Peripheral nerve regeneration in rats using nerve graft in a vein conduit pre-filled with platelet-rich fibrin (PRF).

Treatment of peripheral nerve injury is not always satisfactory. To improve results, specific adjuvant methods have been used, such as platelet-rich fibrin (PRF) and vein conduits. The goal of this study was to assess whether use of PRF and vein conduits after nerve suture improves nerve regeneration as measured by a functional score and histomorphometry analysis. Ten isogenic spontaneously hypertensive rats were randomly assigned to 4 experimental procedures: 1) Sham group (n = 10); 2) Nerve graft (NG) group (n = 10); 3) Nerve graft covered with a vein conduit (NGVC) (n = 10); and 4) Nerve graft covered with a vein conduit pre-filled with PRF (NGVCP) (n = 10). Nerve repair results were evaluated on: sciatic functional index (SFI) at 0, 30, 60 and 90 days; morphometric and morphologic analysis of the distal nerve; and histological analysis of Fluoro-Gold® stained motor neurons in the anterior horn of the spinal cord. Compared to the Sham control group, the NGVC and NGVCP groups exhibited lower SFI on all measures. The NGVC group showed improvement in SFI at day 90, which was significant compared to the NG group. Fiber and axon diameters were comparable in the NGVC and NGVCP groups, which were both significantly lower than in the Sham and NG groups. Significant improvement was expected with PRF, but in fact the release of factors from this substance was not as effective as hoped.

Linburg-Comstock anomaly: A comparison of the prevalence in women with and without clinical carpal tunnel syndrome.

We aimed to compare the prevalence of the Linburg-Comstock anomaly in women with and without a clinical diagnosis of carpal tunnel syndrome. The prevalence of the Linburg-Comstock anomaly was evaluated in 400 hands from 200 women over 40 years of age who were diagnosed clinically with carpal tunnel syndrome (CTS), designated as the CTS group. The volunteer group consisted of 400 hands from 200 healthy women over 40 years of age. The women from both groups were asked to carry out the clinical flexion and pain tests described by Linburg and Comstock (1979) as a basis for the clinical diagnosis. CTS patient ages ranged from 40 to 90 (mean 55.8) years, while volunteer group ages ranged from 40 to 93 (mean 55) years. The flexion test was positive in 305 (76%) hands in the CTS group and 242 (60%) hands in the volunteer group. The pain test was positive in 261 (65%) hands in the CTS group and 108 (27%) hands in the volunteer group. Both tests were positive in 244 (61%) hands in the CTS group and 98 (24%) hands in the volunteer group. All these differences were statistically significant. Based on clinical examination using the flexion and pain tests, the prevalence of Linburg-Comstock anomaly was statistically higher in the group of women with carpal tunnel syndrome than in healthy volunteers.

Brachial plexus injuries: diagnosis performance and reliability of everyday tools.

PURPOSE: Determining the patterns of brachial plexus injuries is challenging. Diagnostic methods have been used to facilitate diagnosis, but there is no consensus regarding which tool best complements physical examination (PE). Magnetic resonance imaging (MRI) and nerve conduction studies (NCSs) are instruments with widespread use and feasibility for everyday assessment. In this study, we evaluated the diagnostic performance of these diagnostic instruments and PE. We also assessed the agreement in the PE and diagnostic instrument findings of two experienced and certified hand surgeons. METHODS: We reviewed data gathered from medical records and compared these data with the results of operative findings. We divided data according to the site of injury and the root injury patterns for all three diagnostic instruments (PE, MRI, and NCSs). RESULTS: We considered 102 assessments. We found poor inter-observer agreement for the PE assessments and poor agreement among the PE, NCS, and MRI assessments. Diagnostic performance was higher for PE: sensitivity = 97.8 [95% confidence interval (C.I.) = 92.1-99.7]; specificity = 30.8 [95% C.I. = 9.1-61.4], and NCSs (sensitivity = 98.9 [95% C.I. = 93.9-100]; specificity = 23.1 [95% C.I. = 5-53.8]. MRI had inferior performance for all measurements. Separate analysis using pre- and post-ganglionic injuries revealed that PE had the lowest sensitivity, 46.7 (95% C.I. = 21.3-73.4) despite having the highest specificity, 81.6 (95% C.I. = 71.9-89.1). DISCUSSION: Low agreement among the findings using different diagnostic instruments demonstrated that PE is the most specific tool, despite its low sensitivity. Detailed PE is cornerstone for evaluating brachial plexus injuries and NCSs are better than MRI for scrutinizing injuries not found in PE. CLINICAL RELEVANCE: In our study, NCSs exhibited superior performance to MRI, and should be considered a more reliable supporting tool after detailed PE.