A Prospective Comparative Study on Improvement of Hyperthyroid Cardiovascular Dysfunction in Patients Undergoing Total Thyroidectomy Versus Medical Management.

INTRODUCTION: Cardiovascular dysfunction (CVD) is a well-recognized complication in patients with hyperthyroidism and is the major cause of mortality. Very few studies have compared the outcome of CVD following different treatment modalities. In this study we intended to compare treatment modalities (antithyroid drugs vs surgery) for reversal of CVD. MATERIALS AND METHODS: Patients with newly detected hyperthyroidism were grouped into, Group I [n = 123, age <60 years, undergoing total thyroidectomy], Group II [n = 42, age <60 years, treated with antithyroid medications] were evaluated with 2D echocardiography, serum N terminal pro brain natriuretic peptide (NT-pro-BNP) at the time of diagnosis (Point A), after achieving euthyroidism (Point B) with antithyroid drugs and 6 months after surgery/continuation of antithyroid medications (Point C). Forty patients (Group III), age < 60 years, undergoing total thyroidectomy for nontoxic benign thyroid nodules served as controls. RESULTS: All groups were age and sex matched. At Point A, CVD was evident in 80/123 (65%) in Group I and 28/42 (66.7%) in Group II. At Point B improvement in CVD occurred in 84/123 (68.3%) in Group and 29/42 (69.04%) in Group II. At Point C dramatic improvement in CVD occurred in 118/123 (95.9%) in Group I, whereas only 33/42 (78.5%) improved in Group II. CVD were comparable between Groups I and II at Point A and Point B (p > 0.05). At Point C there was a significant decrease in all the diastolic dysfunction parameters in Group I, whereas the same was not observed in Group II patients. Systolic dysfunction between Groups II and II had no statistical significance at Point C. CONCLUSION: Total thyroidectomy seems to be the definitive treatment of choice for hyperthyroid cardiac dysfunction with diastolic dysfunction completely reversing at 6 months after TT.

Microanatomical and immunohistochemical study of the human lateral antebrachial cutaneous nerve of forearm at the antecubital fossa and its clinical implications.

Changes in the intraneural anatomy with age can cause poor prognosis of nerve repair in patients after nerve injury. The occurrence of Complex Regional Pain Syndrome-Type II, secondary to peripheral nerve injury, is common. The purpose of this study is to asses changes in cross-sectional anatomy of the lateral antebrachial cutaneous nerve of forearm (LCNF) at the antecubital fossa in the fascicular, nonfascicular components (adipose and nonadipose tissue), and sympathetic fibers area with respect to age. For the purpose of the study, 32 human (37-88 years) fresh cadaveric LCNF were collected from left-antecubital fossae and processed for histological, morphometric analysis [total cross-sectional (Asc), fascicular (Af), and nonfascicular area (Anonf)], and immunohistochemical method (tyrosine hydroxylase) for sympathetic fibers. The LCNF's average total cross-sectional area was 3.024 mm(2), and fascicular area was 0.582 mm(2). The average number of fascicles per mm(2) was 3.09. The cross-sectional area in the nerve was mainly occupied by nonfascicular connective tissue (80.75%). There was increased adipose tissue deposition (48.48% of Asc) and decreased collagen fibers (32.24% of Asc) in interfascicular domains without any definite relationship with age. The average sympathetic fiber area was 0.026 mm(2) within the nerve fascicular area without any correlation with age. In LCNF, there was more adipose tissue and less collagen fibers deposition in the interfascicular domains of all age cases, and this may act as an obstacle for nerve fiber regeneration on using LCNF as an interpositional nerve graft.

Distribution of sympathetic fiber areas of radial nerve in the forearm: an immunohistochemical study in cadavers.

