachii medialis nerve were just exposed; and (3) the transected nerve group: cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied. At 5 months, acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group, and none of the myelinated axons were stained in either the sham or transected nerve groups. Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%. In contrast, no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment. These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.

Superior and anterior inferior cerebellar arteries and their relationship with cerebello-pontine angle cranial nerves revisited in the light of cranial cephalometric indexes: a cadaveric study.

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Habibi, Zohreh; Meybodi, Ali Tayebi; Maleki, Farid; Tabatabai, Seyed

2011-01-01

The aim was to clarify the anatomical features of the superior and anterior inferior cerebellar arteries in relation to the trigeminal nerve and acoustic-facial complex and to the bony structures of the skull in a sample of male Iranian cadavers. Bilateral dissections, calvariectomy, and brain evacuation were performed on 31 adult human fresh brains and skull bases to assess the neurovascular associations, and skull base morphometry. Equations were defined to estimate posterior fossa volume and the relationships between bony and neurovascular elements. Eight SCAs were duplicated from origin. There were 9 cases of SCA-trigeminal contacts, which were at the root entry zone in 7. Mean distance from the origin of AICA to the vertebrobasilar junction was 11.80 mm, while 79% of AICAs originated from the lower half of the BA. This was significantly associated with "posterior fossa funneling" and "basilar narrowing" indexes. In most cases AICA crossed the acoustic-facial complex and coursed between neural bundles (48.3%). The AICA reached or entered the internal acoustic canal in 22.6% of cases and was medial to porous in 77.4%. We documented anatomical variations of the superior and anterior inferior cerebellar arteries along with some cephalometric equations with relevant neurovascular anatomy in Iranian cadavers.

The lumbosacral plexus of the red-rumped agouti (Dasyprocta leporina Linnaeus, 1758 (Rodentia: Caviidae

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Gleidson Benevides de Oliveira

2016-12-01

Full Text Available The red-rumped agouti is a small-sized wild rodent, belonging to the Dasyproctidae family, with great zootechnical potential, and it adapts well to captivity. In order to contribute to the species biology, this study describes the origin of the nerves forming the lumbosacral plexus. Twelve animals (six males and six females were used, from previous experiments. The animals were fixed in a 10% formaldehyde aqueous solution and eviscerated after 72 hours. Then, the major and minor psoas muscles were retracted, exposing the nerves forming the plexus. Cotton soaked with 20-volume hydrogen peroxide was placed on these nerves, remaining for 12 hours straight for bleaching and subsequent dissection. The topographical relations of the lumbosacral plexus were grouped into tables and arranged in terms of simple percentage. In 7 cases (58.34%, the lumbosacral plexus in the red-rumped agouti stemmed from the ventral roots of the last 4 lumbar nerves and the first 3 sacral nerves (Type I – L4-S3, in 4 animals (33.33% it stemmed from L5-S3 (Type II, and in 1 case (8.33% it stemmed from L5-S4 (Type III. The nerves participating of the lumbosacral plexus in the red-rumped agouti were: lateral femoral cutaneous, genitofemoral, femoral, obturator, sciatic, cranial gluteal, caudal gluteal, and pudendal nerve. The origin of the lumbosacral plexus and the spinal nerves making up this plexus in red-rumped agoutis were similar to that described in other rodents, such as rock cavy, lowland paca and spix's yellow-toothed cavy.

Evaluation of retinal nerve fiber layer thickness parameters in myopic population using scanning laser polarimetry (GDxVCC).

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Dada, Tanuj; Aggarwal, A; Bali, S J; Sharma, A; Shah, B M; Angmo, D; Panda, A

2013-01-01

Myopia presents a significant challenge to the ophthalmologist as myopic discs are often large, tilted, with deep cups and have a thinner neuroretinal rim all of which may mimic glaucomatous optic nerve head changes causing an error in diagnosis. To evaluate the retinal fiber layer (RNFL) thickness in low, moderate and high myopia using scanning laser polarimetry with variable corneal compensation (GDxVCC). One hundred eyes of 100 emmetropes, 30 eyes of low myopes (0 to - 4 D spherical equivalent(SE), 45 eyes with moderate myopia (- 4 to - 8D SE), and 30 eyes with high myopia (- 8 to - 15D SE) were subjected to retinal nerve fiber layer assessment using the scanning laser polarimetry (GDxVCC) in all subjects using the standard protocol. Subjects with IOP > 21 mm Hg, optic nerve head or visual field changes suggestive of glaucoma were excluded from the study. The major outcome parameters were temporal-superior-nasal-inferiortemporal (TSNIT) average, the superior and inferior average and the nerve fibre indicator (NFI). The TSNIT average (p = 0.009), superior (p = 0.001) and inferior average (p = 0.008) were significantly lower; the NFI was higher (P less than 0.001) in moderate myopes as compared to that in emmetropes. In high myopia the RNFL showed supranormal values; the TSNIT average, superior and inferior average was significantly higher(p less than 0.001) as compared to that in emmetropes. The RNFL measurements on scanning laser polarimetry are affected by the myopic refractive error. Moderate myopes show a significant thinning of the RNFL. In high myopia due to peripapillary chorioretinal atrophy and contribution of scleral birefringence, the RNFL values are abnormally high. These findings need to be taken into account while assessing and monitoring glaucoma damage in moderate to high myopes on GDxVCC. © NEPjOPH.

GIANT GLUTEAL LIPOMA: A CASE REPORT AND REVIEW OF LITERATURE

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PRASHANT HOMBAL

2015-05-01

Full Text Available Introduction : Lipoma is one of the most common benign mesenchymal tumor which can occur in almost in all organs of the body where fat normally exists, so called as universal tumor or ubiquitous tumor. Lipomas are slow growing that rarely reach a size more than 2-3cms. Lesions larger than 5cms, so called giant lipomas are seldom found inside the muscle compressing nervous-vascular structures. The large and deep seated lipomas represent a real diagnostic and therapeutic challenge. Case report: We report a case of 48 year old man with a giant lipoma involving his left gluteal and thigh region. The patient was managed by wide local excision of the lesion. The key issues surrounding the intramuscular lipoma with literature review is discussed. Conclusion: Intramuscular Giant lipomas are rare and even though they are typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, but when they occur an appropriate workup must be done. This should be followed by adequate open surgical excision and repeat examination over time to monitor for recurrence.

Prolonged electrical stimulation-induced gluteal and hamstring muscle activation and sitting pressure in spinal cord injury: Effect of duty cycle

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Christof A. J. Smit, MD; Karin J. A. Legemate, MSc; Anja de Koning, MSc; Sonja de Groot, PhD; Janneke M. Stolwijk-Swuste, MD, PhD; Thomas W. J. Janssen, PhD

2013-01-01

Pressure ulcers (PUs) are highly prevalent in people with spinal cord injury (SCI). Electrical stimulation (ES) activates muscles and might reduce risk factors. Our objectives were to study and compare the effects of two duty cycles during 3 h of ES-induced gluteal and hamstring activation on interface pressure distribution in sitting individuals with SCI and study the usability of a newly developed electrode garment (ES shorts). Ten individuals with SCI participated in this study, in which t...

MR imaging of the cranial nerves and the intracranial vessels using 3D-SPGR

International Nuclear Information System (INIS)

Hosoya, Takaaki; Sato, Nami; Yamaguchi, Koichi; Sugai, Yukio; Ogushi, Masatoshi; Kubota, Hisashi

1992-01-01

MR angiography (MRA) has developed rapidly, but it is still insufficient to demonstrate the detail of the intracranial vascular anatomy. We found that original images of MRA render more information than MRA images about not only intracranial vessels but also cranial nerves. We have tried to demonstrate cranial nerves and intracranial vessels on 26 patients and evaluated using real time reformation of original images of MRA. MR images were obtained by SPGR (3DFT) after injection of Gd-DTPA. The optic nerve, the oculomotor nerve, the trigeminal nerve, the facial nerve and the vestibulocochlear nerve were visualized clearly on almost patients and detectabilities of these nerves were 100%, 98%, 100%, 94% and 100%, respectively. The abducent nerve was also detectable in 76%. The trochlear nerve, which could not be observed by any modality, was detected at prepontine cistern in 10%. Arteries around brain stem such as the superior cerebellar artery (SCA), the anterior inferior cerebellar artery (AICA), the posterior inferior cerebellar artery (PICA) and the posterior communicating artery (PcomA) were clearly visible, and branching of these arteries and anatomical detail were completely coincide with angiogram on 12 patients. The basal vein of Rosenthal and the petrosal vein were confirmed in 100% and their anastomose were demonstrated obviously. We concluded that this method was extremely useful to observe cranial nerves and intracranial small vessels. (author)

Myelography for nerve root avulsion in birth palsy

Energy Technology Data Exchange (ETDEWEB)

Hashimoto, Tsutomu; Mitomo, Masanori; Hirabuki, Norio; Miura, Takashi; Kawai, Ryuji; Imakita, Satoshi; Harada, Koshi; Nakamura, Hironobu; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

1990-04-01

Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.).

Myelography for nerve root avulsion in birth palsy

International Nuclear Information System (INIS)

Hashimoto, Tsutomu; Mitomo, Masanori; Hirabuki, Norio; Miura, Takashi; Kawai, Ryuji; Imakita, Satoshi; Harada, Koshi; Nakamura, Hironobu; Kozuka, Takahiro

1990-01-01

Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.)

The relationship between the fistula tract and the facial nerve in type II first branchial cleft anomalies.

Science.gov (United States)

Ertas, Burak; Gunaydin, Rıza Onder; Unal, Omer Faruk

2015-04-01

To share our experience involving seven patients with type II first branchial cleft anomalies (hereafter, type II anomalies), to determine whether the location of the external fistula openings of the anomalies are associated with the location of the facial nerve tract, and elucidate the relationship between the location of the fistula opening and the facial nerve. The medical records of seven patients who underwent surgery from 2005 to 2013 for type II anomalies were retrospectively examined. The relationship between the fistula opening and the facial nerve was evaluated in each patient with respect to whether the fistula opening was superior or inferior to the mandibular angle. All patients underwent partial parotidectomy, facial nerve exposure, and total excision of the mass together with connection of a small cuff of the external auditory canal skin to the fistula tract. The fistula tracts were located medially to the facial nerve in two patients, and both fistulae had openings inferior to the mandibular angle. The fistula tracts were located laterally to the facial nerve in the remaining five patients: one patient had no external opening, one had an opening inferior to the mandibular angle, and the remaining three had openings superior to the mandibular angle. Because type II anomalies are rare, their diagnosis is difficult. Surgery of such lesions is challenging and associated with a high risk due to their proximity to the facial nerve. We believe that the location of the fistula opening may help to identify the relationship between the anomalous lesion and facial nerve. Studies involving larger series of cases are needed to confirm our hypothesis; however, because of the rarity of this specific anomaly, it will not be easy to compile a large number of cases. We believe that our study will encourage further investigation on this subject. Copyright © 2014. Published by Elsevier Ireland Ltd.

Techniques for Preservation of the Frontotemporal Branch of Facial Nerve during Orbitozygomatic Approaches

DEFF Research Database (Denmark)

Spiriev, Toma; Poulsgaard, Lars; Fugleholm, Kaare

2015-01-01

Background During orbitozygomatic (OZ) approaches, the frontotemporal branch (FTB) of the facial nerve is exposed to injury if proper measures are not taken. This article describes in detail the nuances of the two most common techniques (interfascial and subfascial dissection). Design The FTB...... of the facial nerve was dissected and followed in its tissue planes on fresh-frozen cadaver heads. The interfascial and subfascial dissections were performed, and every step was photographed and examined. Results The interfascial dissection is safe to be started from the most anterior part of the superior...

Reflex vocal fold adduction in the porcine model: the effects of stimuli delivered to various sensory nerves.

Science.gov (United States)

Woo, Jeong-Soo; Hundal, Jagdeep S; Sasaki, Clarence T; Abdelmessih, Mikhail W; Kelleher, Stephen P

2008-10-01

The aim of this study was to identify a panel of sensory nerves capable of eliciting an evoked glottic closure reflex (GCR) and to quantify the glottic closing force (GCF) of these responses in a porcine model. In 5 pigs, the internal branch of the superior laryngeal nerve (iSLN) and the trigeminal, pharyngeal plexus, glossopharyngeal, radial, and intercostal nerves were surgically isolated and electrically stimulated. During stimulation of each nerve, the GCR was detected by laryngeal electromyography and the GCF was measured with a pressure transducer. The only nerve that elicited the GCR in the 5 pigs was the iSLN. The average GCF was 288.9 mm Hg. This study demonstrates that the only afferent nerve that elicits the GCR in pigs is the iSLN, and that it should remain the focus of research for the rehabilitation of patients with absent or defective reflex vocal fold adduction.

Congenital pits of the optic nerve head and retinochoroidal colobomas.

Science.gov (United States)

Brown, G C; Augsburger, J J

1980-07-01

A 45-year-old man presented with bilateral retinochoroidal colobomas associated with an inferonasal congenital pit of the optic nerve head in each eye. Different theories on the origin of such pits are discussed. This case supports the theory that some congenital optic pits occur as a result of failure of closure of the superior end of the embryonic fissure.

The superiority of 3D-CISS sequence in displaying the cisternal segment of facial, vestibulocochlear nerves and their abnormal changes

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Liang Changhu, E-mail: tigerlch@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Zhang Bin, E-mail: liangchangbo.student@sina.co [Liao Cheng City People' s Hospital, Dongchang Road, Liaocheng, Shandong (China); Wu Lebin, E-mail: Lebinwu518@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Du Yinglin, E-mail: duyinglinzhuo@sohu.co [Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, 72, Jingshi Road, Jinan, Shandong (China); Wang Ximing, E-mail: wxminmg369@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Liu Cheng, E-mail: cacab2a@126.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Yu Fuhua, E-mail: changhu1970@163.co [Weifang Medical College, 7166, West Road Baotong Weifang, Shandong (China)

2010-06-15

Objective: To select the best imaging method for clinical otologic patients through evaluating 3D constructive interference of steady state (CISS) image quality in visualizing the facial, vestibulocochlear nerves (CN:VII-VIII) and their abnormal changes. Methods: The CN:VII-VIII as well as inner ear structures in 48 volunteers were examined using 3D-CISS and 3D turbo spin echo (TSE) sequences respectively, and displayed to the full at the reformatted and maximum intensity projection (MIP) images. The nerve identification and image quality were graded for the CN:VII-VIII as well as inner ear structures. Statistical analysis was performed using the Wilcoxin test, p < 0.05 was considered significant. In addition, 8 patients with abnormality in facial or vestibulocochlear nerves were also examined using 3D-CISS sequence. Results: The identification rates for the cisternal segment of facial, vestibulocochlear nerves and corresponding membranous labyrinth were 100%. Abnormal changes of the facial or vestibulocochlear nerves were clearly shown in 8 patients, among them 1 was caused by bilateral acoustic neurinoma, 1 by cholesteatoma at cerebellopontine angle, 1 by arachnoid cyst, 1 by neurovascular adhesion, 4 by neurovascular compression. Conclusion: With 3D-CISS sequence the fine structure of the CN:VII-VIII and corresponding membranous labyrinth can be clearly demonstrated; lesions at the site of cerebellopontine angle can also be found easily.

Histological methods for assessing myelin sheaths and axons in human nerve trunks.

Science.gov (United States)

Miko, T L; Gschmeissner, S E

1994-03-01

Although there are many histological techniques for assessing myelin sheaths and axons in paraffin embedded or frozen sections of the peripheral nervous system, modern approaches usually use plastic embedded material. Although plastic embedding is superior for small cutaneous branches, this method has limited value for histological assessment of nerve trunks. We report three methods which together yield a comprehensive approach for thorough and detailed investigation of human nerve trunks. The rapid osmication method permitted assessment of myelinated nerve fibers from frozen sections at operation, thus providing the surgeon with guidance on the extent of nerve resection. The modification presented here resulted in permanent slides, allowing comparison of results with those of the other two procedures. The new osmium-hematoxylin technique could be performed on paraffin embedded nerves. Paraffin, unlike plastic, permitted the study of the whole cross sectional area of the nerve in single sections. Moreover, the sharp image of the myelin permitted computerized morphometry. The significantly modified axonal silver impregnation technique was performed on frozen sections mounted on glass slides, as opposed to the time-consuming impregnation of free-floating sections. The latter technique had a high success rate and permitted semiquantitative assessment of axons in nerve trunks. These methods can be performed in any routine histology laboratory and resulted in greater accuracy compared to conventional methods.

Rat optic nerve head anatomy within 3D histomorphometric reconstructions of normal control eyes.

Science.gov (United States)

Pazos, Marta; Yang, Hongli; Gardiner, Stuart K; Cepurna, William O; Johnson, Elaine C; Morrison, John C; Burgoyne, Claude F

2015-10-01

The purpose of this study is to three-dimensionally (3D) characterize the principal macroscopic and microscopic relationships within the rat optic nerve head (ONH) and quantify them in normal control eyes. Perfusion-fixed, trephinated ONH from 8 normal control eyes of 8 Brown Norway Rats were 3D histomorphometrically reconstructed, visualized, delineated and parameterized. The rat ONH consists of 2 scleral openings, (a superior neurovascular and inferior arterial) separated by a thin connective tissue strip we have termed the "scleral sling". Within the superior opening, the nerve abuts a prominent extension of Bruch's Membrane (BM) superiorly and is surrounded by a vascular plexus, as it passes through the sclera, that is a continuous from the choroid into and through the dural sheath and contains the central retinal vein (CRV), (inferiorly). The inferior scleral opening contains the central retinal artery and three long posterior ciliary arteries which obliquely pass through the sclera to obtain the choroid. Bruch's Membrane Opening (BMO) is irregular and vertically elongated, enclosing the nerve (superiorly) and CRV and CRA (inferiorly). Overall mean BMO Depth, BMO Area, Choroidal Thickness and peripapillary Scleral Thickness were 29 μm, 56.5 × 10(3) μm(2), 57 μm and 104 μm respectively. Mean anterior scleral canal opening (ASCO) and posterior scleral canal opening (PSCO) radii were 201 ± 15 μm and 204 ± 16 μm, respectively. Mean optic nerve area at the ASCO and PSCO were 46.3 × 10(3)±4.4 × 10(3) μm(2) and 44.1 × 10(3)±4.5 × 10(3) μm(2) respectively. In conclusion, the 3D complexity of the rat ONH and the extent to which it differs from the primate have been under-appreciated within previous 2D studies. Properly understood, these anatomic differences may provide new insights into the relative susceptibilities of the rat and primate ONH to elevated intraocular pressure. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nerve Blocks

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... News Physician Resources Professions Site Index A-Z Nerve Blocks A nerve block is an injection to ... the limitations of Nerve Block? What is a Nerve Block? A nerve block is an anesthetic and/ ...

Sacral pressure sore reconstruction – the pedicled superior gluteal ...

African Journals Online (AJOL)

Pressure sore reconstruction has always been challenging. Immobile patients are prone to develop pressure sores from unre- lieved pressure on tissue over the sacral area, with shear, friction, moisture and malnutrition as contributing factors. Up to one-third of immobilised patients in long-term care facilities will develop.

Effect of duration and severity of migraine on retinal nerve fiber layer, ganglion cell layer, and choroidal thickness.

Science.gov (United States)

Abdellatif, Mona K; Fouad, Mohamed M

2018-03-01

To investigate the factors in migraine that have the highest significance on retinal and choroidal layers' thickness. Ninety patients with migraine and 40 age-matched healthy participants were enrolled in this observational, cross-sectional study. After full ophthalmological examination, spectral domain-optical coherence tomography was done for all patients measuring the thickness of ganglion cell layer and retinal nerve fiber layer. Enhanced depth imaging technique was used to measure the choroidal thickness. There was significant thinning in the superior and inferior ganglion cell layers, all retinal nerve fiber layer quadrants, and all choroidal quadrants (except for the central subfield) in migraineurs compared to controls. The duration of migraine was significantly correlated with ganglion cell layer, retinal nerve fiber layer, and all choroidal quadrants, while the severity of migraine was significantly correlated with ganglion cell layer and retinal nerve fiber layer only. Multiregression analysis showed that the duration of migraine is the most important determinant factor of the superior retinal nerve fiber layer quadrant (β = -0.375, p = 0.001) and in all the choroidal quadrants (β = -0.531, -0.692, -0.503, -0.461, -0.564, respectively, p  layer quadrants (β = -0.256, -0.335, -0.308; p  = 0.036, 0.005, 0.009, respectively) and the inferior ganglion cell layer hemisphere (β = -0.377 and p = 0.001). Ganglion cell layer, retinal nerve fiber layer, and choroidal thickness are significantly thinner in patients with migraine. The severity of migraine has more significant influence in the thinning of ganglion cell layer and retinal nerve fiber layer, while the duration of the disease affected the choroidal thickness more.

Clinical experience with a novel electromyographic approach to preventing phrenic nerve injury during cryoballoon ablation in atrial fibrillation.

Science.gov (United States)

Mondésert, Blandine; Andrade, Jason G; Khairy, Paul; Guerra, Peter G; Dyrda, Katia; Macle, Laurent; Rivard, Léna; Thibault, Bernard; Talajic, Mario; Roy, Denis; Dubuc, Marc; Shohoudi, Azadeh

2014-08-01

Phrenic nerve palsy remains the most frequent complication associated with cryoballoon-based pulmonary vein (PV) isolation. We sought to characterize our experience using a novel monitoring technique for the prevention of phrenic nerve palsy. Two hundred consecutive cryoballoon-based PV isolation procedures between October 2010 and October 2013 were studied. In addition to standard abdominal palpation during right phrenic nerve pacing from the superior vena cava, all patients underwent diaphragmatic electromyographic monitoring using surface electrodes. Cryoablation was terminated on any perceived reduction in diaphragmatic motion or a 30% decrease in the compound motor action potential (CMAP). During right-sided ablation, a ≥30% reduction in CMAP amplitude occurred in 49 patients (24.5%). Diaphragmatic motion decreased in 30 of 49 patients and was preceded by a 30% reduction in CMAP amplitude in all. In 82% of cases, this reduction in CMAP amplitude occurred during right superior PV isolation. The baseline CMAP amplitude was 946.5±609.2 mV and decreased by 13.8±13.8% at the end of application. This decrease was more marked in the 33 PVs with a reduction in diaphragmatic motion than in those without (40.9±15.3% versus 11.3±10.5%; Pphrenic nerve palsy persisted beyond the end of the procedure, with all cases recovering within 6 months. Despite the shortened application all veins were isolated. At repeat procedure the right-sided PVs reconnected less frequently than the left-sided PVs in those with phrenic nerve palsy. Electromyographic phrenic nerve monitoring using the surface CMAP is reliable, easy to perform, and offers an early warning to impending phrenic nerve injury. © 2014 American Heart Association, Inc.

The oculomotor system of decapod cephalopods: eye muscles, eye muscle nerves, and the oculomotor neurons in the central nervous system.

Science.gov (United States)

Budelmann, B U; Young, J Z

1993-04-29

Fourteen extraocular eye muscles are described in the decapods Loligo and Sepioteuthis, and thirteen in Sepia; they are supplied by four eye muscle nerves. The main action of most of the muscles is a linear movement of the eyeball, only three muscles produce strong rotations. The arrangement, innervation and action of the decapod eye muscles are compared with those of the seven eye muscles and seven eye muscle nerves in Octopus. The extra muscles in decapods are attached to the anterior and superior faces of the eyes. At least, the anterior muscles, and presumably also the superior muscles, are concerned with convergent eye movements for binocular vision during fixation and capture of prey by the tentacles. The remaining muscles are rather similar in the two cephalopod groups. In decapods, the anterior muscles include conjunctive muscles; these cross the midline and each presumably moves both eyes at the same time during fixation. In the squids Loligo and Sepioteuthis there is an additional superior conjunctive muscle of perhaps similar function. Some of the anterior muscles are associated with a narrow moveable plate, the trochlear cartilage; it is attached to the eyeball by trochlear membranes. Centripetal cobalt fillings showed that all four eye muscle nerves have fibres that originate from somata in the ipsilateral anterior lateral pedal lobe, which is the oculomotor centre. The somata of the individual nerves show different but overlapping distributions. Bundles of small presumably afferent fibres were seen in two of the four nerves. They do not enter the anterior lateral pedal lobe but run to the ventral magnocellular lobe; some afferent fibres enter the brachio-palliovisceral connective and run perhaps as far as the palliovisceral lobe.

Unilateral Superior Laryngeal Nerve Lesion in an Animal Model of Dysphagia and Its Effect on Sucking and Swallowing

Science.gov (United States)

Campbell-Malone, Regina; Holman, Shaina D.; Lukasik, Stacey L.; Fukuhara, Takako; Gierbolini-Norat, Estela M.; Thexton, Allan J.; German, Rebecca Z.

2013-01-01

We tested two hypotheses relating to the sensory deficit that follows a unilateral superior laryngeal nerve (SLN) lesion in an infant animal model. We hypothesized that it would result in (1) a higher incidence of aspiration and (2) temporal changes in sucking and swallowing. We ligated the right-side SLN in six 2–3-week-old female pigs. Using videofluoroscopy, we recorded swallows in the same pre- and post-lesion infant pigs. We analyzed the incidence of aspiration and the duration and latency of suck and swallow cycles. After unilateral SLN lesioning, the incidence of silent aspiration during swallowing increased from 0.7 to 41.5 %. The durations of the suck containing the swallow, the suck immediately following the swallow, and the swallow itself were significantly longer in the post-lesion swallows, although the suck prior to the swallow was not different. The interval between the start of the suck containing a swallow and the subsequent epiglottal movement was longer in the post-lesion swallows. The number of sucks between swallows was significantly greater in post-lesion swallows compared to pre-lesion swallows. Unilateral SLN lesion increased the incidence of aspiration and changed the temporal relationships between sucking and swallowing. The longer transit time and the temporal coordinative dysfunction between suck and swallow cycles may contribute to aspiration. These results suggest that swallow dysfunction and silent aspiration are common and potentially overlooked sequelae of unilateral SLN injury. This validated animal model of aspiration has the potential for further dysphagia studies. PMID:23417250

Morphometric study of suprascapular notch in Indian dry scapulae with specific reference to the incidence of completely ossified superior transverse scapular ligament.

Science.gov (United States)

Kannan, Usha; Kannan, N S; Anbalagan, J; Rao, Sudha

2014-03-01

The suprascapular notch, a depression on the lateral part of the superior border of the scapula, medial to the coracoid process, is bridged by the superior transverse scapular ligament, which is sometimes ossified and the foramen which is thus completed, transmits the suprascapular nerve to the supraspinatus fossa. Variations in the morphology of suprascapular notch have been identified as one of the causes of suprascapular nerve entrapment. Rengachary et al. classified this notch into six types, based on its shape. To study morphological variations of suprascapular notch in Indian dry scapulae and to analyze the incidence of completely ossified superior transverse scapular ligament with other ethnic populations which have been cited earlier. A total of 400 human dry scapulae which were obtained from the Department of Anatomy of selected eight medical colleges were analyzed. The type of suprascapular notch was noted and it was recorded as per the description given by Rengachary et al. The results of the present study were compared with the results of previous authors in different populations. In our study, out of 400 scapulae, 40 (10%), were identified to have completely ossified superior transverse scapular ligaments. The frequencies of various types of suprascapular notches were: Type I -20%, Type II -10%, Type III -52%, Type IV -4%, Type V -4%, Type VI -10%. Since the suprascapular nerve entrapment syndrome might be caused by complete ossification of superior transverse scapular ligament with formation of suprascapular foramen and other morphometric variations of suprascapular notch, the knowledge on such variations is essential for clinicians, for making a proper diagnosis and for planning the most suitable surgical intervention.

Coordinated Respiratory Motor Activity in Nerves Innervating the Upper Airway Muscles in Rats.

Directory of Open Access Journals (Sweden)

Satoshi Tachikawa

Full Text Available Maintaining the patency of the upper airway during breathing is of vital importance. The activity of various muscles is related to the patency of the upper airway. In the present study, we examined the respiratory motor activity in the efferent nerves innervating the upper airway muscles to determine the movements of the upper airway during respiration under normocapnic conditions (pH = 7.4 and in hypercapnic acidosis (pH = 7.2. Experiments were performed on arterially perfused decerebrate rats aged between postnatal days 21-35. We recorded the efferent nerve activity in a branch of the cervical spinal nerve innervating the infrahyoid muscles (CN, the hypoglossal nerve (HGN, the external branch of the superior laryngeal nerve (SLN, and the recurrent laryngeal nerve (RLN with the phrenic nerve (PN. Inspiratory nerve discharges were observed in all these nerves under normocapnic conditions. The onset of inspiratory discharges in the CN and HGN was slightly prior to those in the SLN and RLN. When the CO2 concentration in the perfusate was increased from 5% to 8% to prepare for hypercapnic acidosis, the peak amplitudes of the inspiratory discharges in all the recorded nerves were increased. Moreover, hypercapnic acidosis induced pre-inspiratory discharges in the CN, HGN, SLN, and RLN. The onset of pre-inspiratory discharges in the CN, HGN, and SLN was prior to that of discharges in the RLN. These results suggest that the securing of the airway that occurs a certain time before dilation of the glottis may facilitate ventilation and improve hypercapnic acidosis.

Unilateral sectioning of the superior ovarian nerve of rats with polycystic ovarian syndrome restores ovulation in the innervated ovary

Directory of Open Access Journals (Sweden)

Morales-Ledesma Leticia

2010-08-01

Full Text Available Abstract The present study tested the hypothesis that if polycystic ovary syndrome (PCOS results from activating the noradrenergic outflow to the ovary, unilaterally sectioning the superior ovarian nerve (SON will result in ovulation by the denervated ovary, and the restoration of progesterone (P4, testosterone (T and estradiol (E2 normal serum level. A single 2 mg dose of estradiol valerate (EV to adult rats results in the development of a syndrome similar to the human PCOS. Ten-day old rats were injected with EV or vehicle solution (Vh and were submitted to sham surgery, unilateral or bilateral sectioning of the SON at 24-days of age. The animals were sacrificed at 90 to 92 days of age, when they presented vaginal estrus preceded by a pro-estrus smear. In EV-treated animals, unilateral sectioning of the SON restored ovulation by the innervated ovary and unilateral or bilateral sectioning of the SON normalized testosterone and estradiol levels. These results suggest that aside from an increase in ovarian noradrenergic tone in the ovaries, in the pathogenesis of the PCOS participate other neural influences arriving to the ovaries via the SON, regulating spontaneous ovulation. Changes in P4, T and E2 serum levels induced by EV treatment seem to be controlled by neural signals arising from the abdominal wall and other signals arriving to the ovaries through the SON, and presents asymmetry.

