Brachial artery perforator-based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis.

It is difficult for most plastic and orthopaedic surgeons to treat nerve dysfunction related to neural adhesion because the pathophysiology and suitable treatment have not been clarified. In the current report, we describe our experience of surgical treatment for adhesive ulnar neuropathy. A 58-year-old male complained of pain radiating to the ulnar nerve-innervated area during elbow and wrist motion caused by adhesive ulnar neuropathy after complex open trauma of the elbow joint. The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve. This flap may be a useful option for ulnar nerve coverage after neurolysis without microvascular anastomosis in specific cases.

A new nerve block procedure for the suprascapular nerve based on a cadaveric study.

HYPOTHESIS: Shoulder pain after rotator cuff repair surgery is sometimes very severe. Suprascapular nerve block (SSNB) is a method used to relieve this shoulder pain, but is not always completely effective. The purpose of this study is to develop the new effective suprascapular nerve block procedure. METHODS: To obtain an effective SSNB, we investigated an anatomic lesion of the sensory branches of the SSN in 8 cadavers and developed a new procedure. We evaluated its effectiveness by recording visual analog scale (VAS) scores in 8 patients experiencing severe pain after rotator cuff repair surgery before SSNB and for up to 24 hours postoperatively. RESULTS: All cadaver shoulders had 2 or 3 sensory branches that just passed the scapular notch. The branches originated from the SSN, pursued the base of the coracoid process, perforated the supraspinatus muscle, and extended toward the subacromial bursa. The average VAS score of the 8 patients postoperatively was 5.4 +/- 2.7 before SSNB and improved to 2.8 +/- 1.6 immediately after SSNB, to 1.2 +/- 0.6 at 1 hour, and to 0.8 +/- 0.8 at 4 hours. Effective pain control was achieved, and SSNB presented no complications. CONCLUSION: Our SSNB method is safe and effective for pain control in patients after open cuff repair. We expect it will be a useful management tool for pain relief after rotator cuff repair in the future. LEVEL OF EVIDENCE: Basic science study.

Dose-dependent effects of barley cooked with white rice on postprandial glucose and desacyl ghrelin levels.

White rice is an indispensable staple food in Japan, although it is a high glycemic index food. The objective of this study was to estimate how barley cooked with white rice might affect postprandial glucose, insulin and desacyl ghrelin concentrations as well as fullness. The study was conducted in randomized crossover design with nine healthy subjects. Blood glucose, insulin, free fatty acid and desacyl ghrelin concentrations and subjective levels of fullness and hunger were measured for 240 min after intake of glucose, white rice, 30% rolled barley (30BAR), 50% rolled barley (50BAR) and 100% rolled barley (100BAR) containing 75 g of available carbohydrate. Postprandial glucose and insulin levels were suppressed by intake of 30BAR, 50BAR and 100BAR comparing with those of white rice. Area under the curves of plasma glucose and insulin concentrations was reduced by barley intake in a dose-dependent manner. Although plasma desacyl ghrelin levels decreased postprandially, the degree of reduction was suppressed by barley intake in a dose-dependent manner. Postprandial desacyl ghrelin levels can be a sensitive biomarker of carbohydrate metabolism. The combination of white rice with barley plays a beneficial role in preventing and treating type 2 diabetes, obesity and other metabolic diseases.

Nutritional treatment of a patient with hepatic cirrhosis with the novel low glycemic index liquid food (Inslow).

A sixty-six year-old patient with liver cirrhosis and diabetes was nutritionally treated by administration of the low glycemic index liquid food (Inslow) as a late evening sack (LES) for 6 weeks. The mean energy intake increased from 825+/-48 kcal/d to 1567+/-66 kcal/d after the 6-week treatment period. The fasting glucose level did not change, remaining at about 100 mg/dl throughout this period. Interestingly, the amount of insulin administered was reduced from 38 units before treatment to 28 units in the fifth week of treatment without a change in the fasting glucose level. This indicates a marked improvement in insulin sensitivity due to Inslow administration in this patient. In conclusion, the long-term administration of Inslow as an LES may be an effective treatment for cirrhotic patients.