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1.
Vasc Endovascular Surg ; 54(5): 467-470, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32378483

RESUMO

We present a rare case of a 10-cm right subclavian artery pseudoaneurysm, with slow growth over 4 years after a traumatic fracture of the right clavicle. The patient had multiple prior endovascular attempts of embolization and stenting at other hospitals; despite this the pseudoaneurysm continued to grow and caused mass effect and neurologic symptoms. We present our open approach for the repair and a review of literature.


Assuntos
Falso Aneurisma/terapia , Neuropatias do Plexo Braquial/cirurgia , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Artéria Subclávia/cirurgia , Lesões do Sistema Vascular/terapia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Neuropatias do Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/etiologia , Clavícula/lesões , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/instrumentação , Feminino , Fraturas Ósseas/complicações , Humanos , Ligadura , Pessoa de Meia-Idade , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/lesões , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
2.
Expert Rev Med Devices ; 17(2): 111-122, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31964194

RESUMO

Introduction: MR neurography (MRN) of the brachial plexus has emerged in recent years as a safe and accurate modality for the identification of brachial plexopathies in pediatric and adult populations. While clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has long relied upon nonspecific physical exam and electrodiagnostic testing modalities, MRN now permits detailed interrogation of peripheral nerve anatomy and pathology, as well as assessment of surrounding soft tissues and musculature, thereby facilitating accurate diagnosis. The reader will learn about the current state of brachial plexus MRN, including recent advances and future directions, and gain knowledge about the adult and pediatric brachial plexopathies that can be characterized using these techniques.Areas Covered: The review details recent developments in brachial plexus MRN, including increasing availability of 3.0-T MR scanners at both private and academic diagnostic imaging centers, as well as the advent of multiple new vascular and fat signal suppression techniques. A literature search of PubMed and SCOPUS was used as the principal source of information gathered for this review.Expert Opinion: Refinement of fat-suppression, 3D techniques and diffusion MR imaging modalities has improved the accuracy of MRN, rendering it as a useful adjunct to clinical findings during the evaluation of suspected brachial plexus lesions.


Assuntos
Plexo Braquial/diagnóstico por imagem , Imagem por Ressonância Magnética/tendências , Adulto , Neuropatias do Plexo Braquial/diagnóstico por imagem , Criança , Humanos , Traumatismos dos Nervos Periféricos/diagnóstico por imagem
3.
World Neurosurg ; 135: e350-e357, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31837496

RESUMO

OBJECTIVE: To investigate functional outcome from reconstructive surgery in adult traumatic brachial plexus injury (AT-BPI) with associated vascular lesions. METHODS: A retrospective review was performed of 325 patients with AT-BPI who underwent reconstructive surgery between 2001 and 2012. Patients with (vascular group) and without (control group) vascular injuries were identified by review of medical documentation. Patient presentation, characteristics of nerve and associated lesions, and surgical management were evaluated to identify prognostic variables. Postoperative muscle strength, range of motion, and patient-reported disability scores were analyzed to determine long-term outcome. RESULTS: Sixty-eight patients had a concomitant vascular injury. There were no significant differences in age or sex between the control and vascular groups. The vascular group was more likely to have pan-plexus lesions (P < 0.0001), with significantly more associated upper extremity injuries (P < 0.0001). The control group underwent more nerve transfers, whereas the vascular group underwent more nerve grafting (P = 0.003). Complete outcome data were obtained in 139 patients, which included 111 control (43% of all control subjects) and 28 vascular patients (41%). There was no significant difference in patient-reported disability scores between the 2 groups. However, 73% of control subjects had grade 3 or greater postoperative elbow flexion, whereas only 43% of vascular patients achieved this strength (P = 0.003). Control patients demonstrated a greater increase in strength of shoulder abduction as well (P = 0.004). Shoulder external rotation strength was grade 0 in most patients, with no difference between the 2 groups. CONCLUSIONS: Concomitant vascular injury leads to worse functional outcome after reconstructive surgery of traumatic brachial plexus injury.