Effects on steroid hormones secretion resulting from the acute stimulation of sectioning the superior ovarian nerve to pre-pubertal rats

Directory of Open Access Journals (Sweden)

Morales-Ledesma Leticia

2012-10-01

Full Text Available Abstract In the adult rat, neural signals arriving to the ovary via the superior ovarian nerve (SON modulate progesterone (P4, testosterone (T and estradiol (E2 secretion. The aims of the present study were to analyze if the SON in the pre-pubertal rat also modulates ovarian hormone secretion and the release of follicle stimulating hormone (FSH and luteinizing (LH hormone. P4, T, E2, FSH and LH serum levels were measured 30 or 60 minutes after sectioning the SON of pre-pubertal female rats. Our results indicate that the effects on hormone levels resulting from unilaterally or bilaterally sectioning the SON depends on the analyzed hormone, and the time lapse between surgery and autopsy, and that the treatment yielded asymmetric results. The results also suggest that in the pre-pubertal rat the neural signals arriving to the ovaries via the SON regulate the enzymes participating in P4, T and E2 synthesis in a non-parallel way, indicating that the mechanisms regulating the synthesis of each hormone are not regulated by the same signals. Also, that the changes in the steroids hormones are not explained exclusively by the modifications in gonadotropins secretion. The observed differences in hormone levels between rats sacrificed 30 and 60 min after surgery reflect the onset of the compensatory systems regulating hormones secretion.

Raman spectroscopic detection of peripheral nerves towards nerve-sparing surgery

Science.gov (United States)

Minamikawa, Takeo; Harada, Yoshinori; Takamatsu, Tetsuro

2017-02-01

The peripheral nervous system plays an important role in motility, sensory, and autonomic functions of the human body. Preservation of peripheral nerves in surgery, namely nerve-sparing surgery, is now promising technique to avoid functional deficits of the limbs and organs following surgery as an aspect of the improvement of quality of life of patients. Detection of peripheral nerves including myelinated and unmyelinated nerves is required for the nerve-sparing surgery; however, conventional nerve identification scheme is sometimes difficult to identify peripheral nerves due to similarity of shape and color to non-nerve tissues or its limited application to only motor peripheral nerves. To overcome these issues, we proposed a label-free detection technique of peripheral nerves by means of Raman spectroscopy. We found several fingerprints of peripheral myelinated and unmyelinated nerves by employing a modified principal component analysis of typical spectra including myelinated nerve, unmyelinated nerve, and adjacent tissues. We finally realized the sensitivity of 94.2% and the selectivity of 92.0% for peripheral nerves including myelinated and unmyelinated nerves against adjacent tissues. Although further development of an intraoperative Raman spectroscopy system is required for clinical use, our proposed approach will serve as a unique and powerful tool for peripheral nerve detection for nerve-sparing surgery in the future.

Scanning laser polarimetry retinal nerve fiber layer thickness measurements after LASIK.

Science.gov (United States)

Zangwill, Linda M; Abunto, Teresa; Bowd, Christopher; Angeles, Raymund; Schanzlin, David J; Weinreb, Robert N

2005-02-01

To compare retinal nerve fiber layer (RNFL) thickness measurements before and after LASIK. Cohort study. Twenty participants undergoing LASIK and 14 normal controls. Retinal nerve fiber layer thickness was measured before LASIK and approximately 3 months after surgery in one eye each of 20 patients using a scanning laser polarimeter (GDx Nerve Fiber Analyzer) with fixed corneal compensation (FCC), one with variable corneal compensation (GDx VCC), and optical coherence tomography (OCT). Fourteen normal controls also were tested at baseline and approximately 3 months later. Retinal nerve fiber layer thicknesses measured with the GDx FCC, GDx VCC, and OCT. At baseline, mean (95% confidence interval [CI]) RNFL thicknesses for the GDx FCC, GDx VCC, and OCT were 78.1 microm (72.2-83.9), 54.3 microm (52.7-56.0), and 96.8 microm (93.2-100.5), respectively. In both LASIK and control groups, there were no significant changes between baseline and follow-up examinations in GDx VCC and OCT RNFL thickness measurements globally or in the superior and inferior quadrants (mean change, FCC measurements between baseline and follow-up. In LASIK patients, significant reductions were observed in GDx FCC RNFL measurements. Average absolute values of the mean (95% CI) change in thickness were 12.4 microm (7.7-17.2), 15.3 microm (9.6-20.9), and 12.9 microm (7.6-18.1) for GDx FCC RNFL measurements superiorly, inferiorly, and globally, respectively (all Ps FCC RNFL thickness measurements after LASIK is a measurement artifact and is most likely due to erroneous compensation for corneal birefringence. With scanning laser polarimetry, it is mandatory to compensate individually for change in corneal birefringence after LASIK to ensure accurate RNFL assessment.

Vascularized nerve grafts for lower extremity nerve reconstruction.

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Terzis, Julia K; Kostopoulos, Vasileios K

2010-02-01

Vascularized nerve grafts (VNG) were introduced in 1976 but since then, there have been no reports of their usage in lower extremity reconstruction systematically. The factors influencing outcomes as well as a comparison with conventional nerve grafts will be presented.Since 1981, 14 lower extremity nerve injuries in 12 patients have been reconstructed with VNG. Common peroneal nerve was injured in 12 and posterior tibial nerve in 5 patients. The level of the injury was at the knee or thigh. Twelve sural nerves were used as VNG with or without concomitant vascularized posterior calf fascia.All patients regained improved sensibility and adequate posterior tibial nerve function. For common peroneal nerve reconstructions, all patients with denervation time less than 6 months regained muscle strength of grade at least 4, even when long grafts were used for defects of 20 cm or more. Late cases, yielded inadequate muscle function even with the use of VNG.Denervation time of 6 months or less was critical for reconstruction with vascularized nerve graft. Not only the results were statistically significant compared with late cases, but also all early operated patients achieved excellent results. VNG are strongly recommended in traction avulsion injuries of the lower extremity with lengthy nerve damage.

INTERPRETATION OF NERVE CONDUCTION STUDY IN POLYNEUROPATHY WITH MULTIBACILLARY LEPROSY TYPE 2 REACTION

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Diane Tantia Sari

2018-04-01

Full Text Available Leprosy reaction contributes to disability due to peripheral nerve damage. Nerve conduction study (NCS provides a profound physiological description of peripheral nerves. This study aims to report a case of polyneuropathy in leprosy with type 2 reactions (T2R which is evaluated using NCS. A 33-year-old woman complain of painful bumps in her arms and legs, fever, swollen feet since 2 days ago, and history of leprosy. Dermatologic examination on the right superior palpebra, right and left arms and legs revealed multiple tenderness erythematous nodules; right claw hand; and both legs oedema. Slit skin smear revealed positive result. Histopathologic examination supported T2R description. The NCS examination concluded severe axonal demyelinating motoric sensoric polyneurophaty, with left worse. She was treated with MDT-MB, bed rest, orally methylprednisolone, vitamin B, paracetamol, ferrous sulfas, and topical olive oil. Clinical improvement was achieved after 2 weeks. The NCS is used to assess the nerve impuls conduction along the peripheral nerves. In this case, it was found that NCS could showed early neuropathy in nerves that were clinically undetectable. It can be concluded that the NCS examination is an important diagnostic modalities for early detection of neuropathy and confirmed the diagnosis of clinical neuropathy in leprosy.

IGF-1 and Chondroitinase ABC Augment Nerve Regeneration after Vascularized Composite Limb Allotransplantation.

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Nataliya V Kostereva

Full Text Available Impaired nerve regeneration and inadequate recovery of motor and sensory function following peripheral nerve repair remain the most significant hurdles to optimal functional and quality of life outcomes in vascularized tissue allotransplantation (VCA. Neurotherapeutics such as Insulin-like Growth Factor-1 (IGF-1 and chondroitinase ABC (CH have shown promise in augmenting or accelerating nerve regeneration in experimental models and may have potential in VCA. The aim of this study was to evaluate the efficacy of low dose IGF-1, CH or their combination (IGF-1+CH on nerve regeneration following VCA. We used an allogeneic rat hind limb VCA model maintained on low-dose FK506 (tacrolimus therapy to prevent rejection. Experimental animals received neurotherapeutics administered intra-operatively as multiple intraneural injections. The IGF-1 and IGF-1+CH groups received daily IGF-1 (intramuscular and intraneural injections. Histomorphometry and immunohistochemistry were used to evaluate outcomes at five weeks. Overall, compared to controls, all experimental groups showed improvements in nerve and muscle (gastrocnemius histomorphometry. The IGF-1 group demonstrated superior distal regeneration as confirmed by Schwann cell (SC immunohistochemistry as well as some degree of extrafascicular regeneration. IGF-1 and CH effectively promote nerve regeneration after VCA as confirmed by histomorphometric and immunohistochemical outcomes.

Simultaneous occurrence of a severe Morel-Lavallée lesion and gluteal muscle necrosis as a sequela of transcatheter angiographic embolization following pelvic fracture: a case report.

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Shimizu, Takayoshi; Matsuda, Shuichi; Sakuragi, Atsushi; Tsukie, Tomio; Kawanabe, Keiichi

2015-03-26

Morel-Lavallée lesions are posttraumatic hemolymphatic collections caused by disruption of the interfascial planes between the subcutaneous soft tissue and muscle. Severe peripelvic Morel-Lavallée lesions have rarely been reported in the literature. By contrast, a number of cases of gluteal muscle necrosis following transcatheter angiographic embolization for pelvic fracture have been reported. Each entity can result in severe infection and sepsis, and the mortality rate in such cases is quite high. However, to date, no previous reports have described a case in which these life-threatening entities occurred simultaneously. A 32-year-old Asian man simultaneously developed severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis with sepsis following transcatheter angiographic embolization after an unstable pelvic fracture. Extremely large skin and soft tissue defects, which were untreatable with any commonly used flaps, were generated after repeated debridement. In addition, a deep-bone infection was suspected in his left fractured iliac bone, while motor function was almost completely lost in his left leg, possibly as a sequela of transcatheter angiographic embolization. As a result of his condition, a left hemipelvectomy was unavoidable. A pedicled fillet flap from his sacrificed left limb was used for the treatment of the defects and to provide a durable base for a prosthesis. Our patient survived and returned to his previous job 24 months after the surgery wearing a prosthetic left leg. As illustrated by the present case, severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis following transcatheter angiographic embolization can occur simultaneously after unstable pelvic fractures. Physicians should recognize that these entities can result in life-threatening sepsis and, therefore, should attempt to detect them as early as possible. When hemipelvectomy is unavoidable, a pedicled upper and lower leg in-continuity fillet flap may

Acute Bilateral Superior Branch Vestibular Neuropathy

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Dario A. Yacovino

2018-05-01

Full Text Available The rapid onset of a bilateral vestibular hypofunction (BVH is often attributed to vestibular ototoxicity. However, without any prior exposure to ototoxins, the idiopathic form of BVH is most common. Although sequential bilateral vestibular neuritis (VN is described as a cause of BVH, clinical evidence for simultaneous and acute onset bilateral VN is unknown. We describe a patient with an acute onset of severe gait ataxia and oscillopsia with features compatible with acute BVH putatively due to a bilateral VN, which we serially evaluated with clinical and laboratory vestibular function testing over the course of 1 year. Initially, bilateral superior and horizontal semicircular canals and bilateral utricles were impaired, consistent with damage to both superior branches of each vestibular nerve. Hearing was spared. Only modest results were obtained following 6 months of vestibular rehabilitation. At a 1-year follow-up, only the utricular function of one side recovered. This case is the first evidence supporting an acute presentation of bilateral VN as a cause for BVH, which would not have been observed without critical assessment of each of the 10 vestibular end organs.

Nerve Cross-Bridging to Enhance Nerve Regeneration in a Rat Model of Delayed Nerve Repair

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2015-01-01

There are currently no available options to promote nerve regeneration through chronically denervated distal nerve stumps. Here we used a rat model of delayed nerve repair asking of prior insertion of side-to-side cross-bridges between a donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) nerve stump ameliorates poor nerve regeneration. First, numbers of retrogradely-labelled TIB neurons that grew axons into the nerve stump within three months, increased with the size of the perineurial windows opened in the TIB and CP nerves. Equal numbers of donor TIB axons regenerated into CP stumps either side of the cross-bridges, not being affected by target neurotrophic effects, or by removing the perineurium to insert 5-9 cross-bridges. Second, CP nerve stumps were coapted three months after inserting 0-9 cross-bridges and the number of 1) CP neurons that regenerated their axons within three months or 2) CP motor nerves that reinnervated the extensor digitorum longus (EDL) muscle within five months was determined by counting and motor unit number estimation (MUNE), respectively. We found that three but not more cross-bridges promoted the regeneration of axons and reinnervation of EDL muscle by all the CP motoneurons as compared to only 33% regenerating their axons when no cross-bridges were inserted. The same 3-fold increase in sensory nerve regeneration was found. In conclusion, side-to-side cross-bridges ameliorate poor regeneration after delayed nerve repair possibly by sustaining the growth-permissive state of denervated nerve stumps. Such autografts may be used in human repair surgery to improve outcomes after unavoidable delays. PMID:26016986

Nerve conduction and excitability studies in peripheral nerve disorders

DEFF Research Database (Denmark)

Krarup, Christian; Moldovan, Mihai

2009-01-01

counterparts in the peripheral nervous system, in some instances without peripheral nervous system symptoms. Both hereditary and acquired demyelinating neuropathies have been studied and the effects on nerve pathophysiology have been compared with degeneration and regeneration of axons. SUMMARY: Excitability......PURPOSE OF REVIEW: The review is aimed at providing information about the role of nerve excitability studies in peripheral nerve disorders. It has been known for many years that the insight into peripheral nerve pathophysiology provided by conventional nerve conduction studies is limited. Nerve...... excitability studies are relatively novel but are acquiring an increasingly important role in the study of peripheral nerves. RECENT FINDINGS: By measuring responses in nerve that are related to nodal function (strength-duration time constant, rheobase and recovery cycle) and internodal function (threshold...

Análise quantitativa das fibras mielínicas dos nervos laríngeos em humanos de acordo com a idade Quantitative analysis of myelinic fibers in human laryngeal nerves according to age

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Romualdo Suzano Louzeiro Tiago

2008-02-01

Full Text Available INTRODUÇÃO E OBJETIVO: Realizar análise morfométrica das fibras mielínicas dos nervos laríngeos com a finalidade de verificar modificações quantitativas decorrentes do processo de envelhecimento. FORMA DE ESTUDO: Clínico e experimental. Material e Método: Foi coletado fragmento de 1cm dos nervos laríngeos superiores e nervos laríngeos recorrentes de 12 cadáveres do sexo masculino. A amostra foi dividida em dois grupos: idade inferior a 60 anos (Adulto e idade igual ou superior a 60 anos (Idoso. O material foi avaliado em microscópio de luz acoplado a sistema analisador de imagem. RESULTADOS: O número total de fibras mielínicas do nervo laríngeo superior foi semelhante nos dois grupos etários, mas com tendência para o maior número de fibras de 1µm no grupo adulto (p=0,0744. O grupo adulto apresentou maior número total de fibras mielínicas no nervo laríngeo recorrente (p=0,0006, e esta diferença ocorreu nas fibras com diâmetros de 1-3µm (pINTRODUCTION AND AIM: To carry out a morphometric analysis of myelinic fibers in laryngeal nerves aiming to identify quantitative changes as a result of aging. Study design: Clinical and experimental. MATERIAL AND METHOD: A 1cm fragment was collected from the superior laryngeal nerves and recurrent laryngeal nerves taken from twelve male cadavers. The sample was divided into two groups: those aged below 60 years (Adult and those aged 60 years or more (Elderly. The material was evaluated under light microscopy coupled with an image analysis system. RESULTS: The total number of myelinic fibers from the superior laryngeal nerve was similar in both age groups; there was, however, a trend for a higher number of 1μm fibers in the adult group (p=0.0744. The adult group had a higher total number of myelinic fibers in the recurrent laryngeal nerve (p=0.0006, and this difference was seen in fibers with diameters betwee 1-3μm (p<0.007. The adult group had a higher total number of myelinic fibers

Chitin biological absorbable catheters bridging sural nerve grafts transplanted into sciatic nerve defects promote nerve regeneration.

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Wang, Zhi-Yong; Wang, Jian-Wei; Qin, Li-Hua; Zhang, Wei-Guang; Zhang, Pei-Xun; Jiang, Bao-Guo

2018-06-01

To investigate the efficacy of chitin biological absorbable catheters in a rat model of autologous nerve transplantation. A segment of sciatic nerve was removed to produce a sciatic nerve defect, and the sural nerve was cut from the ipsilateral leg and used as a graft to bridge the defect, with or without use of a chitin biological absorbable catheter surrounding the graft. The number and morphology of regenerating myelinated fibers, nerve conduction velocity, nerve function index, triceps surae muscle morphology, and sensory function were evaluated at 9 and 12 months after surgery. All of the above parameters were improved in rats in which the nerve graft was bridged with chitin biological absorbable catheters compared with rats without catheters. The results of this study indicate that use of chitin biological absorbable catheters to surround sural nerve grafts bridging sciatic nerve defects promotes recovery of structural, motor, and sensory function and improves muscle fiber morphology. © 2018 John Wiley & Sons Ltd.

Patterns of lipofuscin accumulation in ganglionic nerve cells of superior cervical ganglion in humans

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Živković Vladimir

2008-01-01

Full Text Available Background/Aim. Considering available literature lipofuscin is a classical age pigment of postmitotic cells, and a consistently recognized phenomenon in humans and animals. Lipofuscin accumulation is characteristic for nerve cells that are postmitotic. This research was focused on lipofuscin accumulation in ganglionic cells (GC (postganglionic sympathetic cell bodies of superior cervical ganglion in humans during ageing. Methods. We analysed 30 ganglions from cadavers ranging from 20 to over 80 years of age. As material the tissue samples were used from the middle portion of the ganglion, which was separated from the surrounding tissue by the method of macrodissection. The tissue samples were routinely fixed in 10% neutral formalin and embedded in paraffin for classical histological analysis, then three consecutive (successive sections 5 μm thick were made and stained with hematoxylin and eosin method (HE, silver impregnation technique by Masson Fontana and trichrome stain by Florantin. Results. Immersion microscopy was used to analyse patterns of lipofuscin accumulation during ageing making possible to distinguish diffuse type (lipofuscin granules were irregularly distributed and non-confluent, unipolar type (lipofuscin granules were grouped at the end of the cell, bipolar type (lipofuscin granules were concentrated at the two opposite ends of a cell with the nucleus in between at the center of a cell, annular type (lipofuscin granules were in the shape of a complete or incomplete ring around the nucleus and a cell completely filled with lipofuscin (two subtypes distinguishing, one with visible a nucleus, and the other with invisible one. Even at the age of 20 there were cells with lipofuscin granules accumulated in diffuse way, but in smaller numbers; the GC without lipofuscin were dominant. Growing older, especially above 60 years, all of the above mentioned patterns of lipofuscin accumulation were present with the evident increase in cells

A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures.

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Tubbs, R Shane; Maldonado, Andrés A; Stoves, Yolanda; Fries, Fabian N; Li, Rong; Loukas, Marios; Oskouian, Rod J; Spinner, Robert J

2018-01-01

OBJECTIVE The accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. The aim of the present study was to identify an anatomical method for such lengthening. METHODS In 20 adult cadavers, the C-2 or C-3 connections to the accessory nerve were identified medial to the sternocleidomastoid (SCM) muscle and the anatomy of the accessory nerve/cervical nerve fibers within the SCM was documented. The cervical nerve connections were cut. Lengths of the accessory nerve were measured. Samples of the cut C-2 and C-3 nerves were examined using immunohistochemistry. RESULTS The anatomy and adjacent neural connections within the SCM are complicated. However, after the accessory nerve was "detethered" from within the SCM and following transection, the additional length of the accessory nerve increased from a mean of 6 cm to a mean of 10.5 cm (increase of 4.5 cm) after cutting the C-2 connections, and from a mean of 6 cm to a mean length of 9 cm (increase of 3.5 cm) after cutting the C-3 connections. The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers. CONCLUSIONS An additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time/distance for regeneration and potentially improving clinical outcomes.

Not just quantity: gluteus maximus muscle characteristics in able-bodied and SCI individuals--implications for tissue viability.

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Wu, Gary A; Bogie, Kath M

2013-08-01

Some individuals with spinal cord injury (SCI) remain pressure ulcer (PU) free whilst others experience a recurring cycle of tissue breakdown. Detailed analysis of gluteal muscle characteristics may provide insights to local tissue viability variability. The study hypothesis was that SCI individuals have altered muscle composition compared to able-bodied (AB). Ten AB and ten SCI received a supine pelvic CT scan, with contrast. Cross-sectional area (CSA) and overall muscle volume were derived using image analysis. Gluteal muscle tissue type was classified at the S2/S3 sacral vertebrae midpoint, the superior greater trochanters margin (GT) and the inferior ischial tuberosities margin (IT) using the linear transformation Hounsfield Unit scale. SCI gluteal CSA was less than for AB throughout the muscle, with the greatest relative atrophy at the IT (48%). Average AB gluteal volume was nearly double SCI. Eight SCI had over 20% infiltrative adipose tissue, three with over 50%. SCI gluteal CSA and intramuscular fat infiltration were significantly negatively correlated (p SCI IT axial slices showed less lean muscle and higher intramuscular fat infiltration than more proximally (p SCI gluteal muscle characteristics were indicative of impaired tissue viability. SCI disuse muscle atrophy was anticipated; the analytic approach further indicated that intramuscular atrophy was not uniform. SCI muscle composition showed increased proportions of both low density muscle and adipose tissue. CT scan with contrast is effective for gluteal muscle characterization. This assessment technique may contribute to determination of personalized risk for PU development and other secondary complications. Published by Elsevier Ltd.

Influence of neural monitoring during thyroid surgery on nerve integrity and postoperative vocal function.

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Engelsman, A F; Warhurst, S; Fraser, S; Novakovic, D; Sidhu, S B

2018-06-01

Integrity of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) can be checked by intraoperative nerve monitoring (IONM) after visualization. The aim of this study was to determine the prevalence and nature of voice dysfunction following thyroid surgery with routine IONM. Thyroidectomies were performed with routine division of strap muscles and nerve monitoring to confirm integrity of the RLN and EBSLN following dissection. Patients were assessed for vocal function before surgery and at 1 and 3 months after operation. Assessment included use of the Voice Handicap Index (VHI) 10, maximum phonation time, fundamental frequency, pitch range, harmonic to noise ratio, cepstral peak prominence and smoothed cepstral peak prominence. A total of 172 nerves at risk were analysed in 102 consecutive patients undergoing elective thyroid surgery. In 23·3 per cent of EBSLNs and 0·6 per cent of RLNs nerve identification required the assistance of IONM in addition to visualization. Nerve integrity was confirmed during surgery for 98·8 per cent of EBSLNs and 98·3 per cent of RLNs. There were no differences between preoperative and postoperative VHI-10 scores. Acoustic voice assessment showed small changes in maximum phonation time at 1 and 3 months after surgery. Where there is routine division of strap muscles, thyroidectomy using nerve monitoring confirmation of RLN and EBSLN function following dissection results in no clinically significant voice change.

Selective reinnervation: a comparison of recovery following microsuture and conduit nerve repair.

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Evans, P J; Bain, J R; Mackinnon, S E; Makino, A P; Hunter, D A

1991-09-20

Selective reinnervation was studied by comparing the regeneration across a conventional neurorraphy versus a conduit nerve repair. Lewis rats underwent right sciatic nerve transection followed by one of four different nerve repairs (n = 8/group). In groups I and II a conventional neurorraphy was performed and in groups III and IV the proximal and distal stumps were coapted by use of a silicone conduit with an interstump gap of 5 mm. The proximal and distal stumps in groups I and III were aligned anatomically correct and the proximal stump was rotated 180 degrees in groups II and IV (i.e. proximal peroneal nerve opposite the distal tibial nerve and the proximal tibial nerve opposite the distal peroneal nerve). By 14 weeks, there was an equivalent, but incomplete return in sciatic function index (SFI) in groups I, III, and IV as measured by walking track analysis. However, the SFI became unmeasurable by 6 weeks in all group II animals. At 14 weeks, the percent innervation of the tibialis anterior and medial gastronemius muscles by the peroneal and tibial nerves respectively was estimated by selective compound muscle action potential amplitude recordings. When fascicular alignment was reversed, there was greater tibial (P = 0.02) and lesser peroneal (P = 0.005) innervation of the gastrocnemius muscle in the conduit (group IV) versus the neurorraphy (group II) group. This suggests that the gastrocnemius muscle may be selectively reinnervated by the tibial nerve. However, there was no evidence of selective reinnervation of the tibialis anterior muscle. Despite these differences, the functional recovery in both conduit repair groups (III and IV) was equivalent to a correctly aligned microsuture repair (group I) and superior to that in the incorrectly aligned microsuture repair (group II).

Nanofiber Nerve Guide for Peripheral Nerve Repair and Regeneration

Science.gov (United States)

2016-04-01

1 Award Number: W81XWH-11-2-0047 TITLE: Nanofiber Nerve Guide for Peripheral Nerve Repair and Regeneration PRINCIPAL INVESTIGATOR: Ahmet Höke...TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-11-2-0047 Nanofiber nerve guide for peripheral nerve repair and regeneration 5b. GRANT NUMBER...goal of this collaborative research project was to develop next generation engineered nerve guide conduits (NGCs) with aligned nanofibers and

Radial nerve dysfunction

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Neuropathy - radial nerve; Radial nerve palsy; Mononeuropathy ... Damage to one nerve group, such as the radial nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

Traumatic Hemipelvectomy with Free Gluteus Maximus Fillet Flap Covers: A Case Report

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WI Faisham

2012-07-01

Full Text Available threatening injury. We report a case of a 16-year-old boy involved in a traffic accident who presented with an almost circumferential pelvic wound with wide diastasis of the right sacroiliac joint and symphysis pubis. The injury was associated with complete avulsion of external and internal iliac vessels as well as the femoral and sciatic nerves. He also had ipsilateral open comminuted fractures of the femur and tibia. Emergency debridement and completion of amputation with preservation of the posterior gluteal flap and primary anastomosis of the inferior gluteal vessels to the internal iliac artery stump were performed. A free fillet flap was used to close the massive exposed area.

Morphometric study of the upper intercostal nerves: practical application for neurotizations in traumatic brachial plexus palsies.

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Asfazadourian, H; Tramond, B; Dauge, M C; Oberlin, C

1999-01-01

The aim of the study was a morphometric evaluation of the intercostal nerves at different levels along their course in order to determine their adequacy in neurotizing the recipient nerves. The intercostal nerves were harvested from 5 cadavers. A biopsy of the nerve was obtained at 2 levels for each nerve in the parasternal region and at the level of the mid-axillary line. The musculocutaneous nerve was isolated at its origin from the lateral cord. Each harvested specimen was embedded in paraffin and sections were made using a microtome. These sections were then stained histochemically using HPS (Hematein, Phloxine, Safran). Real-time digitalisation of the video image under the microscope was performed. The sum of the different fascicular zones is the effective sensorimotor surface of the nerve at the level being studied. Direct suture of the upper three intercostal nerves to the musculocutaneous nerve is always possible upto the axillary fossa. The sixth intercostal nerve can be delivered upto this level in only 50% of cases without dissection of the musculocutaneous nerve upto its entry into the coracobrachialis. The musculocutaneous nerve presents a mean surface area of 2.64 mm2 while the nerve to the biceps has a mean surface area of 0.34 mm2 i.e. a ration of 1/8. The mean surface area of the intercostal nerves at the parasternal level is 0.23 mm2 while that at the axillary level is 0.34 mm2. Thus a loss of 33% in surface area occurs between the axillary and the parasternal levels. Our study confirms the insufficiency between the surface area of the intercostal nerves and the different nerve trunks to be neurotized. The relationship between the surface area of the musculocutaneous nerve and the three intercostal nerves is 26.72% with a minimum of 17.2%. If a fourth intercostal nerve is added, this ratio nerves appears to be a superior technique. We were able to deliver the sixth intercostal nerve for a direct suture to the musculocutaneous nerve in only half

Malignant peripheral nerve sheath tumor of the oculomotor nerve

DEFF Research Database (Denmark)

Kozic, D; Nagulic, M; Ostojic, J

2006-01-01

We present the short-term follow-up magnetic resonance (MR) studies and 1H-MR spectroscopy in a child with malignant peripheral nerve sheath tumor of the oculomotor nerve associated with other less aggressive cranial nerve schwannomas. The tumor revealed perineural extension and diffuse nerve...

Scaffoldless tissue-engineered nerve conduit promotes peripheral nerve regeneration and functional recovery after tibial nerve injury in rats

Institute of Scientific and Technical Information of China (English)

Aaron M. Adams; Keith W. VanDusen; Tatiana Y. Kostrominova; Jacob P. Mertens; Lisa M. Larkin

2017-01-01

Damage to peripheral nerve tissue may cause loss of function in both the nerve and the targeted muscles it innervates. This study compared the repair capability of engineered nerve conduit (ENC), engineered fibroblast conduit (EFC), and autograft in a 10-mm tibial nerve gap. ENCs were fabricated utilizing primary fibroblasts and the nerve cells of rats on embryonic day 15 (E15). EFCs were fabricated utilizing primary fi-broblasts only. Following a 12-week recovery, nerve repair was assessed by measuring contractile properties in the medial gastrocnemius muscle, distal motor nerve conduction velocity in the lateral gastrocnemius, and histology of muscle and nerve. The autografts, ENCs and EFCs reestablished 96%, 87% and 84% of native distal motor nerve conduction velocity in the lateral gastrocnemius, 100%, 44% and 44% of native specific force of medical gastrocnemius, and 63%, 61% and 67% of native medial gastrocnemius mass, re-spectively. Histology of the repaired nerve revealed large axons in the autograft, larger but fewer axons in the ENC repair, and many smaller axons in the EFC repair. Muscle histology revealed similar muscle fiber cross-sectional areas among autograft, ENC and EFC repairs. In conclusion, both ENCs and EFCs promot-ed nerve regeneration in a 10-mm tibial nerve gap repair, suggesting that the E15 rat nerve cells may not be necessary for nerve regeneration, and EFC alone can suffice for peripheral nerve injury repair.

Communication between radial nerve and medial cutaneous nerve of forearm

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R R Marathe

2010-01-01

Full Text Available Radial nerve is usually a branch of the posterior cord of the brachial plexus. It innervates triceps, anconeous, brachialis, brachioradialis, extensor carpi radialis longus muscles and gives the posterior cutaneous nerve of the arm, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of forearm; without exhibiting any communication with the medial cutaneous nerve of forearm or any other nerve. We report communication between the radial nerve and medial cutaneous nerve of forearm on the left side in a 58-year-old male cadaver. The right sided structures were found to be normal. Neurosurgeons should keep such variations in mind while performing the surgeries of axilla and upper arm.