PURPOSE: Secondary to peripheral nerve injuries, involvement of sympathetic fibers complications such as complex regional pain syndrome (CRPS) have been reported. There are limited studies on the sympathetic fibers and their distribution in the upper limb nerves. There are no reports available in the distribution of the sympathetic fibers/areas of radial nerve in the forearm. The aim of the present study was an attempt to find the distribution of sympathetic fibers in the radial nerve just above cubital fossa (RN), superficial branch of radial nerve at cubital fossa (SBRN-1) and above wrist (SBRN-2). METHODS: We have studied on 19 fresh human cadaveric RN, SBRN-1, and SBRN-2 samples. Frozen sections of these nerves were processed by immunohistochemical (tyrosine hydroxylase) method for sympathetic fibers. RESULTS: The sympathetic fibers area (Asym) was found to be more in RN when compared to SBRN-1 and SBRN-2. The comparison of the sympathetic index (SI = sympathetic fibers area/total fascicular area of the nerve) between RN and SBRN-1 (p < 0.001), RN and SBRN-2 (p < 0.001), and SBRN-1 and SBRN-2 (p = 0.016) were statistically significant. The sympathetic index (SI) for SBRN-1 was more when compared to RN and SBRN-2. CONCLUSIONS: Sympathetic fibers area (Asym) was found to be more in RN when compared to SBRN-1 and SBRN-2. The sympathetic ratio (SI) and percentage of sympathetic fibers area (Asym %) was more in SBRN-1 when compared to RN and SBRN-2. These results of the study might help to explain sympathetic system-related diseases in the area of distribution of RN and SBRN.

A comparative microanatomical study on cross-sections of superficial branch of radial nerve in proximal and distal parts of the forearm: a cadaveric study.

PURPOSE OF STUDY: Changes in peripheral nerve anatomy with age may be the cause for poor prognosis after nerve repair in elderly cases. The aim of the present study is to find out and compare the cross-sectional microanatomy as well as age-related changes in the non-fascicular components of superficial branch of radial nerve at cubital fossa (SBRN-1) and above wrist (SBRN-2). METHODS: Thirty-eight fresh human (14 male and five female) cadaveric SBRN-1 and SBRN-2 were collected from both sides of 19 cadavers and study has been performed at different magnifications after routine histological (Masson's trichrome stain) processing was done for morphometric analysis (total cross-sectional area [Asc], fascicular area [Af], non-Af [Anonf], adipose [FAT] area and non-adipose area [nFAT]). RESULTS: SBRN-1 and SBRN-2 belonged to polyfascicular type and showed difference in amount of connective and adipose tissues in Anonf. The number of fascicles in SBRN-1 ranged from 2 to 6 (3.66±0.21, mean±SEM) and in SBRN-2 ranged from 7.5 to 11.5 (9.24±0.26). On comparing the percentage level of adipose tissue (FAT) in total cross-section area (Asc) and in Anonf of SBRN-1 and SBRN-2, the level of adipose tissue was increased with age. CONCLUSIONS: The amount of adipose tissue in SBRN-1 and SBRN-2 Anonf was found to be high in most of the elderly cases. On comparison, there was not much difference between SBRN-1 and SBRN-2, but, the fascicle count was found to be increasing gradually from proximal to distal part of the SBRN.

Microanatomical and immunohistochemical study of the human anterior branch of the medial antebrachial cutaneous nerve of forearm at the antecubital fossa and its clinical implications.

PURPOSE: Poor prognosis of nerve repair in patients may be due to changes in intraneural anatomy with age. Also, chances of Complex Regional Pain Syndrome-Type I (CRPS-I) secondary to peripheral nerve injury are comparatively high. The present study is to find the fascicular pattern of the anterior branch of the medial antebrachial cutaneous nerve of forearm (MACN) (at antecubital fossa), microanatomic morphometric characteristics of its connective tissue components (adipose tissue) and changes with age and study of intraneural sympathetic fiber content. MATERIAL AND METHODS: Sixty six human (37-88-year-old) cadaveric anterior branch of MACN have been collected from antecubital fossa and the study has been performed at magnifications (5x, 10x, 20x, and 40x objective) after routine histological (Hematoxylin & Eosin stain, Masson's trichrome stain) processing was done for morphometric analysis (total cross-sectional, fascicular and non-fascicular area) and immunohistochemical (tyrosine hydroxylase) processing for sympathetic fibers. RESULTS AND CONCLUSIONS: The anterior branch of the MACN's average total cross section area was 1.150 mm(2) on right side and 1.156 mm(2) on left side. There was significant increase in non-fascicular connective tissue area. In non-fascicular area, there was very less amount of adipose tissue in 86.37% of cases and more adipose tissue in 13.63% (elderly) cases. The average sympathetic fiber area is 0.0109 mm(2) without definite relationship with age. Our study makes an attempt to build a normal data base for MACN which might be helpful during the application of diagnostic and surgical nerve graft procedures.