Assuntos
Plexo Braquial/lesões , Procedimentos Neurocirúrgicos , Lesões do Sistema Vascular/fisiopatologia , Adulto , Neuropatias do Plexo Braquial , Humanos , Masculino , Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos/métodos , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
4.
Muscle Nerve ; 61(3): 390-395, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31820462

RESUMO

INTRODUCTION: After traumatic nerve injury, neuromuscular junction remodeling plays a key role in determining functional outcomes. Immunohistochemical analyses of denervated muscle biopsies may provide valuable prognostic data regarding clinical outcomes to supplement electrodiagnostic studies. METHODS: We performed biopsies on nonfunctioning deltoid muscles in two patients after gunshot wounds and visualized the neuromuscular junctions using two-photon microscopy with immunohistochemistry. RESULTS: Although the nerves in both patients showed evidence of acute Wallerian degeneration, some of the motor endplates were intact but exhibited significantly decreased surface area and volume. Both patients exhibited substantial recovery of motor function over several weeks postinjury. DISCUSSION: Two-photon microscopic assessment of neuromuscular junction integrity and motor endplate morphometry in muscle biopsies provided evidence of partial sparing of muscle innervation. This finding supported the clinical judgment that eventual recovery would occur. With further study, this technique may help to guide operative decisionmaking after traumatic nerve injuries.


Assuntos
Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/patologia , Placa Motora/patologia , Adulto , Neuropatias do Plexo Braquial/fisiopatologia , Músculo Deltoide/inervação , Músculo Deltoide/patologia , Eletromiografia , Humanos , Masculino , Microscopia , Placa Motora/fisiologia , Condução Nervosa , Imagem Óptica , Adulto Jovem
6.
Ann Vasc Surg ; 62: 70-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31207398

RESUMO

BACKGROUND: The objective of this study was to characterize phrenic nerve and brachial plexus variation encountered during supraclavicular decompression for neurogenic thoracic outlet syndrome and to identify associated postoperative neurologic complications. METHODS: A multicenter retrospective review was performed to evaluate anatomic variation of the phrenic nerve and brachial plexus from November 2010 to July 2018. After initial characterization, the following two groups were identified: variant anatomy (VA) group and standard anatomy (SA) group. Complications were analyzed and compared between the two groups. RESULTS: In total, 105 patients were identified, and 100 patients met inclusion criteria. Any anatomic variation of the standard course or configuration of the phrenic nerve and/or brachial plexus was encountered in 47 (47%) patients. Phrenic nerve anatomic variations were identified in 28 (28%) patients. These included 9 duplicated nerves, 6 lateral accessory nerves, 8 medial displacement, and 5 lateral displacement. Brachial plexus anatomic variation was found in 34 (34%) patients. The most common variant configuration of a fused middle and inferior trunk was identified in 25 (25%) patients. Combined phrenic nerve and brachial plexus anatomic variation was demonstrated in 15 (15%) patients. The VA and SA groups consisted of 47 and 53 patients, respectively. Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm was documented in 3 (6.4%) patients in the VA group and 6 (11.3%) patients in the SA group (P = 0.49). Permanent phrenic nerve injury was identified in 1 (2.1%) patient in the VA group (P = 0.47) and none in the SA group. Transient brachial plexopathy was encountered in 1 (1.9%) patient in the SA group (P = 1.0) with full recovery to normal function. CONCLUSIONS: Anatomic variability of the phrenic nerve and brachial plexus are encountered more frequently than previously reported. While the incidence of nerve injury is low, surgeons operating within the thoracic aperture should be familiar with variant anatomy to reduce postoperative complications.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/anormalidades , Descompressão Cirúrgica/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Frênico/anormalidades , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Masculino , Maryland , Traumatismos dos Nervos Periféricos/fisiopatologia , Philadelphia , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento
8.
BMJ Case Rep ; 12(12)2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874847

RESUMO

We report a 28-year-old man admitted postmotorcycle versus car in September 2017. The patient sustained multiple injuries in both the upper and lower limbs. He sustained a complex brachial plexus injury on his left side and was transferred immediately to Stanmore Hospital to undergo specialist surgery (supraclavicular brachial plexus exploration and neurolysis) to repair his brachial plexus injury. The patient was transferred back to the specialist trauma ward for additional surgeries for his subsequent injuries. Due to the complexity of the injury and surgery the patient was not able to start rehabilitation until six weeks post operation, at which point he was referred to outpatient physiotherapy. Prior to this his left upper limb was in a sling but was instructed to move it as able. The patient commenced his comprehensive physiotherapy programme in January 2018.