Ulnar nerve dysfunction

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Neuropathy - ulnar nerve; Ulnar nerve palsy; Mononeuropathy; Cubital tunnel syndrome ... Damage to one nerve group, such as the ulnar nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

The anatomy of the hip abductor muscles.

Science.gov (United States)

Flack, N A M S; Nicholson, H D; Woodley, S J

2014-03-01

The anatomy of the hip abductors has not been comprehensively examined, yet is important to understanding function and pathology in the gluteal region. For example, pathology of the hip abductor muscle-tendon complexes can cause greater trochanteric pain syndrome, and may be associated with gluteal atrophy and fatty infiltration. The purpose of this study was to investigate the detailed morphology of gluteus medius (GMed), gluteus minimus (GMin), and tensor fascia lata (TFL), and determine whether the muscles comprised anatomical compartments. The gluteal region from 12 cadavers was dissected and data collected on attachment sites, volume, fascicular and tendinous anatomy, and innervation. Three sites of GMed origin were identified (gluteal fossa, gluteal aponeurosis, and posteroinferior edge of the iliac crest) and the distal tendon had lateral and posterior parts. GMed was the largest in volume (27.6 ± 11.6 cm(3); GMin 14.1 ± 11.1 cm(3); TFL 1.8 ± 0.8 cm(3)). Fascicles of GMin originated from the gluteal fossa, inserting onto the deep surface of its distal tendon and the hip joint capsule. TFL was encapsulated in the fascia lata, having no bony attachment. Primary innervation patterns varied for GMed, with three or four branches supplying different regions of muscle. Distinct secondary nerve branches entered four regions of GMin; no differential innervation was observed for TFL. On the basis of architectural parameters and innervation, GMed, and GMin each comprise of four compartments but TFL is a homogenous muscle. It is anticipated that these data will be useful for future clinical and functional studies of the hip abductors. Copyright © 2013 Wiley Periodicals, Inc.

Effect of controlled exercise on middle gluteal muscle fibre composition in Thoroughbred foals.

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Eto, D; Yamano, S; Kasashima, Y; Sugiura, T; Nasu, T; Tokuriki, M; Miyata, H

2003-11-01

Most racehorses are trained regularly from about age 18 months; therefore, little information is available on the effect of training in Thoroughbred foals. Well-controlled exercise could improve muscle potential ability for endurance running. Thoroughbred foals at age 2 months were separated into control and training (treadmill exercise) groups and samples obtained from the middle gluteal muscle at 2 and 12 months post partum. Muscle fibre compositions were determined by histochemical and electrophoretical techniques and succinic dehydrogenase (SDH) activity was analysed in each fibre type. All fibre types were hypertrophied with growth and type I and IIA fibres were significantly larger in the training than the control group at age 12 months. A significant increase of SDH activity was found in type IIX muscle fibres in the training group. Training in young Thoroughbred horses can facilitate muscle fibre hypertrophy and increase the oxidative capacity of type IIX fibres, which could potentially enhance stamina at high speeds. To apply this result to practical training, further studies are needed to determine more effective and safe intensities of controlled exercise.

Surgical anatomy of the radial nerve in the deltopectoral approach for revision shoulder arthroplasty and periprosthetic fracture fixation: a cadaveric study.

Science.gov (United States)

Fu, Michael C; Hendel, Michael D; Chen, Xiang; Warren, Russell F; Dines, David M; Gulotta, Lawrence V

2017-12-01

Radial nerve injury is a rare but clinically significant complication of revision shoulder arthroplasty and fixation of native and periprosthetic proximal humeral fractures. Understanding of the anatomic relationship between the radial nerve as it enters the humeral spiral groove and anterior shoulder landmarks in a deltopectoral approach is necessary to avoid iatrogenic radial nerve injury. Eight forequarter cadaveric specimens were dissected through a deltopectoral approach. Distances between the radial nerve entry into the proximal spiral groove and the coracoid process, distal lesser tuberosity/inferior subscapularis insertion, superior latissimus insertion, and inferior latissimus insertion were measured. Means, standard deviations, and ranges were determined for each distance. The radial nerve entry into the proximal spiral groove averaged 133.1 mm (range, 110.3-153.0 mm) from the coracoid process, 101.9 mm (range, 76.5-124.3 mm) from the distal lesser tuberosity/inferior subscapularis insertion, 81.0 mm (range, 63.4-101.5 mm) from the superior latissimus insertion, and 39.6 mm (range, 25.5-55.4 mm) from the inferior latissimus insertion. The proximal spiral groove was distal to the inferior latissimus insertion in all specimens. The risk of iatrogenic injury to the radial nerve at the spiral groove may be minimized through proper identification and protection or avoidance of circumferential fixation. However, if encircling fixation with cerclage cables is necessary, instrumentation proximal to the inferior edge of the latissimus dorsi insertion may reduce the risk of radial nerve injury. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Alteração da camada de fibras nervosas da retina em usuários crônicos de cloroquina Retinal nerve fiber layer alteration in chronic users of chloroquine

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Daniela de Almeida Lyra Antunes

2005-04-01

Full Text Available OBJETIVOS: Avaliar a camada de fibras nervosas da retina (CFN por meio da polarimetria a laser, em pacientes em uso crônico de cloroquina. MÉTODOS: Foram estudados 44 olhos de 22 pacientes em uso de cloroquina por doenças reumatológicas, por pelo menos um ano. Como controle, foram incluídos vinte indivíduos sem uso de cloroquina com idade, gênero e raça similares. Foram excluídos os pacientes que apresentavam história familiar de hipertensão ocular ou glaucoma. Ambos os olhos foram submetidos à análise da camada de fibras nervosas da retina, com o aparelho GDx® Nerve Fiber Analyser, pelo mesmo examinador. RESULTADOS: Nos usuários crônicos de cloroquina, verificou-se alteração em mais de dois parâmetros do GDx em 28 olhos (63,6%. Ocorreu também alteração no gráfico "Deviation from normal" com perda de fibras nervosas em 11 olhos (25%. Quando comparado com o grupo controle, os parâmetros que demonstraram diferença estatisticamente significante foram: Superior Ratio, Inferior Ratio, Superior Nasal, Elipse Modulation, The Number, Superior Average e Superior Integral. Houve também associação estatisticamente significante entre o tempo de uso de cloroquina e perda da CFN. CONCLUSÕES: Comprovou-se a associação entre o uso crônico da cloroquina e a alteração da CFN detectada pelo GDx. Desta forma, esses resultados podem contribuir para o diagnóstico precoce da perda de fibras nervosas na retinopatia por cloroquina.PURPOSES: To evaluate the retina nerve fiber layer by laser polarimetry in patients in chronic use of chloroquine. METHODS: Forty-four eyes of twenty-two patients were studied. These were in use of chloroquine due to rheumatic diseases during at least one year. As a control group, twenty patients without use of chloroquine with similar characteristics (age, gender and race were included. Patients who had a family history of ocular hypertension or glaucoma were not included in this group. Both eyes were

Peripapillary retinal nerve fiber layer and optic nerve head characteristics in eyes with situs inversus of the optic disc.

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Kang, Sunah; Jin, Sunyoung; Roh, Kyu Hwa; Hwang, Young Hoon

2015-01-01

This study was performed to investigate the peripapillary retinal nerve fiber layer (RNFL) and optic nerve head (ONH) characteristics, as determined using a spectral-domain optical coherence tomography (OCT), in eyes with situs inversus of the optic disc. The peripapillary RNFL and the ONH were assessed in 12 eyes belonging to 6 subjects with situs inversus of the optic disc (situs inversus group) and 24 eyes in 12 age-matched, sex-matched, and refractive error-matched healthy subjects (control group) by using OCT. The average, quadrant, and clock-hour RNFL thicknesses (clock-hour 9 on the scan represented the temporal side of the optic disc in both eyes), the superior/inferior RNFL peak locations, and ONH characteristics such as disc area, rim area, cup-to-disc ratio, vertical cup-to-disc ratio, and cup volume were obtained. The differences in RNFL and ONH characteristics between the 2 groups were analyzed. The situs inversus group had a thicker RNFL in the clock-hour sectors 3 and 4, a thinner RNFL in the clock-hour sectors 7, 8, and 11, and more nasally located superior and inferior RNFL peak locations than the control group (P≤0.001). The situs inversus group had a smaller cup-to-disc area ratio, smaller vertical cup-to-disc ratio, and a lesser cup volume than the control group (Poptic disc showed different peripapillary RNFL and ONH characteristics from those without this abnormality. These findings should be considered when assessing eyes with situs inversus of the optic disc.

The First Experience of Triple Nerve Transfer in Proximal Radial Nerve Palsy.

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Emamhadi, Mohammadreza; Andalib, Sasan

2018-01-01

Injury to distal portion of posterior cord of brachial plexus leads to palsy of radial and axillary nerves. Symptoms are usually motor deficits of the deltoid muscle; triceps brachii muscle; and extensor muscles of the wrist, thumb, and fingers. Tendon transfers, nerve grafts, and nerve transfers are options for surgical treatment of proximal radial nerve palsy to restore some motor functions. Tendon transfer is painful, requires a long immobilization, and decreases donor muscle strength; nevertheless, nerve transfer produces promising outcomes. We present a patient with proximal radial nerve palsy following a blunt injury undergoing triple nerve transfer. The patient was involved in a motorcycle accident with complete palsy of the radial and axillary nerves. After 6 months, on admission, he showed spontaneous recovery of axillary nerve palsy, but radial nerve palsy remained. We performed triple nerve transfer, fascicle of ulnar nerve to long head of the triceps branch of radial nerve, flexor digitorum superficialis branch of median nerve to extensor carpi radialis brevis branch of radial nerve, and flexor carpi radialis branch of median nerve to posterior interosseous nerve, for restoration of elbow, wrist, and finger extensions, respectively. Our experience confirmed functional elbow, wrist, and finger extensions in the patient. Triple nerve transfer restores functions of the upper limb in patients with debilitating radial nerve palsy after blunt injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

One-stage human acellular nerve allograft reconstruction for digital nerve defects

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Xue-yuan Li

2015-01-01

Full Text Available Human acellular nerve allografts have a wide range of donor origin and can effectively avoid nerve injury in the donor area. Very little is known about one-stage reconstruction of digital nerve defects. The present study observed the feasibility and effectiveness of human acellular nerve allograft in the reconstruction of < 5-cm digital nerve defects within 6 hours after injury. A total of 15 cases of nerve injury, combined with nerve defects in 18 digits from the Department of Emergency were enrolled in this study. After debridement, digital nerves were reconstructed using human acellular nerve allografts. The patients were followed up for 6-24 months after reconstruction. Mackinnon-Dellon static two-point discrimination results showed excellent and good rates of 89%. Semmes-Weinstein monofilament test demonstrated that light touch was normal, with an obvious improvement rate of 78%. These findings confirmed that human acellular nerve allograft for one-stage reconstruction of digital nerve defect after hand injury is feasible, which provides a novel trend for peripheral nerve reconstruction.

Use of inferior gluteal artery and posterior thigh perforators in management of ischial pressure sores with limited donor sites for flap coverage.

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Unal, Cigdem; Ozdemir, Jale; Yirmibesoglu, Oktay; Yucel, Ergin; Agir, Hakan

2012-07-01

Reconstructive surgery for ischial pressure sore defects presents a challenge because of high rates of recurrence. The aim of this study was to describe the use of inferior gluteal artery (IGA) and posterior thigh perforators in management of ischial pressure sores with limited donor sites. Between September 2005 and 2009, 11 patients (9 male, 2 female) with ischial sores were operated by using IGA and posterior thigh perforator flaps. The data of patients included age, sex, cause of paraplegia, flap size, perforator of flap, previous surgeries, recurrences, complications, and postoperative follow-up. Nine IGA and 5 posterior thigh perforator flaps were used. Six patients presented with recurrent lesions, 5 patients were operated for sacral and contralateral ischial pressure sores previously. In 2 patients, IGA and posterior thigh perforator flaps were used in combination. Patients were followed for an average of 34.3 months. In 2 recurrent cases, readvancement of IGA perforator flap and gluteus maximus myocutaneous flap were treatment of choice. Treatment of patients with recurrent lesions or multiple pressure sores is challenging because of limited available flap donor sites. In this study, posterior thigh perforator flaps were preferred in patients in whom the previous donor site was the gluteal region. IGA perforator flaps were the treatment of choice in patients for whom posterior thigh region was previously used. Alternately, preserved perforators of previous conventional myocutaneous flaps enabled us to use these perforators in recurrences.

Nerves and nerve endings in the skin of tropical cattle.

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Amakiri, S F; Ozoya, S E; Ogunnaike, P O

1978-01-01

The nerves and nerve endings in the skin of tropical cattle were studied using histological and histochemical techniques. Many nerve trunks and fibres were present in the reticular and papillary dermis in both hairy and non-hairy skin sites. In non-hairy skin locations such as the muzzle and lower lip, encapsulated endings akin to Krause and Ruffini end bulbs, which arise from myelinated nerve trunks situated lower down the dermis were observed at the upper papillary layer level. Some fibre trunks seen at this level extended upwards to terminate within dermal papillae as bulb-shaped longitudinally lamellated Pacinian-type endings, while other onion-shaped lamellated nerve structures were located either within dermal papillae or near the dermo-epidermal area. Intraepidermal free-ending nerve fibres, appearing non-myelinated were observed in areas with thick epidermis. Intraepidermal free-ending nerve fibres, appearing non-myelinated were observed in areas with thick epidermis. On hairy skin sites, however, organized nerve endings or intraepidermal nerve endings were not readily identifiable.

Diagnostic nerve ultrasonography

International Nuclear Information System (INIS)

Baeumer, T.; Grimm, A.; Schelle, T.

2017-01-01

For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [de

Nerve ultrasound shows subclinical peripheral nerve involvement in neurofibromatosis type 2.

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Telleman, Johan A; Stellingwerff, Menno D; Brekelmans, Geert J; Visser, Leo H

2018-02-01

Neurofibromatosis type 2 (NF2) is mainly associated with central nervous system (CNS) tumors. Peripheral nerve involvement is described in symptomatic patients, but evidence of subclinical peripheral nerve involvement is scarce. We conducted a cross-sectional pilot study in 2 asymptomatic and 3 minimally symptomatic patients with NF2 to detect subclinical peripheral nerve involvement. Patients underwent clinical examination, nerve conduction studies (NCS), and high-resolution ultrasonography (HRUS). A total of 30 schwannomas were found, divided over 20 nerve segments (33.9% of all investigated nerve segments). All patients had at least 1 schwannoma. Schwannomas were identified with HRUS in 37% of clinically unaffected nerve segments and 50% of nerve segments with normal NCS findings. HRUS shows frequent subclinical peripheral nerve involvement in NF2. Clinicians should consider peripheral nerve involvement as a cause of weakness and sensory loss in the extremities in patients with this disease. Muscle Nerve 57: 312-316, 2018. © 2017 Wiley Periodicals, Inc.

Early corneal nerve damage and recovery following small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK).

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Mohamed-Noriega, Karim; Riau, Andri K; Lwin, Nyein C; Chaurasia, Shyam S; Tan, Donald T; Mehta, Jodhbir S

2014-03-25

We compared early corneal nerve changes after small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). A total of 12 rabbits underwent LASIK in one eye and SMILE in the fellow eye. Baseline and follow-up evaluations at 1, 2, and 4 weeks postoperatively were performed with in vivo confocal microscopy to evaluate 5 different areas within the treated zone: center, superior, inferior, nasal, and temporal. Cryosections of the corneas and whole mount of the extracted SMILE lenticules were analyzed with immunostaining of βIII-tubulin. One week after SMILE and LASIK, a decrease in nerve length and density was observed in all evaluated areas. A trend toward greater subbasal nerve length and density (SLD), more eyes with subbasal nerves (ESN), more eyes with subbasal nerves longer than 200 μm (SNL), and higher mean number of subbasal nerves by frame (NSN) in SMILE than in LASIK groups was observed at subsequent follow-up time points. Only the SMILE group showed a recovery of SLD, ESN, and NSN by week 4 (P > 0.05). A trend toward more eyes with sprouting subbasal nerves and greater mean number of sprouting nerves was observed in LASIK than in SMILE, indicating that more subbasal nerves were disrupted and undergoing regeneration after LASIK. Immunostaining at postoperative week 4 revealed a faster stromal nerve recovery in post-SMILE eyes compared to post-LASIK eyes. Our findings suggest that SMILE results in less nerve damage and faster nerve recovery than LASIK.

Significant correlations between optic nerve head microcirculation and visual field defects and nerve fiber layer loss in glaucoma patients with myopic glaucomatous disk

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Yokoyama Y

2011-12-01

Full Text Available Yu Yokoyama, Naoko Aizawa, Naoki Chiba, Kazuko Omodaka, Masahiko Nakamura, Takaaki Otomo, Shunji Yokokura, Nobuo Fuse, Toru NakazawaDepartment of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, JapanBackground: Eyes with glaucoma are characterized by optic neuropathy with visual field defects in the areas corresponding to the optic disk damage. The exact cause for the glaucomatous optic neuropathy has not been determined. Myopia has been shown to be a risk factor for glaucoma. The purpose of this study was to determine whether a significant correlation existed between the microcirculation of the optic disk and the visual field defects and the retinal nerve fiber layer thickness (RNFLT in glaucoma patients with myopic optic disks.Methods: Sixty eyes of 60 patients with myopic disks were studied; 36 eyes with glaucoma (men:women = 19:17 and 24 eyes with no ocular diseases (men:women = 14:10. The mean deviation (MD determined by the Humphrey field analyzer, and the peripapillary RNFLT determined by the Stratus-OCT were compared between the two groups. The ocular circulation was determined by laser speckle flowgraphy (LSFG, and the mean blur rate (MBR was compared between the two groups. The correlations between the RNFLT and MBR of the corresponding areas of the optic disk and between MD and MBR of the optic disk in the glaucoma group were determined by simple regression analyses.Results: The average MBR for the entire optic disk was significantly lower in the glaucoma group than that in the control group. The differences of the MBR for the tissue in the superior, inferior, and temporal quadrants of the optic disk between the two groups were significant. The MBR for the entire optic disk was significantly correlated with the MD (r = 0.58, P = 0.0002 and the average RNFLT (r = 0.53, P = 0.0008. The tissue MBR of the optic disk was significantly correlated with the RNFLT in the superior, inferior, and temporal quadrants

Polymeric Nerve Conduits with Contact Guidance Cues Used in Nerve Repair

Institute of Scientific and Technical Information of China (English)

G DAI; X NIU; J YIN

2016-01-01

In the modern life, the nerve injury frequently happens due to mechanical, chemical or thermal accidents. In the trivial injuries, the peripheral nerves can regenerate on their own; however, in most of the cases the clinical treatments are required, where relatively large nerve injury gaps are formed. Currently, the nerve repair can be accomplished by direct suture when the injury gap is not too large;while the autologous nerve graft working as the gold standard of peripheral nerve injury treatment for nerve injuries with larger gaps. However, the direct suture is limited by heavy tension at the suture sites, and the autologous nerve graft also has the drawbacks of donor site morbidity and insufifcient donor tissue. Recently, artiifcial nerve conduits have been developed as an alternative for clinical nerve repair to overcome the limitations associated with the above treatments. In order to further improve the efifciency of nerve conduits, various guidance cues are incorporated, including physical cues, biochemical signals, as well as support cells. First, this paper reviewed the contact guidance cues applied in nerve conduits, such as lumen ifllers, multi-channels and micro-patterns on the inner surface. Then, the paper focused on the polymeric nerve conduits with micro inner grooves. The polymeric nerve conduits were fabricated using the phase inversion-based ifber spinning techniques. The smart spinneret with grooved die was designed in the spinning platform, while different spinning conditions, including flow rates, air-gap distances, and polymer concentrations, were adjusted to investigate the inlfuence of fabrication conditions on the geometry of nerve conduits. The inner groove size in the nerve conduits can be precisely controlled in our hollow ifber spinning process, which can work as the efifcient contact guidance cue for nerve regeneration.

Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

International Nuclear Information System (INIS)

Binkert, Christoph A.; Hirzel, Florian C.; Gutzeit, Andreas; Zollikofer, Christoph L.; Hess, Thomas

2015-01-01

PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h

Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

Energy Technology Data Exchange (ETDEWEB)

Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hirzel, Florian C. [Kantonsspital Winterthur, Department of Gynecology (Switzerland); Gutzeit, Andreas; Zollikofer, Christoph L. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hess, Thomas [Kantonsspital Winterthur, Department of Gynecology (Switzerland)

2015-10-15

PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

Tissue-engineered spiral nerve guidance conduit for peripheral nerve regeneration.

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Chang, Wei; Shah, Munish B; Lee, Paul; Yu, Xiaojun

2018-06-01

Recently in peripheral nerve regeneration, preclinical studies have shown that the use of nerve guidance conduits (NGCs) with multiple longitudinally channels and intra-luminal topography enhance the functional outcomes when bridging a nerve gap caused by traumatic injury. These features not only provide guidance cues for regenerating nerve, but also become the essential approaches for developing a novel NGC. In this study, a novel spiral NGC with aligned nanofibers and wrapped with an outer nanofibrous tube was first developed and investigated. Using the common rat sciatic 10-mm nerve defect model, the in vivo study showed that a novel spiral NGC (with and without inner nanofibers) increased the successful rate of nerve regeneration after 6 weeks recovery. Substantial improvements in nerve regeneration were achieved by combining the spiral NGC with inner nanofibers and outer nanofibrous tube, based on the results of walking track analysis, electrophysiology, nerve histological assessment, and gastrocnemius muscle measurement. This demonstrated that the novel spiral NGC with inner aligned nanofibers and wrapped with an outer nanofibrous tube provided a better environment for peripheral nerve regeneration than standard tubular NGCs. Results from this study will benefit for future NGC design to optimize tissue-engineering strategies for peripheral nerve regeneration. We developed a novel spiral nerve guidance conduit (NGC) with coated aligned nanofibers. The spiral structure increases surface area by 4.5 fold relative to a tubular NGC. Furthermore, the aligned nanofibers was coated on the spiral walls, providing cues for guiding neurite extension. Finally, the outside of spiral NGC was wrapped with randomly nanofibers to enhance mechanical strength that can stabilize the spiral NGC. Our nerve histological data have shown that the spiral NGC had 50% more myelinated axons than a tubular structure for nerve regeneration across a 10 mm gap in a rat sciatic nerve

Sensation, mechanoreceptor, and nerve fiber function after nerve regeneration

DEFF Research Database (Denmark)

Krarup, Christian; Rosén, Birgitta; Boeckstyns, Michel

2017-01-01

Objective: Sensation is essential for recovery after peripheral nerve injury. However, the relationship between sensory modalities and function of regenerated fibers is uncertain. We have investigated the relationships between touch threshold, tactile gnosis, and mechanoreceptor and sensory fiber...... function after nerve regeneration. Methods: Twenty-one median or ulnar nerve lesions were repaired by a collagen nerve conduit or direct suture. Quantitative sensory hand function and sensory conduction studies by near-nerve technique, including tactile stimulation of mechanoreceptors, were followed for 2...... years, and results were compared to noninjured hands. Results: At both repair methods, touch thresholds at the finger tips recovered to 81 ± 3% and tactile gnosis only to 20 ± 4% (p nerve action potentials (SNAPs) remained dispersed and areas recovered to 23 ± 2...

Optic Nerve Head and Retinal Nerve Fiber Layer Analysis in Ocular Hypertension and Early-Stage Glucoma Using Spectral-Domain Optical Coherence Tomography Copernicus

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Nilgün Solmaz

2014-01-01

Full Text Available Objectives: Evaluation of structural alterations of the optic nerve head (ONH and the retinal nerve fiber layer (RNFL in patients with ocular hypertension (OHT and early-stage glaucoma and assessment of the discriminatory diagnostic performance of spectral-domain optical coherence tomography (SD-OCT Copernicus (Optopol Technology S.A.. Materials and Methods: This study included 59 eyes of a total of 59 patients, 29 of whom were diagnosed with OHT (Group 1 and 30 with early-stage glaucoma (Group 2. The differentiation of early-stage glaucoma and OHT was carried out on the basis of standard achromatic visual field test results. Analysis of the ONH and RNFL thickness of all cases was made using SD-OCT. Group 1 and Group 2 were compared with respect to the ONH parameters and RNFL thickness. The diagnostic sensitivity of the OCT parameters was evaluated by the area under the receiver operating characteristics curves (AUC. Results: The average, superior, inferior, and nasal RNFL thicknesses in early-stage glaucoma cases were approximately 10% (12-14 µm less compared to the OHT eyes, with differences being highly significant (p≤0.001. However, there was no statistically significant difference in the temporal RNFL thicknesses. The most sensitive parameter in the early diagnosis of glaucoma was average RNFL thickness corresponding to AUC: 0.852, followed by AUC: 0.816 and AUC: 0.773 values in superior and inferior RNFL thickness, respectively. In localized RNFL defects, the highest sensitivity corresponded to superior and superonasal quadrants (ACU: 0.805 and ACU: 0.781, respectively. There were not any statistically significant differences between the ONH morphological parameters of the two groups. Conclusion: RNFL analysis obtained using SD-OCT Copernicus is able to discriminate early-stage glaucoma eyes from those with OHT. However, ONH morphological parameters do not have the same diagnostic sensitivity. Turk J Ophthalmol 2014; 44: 35-41

The role of great auricular-facial nerve neurorrhaphy in facial nerve damage

OpenAIRE

Sun, Yan; Liu, Limei; Han, Yuechen; Xu, Lei; Zhang, Daogong; Wang, Haibo

2015-01-01

Background: Facial nerve is easy to be damaged, and there are many reconstructive methods for facial nerve reconstructive, such as facial nerve end to end anastomosis, the great auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. However, there is still little study about great auricular-facial nerve neurorrhaphy. The aim of the present study was to identify the role of great auricular-facial nerve neurorrhaphy and the mechanism. Methods: Rat models of facia...

Elastofibroma of the gluteal region with a concomitant contralateral lesion: case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Cevolani, Luca; Casadei, R.; Donati, D. [Rizzoli Orthopaedic Institute, III Orthopaedic and Traumatology Clinic, Bologna (Italy); Vanel, D.; Gambarotti, M. [Rizzoli Orthopaedic Institute, Bone Tumor Center, Bologna (Italy)

2017-03-15

A 51-year-old man presented with elastofibroma (EF) of the gluteal region with a concomitant contralateral lesion. The patient presented with a slow growing mass of the proximal third of the right buttock and had swelling, discomfort in sitting, and right-hip pain during walking for 2 months. On MRI, a soft-tissue mass was noted between the gluteus maximus and the gluteus medius muscle. The mass showed similar signal intensity to the surrounding tissue on T1- and T2-weighted images and with linear hyperintense areas in its internal structure. At surgery, a soft, non-encapsulated, irregular, and rubber-like mass was found attached to the gluteus medius muscles. It was pathologically confirmed to be an EF. This unusual manifestation of an EF is discussed. (orig.)

The role of great auricular-facial nerve neurorrhaphy in facial nerve damage.

Science.gov (United States)

Sun, Yan; Liu, Limei; Han, Yuechen; Xu, Lei; Zhang, Daogong; Wang, Haibo

2015-01-01

Facial nerve is easy to be damaged, and there are many reconstructive methods for facial nerve reconstructive, such as facial nerve end to end anastomosis, the great auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. However, there is still little study about great auricular-facial nerve neurorrhaphy. The aim of the present study was to identify the role of great auricular-facial nerve neurorrhaphy and the mechanism. Rat models of facial nerve cut (FC), facial nerve end to end anastomosis (FF), facial-great auricular neurorrhaphy (FG), and control (Ctrl) were established. Apex nasi amesiality observation, electrophysiology and immunofluorescence assays were employed to investigate the function and mechanism. In apex nasi amesiality observation, it was found apex nasi amesiality of FG group was partly recovered. Additionally, electrophysiology and immunofluorescence assays revealed that facial-great auricular neurorrhaphy could transfer nerve impulse and express AChR which was better than facial nerve cut and worse than facial nerve end to end anastomosis. The present study indicated that great auricular-facial nerve neurorrhaphy is a substantial solution for facial lesion repair, as it is efficiently preventing facial muscles atrophy by generating neurotransmitter like ACh.

Pinched Nerve

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... You are here Home » Disorders » All Disorders Pinched Nerve Information Page Pinched Nerve Information Page What research is being done? Within the NINDS research programs, pinched nerves are addressed primarily through studies associated with pain ...

Unilateral blindness with third cranial nerve palsy and abnormal enhancement of extraocular muscles on magnetic resonance imaging of orbit after the ingestion of methanol.

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Chung, Tae Nyoung; Kim, Sun Wook; Park, Yoo Seok; Park, Incheol

2010-05-01

Methanol is generally known to cause visual impairment and various systemic manifestations. There are a few reported specific findings for methanol intoxication on magnetic resonance imaging (MRI) of the brain. A case is reported of unilateral blindness with third cranial nerve palsy oculus sinister (OS) after the ingestion of methanol. Unilateral damage of the retina and optic nerve were confirmed by fundoscopy, flourescein angiography, visual evoked potential and electroretinogram. The optic nerve and extraocular muscles (superior rectus, medial rectus, inferior rectus and inferior oblique muscle) were enhanced by gadolinium-DTPA on MRI of the orbit. This is the first case report of permanent monocular blindness with confirmed unilateral damage of the retina and optic nerve, combined with third cranial nerve palsy after methanol ingestion.

Peripheral nerve regeneration through P(DLLA-epsilon-CL) nerve guides

NARCIS (Netherlands)

Den Dunnen, WFA; Meek, MF; Robinson, PH; Schakernraad, JM

1998-01-01

P(DLLA-epsilon-CL) nerve guides can be used perfectly for short nerve gaps in rats, and are even better than short autologous nerve grafts. The tube dimensions, such as the internal diameter and wall thickness, are very important for the final outcome of peripheral nerve regeneration, as well as the

Intra-articular versus intravenous magnesium-sulfate as adjuvant to femoral nerve block in arthroscopic knee sur

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Mohamed Abdulatif

2015-07-01

Conclusion: The combined use of femoral nerve block with IA or IV MgSO4 is associated with significant reduction of the intensity and duration of postoperative pain and postoperative analgesic requirements in patients undergoing arthroscopic knee surgery with the IA MgSO4 being superior to IV route of administration.

