Surgical treatment of painful neuroma in medial antebrachial cutaneous nerve.

The branches of the medial antebrachial cutaneous nerve (MACN) are located at the medial site of the elbow. The MACN, especially the posterior branches, may be injured or transected during cubital tunnel surgery or other medial approaches to the elbow. Damage to the nerve can cause a neuroma, which leads to disabling pain and restriction of elbow movement. The initial treatment of the neuroma is nonsurgical, and includes local massage, desensitization, physiotherapy, and systemic medication. If after 6 months of these nonsurgical treatments there is no improvement, surgery is indicated. The authors report their experience with 12 patients treated surgically for painful neuroma by high resection of the proximal end or its implantation into the triceps muscle. After surgery there was a high success rate of pain relief and functional improvement in both elbow movement and handgrip strength.

[Compartment syndrome or gas gangrene? A case report]. / Sindrome compartimentale o gangrena gassosa? Caso clinico.

A case of forearm compartment syndrome due to a minor trauma is reported. The severe clinical conditions due to a shock state lead to an initial misdiagnosis of clostridial myonecrosis. The patient, 68 y-old woman, was admitted to the intensive care unit of Authors' hospital for a traumatic injury of the right forearm. A diagnosis of gas gangrene due to clostridial myonecrosis was done and forearm amputation suggested. In spite of this indication a decompression fasciotomy of the forearm compartments was performed as well as a hyperbaric oxygene therapy. Since culture of necrotic tissue samples did not demonstrate any bacterial growth, the Authors decided to avoid amputation and perform a radial arteriovenous fistula to improve venous return and reduce distal edema and continuous bleeding, with a complete recovery within 40 days. Good evaluation of patient with suspected compartment syndrome means correct and not delayed treatment, avoiding invalidating outcome.

Motor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation.

The effects of spinal cord stimulation (SCS), deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) were analyzed in 19 patients with phantom limb pain. All of the patients underwent SCS and, if the SCS failed to reduce the pain, the patients were considered for DBS and/or MCS. Satisfactory pain control for the long-term was achieved in 6 of 19 (32%) by SCS, 6 of 10 (60%) by DBS and 1 (20%) of 5 by MCS. SCS and DBS of the VC sometimes produced a dramatic effect on the pain, leading to a long pain-free interval and infrequent use of stimulation. The effects of both DBS of the VC and MCS were tested in four. One patient of them reported better pain control by MCS than by DBS, whereas two reported the opposite results. There is no evidence at present for an advantage of MCS over SCS and DBS of the VC in controlling phantom limb pain.

Systemic hormonal, electrolyte, and substrate changes after non-thermal limb injury in children.

Relatively little is known regarding the hormonal changes after injury in children. Adult protocols are often applied to children, although the latter often have different physiological responses to trauma. Twenty children with an angulated displaced fracture of the radius and/or ulna (injury severity score 9) were studied prospectively for changes in adrenaline, noradrenaline, cortisol, angiotensin II, arginine vasopressin, urea, electrolytes, and glucose. Two blood samples were taken: one an arrival at the accident and emergency department and one preoperatively several hours later. There were marked increases in adrenaline, noradrenaline, cortisol, and arginine vasopressin above the normal range. Five (25%) cases demonstrated greater early increases in adrenaline than those reported for adult injuries of similar severity. Early hypokalaemia in four cases had corrected towards normal within a few hours, without potassium supplementation.

Brain-gut axis and mucosal immunity: a perspective on mucosal psychoneuroimmunology.

The role of the brain-gut axis has traditionally been investigated in relation to intestinal motility, secretion, and vascularity. More recently, the concept of brain-gut dialogue has extended to the relationship between the nervous system and mucosal immune function. There is compelling evidence for a reciprocal or bi-directional communication between the immune system and the neuroendocrine system. This is mediated, in part, by shared ligands (chemical messengers) and receptors that are common to the immune and nervous systems. Although the concept of psychoneuroimmunology and neuroimmune cross-talk has been studied primarily in the context of the systemic immune system, it is likely to have special significance in the gut. The mucosal immune system is anatomically, functionally, and operationally distinct from the systemic immune system and is subject to independent regulatory signals. Furthermore, the intestinal mucosal immune system operates in a local milieu that depends on a dense innervation for its integrity, with juxtaposition of neuroendocrine cells and mucosal immune cells. An overview of evidence for the biologic plausibility of a brain-gut-immune axis is presented and its potential relevance to mucosal inflammatory disorders is discussed.

Dorsal compartment syndrome of the upper arm. A case report.

A rare case of posttraumatic dorsal compartment syndrome of the upper arm is reported. This case was diagnosed by measuring the intracompartmental pressure. The patient was administered local anesthesia and immediately underwent surgery. The result was successful.

Rehabilitation of patient with brachial plexus lesion and break in axillary artery. Case study.