Assuntos
Plexo Braquial/lesões , Terapia por Estimulação Elétrica/métodos , Traumatismo Múltiplo/etiologia , Acidentes de Trânsito , Adulto , Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/reabilitação , Humanos , Masculino , Motocicletas , Traumatismo Múltiplo/reabilitação , Tomografia Computadorizada por Raios X
10.
Eur J Obstet Gynecol Reprod Biol ; 243: 57-62, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31671293

RESUMO

OBJECTIVES: To establish the incidence of obstetric neonatal brachial plexus and facial nerve injuries in a tertiary maternity hospital in the United Kingdom and to identify associated risk factors with an emphasis on the time of delivery. STUDY DESIGN: From our hospital electronic data bases we identified all live births born between 2000 and 2016 and those neonates who sustained a nerve injury during delivery. We performed a logistic regression analysis linking "facial nerve injury" and "brachial plexus injury" with variables for which we had complete cohort data including "breech", "gestation", "sex", "birthweight", "day of week", "time of delivery", "method of delivery", "singleton/multiple deliveries" and "number of deliveries per day". Significance level was set at 5%. RESULTS: We identified 87,461 live births of which 29 had sustained a facial nerve and 45 a brachial plexus injury. Logistic regression showed a significant positive association between "facial nerve injury" and "forceps delivery" (95% CI: 25-1398), "Ventouse delivery" (95% CI: 1.7-207) and "emergency Caesarean section" (95% CI: 1.7-148) and between "brachial plexus injury "and "birthweight" (95% CI: 1.001-1.003), "forceps delivery" (95% CI: 3.4-14) and "Ventouse delivery" (95% CI: 2.5-13). There was no increased risk for weekend and out of hours deliveries. All babies with a nerve injury made a full recovery. CONCLUSIONS: Our obstetric neonatal nerve injury rate (0.085%) was low with our brachial plexus injury rate (0.051%) being about one third of a historical rate from Ireland (0.15%) and half of the rate recently reported from the United States (0.12%) which could be linked to our staff dealing with many high risk pregnancies. Neonatal birth injury data should be included as a clinical safety marker for delivery units.


Assuntos
Traumatismos do Nascimento/epidemiologia , Neuropatias do Plexo Braquial/epidemiologia , Extração Obstétrica/estatística & dados numéricos , Traumatismos do Nervo Facial/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Clavícula/lesões , Estudos de Coortes , Parto Obstétrico , Feminino , Fraturas Ósseas/epidemiologia , Maternidades , Humanos , Fraturas do Úmero/epidemiologia , Recém-Nascido , Gravidez , Recuperação de Função Fisiológica , Estudos Retrospectivos , Centros de Atenção Terciária , Vácuo-Extração/estatística & dados numéricos
12.
Plast Reconstr Surg ; 144(5): 1116-1122, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688758

RESUMO

BACKGROUND: This study evaluated the validity of the factor structure of the Disabilities of the Arm, Shoulder and Hand questionnaire to assess upper extremity disability in patients with upper extremity nerve injury. METHODS: Data were used from previous cross-sectional studies of patients with upper extremity nerve injuries. Research ethics approval was obtained for secondary data analyses. Descriptive and factor analyses were performed. RESULTS: Patients (n = 242; 170 men and 72 women) with upper extremity nerve injury included distal nerve (n = 131), brachial plexus (n = 88), and single proximal shoulder nerve (n = 23). The mean Disabilities of the Arm, Shoulder and Hand questionnaire score was 47.3 ± 22. For the questionnaire, a three-factor structure had the highest variance and no overlap between factors. The factors related to (1) light effort tasks, (2) greater effort tasks, and (3) work/social activity limitations and pain. Brachial plexus injuries had significantly higher overall questionnaire scores compared to distal and single proximal nerve injuries. The light effort factor scores were significantly lower in single proximal nerve injuries compared with brachial plexus and distal nerve injuries. Nondominant compared to dominant hand involvement revealed no difference in overall questionnaire scores but significantly higher dominant hand scores in the light effort factor (p = 0.001). CONCLUSIONS: In patients with nerve injury, the factor analysis of the Disabilities of the Arm, Shoulder and Hand questionnaire indicated a multifactor construct. These domains should be considered when using the questionnaire and may be helpful to assess disability related to specific tasks in different nerve injuries and with dominant hand involvement.


Assuntos
Neuropatias do Plexo Braquial/diagnóstico , Avaliação da Deficiência , Lesões do Ombro/diagnóstico , Inquéritos e Questionários/normas , Adolescente , Adulto , Fatores Etários , Traumatismos do Braço/diagnóstico , Estudos Transversais , Análise Fatorial , Feminino , Traumatismos da Mão/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Sensibilidade e Especificidade , Fatores Sexuais , Extremidade Superior/lesões , Adulto Jovem
13.
Niger J Clin Pract ; 22(9): 1301-1303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489871