Morphological pattern of intrinsic nerve plexus distributed on the rabbit heart and interatrial septum

Science.gov (United States)

Saburkina, Inga; Gukauskiene, Ligita; Rysevaite, Kristina; Brack, Kieran E; Pauza, Audrys G; Pauziene, Neringa; Pauza, Dainius H

2014-01-01

Although the rabbit is routinely used as the animal model of choice to investigate cardiac electrophysiology, the neuroanatomy of the rabbit heart is not well documented. The aim of this study was to examine the topography of the intrinsic nerve plexus located on the rabbit heart surface and interatrial septum stained histochemically for acetylcholinesterase using pressure-distended whole hearts and whole-mount preparations from 33 Californian rabbits. Mediastinal cardiac nerves entered the venous part of the heart along the root of the right cranial vein (superior caval vein) and at the bifurcation of the pulmonary trunk. The accessing nerves of the venous part of the heart passed into the nerve plexus of heart hilum at the heart base. Nerves approaching the heart extended epicardially and innervated the atria, interatrial septum and ventricles by five nerve subplexuses, i.e. left and middle dorsal, dorsal right atrial, ventral right and left atrial subplexuses. Numerous nerves accessed the arterial part of the arterial part of the heart hilum between the aorta and pulmonary trunk, and distributed onto ventricles by the left and right coronary subplexuses. Clusters of intrinsic cardiac neurons were concentrated at the heart base at the roots of pulmonary veins with some positioned on the infundibulum. The mean number of intrinsic neurons in the rabbit heart is not significantly affected by aging: 2200 ± 262 (range 1517–2788; aged) vs. 2118 ± 108 (range 1513–2822; juvenile). In conclusion, despite anatomic differences in the distribution of intrinsic cardiac neurons and the presence of well-developed nerve plexus within the heart hilum, the topography of all seven subplexuses of the intrinsic nerve plexus in rabbit heart corresponds rather well to other mammalian species, including humans. PMID:24527844

Electrophysiology of Cranial Nerve Testing: Spinal Accessory and Hypoglossal Nerves.

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Stino, Amro M; Smith, Benn E

2018-01-01

Multiple techniques have been developed for the electrodiagnostic evaluation of cranial nerves XI and XII. Each of these carries both benefits and limitations, with more techniques and data being available in the literature for spinal accessory than hypoglossal nerve evaluation. Spinal accessory and hypoglossal neuropathy are relatively uncommon cranial mononeuropathies that may be evaluated in the outpatient electrodiagnostic laboratory setting. A review of available literature using PubMed was conducted regarding electrodiagnostic technique in the evaluation of spinal accessory and hypoglossal nerves searching for both routine nerve conduction studies and repetitive nerve conduction studies. The review provided herein provides a resource by which clinical neurophysiologists may develop and implement clinical and research protocols for the evaluation of both of these lower cranial nerves in the outpatient setting.

Mechanism to preserve phrenic nerve function during photosensitization reaction: drug uptake and photosensitization reaction effect on electric propagation

Science.gov (United States)

Takahashi, Haruka; Hamada, Risa; Ogawa, Emiyu; Arai, Tsunenori

2018-02-01

To study a mechanism of phrenic nerve preservation phenomena during a photosensitization reaction, we investigated an uptake of talaporfin sodium and photosensitization reaction effect on an electric propagation. Right phrenic nerve was completely preserved after superior vena cava isolations using the photosensitization reaction in canine animal experiments, in spite of adjacent myocardium was electrically blocked. We predicted that low drug uptake and/or low photosensitization reaction effect on the nerve might be a mechanism of that phenomena. To investigate uptake to various nerve tissue, a healthy extracted crayfish ventral nerve cord and an extracted porcine phrenic nerve were immersed in 20 μg/ml talaporfin sodium solution for 0-240 min. The mean talaporfin sodium fluorescence brightness increased depending on the immersion time. This brightness saturated around the immersion time of 120 min. We found that talaporfin sodium uptake inside the perineurium which directly related to the electric propagation function was lower than that of outside in the porcine phrenic nerve. To investigate photosensitization reaction effect on electric propagation, the crayfish nerve was immersed into the same solution for 15 min and irradiated by a 663 nm laser light with 120 mW/cm2. Since we found the action potential disappeared when the irradiation time was 25-65 s, we consider that the crayfish nerve does not tolerant to the photosensitization reaction on electric propagation function at atmospheric pressure. From these results, we think that the low uptake of talaporfin sodium inside the perineurium and low oxygen partial pressure of nerve might be the possible mechanism to preserve phrenic nerve in vivo.

Evaluation of Morphological and Functional Nerve Recovery of Rat Sciatic Nerve with a Hyaff11-Based Nerve Guide

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K. Jansen

2006-01-01

Full Text Available Application of a Hyaff11-based nerve guide was studied in rats. Functional tests were performed to study motor nerve recovery. A withdrawal reflex test was performed to test sensory recovery. Morphology was studied by means of histology on explanted tissue samples. Motor nerve recovery was established within 7 weeks. Hereafter, some behavioral parameters like alternating steps showed an increase in occurence, while others remained stable. Sensory function was observed within the 7 weeks time frame. Nerve tissue had bridged the 10-mm gap within 7 weeks. The average nerve fiber surface area increased significantly in time. In situ degradation of the nerve conduit was fully going on at week 7 and tubes had collapsed by then. At weeks 15 and 21, the knitted tube wall structure was completely surrounded by macrophages and giant cells, and matrix was penetrating the tube wall. We conclude that a Hyaff11-based nerve guide can be used to bridge short peripheral nerve defects in rat. However, adaptations need to be made.

[Facial nerve neurinomas].

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Sokołowski, Jacek; Bartoszewicz, Robert; Morawski, Krzysztof; Jamróz, Barbara; Niemczyk, Kazimierz

2013-01-01

Evaluation of diagnostic, surgical technique, treatment results facial nerve neurinomas and its comparison with literature was the main purpose of this study. Seven cases of patients (2005-2011) with facial nerve schwannomas were included to retrospective analysis in the Department of Otolaryngology, Medical University of Warsaw. All patients were assessed with history of the disease, physical examination, hearing tests, computed tomography and/or magnetic resonance imaging, electronystagmography. Cases were observed in the direction of potential complications and recurrences. Neurinoma of the facial nerve occurred in the vertical segment (n=2), facial nerve geniculum (n=1) and the internal auditory canal (n=4). The symptoms observed in patients were analyzed: facial nerve paresis (n=3), hearing loss (n=2), dizziness (n=1). Magnetic resonance imaging and computed tomography allowed to confirm the presence of the tumor and to assess its staging. Schwannoma of the facial nerve has been surgically removed using the middle fossa approach (n=5) and by antromastoidectomy (n=2). Anatomical continuity of the facial nerve was achieved in 3 cases. In the twelve months after surgery, facial nerve paresis was rated at level II-III° HB. There was no recurrence of the tumor in radiological observation. Facial nerve neurinoma is a rare tumor. Currently surgical techniques allow in most cases, the radical removing of the lesion and reconstruction of the VII nerve function. The rate of recurrence is low. A tumor of the facial nerve should be considered in the differential diagnosis of nerve VII paresis. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

Comparison of fasciocutaneous V-Y and rotational flaps for defect coverage of sacral pressure sores: a critical single-centre appraisal.

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Djedovic, Gabriel; Metzler, Julia; Morandi, Evi M; Wachter, Tanja; Kühn, Shafreena; Pierer, Gerhard; Rieger, Ulrich M

2017-12-01

Pressure sore rates remain high in both nursing homes as well as in hospitals. Numerous surgical options are available for defect coverage in the sacral region. However, objective data is scarce as to whether a specific flap design is superior to another. Here, we aim to compare two fasciocutaneous flap designs for sacral defect coverage: the gluteal rotation flap and the gluteal V-Y flap. All primary sacral pressure sores of grades III-IV that were being covered with gluteal fasciocutaneous rotational or V-Y flaps between January 2008 and December 2014 at our institution were analysed. A total of 41 patients received a total of 52 flaps. Of these, 18 patients received 20 gluteal rotational flaps, and 23 patients received 32 V-Y flaps. Both groups were comparable with regards to demographics, comorbidities and complications. Significantly more V-Y flaps were needed to cover smaller defects. Mean length of hospital stay was significantly prolonged when surgical revision had to be carried out. Both flap designs have proven safe and reliable for defect coverage after sacral pressure sores. Gluteal rotational flaps appear to be more useful for larger defects. Both flap designs facilitate their reuse in case of pressure sore recurrence. Complication rates appear to be comparable in both designs and to the current literature. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries

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Samuel Ribak

2016-02-01

Full Text Available ABSTRACT OBJECTIVE: To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. METHODS: This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve was identified. The proximal limit of the sensitive branch was found at this point. RESULTS: The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. CONCLUSIONS: Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review

DEFF Research Database (Denmark)

Neimann, Jens Dupont Børglum; Bartholdy, Anne; Hautopp, H

2011-01-01

We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left...... shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low...... impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management...

Delayed peripheral nerve repair: methods, including surgical 'cross-bridging' to promote nerve regeneration.

Science.gov (United States)

Gordon, Tessa; Eva, Placheta; Borschel, Gregory H

2015-10-01

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges) into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to 'protect' chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.

Sensory nerve function and auto-mutilation after reconstruction of various gap lengths with nerve guides and autologous nerve grafts

NARCIS (Netherlands)

den Dunnen, WFA; Meek, MF

The aim of this study was to evaluate sensory nerve recovery and auto-mutilation after reconstruction of various lengths of nerve gaps in the sciatic nerve of the rat, using different techniques. Group 4, in which the longest nerve gap (15 mm) was reconstructed with a thin-walled

Nerve supply to the internal anal sphincter differs from that to the distal rectum: an immunohistochemical study of cadavers.

Science.gov (United States)

Kinugasa, Yusuke; Arakawa, Takashi; Murakami, Gen; Fujimiya, Mineko; Sugihara, Kenichi

2014-04-01

Fecal incontinence is a common problem after anal sphincter-preserving operations. The intersphincteric autonomic nerves supplying the internal anal sphincter (IAS) are formed by the union of: (1) nerve fibers from Auerbach's nerve plexus of the most distal part of the rectum and (2) the inferior rectal branches of the pelvic plexus (IRB-PX) running along the conjoint longitudinal muscle coat. The aim of the present study is to identify the detailed morphology of nerves to the IAS. The study comprised histological and immunohistochemical evaluations of paraffin-embedded sections from a large block of anal canal from the preserved 10 cadavers. The IRB-PX came from the superior aspect of the levator ani and ran into the anal canal on the anterolateral side. These nerves contained both sympathetic and parasympathetic fibers, but the sympathetic content was much higher than in nerves from the distal rectum. All intramural ganglion cells in the distal rectum were neuronal nitric oxide synthase-positive and tyrosine hydroxylase-negative and were restricted to above the squamous-columnar epithelial junction. Parasympathetic nerves formed a lattice-like plexus in the circular smooth muscles of the distal rectum, whereas the IAS contained short, longitudinally running sympathetic and parasympathetic nerves, although sympathetic nerves were dominant. The major autonomic nerve input to the IAS seemed not to originate from the distal rectum but from the IRB-PX. Injury to the IRB-PX during surgery seemed to result in loss of innervation to the major part of the IAS.

Tissue-engineered rhesus monkey nerve grafts for the repair of long ulnar nerve defects: similar outcomes to autologous nerve grafts

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Chang-qing Jiang

2016-01-01

Full Text Available Acellular nerve allografts can help preserve normal nerve structure and extracellular matrix composition. These allografts have low immunogenicity and are more readily available than autologous nerves for the repair of long-segment peripheral nerve defects. In this study, we repaired a 40-mm ulnar nerve defect in rhesus monkeys with tissue-engineered peripheral nerve, and compared the outcome with that of autograft. The graft was prepared using a chemical extract from adult rhesus monkeys and seeded with allogeneic Schwann cells. Pathomorphology, electromyogram and immunohistochemistry findings revealed the absence of palmar erosion or ulcers, and that the morphology and elasticity of the hypothenar eminence were normal 5 months postoperatively. There were no significant differences in the mean peak compound muscle action potential, the mean nerve conduction velocity, or the number of neurofilaments between the experimental and control groups. However, outcome was significantly better in the experimental group than in the blank group. These findings suggest that chemically extracted allogeneic nerve seeded with autologous Schwann cells can repair 40-mm ulnar nerve defects in the rhesus monkey. The outcomes are similar to those obtained with autologous nerve graft.

Tissue-engineered rhesus monkey nerve gratfs for the repair of long ulnar nerve defects：similar outcomes to autologous nerve gratfs

Institute of Scientific and Technical Information of China (English)

Chang-qing Jiang; Jun Hu; Jian-ping Xiang; Jia-kai Zhu; Xiao-lin Liu; Peng Luo

2016-01-01

Acellular nerve allogratfs can help preserve normal nerve structure and extracellular matrix composition. These allogratfs have low immu-nogenicity and are more readily available than autologous nerves for the repair of long-segment peripheral nerve defects. In this study, we repaired a 40-mm ulnar nerve defect in rhesus monkeys with tissue-engineered peripheral nerve, and compared the outcome with that of autogratf. The gratf was prepared using a chemical extract from adult rhesus monkeys and seeded with allogeneic Schwann cells. Pathomo-rphology, electromyogram and immunohistochemistry ifndings revealed the absence of palmar erosion or ulcers, and that the morphology and elasticity of the hypothenar eminence were normal 5 months postoperatively. There were no signiifcant differences in the mean peak compound muscle action potential, the mean nerve conduction velocity, or the number of neuroiflaments between the experimental and control groups. However, outcome was signiifcantly better in the experimental group than in the blank group. These ifndings suggest that chemically extracted allogeneic nerve seeded with autologous Schwann cells can repair 40-mm ulnar nerve defects in the rhesus monkey. The outcomes are similar to those obtained with autologous nerve gratf.

Evidence Suggesting that the Buccal and Zygomatic Branches of the Facial Nerve May Contain Parasympathetic Secretomotor Fibers to the Parotid Gland by Means of Communications from the Auriculotemporal Nerve.

Science.gov (United States)

Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

2015-12-01

The auriculotemporal nerve is one of the peripheral nerves that communicates with the facial nerve. However, the function of these communications is poorly understood. Details of how these communications form and connect with each other are still unclear. In addition, a reliable anatomical landmark for locating these communications during surgery has not been sufficiently described. Microdissection was performed on 20 lateral hemifaces of 10 soft-embalmed cadavers to investigate facial-auriculotemporal nerve communications with emphasis on determining their function. The auriculotemporal nerve was identified in the retromandibular space and traced towards its terminations. The communicating branches were followed and the anatomical relationships to surrounding structures observed. The auriculotemporal nerve is suspended above the maxillary artery in the dense retromandibular fascia behind the mandibular ramus. It forms a knot and fans out, providing multiple branches in all directions in the sagittal plane. Inferiorly, it connects the maxillary periarterial plexus, while minute branches supply the temporomandibular joint anteriorly. The larger branches mainly communicate with the branches of the temporofacial division of the facial nerve, and the auricular branches enter the fascia of the auricular cartilage posteriorly. The temporal branches and occasionally the zygomatic branches arise superiorly to distribute within the temporoparietal fascia. The auriculotemporal nerve forms the parotid retromandibular plexus through two types of communication. It sends one to three branches to join the zygomatic and buccal branches of the facial nerve at the branching area of the temporofacial division. It also communicates with the periarterial plexus of the superficial temporal and maxillary arteries. This plexus continues anteriorly along the branches of the facial nerve and the periarterial plexus of the transverse facial artery as the parotid periductal autonomic plexus

Superiority of resection over enucleation for schwannomas of the cervical vagus nerve: A retrospective cohort study of 22 consecutive patients.

Science.gov (United States)

Illuminati, Giulio; Pizzardi, Giulia; Minni, Antonio; Masci, Federica; Ciamberlano, Bernardo; Pasqua, Rocco; Calio, Francesco G; Vietri, Francesco

2016-05-01

Schwannoma of the cervical vagus nerve is rare. Treatment options include intracapsular enucleation and en bloc resection. The purpose of this study was to compare the outcomes of enucleation and resection in terms of postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence, quality-adjusted life-year (QALY) and vocal handicap index (VHI). Twentytwo consecutive patients were divided into two groups. Patients in group A (n = 9) underwent intracapsular enucleation, whereas patients in Group B (n = 13) underwent en bloc resection. Main endpoints of the study were postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence and quality of life. The quality of life after surgery was assessed according to the quality-adjusted life-year (QALY) EQ-5D-5L methodology, and calculation of the voice handicap index (VHI). Postoperative mortality was nil. Morbidity included 1 wound dehiscence in group A and 2 transitory dysphagias in group B. Freedom from vocal cord palsy was 22% in group A and zero in group B (p = 0.15). Operation-specific local recurrence rate was 33% (3/9 patients) in group A and nil in group B (0/23 patients) (p = 0.05). QALYs was 0.55 in group A and 0.54 in group B (p = 1.0). VHI was 23.77 in group A and 26.15 in group B (p = 1.00). Resection is superior to enucleation in terms of freedom from local recurrence. Functional results are comparable for both techniques. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Optic nerve oxygenation

DEFF Research Database (Denmark)

Stefánsson, Einar; Pedersen, Daniella Bach; Jensen, Peter Koch

2005-01-01

The oxygen tension of the optic nerve is regulated by the intraocular pressure and systemic blood pressure, the resistance in the blood vessels and oxygen consumption of the tissue. The oxygen tension is autoregulated and moderate changes in intraocular pressure or blood pressure do not affect...... the optic nerve oxygen tension. If the intraocular pressure is increased above 40 mmHg or the ocular perfusion pressure decreased below 50 mmHg the autoregulation is overwhelmed and the optic nerve becomes hypoxic. A disturbance in oxidative metabolism in the cytochromes of the optic nerve can be seen...... at similar levels of perfusion pressure. The levels of perfusion pressure that lead to optic nerve hypoxia in the laboratory correspond remarkably well to the levels that increase the risk of glaucomatous optic nerve atrophy in human glaucoma patients. The risk for progressive optic nerve atrophy in human...

The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

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Anuar RIM

2015-11-01

Full Text Available The supracondylar humerus fracture (SCHF in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.

Poly(DL-lactide-epsilon-caprolactone) nerve guides perform better than autologous nerve grafts

NARCIS (Netherlands)

DenDunnen, WFA; VanderLei, B; Schakenraad, JM; Stokroos, [No Value; Blaauw, E; Pennings, AJ; Robinson, PH; Bartels, H.

1996-01-01

The aim of this study was to compare the speed and quality of nerve regeneration after reconstruction using a biodegradable nerve guide or an autologous nerve graft. We evaluated nerve regeneration using light microscopy, transmission electron microscopy and morphometric analysis. Nerve regeneration

Neural stem cells enhance nerve regeneration after sciatic nerve injury in rats.

Science.gov (United States)

Xu, Lin; Zhou, Shuai; Feng, Guo-Ying; Zhang, Lu-Ping; Zhao, Dong-Mei; Sun, Yi; Liu, Qian; Huang, Fei

2012-10-01

With the development of tissue engineering and the shortage of autologous nerve grafts in nerve reconstruction, cell transplantation in a conduit is an alternative strategy to improve nerve regeneration. The present study evaluated the effects and mechanism of brain-derived neural stem cells (NSCs) on sciatic nerve injury in rats. At the transection of the sciatic nerve, a 10-mm gap between the nerve stumps was bridged with a silicon conduit filled with 5 × 10(5) NSCs. In control experiments, the conduit was filled with nerve growth factor (NGF) or normal saline (NS). The functional and morphological properties of regenerated nerves were investigated, and expression of hepatocyte growth factor (HGF) and NGF was measured. One week later, there was no connection through the conduit. Four or eight weeks later, fibrous connections were evident between the proximal and distal segments. Motor function was revealed by measurement of the sciatic functional index (SFI) and sciatic nerve conduction velocity (NCV). Functional recovery in the NSC and NGF groups was significantly more advanced than that in the NS group. NSCs showed significant improvement in axon myelination of the regenerated nerves. Expression of NGF and HGF in the injured sciatic nerve was significantly lower in the NS group than in the NSCs and NGF groups. These results and other advantages of NSCs, such as ease of harvest and relative abundance, suggest that NSCs could be used clinically to enhance peripheral nerve repair.

Using Eggshell Membrane as Nerve Guide Channels in Peripheral Nerve Regeneration

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Gholam Hossein Farjah

2013-08-01

Full Text Available Objective(s:  The aim of this study was to evaluate the final outcome of nerve regeneration across the eggsell membrane (ESM tube conduit in comparison with autograft. Materials and Methods: Thirty adult male rats (250-300 g were randomized into (1 ESM conduit, (2 autograft, and (3 sham surgery groups. The eggs submerged in 5% acetic acid. The decalcifying membranes were cut into four pieces, rotated over the teflon mandrel and dried at   37°C. The left sciatic nerve was surgically cut. A 10-mm nerve segment was cut and removed. In the ESM group, the proximal and distal cut ends of the sciatic nerve were telescoped into the nerve guides. In the autograft group, the 10 mm nerve segment was reversed and used as an autologous nerve graft. All animals were evaluated by sciatic functional index (SFI and electrophysiology testing.  Results:The improvement in SFI from the first to the last evalution in ESM and autograft groups were evaluated. On days 49 and 60 post-operation, the mean SFI of ESM group was significantly greater than the autograft group (P 0.05. Conclusion:These findings demonstrate that ESM effectively enhances nerve regeneration and promotes functional recovery in injured sciatic nerve of rat.

Combined use of decellularized allogeneic artery conduits with autologous transdifferentiated adipose-derived stem cells for facial nerve regeneration in rats.

Science.gov (United States)

Sun, Fei; Zhou, Ke; Mi, Wen-juan; Qiu, Jian-hua

2011-11-01

Natural biological conduits containing seed cells have been widely used as an alternative strategy for nerve gap reconstruction to replace traditional nerve autograft techniques. The purpose of this study was to investigate the effects of a decellularized allogeneic artery conduit containing autologous transdifferentiated adipose-derived stem cells (dADSCs) on an 8-mm facial nerve branch lesion in a rat model. After 8 weeks, functional evaluation of vibrissae movements and electrophysiological assessment, retrograde labeling of facial motoneurons and morphological analysis of regenerated nerves were performed to assess nerve regeneration. The transected nerves reconstructed with dADSC-seeded artery conduits achieved satisfying regenerative outcomes associated with morphological and functional improvements which approached those achieved with Schwann cell (SC)-seeded artery conduits, and superior to those achieved with artery conduits alone or ADSC-seeded artery conduits, but inferior to those achieved with nerve autografts. Besides, numerous transplanted PKH26-labeled dADSCs maintained their acquired SC-phenotype and myelin sheath-forming capacity inside decellularized artery conduits and were involved in the process of axonal regeneration and remyelination. Collectively, our combined use of decellularized allogeneic artery conduits with autologous dADSCs certainly showed beneficial effects on nerve regeneration and functional restoration, and thus represents an alternative approach for the reconstruction of peripheral facial nerve defects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Retinal nerve fiber layer analysis with scanning laser polarimetry and RTVue-OCT in patients of retinitis pigmentosa.

Science.gov (United States)

Xue, Kang; Wang, Min; Chen, Junyi; Huang, Xin; Xu, Gezhi

2013-01-01

To measure the thickness of the retinal nerve fiber layer (RNFL) of patients with retinitis pigmentosa (RP) and that of normal controls by scanning laser polarimetry with enhanced corneal compensation (GDxECC) and RTVue-optical coherence tomography (OCT). Fifty-two eyes of 26 patients were included. All patients underwent complete ophthalmological examinations and testing with GDxECC. Twenty-eight of 52 eyes of RP patients underwent RTVue-OCT measurements. A group of 50 eyes of 25 normal subjects (controls) was also included. GDxECC measured RNFL thickness in the peripapillary area in all subjects as well as temporal-superior-nasal-inferior-temporal (TSNIT) parameters, including TSNIT means, superior and inferior region means, TSNIT standard deviation (SD), inter-eye symmetry and nerve fiber indicator (NFI). RTVue-OCT measured the mean, superior, inferior, temporal and nasal quadrant RNFL thickness. In RP patients and controls, TSNIT means by GDxECC were, respectively, 65.00 ± 7.35 and 55.32 ± 5.20. Mean superior quadrant thicknesses were 80.56 ± 10.93 and 69.54 ± 7.45. Mean inferior thicknesses were 80.58 ± 9.34 and 69.12 ± 7.78. SDs were 27.92 ± 5.21 and 28.23 ± 4.01. Inter-eye symmetries were 0.82 ± 0.17 and 0.87 ± 0.09. NFIs were 9.74 ± 8.73 and 16.81 ± 8.13. The differences between mean TSNIT, mean superior and mean inferior quadrant thicknesses and NFIs were statistically significant (p < 0.001). In RTVue-OCT measurements, the differences between mean, superior, inferior and temporal quadrant RNFL thicknesses were statistically significant (p = 0.0322, 0.0213, 0.0387, 0.0005). The RNFL measured by GDxECC was significantly thicker in RP patients than in controls. RNFL thickness measured by RTVue-OCT was significantly greater in RP patients than in controls in the superior, inferior and temporal regions. This contribution provides information on RNFL thickness and discusses the mechanism underlying this phenomenon. Copyright © 2012 S. Karger AG

An analysis of facial nerve function in irradiated and unirradiated facial nerve grafts

International Nuclear Information System (INIS)

Brown, Paul D.; Eshleman, Jeffrey S.; Foote, Robert L.; Strome, Scott E.

2000-01-01

Purpose: The effect of high-dose radiation therapy on facial nerve grafts is controversial. Some authors believe radiotherapy is so detrimental to the outcome of facial nerve graft function that dynamic or static slings should be performed instead of facial nerve grafts in all patients who are to receive postoperative radiation therapy. Unfortunately, the facial function achieved with dynamic and static slings is almost always inferior to that after facial nerve grafts. In this retrospective study, we compared facial nerve function in irradiated and unirradiated nerve grafts. Methods and Materials: The medical records of 818 patients with neoplasms involving the parotid gland who received treatment between 1974 and 1997 were reviewed, of whom 66 underwent facial nerve grafting. Fourteen patients who died or had a recurrence less than a year after their facial nerve graft were excluded. The median follow-up for the remaining 52 patients was 10.6 years. Cable nerve grafts were performed in 50 patients and direct anastomoses of the facial nerve in two. Facial nerve function was scored by means of the House-Brackmann (H-B) facial grading system. Twenty-eight of the 52 patients received postoperative radiotherapy. The median time from nerve grafting to start of radiotherapy was 5.1 weeks. The median and mean doses of radiation were 6000 and 6033 cGy, respectively, for the irradiated grafts. One patient received preoperative radiotherapy to a total dose of 5000 cGy in 25 fractions and underwent surgery 1 month after the completion of radiotherapy. This patient was placed, by convention, in the irradiated facial nerve graft cohort. Results: Potential prognostic factors for facial nerve function such as age, gender, extent of surgery at the time of nerve grafting, preoperative facial nerve palsy, duration of preoperative palsy if present, or number of previous operations in the parotid bed were relatively well balanced between irradiated and unirradiated patients. However

Bilateral simultaneous breast reconstruction with SGAP flaps.

Science.gov (United States)

Flores, Jaime I; Magarakis, Michael; Venkat, Raghunandan; Shridharani, Sachin M; Rosson, Gedge D

2012-07-01

Two work-horse approaches to postmastectomy breast reconstruction are the deep inferior epigastric perforator flap and the superior gluteal artery perforator (SGAP) flap [and its variation, the lateral septocutaneous superior gluteal artery perforator flap]. Our purpose was fourfold: 1) to analyze our experience with the SGAP flaps for simultaneous bilateral breast reconstruction; 2) to analyze our experience with lateral septocutaneous superior gluteal artery perforator flaps for that procedure; 3) to compare our results with those in the literature; and 4) to highlight the importance of preoperative three-dimensional computed tomographic angiography. A retrospective chart review was completed for 23 patients who underwent breast reconstruction between December 2005 and January 2010 via an SGAP flap (46 flaps). We reviewed flap weight, ischemia time, length of stay, overall flap survival, fat necrosis development, and emergency re-exploration. Mean weights were 571.2 ± 222.0 g (range 186-1,117 g) and 568.0 ± 237.5 g (range 209-1,115 g) for the left and right buttock flap, respectively. Mean ischemia time was 129.1 ± 15.7 and 177.7 ± 24.7 minutes for the first and second flap, respectively. Mean hospital stay was 5.3 ± 2.5 days. All flaps survived. Fat necrosis developed in five flaps (10.8%), and emergency re-exploration was required in three patients (three flaps). When harvesting abdominal tissue is a poor option, the SGAP flap is an efficacious procedure for patients desiring autologous breast reconstruction, and bilateral procedures can be performed simultaneously. Copyright © 2012 Wiley Periodicals, Inc.

Iliac hyperdense line: a new radiographic sign of gluteal muscle contracture

International Nuclear Information System (INIS)

Cai, Jin-Hua; Gan, Lan-Feng; Zheng, He-Lin; Li, Hao

2005-01-01

A hyperdense line on the ilium that runs roughly parallel to the sacroiliac joint (we called it ''iliac hyperdense line sign'') was frequently observed on pelvic radiographs of patients with gluteal muscle contracture (GMC). A literature search revealed no description of this sign. To determine the relationship between the iliac hyperdense line sign and GMC and to explore how this sign is formed. Pelvic plain films of 103 cases of GMC and those of 200 control individuals were reviewed for the presence or absence of the iliac hyperdense line sign. Pelvic CT scans in 8 of 103 cases and 13 of 200 controls were analyzed with relation to the plain films. The iliac hyperdense line sign was visualized in 85 of 103 (82.5%) cases of GMC and none of the 200 controls. In the GMC group, pelvic CT scans showed a deformity of the posterior ilium. The lateral cortex of the posterior ilium took on a partly or completely anteroposterior course, while in the control group the course appeared as an oblique orientation from posteromedial to anterolateral. The iliac hyperdense line on pelvic plain film can be used as a radiographic sign to suggest a diagnosis of GMC. This sign might be a result of the long and persistent pulling effect of the contracted gluteus maximus muscle, which deforms the lateral cortex of the posterior ilium from an oblique course to an anteroposterior course tangential to the X-ray beam. (orig.)