Distribution of sympathetic fiber areas in the sensory nerves of forearm: an immunohistochemical study in cadavers.

PURPOSE: Secondary to peripheral nerve injuries, involvement of sympathetic fibers complications such as Complex Regional Pain Syndrome (CRPS) have been reported. There are no reports available in the distribution of the sympathetic fibers/areas of sensory nerves in the forearm. MATERIALS AND METHODS: The present study aim is an attempt to find the distribution of sympathetic fibers in the anterior branch of medial antebrachial cutaneous nerve of forearm (AMACN), lateral antebrachial cutaneous nerve of forearm (LACN) and superficial branch of radial nerve (SBRN) at cubital fossae. We have studied on 17 fresh human cadaveric AMACN, LACN and SRBN samples. Frozen sections of these nerves were processed by immunohistochemical (tyrosine hydroxylase) method for sympathetic fibers. RESULTS: Sympathetic fibers area (Asym) was found to be more in SBRN when compared to AMACN and LACN. The comparison of the sympathetic index (SI = sympathetic fibers area / total fascicular area of the nerve) between AMACN and LACN (p-value < 0.001), AMACN and SBRN (p-value <0.001), LACN and SBRN (p-value < 0.001) were statistically significant. Sympathetic index (SI) for SBRN was more when compared to AMACN and LACN. SBRN had maximum percentage (5.16%) of Asym when compared with LACN and AMACN. CONCLUSIONS: Sympathetic fibers area (Asym), sympathetic index (SI) and percentage of sympathetic fibers area (Asym %) were found to be more in SBRN when compared with AMACN and LACN. These results of the study might help to explain sympathetic system-related diseases in the area of distribution of AMACN, LACN and SBRN.

Ultrasonographical and histological cross-sectional study of the human superficial branch of the radial nerve.

PURPOSE: The superficial branch of radial nerve (SBRN) is one of the cutaneous nevus biopsied for diagnosis of peripheral neuropathy. The purpose of this study is to find out the cross sectional microanatomy of the (SBRN) at antecubital fossa for changes in the fascicular, non-fascicular components with respect to age and also to find cross sectional area of SBRN in healthy volunteers. MATERIALS AND METHODS: Sixty SBRN were harvested bilaterally from 30 fresh human bodies (25 males and five females) with ages of 37 to 88 years. Samples were divided into three age groups (G1, 37-55 years; G2, 55-70 years; G3, ≥ 71 years) and studied at different magnifications after histological processing for morphometric analysis - total cross-sectional (Asc), fascicular (Af), and non-fascicular area (Anonf). Fifteen volunteers SBRN cross sectional area was measured by ultrasonography (US). RESULTS: The SBRN was found to have 2-6 fascicles. The differences in the adipose tissue (FAT) areas, between G1 and G2 (p=0.233) and between G2 and G3 (p=0.458) were not statistically significant. However, a significant difference was seen between G3 and G1 (p=0.021). The differences in the non-adipose tissue (FAT) areas, between G1 and G2 (p=0.110), between G2 and G3 (p=0.950) and between G3 and G1 (p=0.210) were not statistically significant. The amount of adipose tissue (FAT) in the epifascicular and interfascicular region increased in elderly individuals (age ≥ 71 years). Ultrasonographic cross-sectional area ranged from 2 to 3 mm². CONCLUSIONS: Our study revealed comparatively more adipose tissue in human SBRN with advanced age (≥ 71 years). Findings may help to explain poor prognosis with advancing age following repair. SBRN ultrasonographical Asc was comparable to histological Asc in ages between 37-55 years.

Anthropometric analysis of the infraorbital foramen in a South Indian population.