This paper describes the physiotherapy and occupational therapy used in treating a 74-year-old woman with a left brachial plexus lesion, a break in the axillary artery, dislocation of the acromioclavicular joint, a broken scapula and clavicula, serial left rib fractures, and lacerations on the upper and lower arm. After testing the patient, the following goals were set: reduce pain, soften scar tissue, and improve joint motion, muscle strength, and functionality of the hand. A 12-month outpatient program was used. Various analgesics were used to reduce pain, and a special aid was made to unweight the shoulder and elbow joints. Physiotherapy included kinesiotherapy, audiovisual biofeedback, electrical stimulation, friction massage, and lymph drainage. Occupational therapy included active functional exercises and re-education. As a result of this program, the patient no longer had pain, passive range of motion was close to normal, active motion where present was improved, swelling was reduced, and the hand became functional again. Complex physiotherapy, occupational therapy, and the patient's motivation resulted in the rehabilitation of severe trauma of the hand.

[A trial of using a weak geomagnetic field in treating acute and chronic surgical infection]. / Opyt primeneniia oslablennogo geomagnitnogo polia v lechenii ostroi i kronicheskoi khirurgicheskoi infektsii.

Results of treatment of 147 stomatologic and traumatologic patients with acute and chronic surgical infection are presented. A weak geomagnetic induction field (B approximately 0,125 x 10(-4) T) is a medical factor. Local partial screening of the geomagnetic field in the area of the pathological focus shows high efficiency of treatment of the patients in question. The nearest positive results of treatment equals 99,3%. Long-term positive results--91,9%.

[The use of physical factors in the combined treatment of traumatic damages to the nerve trunks of the extremities]. / Primenenie fizicheskikh faktorov v kompleksnom lechenii pri travmaticheskikh povrezhdeniiakh nervnykh stvolov konechnostei.

Traumatic impairment of peripheral nerves in the limbs requires multimodality treatment including physiotherapy, chemotherapy, orthopedic methods, massage, manual therapy. The above complex produced responses in the majority of patients treated.

[Medical gymnastics in the rehabilitative treatment of patients with locomotor injuries in combined and multiple trauma]. / Lechebnaia gimnastika v vostanovitel'nom lechenii bol'nykh s povrezhdeniiami oporno-dvigatel'nogo apparata pri sochetannoi i mnozhestvennoi travme.

The follow-up of 70 patients with trauma-related locomotor disorders proved that breathing exercises, vibratory massage, chest heparin electrophoresis, drug inhalations early after the injury can be effective in prevention and treatment of pulmonary complications. Transcutaneous neuroelectrostimulation noticeably enhanced the recovery of the locomotor function.

[Effectiveness of regional electric stimulation of the sympathetic ganglia in the treatment of suppurative wounds]. / Effektivnost' regionarnoi élektrostimuliatsii uzlov simpaticheskogo stvola v lechenii gnoinoi rany.

A new method of regional electrostimulation by means of influencing with low-intensity and frequency rectangular impulse current upon the sympathetic trunk in combination with a purulent wound treatment by the low-frequency ultrasound in the liquid media of tomicide contributes to significant enhancing the effectiveness of treatment of the patients, 2-fold shortening of a hydratation phase duration, rapid stabilization of general state of the patients. No side effects and complications were noted in performance of electrostimulation.

[Assessment of the value of stimulation from a preparation of Tolpa peat for treatment of trauma related osteomyelitis]. / Badania wartosci stymulujacej preparatu torfowego Tolpy w leczeniu pourazowego zapalenia kosci.

Tolpa peat preparation at the dose of 5 mg per day was administered to 10 patients with chronic posttraumatic osteomyelitis for 6 weeks period of time. Good clinical result (ceasing of the inflammatory process) was found in 4 patients but 3 of them were concurrently treated surgically. Immunological examination (angiogenesis test and chemiluminescence test) performed before the onset and after completion of the treatment with Tolpa preparation did not reveal meaningful changes indicating immunomodulating action of the preparation on the course of posttraumatic osteomyelitis.

[Experimental substantiation of using gentacycol for prevention of wound infection in gunshot bone fractures of the extremities]. / Eksperimental'noe obosnovanie primeneniia gentatsikola dlia profilaktiki ranevoi infektsii pri ognestrel'nykh perelomakh kostei konechnoste'i.

There have been experimentally studied the antibacterial properties of the preparation "gentacycol" developed in the research institute of antibiotics. Its effective agent is gentamycin and as the matrix of a carrier modified collagen is used. It is indicated that in vitro and at implantation in preliminary infected ordinary and gunshot osseous wounds in rabbits and dogs gentacycol inhibits the growth of aerobic and, that is especially important, anaerobic microflora, limits the development of inflammatory Process and stimulates, to a certain extent, reparative osteogenesis. The obtained data allows to recommend gentacycol application for prophylaxis of wound infection in treatment of gunshot limb bone injuries.

[Prevention of wound infection after open injuries of the limbs by hyperbaric oxygenation]. / Profilaktika ranevoi infektsii pri otkrytoi travme konechnostei posredstvom giperbaricheskoi oksigenatsii.

The effect of HBO on the clinical course of open traumas of extremities was studied in 165 patients. The early inclusion of HBO in the complex therapy of such patients was found to give 2,4 times less incidence of wound infections. The normalizing effect of HBO on central hemodynamics, local blood circulation in the trauma zone, microcirculation in this area, immunity and external ventilation was noted.