Iliac hyperdense line: a new radiographic sign of gluteal muscle contracture

Energy Technology Data Exchange (ETDEWEB)

Cai, Jin-Hua; Gan, Lan-Feng; Zheng, He-Lin; Li, Hao [Chongqing Medical University, Department of Radiology, Children' s Hospital, Chongqing (China)

2005-10-01

A hyperdense line on the ilium that runs roughly parallel to the sacroiliac joint (we called it ''iliac hyperdense line sign'') was frequently observed on pelvic radiographs of patients with gluteal muscle contracture (GMC). A literature search revealed no description of this sign. To determine the relationship between the iliac hyperdense line sign and GMC and to explore how this sign is formed. Pelvic plain films of 103 cases of GMC and those of 200 control individuals were reviewed for the presence or absence of the iliac hyperdense line sign. Pelvic CT scans in 8 of 103 cases and 13 of 200 controls were analyzed with relation to the plain films. The iliac hyperdense line sign was visualized in 85 of 103 (82.5%) cases of GMC and none of the 200 controls. In the GMC group, pelvic CT scans showed a deformity of the posterior ilium. The lateral cortex of the posterior ilium took on a partly or completely anteroposterior course, while in the control group the course appeared as an oblique orientation from posteromedial to anterolateral. The iliac hyperdense line on pelvic plain film can be used as a radiographic sign to suggest a diagnosis of GMC. This sign might be a result of the long and persistent pulling effect of the contracted gluteus maximus muscle, which deforms the lateral cortex of the posterior ilium from an oblique course to an anteroposterior course tangential to the X-ray beam. (orig.)

[Imaging anatomy of the cranial nerves using 3.0 Tesla MRI: a practical review for clinicians].

Science.gov (United States)

Chávez-Barba, Oscar; Martínez-Martínez, Lidieth; Cazares-Arellano, José Luis; Martínez-López, Manuel; Roldan-Valadez, Ernesto

2011-01-01

Magnetic resonance (MR) imaging is the method of choice to evaluate the cranial nerves (CN). These nerves constitute a group of structures that have acquired during their phylogenetic development a high degree of specialization. There are 12 pairs of CN to which we use their specific name or number. The olfactory (I) and optic (II) pairs are not real nerves but tracts from the encephalon. The spinal nerve (XI) derives from superior cervical segment of the spine. The other 9 pairs of CN are related with the brain stem. Although the skull base foramina can be seen on computed tomography, the nerves themselves can only be visualized in detail on MR. That means, in order to see the different segments of nerves I to XII, the right sequences must be used. It is important to provide detailed clinical information to the radiologist so that a tailored MR study can be performed. In this review, the basic imaging anatomy of the 12 CN is discussed and illustrated briefly with an emphasis on more advanced extra-axial anatomy, illustrated with high-resolution MR images. Clinicians looking for complete anatomic descriptions and/or MR illustrations are advised to consult specialized textbooks considering it is not possible to describe all of the anatomy in one article. This manuscript is intended to be a practical review for clinicians.

Optic Nerve Imaging

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... News About Us Donate In This Section Optic Nerve Imaging email Send this article to a friend ... measurements of nerve fiber damage (or loss). The Nerve Fiber Analyzer (GDx) uses laser light to measure ...

POROSITY OF THE WALL OF A NEUROLAC (R) NERVE CONDUIT HAMPERS NERVE REGENERATION

NARCIS (Netherlands)

Meek, Marcel F.; Den Dunnen, Wilfred F. A.

2009-01-01

One way to improve nerve regeneration and bridge longer nerve gaps may be the use of semipermeable/porous conduits. With porosity less biomaterial is used for the nerve conduit. We evaluated the short-term effects of porous Neurolac (R) nerve conduits for in vivo peripheral nerve regeneration. In 10

Complement components of nerve regeneration conditioned fluid influence the microenvironment of nerve regeneration

Directory of Open Access Journals (Sweden)

Guang-shuai Li

2016-01-01

Full Text Available Nerve regeneration conditioned fluid is secreted by nerve stumps inside a nerve regeneration chamber. A better understanding of the proteinogram of nerve regeneration conditioned fluid can provide evidence for studying the role of the microenvironment in peripheral nerve regeneration. In this study, we used cylindrical silicone tubes as the nerve regeneration chamber model for the repair of injured rat sciatic nerve. Isobaric tags for relative and absolute quantitation proteomics technology and western blot analysis confirmed that there were more than 10 complement components (complement factor I, C1q-A, C1q-B, C2, C3, C4, C5, C7, C8ß and complement factor D in the nerve regeneration conditioned fluid and each varied at different time points. These findings suggest that all these complement components have a functional role in nerve regeneration.

Delayed peripheral nerve repair: methods, including surgical ?cross-bridging? to promote nerve regeneration

OpenAIRE

Gordon, Tessa; Eva, Placheta; Borschel, Gregory H.

2015-01-01

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour per...

Electrophysiology of Cranial Nerve Testing: Trigeminal and Facial Nerves.

Science.gov (United States)

Muzyka, Iryna M; Estephan, Bachir

2018-01-01

The clinical examination of the trigeminal and facial nerves provides significant diagnostic value, especially in the localization of lesions in disorders affecting the central and/or peripheral nervous system. The electrodiagnostic evaluation of these nerves and their pathways adds further accuracy and reliability to the diagnostic investigation and the localization process, especially when different testing methods are combined based on the clinical presentation and the electrophysiological findings. The diagnostic uniqueness of the trigeminal and facial nerves is their connectivity and their coparticipation in reflexes commonly used in clinical practice, namely the blink and corneal reflexes. The other reflexes used in the diagnostic process and lesion localization are very nerve specific and add more diagnostic yield to the workup of certain disorders of the nervous system. This article provides a review of commonly used electrodiagnostic studies and techniques in the evaluation and lesion localization of cranial nerves V and VII.

Miconazole enhances nerve regeneration and functional recovery after sciatic nerve crush injury.

Science.gov (United States)

Lin, Tao; Qiu, Shuai; Yan, Liwei; Zhu, Shuang; Zheng, Canbin; Zhu, Qingtang; Liu, Xiaolin

2018-05-01

Improving axonal outgrowth and remyelination is crucial for peripheral nerve regeneration. Miconazole appears to enhance remyelination in the central nervous system. In this study we assess the effect of miconazole on axonal regeneration using a sciatic nerve crush injury model in rats. Fifty Sprague-Dawley rats were divided into control and miconazole groups. Nerve regeneration and myelination were determined using histological and electrophysiological assessment. Evaluation of sensory and motor recovery was performed using the pinprick assay and sciatic functional index. The Cell Counting Kit-8 assay and Western blotting were used to assess the proliferation and neurotrophic expression of RSC 96 Schwann cells. Miconazole promoted axonal regrowth, increased myelinated nerve fibers, improved sensory recovery and walking behavior, enhanced stimulated amplitude and nerve conduction velocity, and elevated proliferation and neurotrophic expression of RSC 96 Schwann cells. Miconazole was beneficial for nerve regeneration and functional recovery after peripheral nerve injury. Muscle Nerve 57: 821-828, 2018. © 2017 Wiley Periodicals, Inc.

Delayed peripheral nerve repair: methods, including surgical ′cross-bridging′ to promote nerve regeneration

Directory of Open Access Journals (Sweden)

Tessa Gordon

2015-01-01

Full Text Available Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to ′protect′ chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.

Optic Nerve Disorders

Science.gov (United States)

The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting ... retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision ...

Interocular symmetry of retinal nerve fiber layer and optic nerve head parameters measured by Cirrus high-definition optical coherence tomography in a normal pediatric population.

Science.gov (United States)

Pawar, Neelam; Maheshwari, Devendra; Ravindran, Meenakshi; Ramakrishnan, Renagappa

2017-10-01

To determine interocular differences in the retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters in a pediatric population using Cirrus high-definition optical coherence tomography (HD-OCT). Seventy normal Indian children aged 5-17 years presenting to the Pediatric Clinic were included in this observational cross-sectional study. All subjects underwent a comprehensive ophthalmologic examination and an evaluation of the RNFL and ONH by Cirrus HD-OCT. Differences between the right and left eyes were calculated and values were compared by means of a paired t-test. Subjects were also divided into two groups based on age (under or over 10 years of age). Interocular differences in RNFL and ONH parameters together with sex and age variations for these differences were determined. The mean age of studied pediatric population was 11.83 ± 3.3 years (range 5-17). Average RNFL thickness was 94.46 ± 8.7 μm (± SD) (range 77-111). Differences in the average RNFL between right and left eyes were not statistically significant (P = 0.060). Superior quadrant RNFL was thicker in the left eye and temporal quadrant was thicker in the right eye. Among ONH parameters, there were no statistically significant differences in any parameters, except vertical cup-disc (CD) ratio which was significant (P = 0.007). The 2.5%-97.5% limits of asymmetry were 9 μm for average RNFL, 0.14 for average CD ratio, and 0.22 for vertical CD ratio. Mean interocular RNFL thickness differences in superior, superior nasal, and temporal superior quadrants were 10.61 (P sex, while only significant differences with age were observed in 12 clock hour sector analysis, mainly in nasal inferior and inferior quadrant. We report the degree of interocular symmetry of RNFL and ONH parameters measured by Cirrus HD-OCT in a healthy pediatric population. The normal interocular RNFL asymmetry should not exceed 9 μm and vertical CD ratio beyond 0.22 should be considered for further investigations. The

Progress of nerve bridges in the treatment of peripheral nerve disruptions

OpenAIRE

Ao,Qiang

2016-01-01

Qiang Ao Department of Tissue Engineering, School of Fundamental Science, China Medical University, Shenyang, Liaoning, Peoples’ Republic of China Abstract: Clinical repair of a nerve defect is one of the most challenging surgical problems. Autologous nerve grafting remains the gold standard treatment in addressing peripheral nerve injuries that cannot be bridged by direct epineural suturing. However, the autologous nerve graft is not readily available, and the process of harvesting...

Optic Nerve Pit

Science.gov (United States)

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

Outer Electrospun Polycaprolactone Shell Induces Massive Foreign Body Reaction and Impairs Axonal Regeneration through 3D Multichannel Chitosan Nerve Guides

Directory of Open Access Journals (Sweden)

Sven Duda

2014-01-01

Full Text Available We report on the performance of composite nerve grafts with an inner 3D multichannel porous chitosan core and an outer electrospun polycaprolactone shell. The inner chitosan core provided multiple guidance channels for regrowing axons. To analyze the in vivo properties of the bare chitosan cores, we separately implanted them into an epineural sheath. The effects of both graft types on structural and functional regeneration across a 10 mm rat sciatic nerve gap were compared to autologous nerve transplantation (ANT. The mechanical biomaterial properties and the immunological impact of the grafts were assessed with histological techniques before and after transplantation in vivo. Furthermore during a 13-week examination period functional tests and electrophysiological recordings were performed and supplemented by nerve morphometry. The sheathing of the chitosan core with a polycaprolactone shell induced massive foreign body reaction and impairment of nerve regeneration. Although the isolated novel chitosan core did allow regeneration of axons in a similar size distribution as the ANT, the ANT was superior in terms of functional regeneration. We conclude that an outer polycaprolactone shell should not be used for the purpose of bioartificial nerve grafting, while 3D multichannel porous chitosan cores could be candidate scaffolds for structured nerve grafts.

Outer electrospun polycaprolactone shell induces massive foreign body reaction and impairs axonal regeneration through 3D multichannel chitosan nerve guides.

Science.gov (United States)

Duda, Sven; Dreyer, Lutz; Behrens, Peter; Wienecke, Soenke; Chakradeo, Tanmay; Glasmacher, Birgit; Haastert-Talini, Kirsten

2014-01-01

We report on the performance of composite nerve grafts with an inner 3D multichannel porous chitosan core and an outer electrospun polycaprolactone shell. The inner chitosan core provided multiple guidance channels for regrowing axons. To analyze the in vivo properties of the bare chitosan cores, we separately implanted them into an epineural sheath. The effects of both graft types on structural and functional regeneration across a 10 mm rat sciatic nerve gap were compared to autologous nerve transplantation (ANT). The mechanical biomaterial properties and the immunological impact of the grafts were assessed with histological techniques before and after transplantation in vivo. Furthermore during a 13-week examination period functional tests and electrophysiological recordings were performed and supplemented by nerve morphometry. The sheathing of the chitosan core with a polycaprolactone shell induced massive foreign body reaction and impairment of nerve regeneration. Although the isolated novel chitosan core did allow regeneration of axons in a similar size distribution as the ANT, the ANT was superior in terms of functional regeneration. We conclude that an outer polycaprolactone shell should not be used for the purpose of bioartificial nerve grafting, while 3D multichannel porous chitosan cores could be candidate scaffolds for structured nerve grafts.

Coexpression network analysis in abdominal and gluteal adipose tissue reveals regulatory genetic loci for metabolic syndrome and related phenotypes

DEFF Research Database (Denmark)

Min, Josine L; Nicholson, George; Halgrimsdottir, Ingileif

2012-01-01

Metabolic Syndrome (MetS) is highly prevalent and has considerable public health impact, but its underlying genetic factors remain elusive. To identify gene networks involved in MetS, we conducted whole-genome expression and genotype profiling on abdominal (ABD) and gluteal (GLU) adipose tissue...... and 51 (0.6%) in GLU only. Differential eigengene network analysis of 8,256 shared probesets detected 22 shared modules with high preservation across adipose depots (D(ABD-GLU) = 0.89), seven of which were associated with MetS (FDR P100,000 individuals; rs10282458, affecting expression of RARRES2...... and their interactions influence complex traits such as MetS, integrated analysis of genotypes and coexpression networks across multiple tissues relevant to clinical traits is an efficient strategy to identify novel associations....

Functional nerve recovery after bridging a 15 mm gap in rat sciatic nerve with a biodegradable nerve guide

NARCIS (Netherlands)

Meek, MF; Klok, F; Robinson, PH; Nicolai, JPA; Gramsbergen, A; van der Werf, J.F.A.

2003-01-01

Recovery of nerve function was evaluated after bridging a 15 mm sciatic nerve gap in 51 rats with a biodegradable poly(DL-lactide-epsilon-caprolactone) nerve guide. Recovery of function was investigated by analysing the footprints, by analysing video recordings of gait, by electrically eliciting the

The Use of Degradable Nerve Conduits for Human Nerve Repair: A Review of the Literature

Directory of Open Access Journals (Sweden)

M. F. Meek

2005-01-01

Full Text Available The management of peripheral nerve injury continues to be a major clinical challenge. The most widely used technique for bridging defects in peripheral nerves is the use of autologous nerve grafts. This technique, however, has some disadvantages. Many alternative experimental techniques have thus been developed, such as degradable nerve conduits. Degradable nerve guides have been extensively studied in animal experimental studies. However, the repair of human nerves by degradable nerve conduits has been limited to only a few clinical studies. In this paper, an overview of the available international published literature on degradable nerve conduits for bridging human peripheral nerve defects is presented for literature available until 2004. Also, the philosophy on the use of nerve guides and nerve grafts is given.

[Glaucoma and optic nerve drusen: Limitations of optic nerve head OCT].

Science.gov (United States)

Poli, M; Colange, J; Goutagny, B; Sellem, E

2017-09-01

Optic nerve head drusen are congenital calcium deposits located in the prelaminar section of the optic nerve head. Their association with visual field defects has been classically described, but the diagnosis of glaucoma is not easy in these cases of altered optic nerve head anatomy. We describe the case of a 67-year-old man with optic nerve head drusen complicated by glaucoma, which was confirmed by visual field and OCT examination of the peripapillary retinal nerve fiber layer (RNFL), but the measurement of the minimum distance between the Bruch membrane opening and the internal limiting membrane (minimum rim width, BMO-MRW) by OCT was normal. OCT of the BMO-MRW is a new diagnostic tool for glaucoma. Superficial optic nerve head drusen, which are found between the internal limiting membrane and the Bruch's membrane opening, overestimate the value of this parameter. BMO-MRW measurement is not adapted to cases of optic nerve head drusen and can cause false-negative results for this parameter, and the diagnosis of glaucoma in this case should be based on other parameters such as the presence of a fascicular defect in the retinal nerve fibers, RNFL or macular ganglion cell complex thinning, as well as visual field data. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Transient facial nerve palsy after occipital nerve block: a case report.

Science.gov (United States)

Strauss, Lauren; Loder, Elizabeth; Rizzoli, Paul

2014-01-01

Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated. We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block. © 2014 American Headache Society.

Allotransplanted neurons used to repair peripheral nerve injury do not elicit overt immunogenicity.

Directory of Open Access Journals (Sweden)

Weimin Liu

Full Text Available A major problem hindering the development of autograft alternatives for repairing peripheral nerve injuries is immunogenicity. We have previously shown successful regeneration in transected rat sciatic nerves using conduits filled with allogeneic dorsal root ganglion (DRG cells without any immunosuppression. In this study, we re-examined the immunogenicity of our DRG neuron implanted conduits as a potential strategy to overcome transplant rejection. A biodegradable NeuraGen® tube was infused with pure DRG neurons or Schwann cells cultured from a rat strain differing from the host rats and used to repair 8 mm gaps in the sciatic nerve. We observed enhanced regeneration with allogeneic cells compared to empty conduits 16 weeks post-surgery, but morphological analyses suggest recovery comparable to the healthy nerves was not achieved. The degree of regeneration was indistinguishable between DRG and Schwann cell allografts although immunogenicity assessments revealed substantially increased presence of Interferon gamma (IFN-γ in Schwann cell allografts compared to the DRG allografts by two weeks post-surgery. Macrophage infiltration of the regenerated nerve graft in the DRG group 16 weeks post-surgery was below the level of the empty conduit (0.56 fold change from NG; p<0.05 while the Schwann cell group revealed significantly higher counts (1.29 fold change from NG; p<0.001. Major histocompatibility complex I (MHC I molecules were present in significantly increased levels in the DRG and Schwann cell allograft groups compared to the hollow NG conduit and the Sham healthy nerve. Our results confirmed previous studies that have reported Schwann cells as being immunogenic, likely due to MHC I expression. Nerve gap injuries are difficult to repair; our data suggest that DRG neurons are superior medium to implant inside conduit tubes due to reduced immunogenicity and represent a potential treatment strategy that could be preferable to the current gold

The significance of a hypoplastic bony canal for the cochlear nerve in patients with sensorineural hearing loss: CT and MRI findings

International Nuclear Information System (INIS)

Choi, Yoon Jung; Park, Sang Yoo; Kim, Myung Soon; Sung, Ki Jun

2004-01-01

The purpose of this study is to evaluate the significance of the hypoplastic canal for the cochlear nerve in patients with sensorineural hearing loss (SNHL) and the relationship between the hypoplastic bony canal and aplasia or hypoplasia of the cochlear nerve. A retrospective review of high resolution temporal CT(HRCT) and MRI findings was conducted. The narrow bony canal of the cochlear nerve and the relative size of the internal auditory canal were correlated with the cochlear nerve deficiency on MRI. The comparative size of the component nerves (facial, cochlear, superior vestibular, inferior vestibular nerve), and the relative size of the internal auditory canal and the bony canal of the cochlear nerve were measured. The clinical history and the results of the clinical examination were reviewed for each patient. High resolution MRI showed aplasia of the common vestibulocochlear nerve in one patient and a deficiency of the cochlear nerve in 9 patients. These abnormalities occurred in association with a prominent narrowing of the canal for the cochlear nerve and a stenosis of the internal auditory canal, which was observed on temporal bone CT in 9 patients with congenital SNHL. Three patients had normal IAC, despite the presence of a hypoplastic cochlear nerve on the side on which they had SNHL. In one patient, the narrowing of the canal for the cochlear nerve and internal auditory canal were not found to be associated with acquired SNHL. The hypoplastic bony canal for the cochlear nerve might be more highly indicative of congenital cochlear nerve deficiency than that of the narrow internal auditory canal, and the position of the crista falciformis should also be carefully

The significance of a hypoplastic bony canal for the cochlear nerve in patients with sensorineural hearing loss: CT and MRI findings

Energy Technology Data Exchange (ETDEWEB)

Choi, Yoon Jung; Park, Sang Yoo; Kim, Myung Soon; Sung, Ki Jun [College of Medicine, Yonsei Univ., Wonju (Korea, Republic of)

2004-04-01

The purpose of this study is to evaluate the significance of the hypoplastic canal for the cochlear nerve in patients with sensorineural hearing loss (SNHL) and the relationship between the hypoplastic bony canal and aplasia or hypoplasia of the cochlear nerve. A retrospective review of high resolution temporal CT(HRCT) and MRI findings was conducted. The narrow bony canal of the cochlear nerve and the relative size of the internal auditory canal were correlated with the cochlear nerve deficiency on MRI. The comparative size of the component nerves (facial, cochlear, superior vestibular, inferior vestibular nerve), and the relative size of the internal auditory canal and the bony canal of the cochlear nerve were measured. The clinical history and the results of the clinical examination were reviewed for each patient. High resolution MRI showed aplasia of the common vestibulocochlear nerve in one patient and a deficiency of the cochlear nerve in 9 patients. These abnormalities occurred in association with a prominent narrowing of the canal for the cochlear nerve and a stenosis of the internal auditory canal, which was observed on temporal bone CT in 9 patients with congenital SNHL. Three patients had normal IAC, despite the presence of a hypoplastic cochlear nerve on the side on which they had SNHL. In one patient, the narrowing of the canal for the cochlear nerve and internal auditory canal were not found to be associated with acquired SNHL. The hypoplastic bony canal for the cochlear nerve might be more highly indicative of congenital cochlear nerve deficiency than that of the narrow internal auditory canal, and the position of the crista falciformis should also be carefully.

142 Key words: Brachialis, radial nerve, musculocutaneous nerve.

African Journals Online (AJOL)

AWORI KIRSTEEN

The innervation of brachialis muscle by the musculocutaneous nerve has been described as either type I or type II and the main trunk to this muscle is rarely absent. The contribution .... brachialis muscle by fiber analysis of supply nerves].

Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes

Science.gov (United States)

Seifpanahi, Sadegh; Izadi, Farzad; Jamshidi, Ali-Ashraf; Torabinezhad, Farhad; Sarrafzadeh, Javad; Mohammadi, Siavash

2016-01-01

Background: Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES) have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN) and create voice changes. Methods: Thirty-two normal individuals (22 females and 10 males) participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test. Results: The findings indicated significant changes (P=0.00) in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0) at rest was 1.54 (SD=0.55) versus 4.15 (SD=3.00) for the SES period. The other investigated parameters comprised fundamental frequency (F0), minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR), mean intensity, and minimum intensity. Conclusion: These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research. PMID:27582586

Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes

Directory of Open Access Journals (Sweden)

Sadegh Seifpanahi

2016-09-01

Full Text Available Background: Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN and create voice changes. Methods: Thirty-two normal individuals (22 females and 10 males participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test. Results: The findings indicated significant changes (P=0.00 in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0 at rest was 1.54 (SD=0.55 versus 4.15 (SD=3.00 for the SES period. The other investigated parameters comprised fundamental frequency (F0, minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR, mean intensity, and minimum intensity. Conclusion: These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research.

Facial reanimation by muscle-nerve neurotization after facial nerve sacrifice. Case report.

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Taupin, A; Labbé, D; Babin, E; Fromager, G

2016-12-01

Recovering a certain degree of mimicry after sacrifice of the facial nerve is a clinically recognized finding. The authors report a case of hemifacial reanimation suggesting a phenomenon of neurotization from muscle-to-nerve. A woman benefited from a parotidectomy with sacrifice of the left facial nerve indicated for recurrent tumor in the gland. The distal branches of the facial nerve, isolated at the time of resection, were buried in the masseter muscle underneath. The patient recovered a voluntary hémifacial motricity. The electromyographic analysis of the motor activity of the zygomaticus major before and after block of the masseter nerve showed a dependence between mimic muscles and the masseter muscle. Several hypotheses have been advanced to explain the spontaneous reanimation of facial paralysis. The clinical case makes it possible to argue in favor of muscle-to-nerve neurotization from masseter muscle to distal branches of the facial nerve. It illustrates the quality of motricity that can be obtained thanks to this procedure. The authors describe a simple implantation technique of distal branches of the facial nerve in the masseter muscle during a radical parotidectomy with facial nerve sacrifice and recovery of resting tone but also a quality voluntary mimicry. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury

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Xing-long Cheng

2015-01-01

Full Text Available Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineurium was then sutured closed, requiring no stump anastomosis. In the control group, the sciatic nerve was completely transected, and the epineurium was repaired by anastomosis. At 2 and 4 weeks after surgery, Wallerian degeneration was observed in both groups. In the experimental group, at 8 and 12 weeks after surgery, distinct medullary nerve fibers and axons were observed in the injured sciatic nerve. Regular, dense myelin sheaths were visible, as well as some scarring. By 12 weeks, the myelin sheaths were normal and intact, and a tight lamellar structure was observed. Functionally, limb movement and nerve conduction recovered in the injured region between 4 and 12 weeks. The present results demonstrate that longitudinal epineural incision with nerve transection can stably replicate a model of Sunderland grade IV peripheral nerve injury. Compared with the complete sciatic nerve transection model, our method reduced the difficulties of micromanipulation and surgery time, and resulted in good stump restoration, nerve regeneration, and functional recovery.

An anatomical study of porcine peripheral nerve and its potential use in nerve tissue engineering

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Zilic, Leyla; Garner, Philippa E; Yu, Tong; Roman, Sabiniano; Haycock, John W; Wilshaw, Stacy-Paul

2015-01-01

Current nerve tissue engineering applications are adopting xenogeneic nerve tissue as potential nerve grafts to help aid nerve regeneration. However, there is little literature that describes the exact location, anatomy and physiology of these nerves to highlight their potential as a donor graft. The aim of this study was to identify and characterise the structural and extracellular matrix (ECM) components of porcine peripheral nerves in the hind leg. Methods included the dissection of porcine nerves, localisation, characterisation and quantification of the ECM components and identification of nerve cells. Results showed a noticeable variance between porcine and rat nerve (a commonly studied species) in terms of fascicle number. The study also revealed that when porcine peripheral nerves branch, a decrease in fascicle number and size was evident. Porcine ECM and nerve fascicles were found to be predominately comprised of collagen together with glycosaminoglycans, laminin and fibronectin. Immunolabelling for nerve growth factor receptor p75 also revealed the localisation of Schwann cells around and inside the fascicles. In conclusion, it is shown that porcine peripheral nerves possess a microstructure similar to that found in rat, and is not dissimilar to human. This finding could extend to the suggestion that due to the similarities in anatomy to human nerve, porcine nerves may have utility as a nerve graft providing guidance and support to regenerating axons. PMID:26200940

Microvascular Cranial Nerve Palsy

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... Español Eye Health / Eye Health A-Z Microvascular Cranial Nerve Palsy Sections What Is Microvascular Cranial Nerve Palsy? ... Microvascular Cranial Nerve Palsy Treatment What Is Microvascular Cranial Nerve Palsy? Leer en Español: ¿Qué es una parálisis ...

Engineering a multimodal nerve conduit for repair of injured peripheral nerve

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Quigley, A. F.; Bulluss, K. J.; Kyratzis, I. L. B.; Gilmore, K.; Mysore, T.; Schirmer, K. S. U.; Kennedy, E. L.; O'Shea, M.; Truong, Y. B.; Edwards, S. L.; Peeters, G.; Herwig, P.; Razal, J. M.; Campbell, T. E.; Lowes, K. N.; Higgins, M. J.; Moulton, S. E.; Murphy, M. A.; Cook, M. J.; Clark, G. M.; Wallace, G. G.; Kapsa, R. M. I.

2013-02-01

Injury to nerve tissue in the peripheral nervous system (PNS) results in long-term impairment of limb function, dysaesthesia and pain, often with associated psychological effects. Whilst minor injuries can be left to regenerate without intervention and short gaps up to 2 cm can be sutured, larger or more severe injuries commonly require autogenous nerve grafts harvested from elsewhere in the body (usually sensory nerves). Functional recovery is often suboptimal and associated with loss of sensation from the tissue innervated by the harvested nerve. The challenges that persist with nerve repair have resulted in development of nerve guides or conduits from non-neural biological tissues and various polymers to improve the prognosis for the repair of damaged nerves in the PNS. This study describes the design and fabrication of a multimodal controlled pore size nerve regeneration conduit using polylactic acid (PLA) and (PLA):poly(lactic-co-glycolic) acid (PLGA) fibers within a neurotrophin-enriched alginate hydrogel. The nerve repair conduit design consists of two types of PLGA fibers selected specifically for promotion of axonal outgrowth and Schwann cell growth (75:25 for axons; 85:15 for Schwann cells). These aligned fibers are contained within the lumen of a knitted PLA sheath coated with electrospun PLA nanofibers to control pore size. The PLGA guidance fibers within the nerve repair conduit lumen are supported within an alginate hydrogel impregnated with neurotrophic factors (NT-3 or BDNF with LIF, SMDF and MGF-1) to provide neuroprotection, stimulation of axonal growth and Schwann cell migration. The conduit was used to promote repair of transected sciatic nerve in rats over a period of 4 weeks. Over this period, it was observed that over-grooming and self-mutilation (autotomy) of the limb implanted with the conduit was significantly reduced in rats implanted with the full-configuration conduit compared to rats implanted with conduits containing only an alginate

Sex differences in the branching position of the nerve to the abductor digiti minimi muscle: an anatomical study of cadavers.

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Mizuno, Daisuke; Naito, Munekazu; Hayashi, Shogo; Ohmichi, Yusuke; Ohmichi, Mika; Nakano, Takashi

2015-01-01

The nerve to the abductor digiti minimi muscle (ADMM nerve) is the first branch of the lateral plantar nerve or originates directly from the posterior tibial nerve. Damage to the ADMM nerve is a cause of heel pain and eventually results in ADMM atrophy. It is known that ADMM atrophy occurs more often in females than in males, and the reason remains unclear. This study aimed to explore sex differences in the branching pattern, position, and angle of the ADMM nerve. Forty-two cadavers (20 males, 22 females) were dissected at Aichi Medical University between 2011 and 2015. Cases of foot deformity or atrophy were excluded and 67 ft (30 male, 37 female) were examined to assess the branching pattern, position, and angle of the ADMM nerve. The branching positions of the ADMM nerve were superior to the malleolar-calcaneal axis (MCA) in 37 ft (55 %), on the MCA in 10 ft (15 %), and inferior to the MCA in 20 ft (30 %). There was no case among male feet in which the ADMM nerve branched inferior to the MCA, whereas this pattern was observed in 19 of 37 female feet (51 %). The branching position of the ADMM nerve was significantly closer to the MCA in female feet than in male feet. There were no significant sex differences in the branching pattern and angle of the ADMM nerve. The ADMM nerve sometimes branches off inferior to the MCA in females, but not in males. This difference may be the reason for the more frequent occurrence of ADMM atrophy in females than in males.

Transfer of obturator nerve for femoral nerve injury: an experiment study in rats.