INTRODUCTION: The aim of this study was to document the morphological and topographical anatomy of the infraorbital foramen (IOF) in relation to the infraorbital rim (IOR), which is necessary in clinical situations that require regional nerve blocks. METHODS: A total of 80 dry South Indian adult human skulls of unknown age and gender were studied. In each skull, the IOF on both sides was measured using a metal casing digital vernier caliper, with the IOR as the reference point. The IOF's location and its transverse and vertical diameters were measured. The shape, size, orientation and accessory foramens of the IOF were also documented. RESULTS: The majority of IOF among the skulls were oval-shaped on both the right (55 percent) and left (51.25 percent) sides. The majority were directed inferomedially on both the right (55 percent) and left (52.50 percent) sides. The overall combined distance between the IOR and IOF was 4.1 to 11.5 (6.57 +/- 1.28) mm. The overall combined vertical diameter was 1.2 to 4.7 (2.82 +/- 0.79) mm. The overall combined transverse diameter was 1 to 5.1 (2.87 +/- 0.78) mm. Accessory foramens of IOF were found in 13 (16.25 percent) skulls. CONCLUSION: Knowledge of the anatomical characteristics of IOF locations, diameters, shapes, directions and its accessory foramens may have important implications on blocking the infraorbital nerve for surgical and local anaesthetic planning. Information on the shape of the foramens obtained from this study may provide additional guidance to surgeons when introducing needles in anaesthetic procedures.

A comparative microanatomical study on cross sections of medial and lateral cutaneous nerves of forearm at the antecubital fossa: a cadaveric study.

BACKGROUND: The anterior branch of the medial antebrachial cutaneous nerve of the forearm (AMACN) and the lateral antebrachial cutaneous nerve of the forearm (LACN) are used as potential donor grafts for repairing sensory nerves. A higher percentage of connective tissue plays an important role in predicting prognosis after nerve repair. The aim is to perform a comparative study on cross-sectional microanatomy and age related changes in non-fascicular components of the AMACN and LACN. METHODS: Thirty six fresh human (from both sides of 14 male and 4 female) cadaveric AMACN and LACN were collected at antecubital fossae and studied at different magnifications for morphometric analysis (total cross-sectional area (Asc), fascicular area (Af) and non-fascicular area (Anonf)), after histological (Masson's trichrome stain) processing. RESULTS: AMACN and LACN belong to polyfascicular type and showed differences in amount of connective and adipose tissues in non-fascicular areas. In the AMACN, there was less adipose tissue (19.38% in Asc and 25.57% in Anonf) with more collagen fibers (57.28% in Asc and 75.57% in Anonf) and in the LACN, there was more adipose tissue (47.51% in Asc and 58.19% in Anonf) with fewer collagen fibers (34.10% in Asc and 41.76% in Anonf) in interfascicular domains. CONCLUSIONS: The amount of adipose tissue in LACN non-fascicular area was found to be high at all ages. The presence of less adipose tissue and collagen fibers in the non-fascicular area of the AMACN (below 60 years) could be used for successful nerve grafting when compared to LACN.

Microanatomical and immunohistochemical study of the human radial nerve at the antecubital fossa.

BACKGROUND: Poor prognosis of radial nerve repair in elderly patients may be due to changes in intraneural anatomy with age. Also, chances of Complex Regional Pain Syndrome-Type I (CRPS-I) following radial nerve injury are comparatively high. The present study is to find the fascicular pattern of radial nerve (at antecubital fossa), microanatomic morphometric characteristics of its connective tissue components and changes with age and study of intraneural sympathetic fiber content. METHODS: Twenty human (21-87 years) cadaveric radial nerves have been collected from antecubital fossa and the study has been performed at magnifications (10x, 20x and 40x objective) after routine histological (hematoxylin & eosin stain) processing was done for morphometric analysis (total cross-sectional, fascicular and non-fascicular area) and immunohistochemical (tyrosine hydroxylase) processing for sympathetic fibers. RESULTS: The radial nerve is of a polyfascicular type with a grouped pattern of nerve fascicular distribution. The number of fascicles range from 9 to 17, whereas the number of fascicles per square millimeter of a cross-sectional area is 1.95. In elderly cases, there is significant increase in total radial nerve cross-sectional area due to an increase in its non-fascicular connective tissue area and excessive adipose tissue deposition in interfascicular domains. The average sympathetic fiber area is 0.046 mm(2) without definite relationship to age. CONCLUSION: There is an increase in total nerve cross-sectional area of the radial nerve in elderly cases. There is no relationship of sympathetic content to age. Our study makes an attempt to build a normal data base for radial nerve which might be helpful during the application of diagnostic procedures.