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1.
J Hand Surg Am ; 43(5): 417-424, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29395588

RESUMO

PURPOSE: Brachial plexus birth injuries with multiple nerve root avulsions present a particularly difficult reconstructive challenge because of the limited availability of donor nerves. The contralateral C7 has been described for brachial plexus reconstruction in adults but has not been well-studied in the pediatric population. We present our technique and results for retropharyngeal contralateral C7 nerve transfer to the lower trunk for brachial plexus birth injury. METHODS: We performed a retrospective review. Any child aged less than 2 years was included. Charts were analyzed for patient demographic data, operative variables, functional outcomes, complications, and length of follow-up. RESULTS: We had a total of 5 patients. Average nerve graft length was 3 cm. All patients had return of hand sensation to the ulnar nerve distribution as evidenced by a pinch test, unprompted use of the recipient limb without mirror movement, and an Active Movement Scale (AMS) of at least 2/7 for finger and thumb flexion; one patient had an AMS of 7/7 for finger and thumb flexion. Only one patient had return of ulnar intrinsic hand function with an AMS of 3/7. Two patients had temporary triceps weakness in the donor limb and one had clinically insignificant temporary phrenic nerve paresis. No complications were related to the retropharyngeal nerve dissection in any patient. Average follow-up was 3.3 years. CONCLUSIONS: The retropharyngeal contralateral C7 nerve transfer is a safe way to supply extra axons to the severely injured arm in brachial plexus birth injuries with no permanent donor limb deficits. Early functional recovery in these patients, with regard to hand function and sensation, is promising. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Transferência de Nervo/métodos , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/cirurgia , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/etiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Nervo Ulnar/cirurgia
2.
J Clin Invest ; 122(12): 4533-43, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23160197

RESUMO

In multiple sclerosis (MS) pathogenic B cells likely act on both sides of the blood-brain barrier (BBB). However, it is unclear whether antigen-experienced B cells are shared between the CNS and the peripheral blood (PB) compartments. We applied deep repertoire sequencing of IgG heavy chain variable region genes (IgG-VH) in paired cerebrospinal fluid and PB samples from patients with MS and other neurological diseases to identify related B cells that are common to both compartments. For the first time to our knowledge, we found that a restricted pool of clonally related B cells participated in robust bidirectional exchange across the BBB. Some clusters of related IgG-VH appeared to have undergone active diversification primarily in the CNS, while others have undergone active diversification in the periphery or in both compartments in parallel. B cells are strong candidates for autoimmune effector cells in MS, and these findings suggest that CNS-directed autoimmunity may be triggered and supported on both sides of the BBB. These data also provide a powerful approach to identify and monitor B cells in the PB that correspond to clonally amplified populations in the CNS in MS and other inflammatory states.


Assuntos
Linfócitos B/imunologia , Barreira Hematoencefálica/imunologia , Esclerose Múltipla/imunologia , Adulto , Linfócitos B/fisiologia , Barreira Hematoencefálica/patologia , Evolução Clonal , Análise por Conglomerados , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Imunoglobulina G/genética , Região Variável de Imunoglobulina/líquido cefalorraquidiano , Região Variável de Imunoglobulina/genética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/patologia , Receptores de Antígenos de Linfócitos B/genética , Receptores de Antígenos de Linfócitos B/metabolismo , Hipermutação Somática de Imunoglobulina , Adulto Jovem
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