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Meng, Depeng; Zhou, Jun; Lin, Yaofa; Xie, Zheng; Chen, Huihao; Yu, Ronghua; Lin, Haodong; Hou, Chunlin

2018-07-01

Quadriceps palsy is mainly caused by proximal lesions in the femoral nerve. The obturator nerve has been previously used to repair the femoral nerve, although only a few reports have described the procedure, and the outcomes have varied. In the present study, we aimed to confirm the feasibility and effectiveness of this treatment in a rodent model using the randomized control method. Sixty Sprague-Dawley rats were randomized into two groups: the experimental group, wherein rats underwent femoral neurectomy and obturator nerve transfer to the femoral nerve motor branch; and the control group, wherein rats underwent femoral neurectomy without nerve transfer. Functional outcomes were measured using the BBB score, muscle mass, and histological assessment. At 12 and 16 weeks postoperatively, the rats in the experimental group exhibited recovery to a stronger stretch force of the knee and higher BBB score, as compared to the control group (p nerve with myelinated and unmyelinated fibers was observed in the experimental group. No significant differences were observed between groups at 8 weeks postoperatively (p > 0.05). Obturator nerve transfer for repairing femoral nerve injury was feasible and effective in a rat model, and can hence be considered as an option for the treatment of femoral nerve injury.

Enhanced peripheral nerve regeneration through asymmetrically porous nerve guide conduit with nerve growth factor gradient.

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Oh, Se Heang; Kang, Jun Goo; Kim, Tae Ho; Namgung, Uk; Song, Kyu Sang; Jeon, Byeong Hwa; Lee, Jin Ho

2018-01-01

In this study, we fabricated a nerve guide conduit (NGC) with nerve growth factor (NGF) gradient along the longitudinal direction by rolling a porous polycaprolactone membrane with NGF concentration gradient. The NGF immobilized on the membrane was continuously released for up to 35 days, and the released amount of the NGF from the membrane gradually increased from the proximal to distal NGF ends, which may allow a neurotrophic factor gradient in the tubular NGC for a sufficient period. From the in vitro cell culture experiment, it was observed that the PC12 cells sense the NGF concentration gradient on the membrane for the cell proliferation and differentiation. From the in vivo animal experiment using a long gap (20 mm) sciatic nerve defect model of rats, the NGC with NGF concentration gradient allowed more rapid nerve regeneration through the NGC than the NGC itself and NGC immobilized with uniformly distributed NGF. The NGC with NGF concentration gradient seems to be a promising strategy for the peripheral nerve regeneration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 52-64, 2018. © 2017 Wiley Periodicals, Inc.

Primary nerve-sheath tumours of the trigeminal nerve: clinical and MRI findings

International Nuclear Information System (INIS)

Majoie, C.B.L.M.; Hulsmans, F.J.H.; Sie, L.H.; Castelijns, J.A.; Valk, J.; Walter, A.; Albrecht, K.W.

1999-01-01

We reviewed the clinical and MRI findings in primary nerve-sheath tumours of the trigeminal nerve. We retrospectively reviewed the medical records, imaging and histological specimens of 10 patients with 11 primary tumours of the trigeminal nerve. We assessed whether tumour site, size, morphology or signal characteristics were related to symptoms and signs or histological findings. Histological proof was available for 8 of 11 tumours: six schwannomas and two plexiform neurofibromas. The other three tumours were thought to be schwannomas, because they were present in patients with neurofibromatosis type 2 and followed the course of the trigeminal nerve. Uncommon MRI appearances were observed in three schwannomas and included a large intratumoral haemorrhage, a mainly low-signal appearance on T2-weighted images and a rim-enhancing, multicystic appearance. Only four of nine schwannomas caused trigeminal nerve symptoms, including two with large cystic components, one haemorrhagic and one solid tumor. Of the five schwannomas which did not cause any trigeminal nerve symptoms, two were large. Only one of the plexiform neurofibromas caused trigeminal nerve symptoms. Additional neurological symptoms and signs, not related to the trigeminal nerve, could be attributed to the location of the tumour in three patients. (orig.)

A STUDY OF TUMOURS OF THE CRANIAL NERVE AND PARASPINAL NERVE

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Sudesh Shetty

2016-03-01

Full Text Available INTRODUCTION One of the frequent sites of tumour formation is the cranial nerves and paraspinal nerves. The cranial nerves perform a plethora of functions and so the signs and symptoms caused may be different. They are mainly classified into four different types. The aim of the study is: 1. To study the tumours arising from the cranial nerves in an epidemiological point of view. 2. To study the tumours histopathologically. 3. To classify the tumours according to WHO classification. Thirty-eight brain tumor cases were studied in the Department of Medicine, A. J. Shetty Institute of Medical Sciences, Mangalore. Cranial nerve tumours accounts for 4(10% among the intracranial tumours. Schwannomas makes up 3(7.39% among the Intracranial tumours. and constituted 3(75% among cranial nerve tumours. All the 3 schwannomas were located in CP angle. The geographic distribution of cases was found to be 28 cases from Mangalore and 10 cases from Kerala.

Clinical potential and limitation of MRI for degenerative lumbar spinal diseases. Comparison of MRI, myelography, CT and selective nerve root infiltration

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Seki, Michihiro; Kikuchi, Shinichi [Fukushima Medical Coll. (Japan)

1994-12-01

To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.).

Clinical potential and limitation of MRI for degenerative lumbar spinal diseases. Comparison of MRI, myelography, CT and selective nerve root infiltration

International Nuclear Information System (INIS)

Seki, Michihiro; Kikuchi, Shinichi

1994-01-01

To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.)

Electrophysiology of Cranial Nerve Testing: Cranial Nerves IX and X.

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Martinez, Alberto R M; Martins, Melina P; Moreira, Ana Lucila; Martins, Carlos R; Kimaid, Paulo A T; França, Marcondes C

2018-01-01

The cranial nerves IX and X emerge from medulla oblongata and have motor, sensory, and parasympathetic functions. Some of these are amenable to neurophysiological assessment. It is often hard to separate the individual contribution of each nerve; in fact, some of the techniques are indeed a composite functional measure of both nerves. The main methods are the evaluation of the swallowing function (combined IX and X), laryngeal electromyogram (predominant motor vagal function), and heart rate variability (predominant parasympathetic vagal function). This review describes, therefore, the techniques that best evaluate the major symptoms presented in IX and X cranial nerve disturbance: dysphagia, dysphonia, and autonomic parasympathetic dysfunction.

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

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Ying Liu

2015-01-01

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

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

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

2015-02-01

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

Analysis of Spontaneous and Nerve-Evoked Calcium Transients in Intact Extraocular Muscles in Vitro

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Feng, Cheng-Yuan; Hennig, Grant W.; Corrigan, Robert D.; Smith, Terence K.; von Bartheld, Christopher S.

2012-01-01

Extraocular muscles (EOMs) have unique calcium handling properties, yet little is known about the dynamics of calcium events underlying ultrafast and tonic contractions in myofibers of intact EOMs. Superior oblique EOMs of juvenile chickens were dissected with their nerve attached, maintained in oxygenated Krebs buffer, and loaded with fluo-4. Spontaneous and nerve stimulation-evoked calcium transients were recorded and, following calcium imaging, some EOMs were double-labeled with rhodamine-conjugated alpha-bungarotoxin (rhBTX) to identify EOM myofiber types. EOMs showed two main types of spontaneous calcium transients, one slow type (calcium waves with 1/2max duration of 2–12 s, velocity of 25–50 μm/s) and two fast “flash-like” types (Type 1, 30–90 ms; Type 2, 90–150 ms 1/2max duration). Single pulse nerve stimulation evoked fast calcium transients identical to the fast (Type 1) calcium transients. Calcium waves were accompanied by a local myofiber contraction that followed the calcium transient wavefront. The magnitude of calcium-wave induced myofiber contraction far exceeded those of movement induced by nerve stimulation and associated fast calcium transients. Tetrodotoxin eliminated nerve-evoked transients, but not spontaneous transients. Alpha-bungarotoxin eliminated both spontaneous and nerve-evoked fast calcium transients, but not calcium waves, and caffeine increased wave activity. Calcium waves were observed in myofibers lacking spontaneous or evoked fast transients, suggestive of multiply-innervated myofibers, and this was confirmed by double-labeling with rhBTX. We propose that the abundant spontaneous calcium transients and calcium waves with localized contractions that do not depend on innervation may contribute to intrinsic generation of tonic functions of EOMs. PMID:22579493

Schwann cell-mediated delivery of glial cell line-derived neurotrophic factor restores erectile function after cavernous nerve injury.

Science.gov (United States)

May, Florian; Buchner, Alexander; Schlenker, Boris; Gratzke, Christian; Arndt, Christian; Stief, Christian; Weidner, Norbert; Matiasek, Kaspar

2013-03-01

To evaluate the time-course of functional recovery after cavernous nerve injury using glial cell line-derived neurotrophic factor-transduced Schwann cell-seeded silicon tubes. Sections of the cavernous nerves were excised bilaterally (5 mm), followed by immediate bilateral surgical repair. A total of 20 study nerves per group were reconstructed by interposition of empty silicon tubes and silicon tubes seeded with either glial cell line-derived neurotrophic factor-overexpressing or green fluorescent protein-expressing Schwann cells. Control groups were either sham-operated or received bilateral nerve transection without nerve reconstruction. Erectile function was evaluated by relaparotomy, electrical nerve stimulation and intracavernous pressure recording after 2, 4, 6, 8 and 10 weeks. The animals underwent re-exploration only once, and were killed afterwards. The nerve grafts were investigated for the maturation state of regenerating nerve fibers and the fascular composition. Recovery of erectile function took at least 4 weeks in the current model. Glial cell line-derived neurotrophic factor-transduced Schwann cell grafts restored erectile function better than green fluorescent protein-transduced controls and unseeded conduits. Glial cell line-derived neurotrophic factor-transduced grafts promoted an intact erectile response (4/4) at 4, 6, 8 and 10 weeks that was overall significantly superior to negative controls (P cell line-derived neurotrophic factor-transduced grafts compared with negative controls (P = 0.018) and unseeded tubes (P = 0.034). Return of function was associated with the electron microscopic evidence of preganglionic myelinated nerve fibers and postganglionic unmyelinated axons. Schwann cell-mediated delivery of glial cell line-derived neurotrophic factor presents a viable approach for the treatment of erectile dysfunction after cavernous nerve injury. © 2013 The Japanese Urological Association.

MR imaging of spondylolytic spondylolisthesis: changes of intervertebral foramen and nerve root compression

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Kim, Ji Hyung [Ajou Univ. College of Medicine, Seoul (Korea, Republic of); Chung, Tae Sub; Kim, Young Soo [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1999-08-01

To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondylolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8%), stenosis was mild ; in 44 of 120 (36.7%) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3%). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolytic (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocartilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p > 0.05). The degree of intervertebral foramen stenosis and causes of nerve root compression in spondylolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing

MR imaging of spondylolytic spondylolisthesis: changes of intervertebral foramen and nerve root compression

International Nuclear Information System (INIS)

Kim, Ji Hyung; Chung, Tae Sub; Kim, Young Soo

1999-01-01

To evaluate the factors affecting intervertebral foramen stenosis and nerve root compression in spondylolytic spondylolisthesis. We investigated 120 intervertebral foramina of 60 patients with spondylolytic spondylolisthesis who had undergone lumbar MRI. A retrospective review of their MR images revealed the degree of intervertebral foramen stenosis and causes of nerve root compression. The relationship between disk height diminution following spondylolysis and degree of intervertebral foramen stenosis was also evaluated. Forty eight of 60 patients showed a similar degree of intervertebral foramen stenosis, and in 12 patients the degree of stenosis was different. In 110 intervertebral foramina, stenosis of both the superior and inferior compartments of intervertebral foramina was demonstrated. In 37 of 120 cases (30.8%), stenosis was mild ; in 44 of 120 (36.7%) it was modcrate, and in 29 of 120 (24.2%) it was severe. Stenosis of the inferior compartment was demonstrated in ten of 120 intervertebral foramina (8.3%). Nerve root compression was caused by posterior bulging of the intervertebral disk (65/120), descent of the pedicle (51/120), an isthmic bony segment above the site of spondylolytic (44/120), a bony spur formed at a spondylolytic site (11/120), and fibrocartilaginous callus at a spondylolytic site (5/48). In all cases there was degenerative change of the intervertebral disk at the affected level. There was no relationship between degree of disk height diminution and degree of intervertebral foramen stenosis (p > 0.05). The degree of intervertebral foramen stenosis and causes of nerve root compression in spondylolytic spondylolisthesis are variable, and MRI demonstrates them precisely. There was no positive relationship between degree of nerve root compression at an intervertebral foramen and degree of spondylolysis and degeneration of an intervertebral foramen. The degree of nerve root compression is believed to be another criterion for describing

Biomarkers of neuropathic pain in skin nerve degeneration neuropathy: contact heat-evoked potentials as a physiological signature.

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Wu, Shao-Wei; Wang, Yi-Chia; Hsieh, Paul-Chen; Tseng, Ming-Tsung; Chiang, Ming-Chang; Chu, Chih-Pang; Feng, Fang-Ping; Lin, Yea-Huey; Hsieh, Sung-Tsang; Chao, Chi-Chao

2017-03-01

Contact heat-evoked potentials (CHEPs) have become an established method of assessing small-fiber sensory nerves; however, their potential as a physiological signature of neuropathic pain symptoms has not been fully explored. To investigate the diagnostic efficacy in examining small-fiber sensory nerve degeneration, the relationship with skin innervations, and clinical correlates with sensory symptoms, we recruited 188 patients (115 men) with length-dependent sensory symptoms and reduced intraepidermal nerve fiber (IENF) density at the distal leg to perform CHEP, quantitative sensory testing, and nerve conduction study. Fifty-seven age- and sex-matched controls were enrolled for comparison of CHEP and skin innervation. Among patients with neuropathy, 144 patients had neuropathic pain and 64 cases had evoked pain. Compared with quantitative sensory testing and nerve conduction study parameters, CHEP amplitudes showed the highest sensitivity for diagnosing small-fiber sensory nerve degeneration and exhibited the strongest correlation with IENF density in multiple linear regression. Contact heat-evoked potential amplitudes were strongly correlated with the degree of skin innervation in both patients with neuropathy and controls, and the slope of the regression line between CHEP amplitude and IENF density was higher in patients with neuropathy than in controls. Patients with evoked pain had higher CHEP amplitude than those without evoked pain, independent of IENF density. Receiver operating characteristic analysis showed that CHEP had better performance in diagnosing small-fiber sensory nerve degeneration than thermal thresholds. Furthermore, CHEPs showed superior classification accuracy with respect to evoked pain. In conclusion, CHEP is a sensitive tool to evaluate pathophysiology of small-fiber sensory nerve and serves as a physiological signature of neuropathic pain symptoms.

[A comparison of time resolution among auditory, tactile and promontory electrical stimulation--superiority of cochlear implants as human communication aids].

Science.gov (United States)

Matsushima, J; Kumagai, M; Harada, C; Takahashi, K; Inuyama, Y; Ifukube, T

1992-09-01

Our previous reports showed that second formant information, using a speech coding method, could be transmitted through an electrode on the promontory. However, second formant information can also be transmitted by tactile stimulation. Therefore, to find out whether electrical stimulation of the auditory nerve would be superior to tactile stimulation for our speech coding method, the time resolutions of the two modes of stimulation were compared. The results showed that the time resolution of electrical promontory stimulation was three times better than the time resolution of tactile stimulation of the finger. This indicates that electrical stimulation of the auditory nerve is much better for our speech coding method than tactile stimulation of the finger.

Silk fibroin enhances peripheral nerve regeneration by improving vascularization within nerve conduits.

Science.gov (United States)

Wang, Chunyang; Jia, Yachao; Yang, Weichao; Zhang, Cheng; Zhang, Kuihua; Chai, Yimin

2018-07-01

Silk fibroin (SF)-based nerve conduits have been widely used to bridge peripheral nerve defects. Our previous study showed that nerve regeneration in a SF-blended poly (l-lactide-co-ɛ-caprolactone) [P(LLA-CL)] nerve conduit is better than that in a P(LLA-CL) conduit. However, the involved mechanisms remain unclarified. Because angiogenesis within a nerve conduit plays an important role in nerve regeneration, vascularization of SF/P(LLA-CL) and P(LLA-CL) conduits was compared both in vitro and in vivo. In the present study, we observed that SF/P(LLA-CL) nanofibers significantly promoted fibroblast proliferation, and vascular endothelial growth factor secreted by fibroblasts seeded in SF/P(LLA-CL) nanofibers was more than seven-fold higher than that in P(LLA-CL) nanofibers. Conditioned medium of fibroblasts in the SF/P(LLA-CL) group stimulated more human umbilical vein endothelial cells (HUVEC) to form capillary-like networks and promoted faster HUVEC migration. The two kinds of nerve conduits were used to bridge 10-mm-length nerve defects in rats. At 3 weeks of reparation, the blood vessel area in the SF/P(LLA-CL) group was significantly larger than that in the P(LLA-CL) group. More regenerated axons and Schwann cells were also observed in the SF/P(LLA-CL) group, which was consistent with the results of blood vessels. Collectively, our data revealed that the SF/P(LLA-CL) nerve conduit enhances peripheral nerve regeneration by improving angiogenesis within the conduit. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2070-2077, 2018. © 2018 Wiley Periodicals, Inc.

Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis.

Science.gov (United States)

Yan, Zeng; Chen, Zong; Ma, Chuangen

2017-07-01

Postoperative pain control after total shoulder arthroplasty (TSA) can be challenging. Liposomal bupivacaine and interscalene nerve block are 2 common pain control protocol for TSA patients. However, whether liposomal bupivacaine was superior than interscalene nerve block was unknown. This meta-analysis aimed to illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for pain control in patients undergoing TSA. In May 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TSA in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved. The endpoints were the visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, and 2 weeks, total morphine consumption at 24 hours, and the length of hospital stay. Software of Stata 12.0 was used for pooling the final outcomes. Five clinical studies with 573 patients (liposomal bupivacaine group = 239, interscalene nerve block group = 334) were ultimately included in the meta-analysis. There was no significant difference between the VAS at 4 hours, 8 hours, and 2 weeks between liposomal bupivacaine group and interscalene nerve block group (P > .05). Compared with interscalene nerve block group, liposomal bupivacaine was associated with a reduction of VAS score at 12 hours, 24 hours by appropriately 3.31 points and 6.42 points respectively on a 100-point VAS. Furthermore, liposomal bupivacaine was associated with a significantly reduction of the length of hospital stay by appropriately by 0.16 days compared with interscalene nerve block group. Current meta-analysis indicates that compared with interscalene nerve block, liposomal bupivacaine had comparative effectiveness on reducing both pain scores and the length of hospital stay. However, studies with more patients and better-designed methods are needed to

Pre-differentiation of mesenchymal stromal cells in combination with a microstructured nerve guide supports peripheral nerve regeneration in the rat sciatic nerve model.

Science.gov (United States)

Boecker, Arne Hendrik; van Neerven, Sabien Geraldine Antonia; Scheffel, Juliane; Tank, Julian; Altinova, Haktan; Seidensticker, Katrin; Deumens, Ronald; Tolba, Rene; Weis, Joachim; Brook, Gary Anthony; Pallua, Norbert; Bozkurt, Ahmet

2016-02-01

Many bioartificial nerve guides have been investigated pre-clinically for their nerve regeneration-supporting function, often in comparison to autologous nerve transplantation, which is still regarded as the current clinical gold standard. Enrichment of these scaffolds with cells intended to support axonal regeneration has been explored as a strategy to boost axonal regeneration across these nerve guides Ansselin et al. (1998). In the present study, 20 mm rat sciatic nerve defects were implanted with a cell-seeded microstructured collagen nerve guide (Perimaix) or an autologous nerve graft. Under the influence of seeded, pre-differentiated mesenchymal stromal cells, axons regenerated well into the Perimaix nerve guide. Myelination-related parameters, like myelin sheath thickness, benefitted from an additional seeding with pre-differentiated mesenchymal stromal cells. Furthermore, both the number of retrogradely labelled sensory neurons and the axon density within the implant were elevated in the cell-seeded scaffold group with pre-differentiated mesenchymal stromal cells. However, a pre-differentiation had no influence on functional recovery. An additional cell seeding of the Perimaix nerve guide with mesenchymal stromal cells led to an extent of functional recovery, independent of the differentiation status, similar to autologous nerve transplantation. These findings encourage further investigations on pre-differentiated mesenchymal stromal cells as a cellular support for peripheral nerve regeneration. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery

International Nuclear Information System (INIS)

Ahmed, M.; Aurangzeb, A.; Rashid, A.Z.; Qureshi, M.A.; Iqbal, N.; Boota, M.; Ashfaq, M.

2013-01-01

Objective: To compare the frequency of recurrent laryngeal nerve(s) (RLNs) palsy after various thyroid procedures with and without identification of recurrent laryngeal nerve during the operation. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Military Hospital, Rawalpindi, from August 2008 to April 2010. Methodology: Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cord were included in the study. Patients with hoarseness of voice, abnormal vocal cord movements and with solitary nodule in the isthmus were excluded. These patients were randomly divided into 2 groups of 50 each using random number tables. RLN was identified by exposing the inferior thyroid artery and traced along its entire course in group-A. Whereas, in group-B, nerves were not identified during the operations. Immediate postoperative direct laryngoscopy was performed by a surgeon with the help of an anaesthesiologist for the assessment of vocal cords. Patients with persistent hoarseness of voice were followed-up with indirect laryngoscopy at 3 and 6 months. Results: Temporary unilateral recurrent laryngeal nerve palsies occurred in 2 (4%) patients in group-A where the voice and cord movements returned to normal in 6 months. In group-B, it occurred in 8 (16%) patients, 2 bilateral (4%) injuries requiring tracheostomy and 6 unilateral injuries (12%). Among the 2 bilateral recurrent laryngeal nerve injuries, the tracheostomy was removed in one case after 6 months with persistent hoarseness of voice but no respiratory difficulty during routine activities. Tracheostomy was permanent in the other case. Among the 6 cases of unilateral nerve injuries, the voice improved considerably in 4 cases within 6 months but in 2 cases hoarseness persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in group-A as compared to group-B (p = 0

Gluteal tendinopathy and hip osteoarthritis: Different pathologies, different hip biomechanics.

Science.gov (United States)

Allison, Kim; Hall, Michelle; Hodges, Paul W; Wrigley, Tim V; Vicenzino, Bill; Pua, Yong-Hao; Metcalf, Ben; Grimaldi, Alison; Bennell, Kim L

2018-03-01

Gluteal tendinopathy (GT) and hip osteoarthritis (OA) are the most common causes of hip pain and associated disability in older adults. Pain and altered walking biomechanics are common to both conditions. This study aimed to compare three-dimensional walking biomechanics between individuals with unilateral, symptomatic GT and HOA. Sixty individuals with symptomatic unilateral GT confirmed by magnetic-resonance-imaging and 73 individuals with symptomatic unilateral HOA (Kellgren-Lawrence Grade ≥ 2) underwent three-dimensional gait analysis. Maximum and minimum values of the external sagittal hip moment, the first peak, second peak and mid-stance minimum of the hip adduction moment (HAM), sagittal plane hip excursion and hip joint angles, pelvic obliquity and trunk lean, at the three HAM time points during stance phase of walking were compared between groups. Compared to individuals with HOA, those with GT exhibited a greater hip peak extension moment (P < 0.001) and greater HAM throughout the stance phase of walking (P = 0.01-P < 0.001), greater hip adduction (P < 0.001) and internal rotation (P < 0.01-P < 0.001) angles and lower hip flexion angles and excursion (P = 0.02 - P < 0.001). Individuals with HOA exhibited a greater forward trunk lean (P ≤ 0.001) throughout stance, and greater ipsilateral trunk lean in the frontal plane (P < 0.001) than those with GT. Despite presence of pain in both conditions, hip kinematics and kinetics differ between individuals with symptomatic unilateral GT and those with symptomatic unilateral HOA. These condition-specific impairments may be targets for optimization of management of HOA and GT. Copyright © 2018 Elsevier B.V. All rights reserved.

Intraoperative cranial nerve monitoring.

Science.gov (United States)

Harper, C Michel

2004-03-01

The purpose of intraoperative monitoring is to preserve function and prevent injury to the nervous system at a time when clinical examination is not possible. Cranial nerves are delicate structures and are susceptible to damage by mechanical trauma or ischemia during intracranial and extracranial surgery. A number of reliable electrodiagnostic techniques, including nerve conduction studies, electromyography, and the recording of evoked potentials have been adapted to the study of cranial nerve function during surgery. A growing body of evidence supports the utility of intraoperative monitoring of cranial nerve nerves during selected surgical procedures.

Short-term observations of the regenerative potential of injured proximal sensory nerves crossed with distal motor nerves

Directory of Open Access Journals (Sweden)

Xiu-xiu Zhang

2017-01-01

Full Text Available Motor nerves and sensory nerves conduct signals in different directions and function in different ways. In the surgical treatment of peripheral nerve injuries, the best prognosis is obtained by keeping the motor and sensory nerves separated and repairing the nerves using the suture method. However, the clinical consequences of connections between sensory and motor nerves currently remain unknown. In this study, we analyzed the anatomical structure of the rat femoral nerve, and observed the motor and sensory branches of the femoral nerve in the quadriceps femoris. After ligation of the nerves, the proximal end of the sensory nerve was connected with the distal end of the motor nerve, followed by observation of the changes in the newly-formed regenerated nerve fibers. Acetylcholinesterase staining was used to distinguish between the myelinated and unmyelinated motor and sensory nerves. Denervated muscle and newly formed nerves were compared in terms of morphology, electrophysiology and histochemistry. At 8 weeks after connection, no motor nerve fibers were observed on either side of the nerve conduit and the number of nerve fibers increased at the proximal end. The proportion of newly-formed motor and sensory fibers was different on both sides of the conduit. The area occupied by autonomic nerves in the proximal regenerative nerve was limited, but no distinct myelin sheath was visible in the distal nerve. These results confirm that sensory and motor nerves cannot be effectively connected. Moreover, the change of target organ at the distal end affects the type of nerves at the proximal end.

Changes in gluteal muscle forces with alteration of footstrike pattern during running.

Science.gov (United States)

Vannatta, Charles Nathan; Kernozek, Thomas W; Gheidi, Naghmeh

2017-10-01

Gait retraining is a common form of treatment for running related injuries. Proximal factors at the hip have been postulated as having a role in the development of running related injuries. How altering footstrike affects hip muscles forces and kinematics has not been described. Thus, we aimed to quantify differences in hip muscle forces and hip kinematics that may occur when healthy runners are instructed to alter their foot strike pattern from their habitual rear-foot strike to a forefoot strike. This may gain insight on the potential etiology and treatment methods of running related lower extremity injury. Twenty-five healthy female runners completed a minimum of 10 running trials in a controlled laboratory setting under rear-foot strike and instructed forefoot strike conditions. Kinetic and kinematic data were used in an inverse dynamic based static optimization to estimate individual muscle forces during running. Within subject differences were investigated using a repeated measures multi-variate analysis of variance. Peak gluteus medius and minimus and hamstring forces were reduced while peak gluteus maximus force was increased when running with an instructed forefoot strike pattern. Peak hip adduction, hip internal rotation, and heel-COM distance were also reduced. Therefore, instructing habitual rearfoot strike runners to run with a forefoot strike pattern resulted in changes in peak gluteal and hamstring muscle forces and hip kinematics. These changes may be beneficial to the development and treatment of running related lower extremity injury. Copyright © 2017 Elsevier B.V. All rights reserved.

Iliac hyperdense line: a new X-ray sign of gluteal muscle contracture

International Nuclear Information System (INIS)

Cai Jinhua; Gan Lanfeng; Zheng Helin; He Ling; Yu Guorong

2003-01-01

Objective: To elucidate the relationship between gluteal muscle contracture (GMC) and the iliac hyperdense line on pelvic plain film, and to explore how the iliac hyperdense line is formed. Methods: The pelvic plain films of 103 cases with GMC confirmed by operation and those of 200 individuals as control were analyzed. Pelvic CT scanning was performed in 8 cases GMC and 13 cases of normal controls. Results: The iliac hyperdense line at the side of sacroiliac joint was found on the pelvic plain film in 85 of 103 cases with GMC and 5 of 200 in control group. In 103 cases of GMC, the iliac hyperdense line was detected in 81 of 88 patients beyond 5 years, and 83 of 94 was mostly the gluteus maximus contracture. In control group, pelvic CT showed that the outer cortex of posterior ilium at the level of sacroiliac joint appeared as an oblique plane, oriented from posteromedial side to anterolateral side, while in GMC group, the oblique plane became steeper and almost oriented posteroanteriorly. In addition, the posterior part of the ilium which gave the attachment of contracted gluteus maximus muscle deformed and widened. Conclusion: The iliac hyperdense line on the pelvic plain film is resulted from the long and persistent pulling effect of contracted gluteus maximus muscle, which causes the change the oblique plane of posterior ilium into a posteroanterior course parallel to the X-ray beam

Adult Stem Cell Based Enhancement of Nerve Conduit for Peripheral Nerve Repair

Science.gov (United States)

2016-10-01

accompanied by injuries to peripheral nerves; if not repaired, the trauma can lead to significant dysfunction and disability . While nerves have the ability to...recovery, minimized disability , and increased quality of life for our wounded warriors. 2. KEYWORDS: Stem Cell, Nerve Conduit, Peripheral Nerve...would be a paradigm shift away from ordering X-rays at 10-12 weeks and only ordering a CT scan. It has the potential to change the standard of care

Microsurgical reconstruction of large nerve defects using autologous nerve grafts.

Science.gov (United States)

Daoutis, N K; Gerostathopoulos, N E; Efstathopoulos, D G; Misitizis, D P; Bouchlis, G N; Anagnostou, S K

1994-01-01

Between 1986 and 1993, 643 patients with peripheral nerve trauma were treated in our clinic. Primary neurorraphy was performed in 431 of these patients and nerve grafting in 212 patients. We present the functional results after nerve grafting in 93 patients with large nerve defects who were followed for more than 2 years. Evaluation of function was based on the Medical Research Council (MRC) classification for motor and sensory recovery. Factors affecting functional outcome, such as age of the patient, denervation time, length of the defect, and level of the injury were noted. Good results according to the MRC classification were obtained in the majority of cases, although function remained less than that of the uninjured side.

Gradual nerve elongation affects nerve cell bodies and neuro-muscular junctions.

Science.gov (United States)

Kazuo Ikeda, K I; Masaki Matsuda, M M; Daisuke Yamauchi, D Y; Katsuro Tomita, K T; Shigenori Tanaka, S T

2005-07-01

The purpose of this study is to clarify the reactions of the neuro-muscular junction and nerve cell body to gradual nerve elongation. The sciatic nerves of Japanese white rabbits were lengthened by 30 mm in increments of 0.8 mm/day, 2.0 mm/day and 4.0 mm/day. A scanning electron microscopic examination showed no degenerative change at the neuro-muscular junction, even eight weeks after elongation in the 4-mm group. Hence, neuro-muscular junction is not critical for predicting damage from gradual nerve elongation. There were no axon reaction cells in the 0.8-mm group, a small amount in the 2-mm group, and a large amount in the 4-mm group. The rate of growth associated protein-43 positive nerve cells was significant in the 4-mm group. Hence, the safe speed for nerve cells appeared to be 0.8-mm/day, critical speed to be 2.0-mm/day, and dangerous speed to be 4.0-mm/day in this elongation model.

Comparison of percutaneous electrical nerve stimulation and ultrasound imaging for nerve localization

NARCIS (Netherlands)

Wegener, J. T.; Boender, Z. J.; Preckel, B.; Hollmann, M. W.; Stevens, M. F.

2011-01-01

Background. Percutaneous nerve stimulation (PNS) is a non-invasive technique to localize superficial nerves before performing peripheral nerve blocks, but its precision has never been evaluated by high-resolution ultrasound. This study compared stimulating points at the skin with the position of

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness.

Science.gov (United States)

Cohen, Steven P; Peterlin, B Lee; Fulton, Larry; Neely, Edward T; Kurihara, Connie; Gupta, Anita; Mali, Jimmy; Fu, Diana C; Jacobs, Michael B; Plunkett, Anthony R; Verdun, Aubrey J; Stojanovic, Milan P; Hanling, Steven; Constantinescu, Octav; White, Ronald L; McLean, Brian C; Pasquina, Paul F; Zhao, Zirong

2015-12-01

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

Imaging the trigeminal nerve

International Nuclear Information System (INIS)

Borges, Alexandra; Casselman, Jan

2010-01-01

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

Imaging the trigeminal nerve

Energy Technology Data Exchange (ETDEWEB)

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

2010-05-15

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

Primary olfactory projections and the nervus terminalis in the African lungfish: implications for the phylogeny of cranial nerves.

Science.gov (United States)

von Bartheld, C S; Claas, B; Münz, H; Meyer, D L

1988-08-01

Primary olfactory and central projections of the nervus terminalis were investigated by injections of horseradish peroxidase into the olfactory epithelium in the African lungfish. In addition, gonadotropin-releasing hormone (GnRH) immunoreactivity of the nervus terminalis system was investigated. The primary olfactory projections are restricted to the olfactory bulb located at the rostral pole of the telencephalon; they do not extend into caudal parts of the telencephalon. A vomeronasal nerve and an accessory olfactory bulb could not be identified. The nervus terminalis courses through the dorsomedial telencephalon. Major targets include the nucleus of the anterior commissure and the nucleus praeopticus pars superior. some fibers cross to the contralateral side. A few fibers reach the diencephalon and mesencephalon. No label is present in the "posterior root of the nervus terminalis" (= "Pinkus's nerve" or "nervus praeopticus"). GnRH immunoreactivity is lacking in the "anterior root of the nervus terminalis," whereas it is abundant in nervus praeopticus (Pinkus's nerve). These findings may suggest that the nervus terminalis system originally consisted of two distinct cranial nerves, which have fused-in evolution-in most vertebrates. Theories of cranial nerve phylogeny are discussed in the light of the assumed "binerval origin" of the nervus terminalis system.

Transient femoral nerve palsy following ilioinguinal nerve block for ...

African Journals Online (AJOL)

Nigerian Journal of Surgery ... Background: Elective inguinal hernia repair in young fit patients is preferably done under ilioinguinal nerve block anesthesia in the ambulatory setting to improve ... Conclusion: TFNP is a rare complication of ilioinguinal nerve block which delays patient discharge postambulatory hernioplasty.

Ulnar nerve damage (image)

Science.gov (United States)

The ulnar nerve originates from the brachial plexus and travels down arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near the surface of the body where ...

Chondromyxoid fibroma of the mastoid facial nerve canal mimicking a facial nerve schwannoma.

Science.gov (United States)

Thompson, Andrew L; Bharatha, Aditya; Aviv, Richard I; Nedzelski, Julian; Chen, Joseph; Bilbao, Juan M; Wong, John; Saad, Reda; Symons, Sean P

2009-07-01

Chondromyxoid fibroma of the skull base is a rare entity. Involvement of the temporal bone is particularly rare. We present an unusual case of progressive facial nerve paralysis with imaging and clinical findings most suggestive of a facial nerve schwannoma. The lesion was tubular in appearance, expanded the mastoid facial nerve canal, protruded out of the stylomastoid foramen, and enhanced homogeneously. The only unusual imaging feature was minor calcification within the tumor. Surgery revealed an irregular, cystic lesion. Pathology diagnosed a chondromyxoid fibroma involving the mastoid portion of the facial nerve canal, destroying the facial nerve.

Effect of dexmedetomidine as an adjuvant to bupivacaine in femoral nerve block for perioperative analgesia in patients undergoing total knee replacement arthroplasty: A dose–response study

Directory of Open Access Journals (Sweden)

Senthil K Packiasabapathy

2017-01-01

Conclusion: The use of dexmedetomidine at 2 μg/kg dose in femoral nerve block is superior to 1 μg/kg for providing analgesia after TKA, although its role in facilitating early ambulation needs further evaluation.

Femoral nerve damage (image)

Science.gov (United States)

The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

End-to-side nerve suture – a technique to repair peripheral nerve ...

African Journals Online (AJOL)

Lateral sprouting from an intact nerve into an attached nerve does occur, and functional recovery (sensory and motor) has been demonstrated. We have demonstrated conclusively that ETSNS in the human is a viable option in treating peripheral nerve injuries, including injuries to the brachial plexus. Among the many ...

Tumors of the optic nerve

DEFF Research Database (Denmark)

Lindegaard, Jens; Heegaard, Steffen

2009-01-01

A variety of lesions may involve the optic nerve. Mainly, these lesions are inflammatory or vascular lesions that rarely necessitate surgery but may induce significant visual morbidity. Orbital tumors may induce proptosis, visual loss, relative afferent pupillary defect, disc edema and optic...... atrophy, but less than one-tenth of these tumors are confined to the optic nerve or its sheaths. No signs or symptoms are pathognomonic for tumors of the optic nerve. The tumors of the optic nerve may originate from the optic nerve itself (primary tumors) as a proliferation of cells normally present...... in the nerve (e.g., astrocytes and meningothelial cells). The optic nerve may also be invaded from tumors originating elsewhere (secondary tumors), invading the nerve from adjacent structures (e.g., choroidal melanoma and retinoblastoma) or from distant sites (e.g., lymphocytic infiltration and distant...

Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb.

Science.gov (United States)

Kowalska, Berta; Sudoł-Szopińska, Iwona

2012-06-01

The ultrasonographic examination is currently increasingly used in imaging peripheral nerves, serving to supplement the physical examination, electromyography and magnetic resonance imaging. As in the case of other USG imaging studies, the examination of peripheral nerves is non-invasive and well-tolerated by patients. The typical ultrasonographic picture of peripheral nerves as well as the examination technique have been discussed in part I of this article series, following the example of the median nerve. Part II of the series presented the normal anatomy and the technique for examining the peripheral nerves of the upper limb. This part of the article series focuses on the anatomy and technique for examining twelve normal peripheral nerves of the lower extremity: the iliohypogastric and ilioinguinal nerves, the lateral cutaneous nerve of the thigh, the pudendal, sciatic, tibial, sural, medial plantar, lateral plantar, common peroneal, deep peroneal and superficial peroneal nerves. It includes diagrams showing the proper positioning of the sonographic probe, plus USG images of the successively discussed nerves and their surrounding structures. The ultrasonographic appearance of the peripheral nerves in the lower limb is identical to the nerves in the upper limb. However, when imaging the lower extremity, convex probes are more often utilized, to capture deeply-seated nerves. The examination technique, similarly to that used in visualizing the nerves of upper extremity, consists of locating the nerve at a characteristic anatomic reference point and tracking it using the "elevator technique". All 3 parts of the article series should serve as an introduction to a discussion of peripheral nerve pathologies, which will be presented in subsequent issues of the "Journal of Ultrasonography".

Longterm effects of cardiac mediastinal nerve cryoablation on neural inducibility of atrial fibrillation in canines.

Science.gov (United States)

Leiria, Tiago Luiz Luz; Glavinovic, Tamara; Armour, J Andrew; Cardinal, René; de Lima, Gustavo Glotz; Kus, Teresa

2011-04-26

In canines, excessive activation of select mediastinal nerve inputs to the intrinsic cardiac nervous system induces atrial fibrillation (AF). Since ablation of neural elements is proposed as an adjunct to circumferential pulmonary vein ablation for AF, we investigated the short and long-term effects of mediastinal nerve ablation on AF inducibility. Under general anesthesia, in 11 dogs several mediastinal nerve sites were identified on the superior vena cava that, when stimulated electrically during the atrial refractory period, reproducibly initiated AF. Cryoablation of one nerve site was then performed and inducibility retested early (1-2 months post Cryo; n=7) or late (4 months post Cryo; n=4). Four additional dogs that underwent a sham procedure were retested 1 to 2 months post-surgery. Stimulation induced AF at 91% of nerve sites tested in control versus 21% nerve sites early and 54% late post-ablation (both P<0.05). Fewer stimuli were required to induce AF in controls versus the Early Cryo group; this capacity returned to normal values in the Late Cryo group. AF episodes were longer in control versus the Early or Late Cryo groups. Heart rate responses to vagal or stellate ganglion stimulation, as well as to local nicotine infusion into the right coronary artery, were similar in all groups. In conclusion, focal damage to intrinsic cardiac neuronal inputs causes short-term stunning of neuronal inducibility of AF without major loss of overall adrenergic or cholinergic efferent neuronal control. That recovery of AF inducibility occurs rapidly post-surgery indicates the plasticity of intrathoracic neuronal elements to focal injury. Copyright © 2011 Elsevier B.V. All rights reserved.

Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space.

Science.gov (United States)

Lemos-Rodriguez, Ana M; Sreenath, Satyan B; Rawal, Rounak B; Overton, Lewis J; Farzal, Zainab; Zanation, Adam M

2017-03-01

To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm. Anatomical study. Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented. The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA. Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure. N/A. Laryngoscope, 127:585-591, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Electrophysiological Assessment of a Peptide Amphiphile Nanofiber Nerve Graft for Facial Nerve Repair.

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Greene, Jacqueline J; McClendon, Mark T; Stephanopoulos, Nicholas; Álvarez, Zaida; Stupp, Samuel I; Richter, Claus-Peter

2018-04-27

Facial nerve injury can cause severe long-term physical and psychological morbidity. There are limited repair options for an acutely transected facial nerve not amenable to primary neurorrhaphy. We hypothesize that a peptide amphiphile nanofiber neurograft may provide the nanostructure necessary to guide organized neural regeneration. Five experimental groups were compared, animals with 1) an intact nerve, 2) following resection of a nerve segment, and following resection and immediate repair with either a 3) autograft (using the resected nerve segment), 4) neurograft, or 5) empty conduit. The buccal branch of the rat facial nerve was directly stimulated with charge balanced biphasic electrical current pulses at different current amplitudes while nerve compound action potentials (nCAPs) and electromygraphic (EMG) responses were recorded. After 8 weeks, the proximal buccal branch was surgically re-exposed and electrically evoked nCAPs were recorded for groups 1-5. As expected, the intact nerves required significantly lower current amplitudes to evoke an nCAP than those repaired with the neurograft and autograft nerves. For other electrophysiologic parameters such as latency and maximum nCAP, there was no significant difference between the intact, autograft and neurograft groups. The resected group had variable responses to electrical stimulation, and the empty tube group was electrically silent. Immunohistochemical analysis and TEM confirmed myelinated neural regeneration. This study demonstrates that the neuroregenerative capability of peptide amphiphile nanofiber neurografts is similar to the current clinical gold standard method of repair and holds potential as an off-the-shelf solution for facial reanimation and potentially peripheral nerve repair. This article is protected by copyright. All rights reserved.

Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning.

Science.gov (United States)

Garcia-Martin, Elena; Garcia-Campayo, Javier; Puebla-Guedea, Marta; Ascaso, Francisco J; Roca, Miguel; Gutierrez-Ruiz, Fernando; Vilades, Elisa; Polo, Vicente; Larrosa, Jose M; Pablo, Luis E; Satue, Maria

2016-01-01

To investigate whether fibromyalgia induces axonal damage in the optic nerve that can be detected using optical coherence tomography (OCT), as the retinal nerve fiber layer (RNFL) is atrophied in patients with fibromyalgia compared with controls. Fibromyalgia patients (n = 116) and age-matched healthy controls (n = 144) were included in this observational and prospective cohort study. All subjects underwent visual acuity measurement and structural analysis of the RNFL using two OCT devices (Cirrus and Spectralis). Fibromyalgia patients were evaluated according to Giesecke's fibromyalgia subgroups, the Fibromyalgia Impact Questionnaire (FIQ), and the European Quality of Life-5 Dimensions (EQ5D) scale. We compared the differences between fibromyalgia patients and controls, and analyzed the correlations between OCT measurements, disease duration, fibromyalgia subgroups, severity, and quality of life. The impact on quality of life in fibromyalgia subgroups and in patients with different disease severity was also analyzed. A significant decrease in the RNFL was detected in fibromyalgia patients compared with controls using the two OCT devices: Cirrus OCT ganglion cell layer analysis registered a significant decrease in the minimum thickness of the inner plexiform layer (74.99±16.63 vs 79.36±3.38 μm, respectively; p = 0.023), nasal inferior, temporal inferior and temporal superior sectors (p = 0.040; 0.011 and 0.046 respectively). The Glaucoma application of the Spectralis OCT revealed thinning in the nasal, temporal inferior and temporal superior sectors (p = 0.009, 0.006, and 0.002 respectively) of fibromyalgia patients and the Axonal application in all sectors, except the nasal superior and temporal sectors. The odds ratio (OR) to estimate the size effect of FM in RNFL thickness was 1.39. RNFL atrophy was detected in patients with FIQ scores fibromyalgia (FIQ≥60) compared with patients with mild fibromyalgia (FIQfibromyalgia exhibited significant thinning in the

Nerve growth factor receptor immunostaining suggests an extrinsic origin for hypertrophic nerves in Hirschsprung's disease.

OpenAIRE

Kobayashi, H; O'Briain, D S; Puri, P

1994-01-01

The expression of nerve growth factor receptor in colon from 20 patients with Hirshsprung's disease and 10 controls was studied immunohistochemically. The myenteric and submucous plexuses in the ganglionic bowel and hypertrophic nerve trunks in the aganglionic bowel displayed strong expression of nerve growth factor receptor. The most important finding was the identical localisation of nerve growth factor receptor immunoreactivity on the perineurium of both hypertrophic nerve trunks in Hirshs...

Double elevator weakening for unilateral congenital superior oblique palsy with ipsilateral superior rectus contracture and lax superior oblique tendon.

Science.gov (United States)

Khan, Arif O

2012-06-01

In unilateral congenital superior oblique palsy, a large hypertropia is sometimes associated with ipsilateral contracture of the superior rectus muscle and apparent overaction of the contralateral superior oblique. Ipsilateral double elevator weakening is one surgical approach; however, this procedure could compromise supraduction. We report a series of three consecutive patients who underwent ipsilateral superior rectus and inferior oblique recessions for unilateral superior oblique palsy. Intraoperatively, all three patients were found to have a lax ipsilateral superior oblique tendon. Postoperatively, all three patients had satisfactory correction of the hypertropia and abnormal head position with minimal supraduction defect. This procedure seems to be an acceptable initial surgical option for treating congenital superior oblique muscle palsy with ipsilateral contracture of the superior rectus muscle, even when the ipsilateral superior oblique tendon is lax. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Recurrent unilateral facial nerve palsy in a child with dehiscent facial nerve canal

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Christopher Liu

2016-12-01

Full Text Available Objective: The dehiscent facial nerve canal has been well documented in histopathological studies of temporal bones as well as in clinical setting. We describe clinical and radiologic features of a child with recurrent facial nerve palsy and dehiscent facial nerve canal. Methods: Retrospective chart review. Results: A 5-year-old male was referred to the otolaryngology clinic for evaluation of recurrent acute otitis media and hearing loss. He also developed recurrent left peripheral FN palsy associated with episodes of bilateral acute otitis media. High resolution computed tomography of the temporal bones revealed incomplete bony coverage of the tympanic segment of the left facial nerve. Conclusions: Recurrent peripheral FN palsy may occur in children with recurrent acute otitis media in the presence of a dehiscent facial nerve canal. Facial nerve canal dehiscence should be considered in the differential diagnosis of children with recurrent peripheral FN palsy.

Reconstruction of the abdominal vagus nerve using sural nerve grafts in canine models.

Science.gov (United States)

Liu, Jingbo; Wang, Jun; Luo, Fen; Wang, Zhiming; Wang, Yin

2013-01-01

Recently, vagus nerve preservation or reconstruction of vagus has received increasing attention. The present study aimed to investigate the feasibility of reconstructing the severed vagal trunk using an autologous sural nerve graft. Ten adult Beagle dogs were randomly assigned to two groups of five, the nerve grafting group (TG) and the vagal resection group (VG). The gastric secretion and emptying functions in both groups were assessed using Hollander insulin and acetaminophen tests before surgery and three months after surgery. All dogs underwent laparotomy under general anesthesia. In TG group, latency and conduction velocity of the action potential in a vagal trunk were measured, and then nerves of 4 cm long were cut from the abdominal anterior and posterior vagal trunks. Two segments of autologous sural nerve were collected for performing end-to-end anastomoses with the cut ends of vagal trunk (8-0 nylon suture, 3 sutures for each anastomosis). Dogs in VG group only underwent partial resections of the anterior and posterior vagal trunks. Laparotomy was performed in dogs of TG group, and latency and conduction velocity of the action potential in their vagal trunks were measured. The grafted nerve segment was removed, and stained with anti-neurofilament protein and toluidine blue. Latency of the action potential in the vagal trunk was longer after surgery than before surgery in TG group, while the conduction velocity was lower after surgery. The gastric secretion and emptying functions were weaker after surgery in dogs of both groups, but in TG group they were significantly better than in VG group. Anti-neurofilament protein staining and toluidine blue staining showed there were nerve fibers crossing the anastomosis of the vagus and sural nerves in dogs of TG group. Reconstruction of the vagus nerve using the sural nerve is technically feasible.

Reconstruction of the abdominal vagus nerve using sural nerve grafts in canine models.

Directory of Open Access Journals (Sweden)

Jingbo Liu

Full Text Available BACKGROUND: Recently, vagus nerve preservation or reconstruction of vagus has received increasing attention. The present study aimed to investigate the feasibility of reconstructing the severed vagal trunk using an autologous sural nerve graft. METHODS: Ten adult Beagle dogs were randomly assigned to two groups of five, the nerve grafting group (TG and the vagal resection group (VG. The gastric secretion and emptying functions in both groups were assessed using Hollander insulin and acetaminophen tests before surgery and three months after surgery. All dogs underwent laparotomy under general anesthesia. In TG group, latency and conduction velocity of the action potential in a vagal trunk were measured, and then nerves of 4 cm long were cut from the abdominal anterior and posterior vagal trunks. Two segments of autologous sural nerve were collected for performing end-to-end anastomoses with the cut ends of vagal trunk (8-0 nylon suture, 3 sutures for each anastomosis. Dogs in VG group only underwent partial resections of the anterior and posterior vagal trunks. Laparotomy was performed in dogs of TG group, and latency and conduction velocity of the action potential in their vagal trunks were measured. The grafted nerve segment was removed, and stained with anti-neurofilament protein and toluidine blue. RESULTS: Latency of the action potential in the vagal trunk was longer after surgery than before surgery in TG group, while the conduction velocity was lower after surgery. The gastric secretion and emptying functions were weaker after surgery in dogs of both groups, but in TG group they were significantly better than in VG group. Anti-neurofilament protein staining and toluidine blue staining showed there were nerve fibers crossing the anastomosis of the vagus and sural nerves in dogs of TG group. CONCLUSION: Reconstruction of the vagus nerve using the sural nerve is technically feasible.

Electrophysiology of Extraocular Cranial Nerves: Oculomotor, Trochlear, and Abducens Nerve.

Science.gov (United States)

Hariharan, Praveen; Balzer, Jeffery R; Anetakis, Katherine; Crammond, Donald J; Thirumala, Parthasarathy D

2018-01-01

The utility of extraocular cranial nerve electrophysiologic recordings lies primarily in the operating room during skull base surgeries. Surgical manipulation during skull base surgeries poses a risk of injury to multiple cranial nerves, including those innervating extraocular muscles. Because tumors distort normal anatomic relationships, it becomes particularly challenging to identify cranial nerve structures. Studies have reported the benefits of using intraoperative spontaneous electromyographic recordings and compound muscle action potentials evoked by electrical stimulation in preventing postoperative neurologic deficits. Apart from surgical applications, electromyography of extraocular muscles has also been used to guide botulinum toxin injections in patients with strabismus and as an adjuvant diagnostic test in myasthenia gravis. In this article, we briefly review the rationale, current available techniques to monitor extraocular cranial nerves, technical difficulties, clinical and surgical applications, as well as future directions for research.

Conjoined lumbosacral nerve roots

International Nuclear Information System (INIS)

Kyoshima, Kazumitsu; Nishiura, Iwao; Koyama, Tsunemaro

1986-01-01

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

Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs.

Science.gov (United States)

Campoy, Luis; Bezuidenhout, Abraham J; Gleed, Robin D; Martin-Flores, Manuel; Raw, Robert M; Santare, Carrie L; Jay, Ariane R; Wang, Annie L

2010-03-01

To describe an ultrasound-guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Prospective experimental trial. Four hound-cross dogs aged 2 +/- 0 years (mean +/- SD) weighing 30 +/- 5 kg and four Beagles aged 2 +/- 0 years and weighing 8.5 +/- 0.5 kg. Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation-guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Ultrasound-guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.

Secondary digital nerve repair in the foot with resorbable p(DLLA-epsilon-CL) nerve conduits

NARCIS (Netherlands)

Meek, MF; Nicolai, JPA; Robinson, PH

Nerve guides are increasingly being used in peripheral nerve repair. In the last decade, Much preclinical research has been undertaken into a resorbable nerve guide composed of p(DLLA-epsilon-CL). This report describes the results of secondary digital nerve reconstruction in the foot in a patient

Nerve conduction velocity

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... this page: //medlineplus.gov/ency/article/003927.htm Nerve conduction velocity To use the sharing features on this page, please enable JavaScript. Nerve conduction velocity (NCV) is a test to see ...

Genipin-Cross-Linked Chitosan Nerve Conduits Containing TNF-α Inhibitors for Peripheral Nerve Repair.

Science.gov (United States)

Zhang, Li; Zhao, Weijia; Niu, Changmei; Zhou, Yujie; Shi, Haiyan; Wang, Yalin; Yang, Yumin; Tang, Xin

2018-07-01

Tissue engineered nerve grafts (TENGs) are considered a promising alternative to autologous nerve grafting, which is considered the "gold standard" clinical strategy for peripheral nerve repair. Here, we immobilized tumor necrosis factor-α (TNF-α) inhibitors onto a nerve conduit, which was introduced into a chitosan (CS) matrix scaffold utilizing genipin (GP) as the crosslinking agent, to fabricate CS-GP-TNF-α inhibitor nerve conduits. The in vitro release kinetics of TNF-α inhibitors from the CS-GP-TNF-α inhibitor nerve conduits were investigated using high-performance liquid chromatography. The in vivo continuous release profile of the TNF-α inhibitors released from the CS-GP-TNF-α inhibitor nerve conduits was measured using an enzyme-linked immunosorbent assay over 14 days. We found that the amount of TNF-α inhibitors released decreased with time after the bridging of the sciatic nerve defects in rats. Moreover, 4 and 12 weeks after surgery, histological analyses and functional evaluations were carried out to assess the influence of the TENG on regeneration. Immunochemistry performed 4 weeks after grafting to assess early regeneration outcomes revealed that the TENG strikingly promoted axonal outgrowth. Twelve weeks after grafting, the TENG accelerated myelin sheath formation, as well as functional restoration. In general, the regenerative outcomes following TENG more closely paralleled findings observed with autologous grafting than the use of the CS matrix scaffold. Collectively, our data indicate that the CS-GP-TNF-α inhibitor nerve conduits comprised an elaborate system for sustained release of TNF-α inhibitors in vitro, while studies in vivo demonstrated that the TENG could accelerate regenerating axonal outgrowth and functional restoration. The introduction of CS-GP-TNF-α-inhibitor nerve conduits into a scaffold may contribute to an efficient and adaptive immune microenvironment that can be used to facilitate peripheral nerve repair.

[Does intraoperative nerve monitoring reduce the rate of recurrent nerve palsies during thyroid surgery?].

Science.gov (United States)

Timmermann, W; Dralle, H; Hamelmann, W; Thomusch, O; Sekulla, C; Meyer, Th; Timm, S; Thiede, A

2002-05-01

Two different aspects of the influence of neuromonitoring on the possible reduction of post-operative recurrent laryngeal nerve palsies require critical examination: the nerve identification and the monitoring of it's functions. Due to the additional information from the EMG signals, neuromonitoring is the best method for identifying the nerves as compared to visual identification alone. There are still no randomized studies available that compare the visual and electrophysiological recurrent laryngeal nerve detection in thyroid operations with respect to the postoperative nerve palsies. Nevertheless, comparisons with historical collectives show that a constant low nerve-palsy-rate was achieved with electrophysiological detection in comparison to visual detection. The rate of nerve identification is normally very high and amounts to 99 % in our own patients. The data obtained during the "Quality assurance of benign and malignant Goiter" study show that in hemithyreoidectomy and subtotal resection, lower nerve-palsy-rates are achieved with neuromonitoring as compared to solely visual detection. Following subtotal resection, this discrepancy becomes even statistically significant. While monitoring the nerve functions with the presently used neuromonitoring technique, it is possible to observe the EMG-signal remaining constant or decreasing in volume. Assuming that a constant neuromonitoring signal represents a normal vocal cord, our evaluation shows that there is a small percentage of false negative and positive results. Looking at the permanent recurrent nerve palsy rates, this method has a specificity of 98 %, a sensitivity of 100 %, a positive prognostic value of 10 %, and a negative prognostic value of 100 %. Although an altered neuromonitoring signal can be taken as a clear indication of eventual nerve damage, an absolutely reliable statement about the postoperative vocal cord function is presently not possible with intraoperative neuromonitoring.

Fabrication of nerve guidance conduit with luminal filler as scaffold for peripheral nerve repair

International Nuclear Information System (INIS)

Aranilla, Charito T.; Wach, Rodoslaw; Ulanski, Piotr

2015-01-01

Peripheral nerve injury is a serious health concern for society, affecting trauma patients, many of whom acquire life-long disability. The gold standard of treatment for peripheral nerve injury is the use of nerve grafts, wherein nerve autograft or allograft is used to bridge the gap in the damaged nerve. Nerve guidance conduits (NGCs) are an attractive alternative to nerve autografts for aiding in the regeneration of peripheral nerve tissue. NGCs are small cylinders or tubes composed of either natural or synthetic biomaterials that are used to axon regeneration. The ends of the damaged nerve are inserted into either end of the cylinder and the NGC acts both as a connecting bridge for the severed nerve ends as well as a protective shelter for the regenerating nerve. This study aims at fabricating nerve guidance conduits with luminal structure based on synthetic biodegradable and biocompatible polymers such as poly (trimethylene carbonate ) (PTMC), poly (lactic acid) (PLA) and poly (caprolactone) (PCL). Initial base materials for fabrication were PLA acid tubes compared to PCL tubes when prepared by spray and dip-coating methods. The morphology of the tubes where examined by SEM and results showed better porosity of PLA acid tubes compared to PCL tubes when prepared by spraying technique. Poly(lactic acid) was then blended with poly(trimethylene carbonate) at a ratio of 1:4 (5% total polymer content) for further fabrication. Electron beam radiation (25 and 50 kGy) was employed for sterilization and the changes in properties induced by irradiation in comprising polymers were evaluated. The wettability, mechanical thermal properties were not significantly changed by irradiation.In a separate experiment, synthesis of carboxymethyl chitosan hydrogel crosslinked by electron beam radiation was studied to create a luminal filler for PTMC-PLA tubes. Based on proper viscosity of solution before crosslinking, sufficient gel fraction and swelling, 10% w/v concentration of

NERVE REGENERATION THROUGH A 2-PLY BIODEGRADABLE NERVE GUIDE IN THE RAT AND THE INFLUENCE OF ACTH4-9 NERVE GROWTH-FACTOR

NARCIS (Netherlands)

ROBINSON, PH; VANDERLEI, B; HOPPEN, HJ; LEENSLAG, JW; PENNINGS, AJ; NIEUWENHUIS, P

1991-01-01

Biodegradable polyurethane-based (PU) nerve guides, instilled with or without ACTH4-9 analog (a melanocortin) were used for bridging an 8 mm gap in the rat sciatic nerve and were evaluated for function and histological appearance after 16 weeks of implantation. Autologous nerve grafts functioned as

Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb

Directory of Open Access Journals (Sweden)

Berta Kowalska

2012-06-01

Full Text Available The ultrasonographic examination is currently increasingly used in imaging peripheral nerves, serving to supplement the physical examination, electromyography and magnetic resonance imaging. As in the case of other USG imaging studies, the examination of peripheral nerves is non-invasive and well-tolerated by patients. The typical ultrasonographic picture of peripheral nerves as well as the examination technique have been discussed in part I of this article series, following the example of the median nerve. Part II of the series presented the normal anatomy and the technique for examining the peripheral nerves of the upper limb. This part of the article series focuses on the anatomy and technique for examining twelve normal peripheral nerves of the lower extremity: the iliohypogastric and ilioinguinal nerves, the lateral cutaneous nerve of the thigh, the pudendal, sciatic, tibial, sural, medial plantar, lateral plantar, common peroneal, deep peroneal and superficial peroneal nerves. It includes diagrams showing the proper positioning of the sonographic probe, plus USG images of the successively discussed nerves and their surrounding structures. The ultrasonographic appearance of the peripheral nerves in the lower limb is identical to the nerves in the upper limb. However, when imaging the lower extremity, convex probes are more often utilized, to capture deeply-seated nerves. The examination technique, similarly to that used in visualizing the nerves of upper extremity, consists of locating the nerve at a characteristic anatomic reference point and tracking it using the “elevator technique”. All 3 parts of the article series should serve as an introduction to a discussion of peripheral nerve pathologies, which will be presented in subsequent issues of the “Journal of Ultrasonography”.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty.

Science.gov (United States)

Seo, Seung Suk; Kim, Ok Gul; Seo, Jin Hyeok; Kim, Do Hoon; Kim, Youn Gu; Park, Beyoung Yun

2017-09-01

This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps

Neuromuscular ultrasound of cranial nerves.

Science.gov (United States)

Tawfik, Eman A; Walker, Francis O; Cartwright, Michael S

2015-04-01

Ultrasound of cranial nerves is a novel subdomain of neuromuscular ultrasound (NMUS) which may provide additional value in the assessment of cranial nerves in different neuromuscular disorders. Whilst NMUS of peripheral nerves has been studied, NMUS of cranial nerves is considered in its initial stage of research, thus, there is a need to summarize the research results achieved to date. Detailed scanning protocols, which assist in mastery of the techniques, are briefly mentioned in the few reference textbooks available in the field. This review article focuses on ultrasound scanning techniques of the 4 accessible cranial nerves: optic, facial, vagus and spinal accessory nerves. The relevant literatures and potential future applications are discussed.

Musculocutaneous nerve substituting for the distal part of radial nerve: A case report and its embryological basis

Directory of Open Access Journals (Sweden)

A S Yogesh

2011-01-01

Full Text Available In the present case, we have reported a unilateral variation of the radial and musculocutaneous nerves on the left side in a 64-year-old male cadaver. The radial nerve supplied all the heads of the triceps brachii muscle and gave cutaneous branches such as lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of forearm. The radial nerve ended without continuing further. The musculocutaneous nerve supplied the brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis muscles. The musculocutaneous nerve divided terminally into two branches, superficial and deep. The deep branch of musculocutaneous nerve corresponded to usual deep branch of the radial nerve while the superficial branch of musculocutaneous nerve corresponded to usual superficial branch of the radial nerve. The dissection was continued to expose the entire brachial plexus from its origin and it was found to be normal. The structures on the right upper limb were found to be normal. Surgeons should keep such variations in mind while performing the surgeries of the upper limb.

Diagnostic nerve ultrasonography; Diagnostische Nervensonographie

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Baeumer, T. [Universitaet zu Luebeck CBBM, Haus 66, Institut fuer Neurogenetik, Luebeck (Germany); Grimm, A. [Universitaetsklinikum Tuebingen, Klinik und Poliklinik fuer Neurologie, Tuebingen (Germany); Schelle, T. [Staedtisches Klinikum Dessau, Neurologische Klinik, Dessau (Germany)

2017-03-15

For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [German] Fuer die Diagnostik von Nervenlaesionen ist ein bildgebendes Verfahren zur Darstellung des peripheren Nervs und seiner ihn umgebenden Strukturen fuer eine aetiologische Einordnung erforderlich. Mit der klinisch-neurologischen Untersuchung und Elektrophysiologie ist eine funktionelle Aussage ueber die Nervenlaesion moeglich. In der Standard-MRT-Untersuchung wird der periphere Nerv nur unzureichend gut dargestellt. Die MRT-Neurographie ist ein sehr gutes, aber auch zeit- und ressourcenintensives Verfahren. Nutzung des Ultraschalls fuer die

Diagnostic value of the near-nerve needle sensory nerve conduction in sensory inflammatory demyelinating polyneuropathy.

Science.gov (United States)

Odabasi, Zeki; Oh, Shin J

2018-03-01

In this study we report the diagnostic value of the near-nerve needle sensory nerve conduction study (NNN-SNCS) in sensory inflammatory demyelinating polyneuropathy (IDP) in which the routine nerve conduction study was normal or non-diagnostic. The NNN-SNCS was performed to identify demyelination in the plantar nerves in 14 patients and in the median or ulnar nerve in 2 patients with sensory IDP. In 16 patients with sensory IDP, routine NCSs were either normal or non-diagnostic for demyelination. Demyelination was identified by NNN-SNCS by dispersion and/or slow nerve conduction velocity (NCV) below the demyelination marker. Immunotherapy was initiated in 11 patients, 10 of whom improved or remained stable. NNN-SNCS played an essential role in identifying demyelinaton in 16 patients with sensory IDP, leading to proper treatment. Muscle Nerve 57: 414-418, 2018. © 2017 Wiley Periodicals, Inc.

Interfascicular suture with nerve autografts for median, ulnar and radial nerve lesions.

Science.gov (United States)

Pluchino, F; Luccarelli, G

1981-05-01

Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.

Chemoattractive capacity of different lengths of nerve fragments bridging regeneration chambers for the repair of sciatic nerve defects

Institute of Scientific and Technical Information of China (English)

Jiren Zhang; Yubo Wang; Jincheng Zhang

2012-01-01

A preliminary study by our research group showed that 6-mm-long regeneration chamber bridging is equivalent to autologous nerve transplantation for the repair of 12-mm nerve defects.In this study,we compared the efficacy of different lengths (6,8,10 mm) of nerve fragments bridging 6-mm regeneration chambers for the repair of 12-mm-long nerve defects.At 16 weeks after the regeneration chamber was implanted,the number,diameter and myelin sheath thickness of the regenerated nerve fibers,as well as the conduction velocity of the sciatic nerve and gastrocnemius muscle wet weight ratio,were similar to that observed with autologous nerve transplantation.Our results demonstrate that 6-,8-and 10-mm-long nerve fragments bridging 6-mm regeneration chambers effectively repair 12-mm-long nerve defects.Because the chemoattractive capacity is not affected by the length of the nerve fragment,we suggest adopting 6-mm-long nerve fragments for the repair of peripheral nerve defects.

Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery.

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Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut

2012-11-01

Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

Effect of Surface Pore Structure of Nerve Guide Conduit on Peripheral Nerve Regeneration

Science.gov (United States)

Oh, Se Heang; Kim, Jin Rae; Kwon, Gu Birm; Namgung, Uk; Song, Kyu Sang

2013-01-01

Polycaprolactone (PCL)/Pluronic F127 nerve guide conduits (NGCs) with different surface pore structures (nano-porous inner surface vs. micro-porous inner surface) but similar physical and chemical properties were fabricated by rolling the opposite side of asymmetrically porous PCL/F127 membranes. The effect of the pore structure on peripheral nerve regeneration through the NGCs was investigated using a sciatic nerve defect model of rats. The nerve fibers and tissues were shown to have regenerated along the longitudinal direction through the NGC with a nano-porous inner surface (Nanopore NGC), while they grew toward the porous wall of the NGC with a micro-porous inner surface (Micropore NGC) and, thus, their growth was restricted when compared with the Nanopore NGC, as investigated by immunohistochemical evaluations (by fluorescence microscopy with anti-neurofilament staining and Hoechst staining for growth pattern of nerve fibers), histological evaluations (by light microscopy with Meyer's modified trichrome staining and Toluidine blue staining and transmission electron microscopy for the regeneration of axon and myelin sheath), and FluoroGold retrograde tracing (for reconnection between proximal and distal stumps). The effect of nerve growth factor (NGF) immobilized on the pore surfaces of the NGCs on nerve regeneration was not so significant when compared with NGCs not containing immobilized NGF. The NGC system with different surface pore structures but the same chemical/physical properties seems to be a good tool that is used for elucidating the surface pore effect of NGCs on nerve regeneration. PMID:22871377

Anatomy of pudendal nerve at urogenital diaphragm--new critical site for nerve entrapment.

Science.gov (United States)

Hruby, Stephan; Ebmer, Johannes; Dellon, A Lee; Aszmann, Oskar C

2005-11-01

To investigate the relations of the pudendal nerve in this complex anatomic region and determine possible entrapment sites that are accessible for surgical decompression. Entrapment neuropathies of the pudendal nerve are an uncommon and, therefore, often overlooked or misdiagnosed clinical entity. The detailed relations of this nerve as it exits the pelvis through the urogenital diaphragm and enters the mobile part of the penis have not yet been studied. Detailed anatomic dissections were performed in 10 formalin preserved hemipelves under 3.5x loupe magnification. The pudendal nerve was dissected from the entrance into the Alcock canal to the dorsum of the penis. The branching pattern of the nerve and its topographic relationship were recorded and photographs taken. The anatomic dissections revealed that the pudendal nerve passes through a tight osteofibrotic canal just distal to the urogenital diaphragm at the entrance to the base of the penis. This canal is, in part, formed by the inferior ramus of the pubic bone, the suspensory ligament of the penis, and the ischiocavernous body. In two specimens, a fusiform pseudoneuromatous thickening was found. The pudendal nerve is susceptible to compression at the passage from the Alcock canal to the dorsum of the penis. Individuals exposed to repetitive mechanical irritation in this region are especially endangered. Diabetic patients with peripheral neuropathy can have additional compression neuropathy with decreased penile sensibility and will benefit from decompression of the pudendal nerve.

Adult Stem Cell-Based Enhancement of Nerve Conduit for Peripheral Nerve Repair

Science.gov (United States)

2017-10-01

acceptable donor nerves are often not available for this purpose, particularly in patients suffering multiple extremity injuries or faced with traumatic...amputations. Alternatives include the use of a blood vessel graft or a synthetic nerve guide, although these devices are only effective over distances less...of combat-related orthopaedic trauma. Given the severity of the orthopaedic injuries sustained during battlefield trauma, an acceptable donor nerve is

Degenerative Nerve Diseases

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Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many ... viruses. Sometimes the cause is not known. Degenerative nerve diseases include Alzheimer's disease Amyotrophic lateral sclerosis Friedreich's ...

Dual-Component Gelatinous Peptide/Reactive Oligomer Formulations as Conduit Material and Luminal Filler for Peripheral Nerve Regeneration.

Science.gov (United States)

Kohn-Polster, Caroline; Bhatnagar, Divya; Woloszyn, Derek J; Richtmyer, Matthew; Starke, Annett; Springwald, Alexandra H; Franz, Sandra; Schulz-Siegmund, Michaela; Kaplan, Hilton M; Kohn, Joachim; Hacker, Michael C

2017-05-21

Toward the next generation of nerve guidance conduits (NGCs), novel biomaterials and functionalization concepts are required to address clinical demands in peripheral nerve regeneration (PNR). As a biological polymer with bioactive motifs, gelatinous peptides are promising building blocks. In combination with an anhydride-containing oligomer, a dual-component hydrogel system (cGEL) was established. First, hollow cGEL tubes were fabricated by a continuous dosing and templating process. Conduits were characterized concerning their mechanical strength, in vitro and in vivo degradation and biocompatibility. Second, cGEL was reformulated as injectable shear thinning filler for established NGCs, here tyrosine-derived polycarbonate-based braided conduits. Thereby, the formulation contained the small molecule LM11A-31. The biofunctionalized cGEL filler was assessed regarding building block integration, mechanical properties, in vitro cytotoxicity, and growth permissive effects on human adipose tissue-derived stem cells. A positive in vitro evaluation motivated further application of the filler material in a sciatic nerve defect. Compared to the empty conduit and pristine cGEL, the functionalization performed superior, though the autologous nerve graft remains the gold standard. In conclusion, LM11A-31 functionalized cGEL filler with extracellular matrix (ECM)-like characteristics and specific biochemical cues holds great potential to support PNR.

Delayed repair of the peripheral nerve: a novel model in the rat sciatic nerve.

Science.gov (United States)

Wu, Peng; Spinner, Robert J; Gu, Yudong; Yaszemski, Michael J; Windebank, Anthony J; Wang, Huan

2013-03-30

Peripheral nerve reconstruction is seldom done in the acute phase of nerve injury due to concomitant injuries and the uncertainty of the extent of nerve damage. A proper model that mimics true clinical scenarios is critical but lacking. The aim of this study is to develop a standardized, delayed sciatic nerve repair model in rats and validate the feasibility of direct secondary neurrorraphy after various delay intervals. Immediately or 1, 4, 6, 8 and 12 weeks after sciatic nerve transection, nerve repair was carried out. A successful tension-free direct neurorraphy (TFDN) was defined when the gap was shorter than 4.0 mm and the stumps could be reapproximated with 10-0 stitches without detachment. Compound muscle action potential (CMAP) was recorded postoperatively. Gaps between the two nerve stumps ranged from 0 to 9 mm, the average being 1.36, 2.85, 3.43, 3.83 and 6.4 mm in rats with 1, 4, 6, 8 and 12 week delay, respectively. The rate of successful TFDN was 78% overall. CMAP values of 1 and 4 week delay groups were not different from the immediate repair group, whereas CMAP amplitudes of 6, 8 and 12 week delay groups were significantly lower. A novel, standardized delayed nerve repair model is established. For this model to be sensitive, the interval between nerve injury and secondary repair should be at least over 4 weeks. Thereafter the longer the delay, the more challenging the model is for nerve regeneration. The choice of delay intervals can be tailored to meet specific requirements in future studies. Copyright © 2013 Elsevier B.V. All rights reserved.

Effect of cataract surgery on retinal nerve fiber layer thickness parameters using scanning laser polarimetry (GDxVCC).

Science.gov (United States)

Dada, Tanuj; Behera, Geeta; Agarwal, Anand; Kumar, Sanjeev; Sihota, Ramanjit; Panda, Anita

2010-01-01

To study the effect of cataract extraction on the retinal nerve fiber layer (RNFL) thickness, and assessment by scanning laser polarimetry (SLP), with variable corneal compensation (GDx VCC), at the glaucoma service of a tertiary care center in North India. Thirty-two eyes of 32 subjects were enrolled in the study. The subjects underwent RNFL analysis by SLP (GDx VCC) before undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation (Acrysof SA 60 AT) four weeks following cataract surgery. The RNFL thickness parameters evaluated both before and after surgery included temporal, superior, nasal, inferior, temporal (TSNIT) average, superior average, inferior average, and nerve fiber index (NFI). The mean age of subjects was 57.6 +/- 11.7 years (18 males, 14 females). Mean TSNIT average thickness (microm) pre- and post-cataract surgery was 49.2 +/- 14.1 and 56.5 +/- 7.6 ( P = 0.001). There was a statistically significant increase in RNFL thickness parameters (TSNIT average, superior average, and inferior average) and decrease in NFI post-cataract surgery as compared to the baseline values. Mean NFI pre- and post-cataract surgery was 41.3 +/- 15.3 and 21.6 +/- 11.8 ( P = 0.001). Measurement of RNFL thickness parameters by scanning laser polarimetry is significantly altered following cataract surgery. Post the cataract surgery, a new baseline needs to be established for assessing the longitudinal follow-up of a glaucoma patient. The presence of cataract may lead to an underestimation of the RNFL thickness, and this should be taken into account when analyzing progression in a glaucoma patient.

Pathology of the vestibulocochlear nerve

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

2010-05-15

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

Pathology of the vestibulocochlear nerve

International Nuclear Information System (INIS)

De Foer, Bert; Kenis, Christoph; Van Melkebeke, Deborah; Vercruysse, Jean-Philippe; Somers, Thomas; Pouillon, Marc; Offeciers, Erwin; Casselman, Jan W.

2010-01-01

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

Diffusion tensor imaging for nerve fiber bundles in the brain stem and spinocerebellar degeneration

International Nuclear Information System (INIS)

Honma, Tsuguo

2009-01-01

Diffusion tensor imaging (DTI) can create an image of the anisotropic nature of diffusion and express it quantitatively. Nerve fibers have a large anisotropic diffusion, and it is possible to obtain images of the nerve fiber bundle. The purpose of this study is to observe the nerve fiber bundles in the brain stem using DTI and study its potential for diagnosing the type of spinocerebellar degeneration (SCD). Fractional anisotropy (FA) maps and 3D-tractography images were obtained for 41 subjects with no brain stem abnormalities. We created an apparent diffusion coefficient (ADC) map and an FA map using DTI for 16 subjects in the disease group (11 with hereditary SCD and 5 with non-hereditary SCD) and 25 in the control group. The diffusion value of the pons and middle cerebellar peduncle was measured using ADC, and the degree of anisotropic diffusion was measured using FA. The pyramidal tract, superior cerebellar peduncle, and inferior cerebellar peduncle were clearly demonstrated for all cases. ADC for the middle cerebellar peduncle in spinocerebellar ataxin (SCA)1 was significantly higher, similar to that for the pons in dentatorubro-pallidoluysian atrophy (DRPLA). In MSA-C, ADC for both the pons and middle cerebellar peduncle was significantly elevated and FA was significantly decreased. There were no significant changes in SCA3. We could observe the nerve fiber bundles in the brain stem using DTI. FA and ADC measurements with DTI can aid in diagnosing the type of SCD. (author)

Radiation-induced cranial nerve palsy

International Nuclear Information System (INIS)

Berger, P.S.; Bataini, J.P.

1977-01-01

Twenty-five patients with 35 cranial nerve palsies were seen at the Fondation Curie during follow-up after radical radiotherapy for head and neck tumors. The twelfth nerve was involved in 19 cases, the tenth in nine, and the eleventh in five; the fifth and second nerves were involved once each and in the same patient. The twelfth nerve was involved alone in 16 patients and the tenth nerve alone in three, with multiple nerves involved in the remaining six patients. The palsy was noted from 12 to 145 months after diagnosis of the tumor. The latency period could be correlated with dose so that the least square fit equation representing NSD vs delay is NSD = 2598--Delay (in months) x 4.6, with a correlation coefficient of -0.58. The distinction between tumor recurrence and radiation-induced nerve palsy is critical. It can often be inferred from the latency period but must be confirmed by observation over a period of time

Optical coherence tomography of the prostate nerves

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Chitchian, Shahab

Preservation of the cavernous nerves during prostate cancer surgery is critical in preserving a man's ability to have spontaneous erections following surgery. These microscopic nerves course along the surface of the prostate within a few millimeters of the prostate capsule, and they vary in size and location from one patient to another, making preservation of the nerves difficult during dissection and removal of a cancerous prostate gland. These observations may explain in part the wide variability in reported sexual potency rates (9--86%) following prostate cancer surgery. Any technology capable of providing improved identification, imaging, and visualization of the cavernous nerves during prostate cancer surgery would be of great assistance in improving sexual function after surgery, and result in direct patient benefit. Optical coherence tomography (OCT) is a noninvasive optical imaging technique capable of performing high-resolution cross-sectional in vivo and in situ imaging of microstructures in biological tissues. OCT imaging of the cavernous nerves in the rat and human prostate has recently been demonstrated. However, improvements in the OCT system and the quality of the images for identification of the cavernous nerves is necessary before clinical use. The following chapters describe complementary approaches to improving identification and imaging of the cavernous nerves during OCT of the prostate gland. After the introduction to OCT imaging of the prostate gland, the optimal wavelength for deep imaging of the prostate is studied in Chapter 2. An oblique-incidence single point measurement technique using a normal-detector scanning system was implemented to determine the absorption and reduced scattering coefficients, mua and m's , of fresh canine prostate tissue, ex vivo, from the diffuse reflectance profile of near-IR light as a function of source-detector distance. The effective attenuation coefficient, mueff, and the Optical Penetration Depth (OPD) were

Retinal ganglion cell-inner plexiform and nerve fiber layers in neuromyelitis optica.

Science.gov (United States)

Hu, Sai-Jing; Lu, Pei-Rong

2018-01-01

To determine the thickness of the retinal ganglion cell-inner plexiform layer (GCIPL) and the retinal nerve fiber layer (RNFL) in patients with neuromyelitis optica (NMO). We conducted a cross-sectional study that included 30 NMO patients with a total of 60 eyes. Based on the presence or absence of optic neuritis (ON), subjects were divided into either the NMO-ON group (30 eyes) or the NMO-ON contra group (10 eyes). A detailed ophthalmologic examination was performed for each group; subsequently, the GCIPL and the RNFL were measured using high-definition optical coherence tomography (OCT). In the NMO-ON group, the mean GCIPL thickness was 69.28±21.12 µm, the minimum GCIPL thickness was 66.02±10.02 µm, and the RNFL thickness were 109.33±11.23, 110.47±3.10, 64.92±12.71 and 71.21±50.22 µm in the superior, inferior, temporal and nasal quadrants, respectively. In the NMO-ON contra group, the mean GCIPL thickness was 85.12±17.09 µm, the minimum GCIPL thickness was 25.39±25.1 µm, and the RNFL thicknesses were 148.33±23.22, 126.36±23.45, 82.21±22.30 and 83.36±31.28 µm in the superior, inferior, temporal and nasal quadrants, respectively. In the control group, the mean GCIPL thickness was 86.98±22.37 µm, the minimum GCIPL thickness was 85.28±10.75 µm, and the RNFL thicknesses were 150.22±22.73, 154.79±60.23, 82.33±7.01 and 85.62±13.81 µm in the superior, inferior, temporal and nasal quadrants, respectively. The GCIPL and RNFL were thinner in the NMO-ON contra group than in the control group ( P deviation (MD) and corrected pattern standard deviation (PSD) in the NMO-ON group ( P <0.05). The thickness of the GCIPL and RNFL, as measured using OCT, may indicate optic nerve damage in patients with NMO.

MRI appearance of the superior transverse scapular ligament

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Simeone, F.J.; Bredella, Miriam A.; Chang, Connie Y.; Torriani, Martin; Huang, Ambrose J. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States)

2015-11-15

The superior transverse scapular ligament (STSL) forms the roof of the suprascapular notch, which is the most common location of entrapment of the suprascapular nerve, a cause of shoulder pain and weakness. The purpose of this study is to determine the frequency of visualization of the STSL on routine shoulder MRIs, to identify the sequences and imaging planes on which it is visualized most frequently, and to describe its typical MRI appearance, none of which have been previously addressed in the radiologic literature. One hundred twenty-one consecutive shoulder MRIs were reviewed for the presence or absence of the STSL, including the imaging plane and sequence that best depicted the ligament. Dimensions of the ligament were recorded. Fifty four of 121 shoulder MRIs were technically adequate for visualization of the STSL, and it was identified on 51 of these studies (94 %). There was no statistically significant difference between 1.5-T and 3-T systems. The best individual sequence for visualizing the STSL was the sagittal T1-weighted sequence, in which the STSL was visible on 75/80 technically adequate sequences (94 %). The sagittal plane was the best plane for visualizing the STSL, in which it was visible on 65/69 technically adequate studies (94 %). The STSL on average measured 12.8 ± 1.5 mm in transverse dimension. The STSL can be visualized on the majority of shoulder MRIs and is best seen on sagittal T1-weighted images on our imaging protocol. Evaluation of the STSL can potentially help in identifying pathologic conditions affecting the suprascapular nerve. (orig.)

Matching of motor-sensory modality in the rodent femoral nerve model shows no enhanced effect on peripheral nerve regeneration

Science.gov (United States)

Kawamura, David H.; Johnson, Philip J.; Moore, Amy M.; Magill, Christina K.; Hunter, Daniel A.; Ray, Wilson Z.; Tung, Thomas HH.; Mackinnon, Susan E.

2010-01-01

The treatment of peripheral nerve injuries with nerve gaps largely consists of autologous nerve grafting utilizing sensory nerve donors. Underlying this clinical practice is the assumption that sensory autografts provide a suitable substrate for motoneuron regeneration, thereby facilitating motor endplate reinnervation and functional recovery. This study examined the role of nerve graft modality on axonal regeneration, comparing motor nerve regeneration through motor, sensory, and mixed nerve isografts in the Lewis rat. A total of 100 rats underwent grafting of the motor or sensory branch of the femoral nerve with histomorphometric analysis performed after 5, 6, or 7 weeks. Analysis demonstrated similar nerve regeneration in motor, sensory, and mixed nerve grafts at all three time points. These data indicate that matching of motor-sensory modality in the rat femoral nerve does not confer improved axonal regeneration through nerve isografts. PMID:20122927

Expansions of the neurovascular scleral canal and contained optic nerve occur early in the hypertonic saline rat experimental glaucoma model.

Science.gov (United States)

Pazos, Marta; Yang, Hongli; Gardiner, Stuart K; Cepurna, William O; Johnson, Elaine C; Morrison, John C; Burgoyne, Claude F

2016-04-01

To characterize early optic nerve head (ONH) structural change in rat experimental glaucoma (EG). Unilateral intraocular pressure (IOP) elevation was induced in Brown Norway rats by hypertonic saline injection into the episcleral veins and animals were sacrificed 4 weeks later by perfusion fixation. Optic nerve cross-sections were graded from 1 (normal) to 5 (extensive injury) by 5 masked observers. ONHs with peripapillary retina and sclera were embedded, serial sectioned, 3-D reconstructed, delineated, and quantified. Overall and animal-specific EG versus Control eye ONH parameter differences were assessed globally and regionally by linear mixed effect models with significance criteria adjusted for multiple comparisons. Expansions of the optic nerve and surrounding anterior scleral canal opening achieved statistical significance overall (p < 0.0022), and in 7 of 8 EG eyes (p < 0.005). In at least 5 EG eyes, significant expansions (p < 0.005) in Bruch's membrane opening (BMO) (range 3-10%), the anterior and posterior scleral canal openings (8-21% and 5-21%, respectively), and the optic nerve at the anterior and posterior scleral canal openings (11-30% and 8-41%, respectively) were detected. Optic nerve expansion was greatest within the superior and inferior quadrants. Optic nerve expansion at the posterior scleral canal opening was significantly correlated to optic nerve damage (R = 0.768, p = 0.042). In the rat ONH, the optic nerve and surrounding BMO and neurovascular scleral canal expand early in their response to chronic experimental IOP elevation. These findings provide phenotypic landmarks and imaging targets for detecting the development of experimental glaucomatous optic neuropathy in the rat eye. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nerve stimulator-guided sciatic-femoral nerve block in raptors undergoing surgical treatment of pododermatitis.

Science.gov (United States)

d'Ovidio, Dario; Noviello, Emilio; Adami, Chiara

2015-07-01

To describe the nerve stimulator-guided sciatic-femoral nerve block in raptors undergoing surgical treatment of pododermatitis. Prospective clinical trial. Five captive raptors (Falco peregrinus) aged 6.7 ± 1.3 years. Anaesthesia was induced and maintained with isoflurane in oxygen. The sciatic-femoral nerve block was performed with 2% lidocaine (0.05 mL kg(-1) per nerve) as the sole intra-operative analgesic treatment. Intraoperative physiological variables were recorded every 10 minutes from endotracheal intubation until the end of anaesthesia. Assessment of intraoperative nociception was based on changes in physiological variables above baseline values, while evaluation of postoperative pain relied on species-specific behavioural indicators. The sciatic-femoral nerve block was feasible in raptors and the motor responses following electrical stimulation of both nerves were consistent with those reported in mammalian species. During surgery no rescue analgesia was required. The anaesthesia plane was stable and cardiorespiratory variables did not increase significantly in response to surgical stimulation. Iatrogenic complications, namely nerve damage and local anaesthetic toxicity, did not occur. Recovery was smooth and uneventful. The duration (mean ± SD) of the analgesic effect provided by the nerve block was 130 ± 20 minutes. The sciatic-femoral nerve block as described in dogs and rabbits can be performed in raptors as well. Further clinical trials with a control groups are required to better investigate the analgesic efficacy and the safety of this technique in raptors. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

Evaluation of phrenic nerve and diaphragm function with peripheral nerve stimulation and M-mode ultrasonography in potential pediatric phrenic nerve or diaphragm pacing candidates.

Science.gov (United States)

Skalsky, Andrew J; Lesser, Daniel J; McDonald, Craig M

2015-02-01

Assessing phrenic nerve function in the setting of diaphragmatic paralysis in diaphragm pacing candidates can be challenging. Traditional imaging modalities and electrodiagnostic evaluations are technically difficult. Either modality alone is not a direct measure of the function of the phrenic nerve and diaphragm unit. In this article, the authors present their method for evaluating phrenic nerve function and the resulting diaphragm function. Stimulating the phrenic nerve with transcutaneous stimulation and directly observing the resulting movement of the hemidiaphragm with M-mode ultrasonography provides quantitative data for predicting the success of advancing technologies such as phrenic nerve pacing and diaphragm pacing. Copyright © 2015 Elsevier Inc. All rights reserved.

Trends in the design of nerve guidance channels in peripheral nerve tissue engineering.

Science.gov (United States)

Chiono, Valeria; Tonda-Turo, Chiara

2015-08-01

The current trend of peripheral nerve tissue engineering is the design of advanced nerve guidance channels (NGCs) acting as physical guidance for regeneration of nerves across lesions. NGCs should present multifunctional properties aiming to direct the sprouting of axons from the proximal nerve end, to concentrate growth factors secreted by the injured nerve ends, and to reduce the ingrowth of scar tissue into the injury site. A critical aspect in the design of NGCs is conferring them the ability to provide topographic, chemotactic and haptotactic cues that lead to functional nerve regeneration thus increasing the axon growth rate and avoiding or minimizing end-organ (e.g. muscle) atrophy. The present work reviews the recent state of the art in NGCs engineering and defines the external guide and internal fillers structural and compositional requirements that should be satisfied to improve nerve regeneration, especially in the case of large gaps (>2 cm). Techniques for NGCs fabrication were described highlighting the innovative approaches direct to enhance the regeneration of axon stumps compared to current clinical treatments. Furthermore, the possibility to apply stem cells as internal cues to the NGCs was discussed focusing on scaffold properties necessary to ensure cell survival. Finally, the optimized features for NGCs design were summarized showing as multifunctional cues are needed to produce NGCs having improved results in clinics. Copyright © 2015 Elsevier Ltd. All rights reserved.

Facilitation of facial nerve regeneration using chitosan-β-glycerophosphate-nerve growth factor hydrogel.

Science.gov (United States)

Chao, Xiuhua; Xu, Lei; Li, Jianfeng; Han, Yuechen; Li, Xiaofei; Mao, YanYan; Shang, Haiqiong; Fan, Zhaomin; Wang, Haibo

2016-06-01

Conclusion C/GP hydrogel was demonstrated to be an ideal drug delivery vehicle and scaffold in the vein conduit. Combined use autologous vein and NGF continuously delivered by C/GP-NGF hydrogel can improve the recovery of facial nerve defects. Objective This study investigated the effects of chitosan-β-glycerophosphate-nerve growth factor (C/GP-NGF) hydrogel combined with autologous vein conduit on the recovery of damaged facial nerve in a rat model. Methods A 5 mm gap in the buccal branch of a rat facial nerve was reconstructed with an autologous vein. Next, C/GP-NGF hydrogel was injected into the vein conduit. In negative control groups, NGF solution or phosphate-buffered saline (PBS) was injected into the vein conduits, respectively. Autologous implantation was used as a positive control group. Vibrissae movement, electrophysiological assessment, and morphological analysis of regenerated nerves were performed to assess nerve regeneration. Results NGF continuously released from C/GP-NGF hydrogel in vitro. The recovery rate of vibrissae movement and the compound muscle action potentials of regenerated facial nerve in the C/GP-NGF group were similar to those in the Auto group, and significantly better than those in the NGF group. Furthermore, larger regenerated axons and thicker myelin sheaths were obtained in the C/GP-NGF group than those in the NGF group.