RESUMO

Neuropathic pain responds poorly to common analgesics that effectively control nociceptive pain because its pathophysiology is different and it is usually associated with co-morbidities such as sleep disturbance, depression and anxiety. Patients with this chronic pain are sometimes left with neurolysis as the last resort. A 65-year-old male multiply-injured retiree presented with disabling pain following traumatic brachial plexus injury sustained from road traffic accident 5 years earlier. Other injuries resolved with therapy except the chronic severe burning and electrifying pain (VAS score 9) in the paralyzed left upper limb associated with allodynia and insomnia which was unresponsive to conventional analgesics. PainDETECT score was 29. A test supraclavicular block with 0.25% Bupivacaine was done, followed by chemical neurolysis one month later. He was placed on oral Gabapentin. The pain score a week post injection was 3 and has remained same 18 months post injection. Patient's level of satisfaction on 5 point Likert scale was 5. Chronic neuropathic pain following traumatic brachial plexus injury could be successfully managed by chemical neurolysis and oral gabapentin.


Assuntos
Analgésicos/administração & dosagem , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/tratamento farmacológico , Plexo Braquial/lesões , Gabapentina/administração & dosagem , Bloqueio Nervoso/métodos , Neuralgia/tratamento farmacológico , Extremidade Superior/lesões , Adulto , Idoso , Analgésicos/uso terapêutico , Neuropatias do Plexo Braquial/fisiopatologia , Bupivacaína/administração & dosagem , Gabapentina/uso terapêutico , Humanos , Hiperalgesia/etiologia , Masculino , Bloqueio Nervoso/efeitos adversos , Neuralgia/etiologia , Medição da Dor , Sono/efeitos dos fármacos , Distúrbios do Início e da Manutenção do Sono/etiologia , Resultado do Tratamento
14.
Semin Musculoskelet Radiol ; 23(4): 405-418, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31509868

RESUMO

When it comes to examining the brachial plexus, ultrasound (US) and magnetic resonance imaging (MRI) are complementary investigations. US is well placed for screening most extraforaminal pathologies, whereas MRI is more sensitive and accurate for specific clinical indications. For example, MRI is probably the preferred technique for assessment of trauma because it enables a thorough evaluation of both the intraspinal and extraspinal elements, although US can depict extraforaminal neural injury with a high level of accuracy. Conversely, US is probably the preferred technique for examination of neurologic amyotrophy because a more extensive involvement beyond the brachial plexus is the norm, although MRI is more sensitive than US for evaluating muscle denervation associated with this entity. With this synergy in mind, this review highlights the tips for examining the brachial plexus with US and MRI.


Assuntos
Neuropatias do Plexo Braquial/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Plexo Braquial/diagnóstico por imagem , Humanos
16.
J Bone Joint Surg Am ; 101(16): e80, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436660

RESUMO

BACKGROUND: Traumatic brachial plexus injuries (BPIs) disproportionately affect young, able-bodied individuals. Beyond direct costs associated with medical treatment, there are far-reaching indirect costs related to disability and lost productivity. Our objective was to estimate per-patient indirect cost associated with BPI. METHODS: We estimated indirect costs as the sum of (1) short-term wage loss, (2) long-term wage loss, and (3) disability payments. Short-term (6-month) wage loss was the product of missed work days and the average earnings per day. The probability of return to work was derived from a systematic review of the literature, and long-term wage loss and disability payments were estimated. Monte Carlo simulation was used to perform a sensitivity analysis of long-term wage loss by varying age, sex, and return to work simultaneously. Disability benefits were estimated from U.S. Social Security Administration data. All cost estimates are in 2018 U.S. dollars. RESULTS: A systematic review of the literature demonstrated that the patients with BPI had a mean age of 26.4 years, 90.5% were male, and manual labor was the most represented occupation. On the basis on these demographics, our base case was a 26-year-old American man working as a manual laborer prior to BPI, with an annual wage of $36,590. Monte Carlo simulation estimated a short-term wage loss of $22,740, a long-term wage loss of $737,551, and disability benefits of $353,671. The mean total indirect cost of traumatic BPI in the Monte Carlo simulations was $1,113,962 per patient over the post-injury lifetime (median: $801,723, interquartile range: $22,740 to $2,350,979). If the probability of the patient returning to work at a different, lower-paying job was doubled, the per-patient total indirect cost was $867,987. CONCLUSIONS: BPI can have a far-reaching economic impact on both individuals and society. If surgical reconstruction enables patients with a BPI to return to work, the indirect cost of this injury decreases. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Plexo Braquial/lesões , Efeitos Psicossociais da Doença , Avaliação da Deficiência , Traumatismos dos Nervos Periféricos/economia , Traumatismos dos Nervos Periféricos/terapia , Ferimentos e Lesões/complicações , Adulto , Neuropatias do Plexo Braquial/economia , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/terapia , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Traumatismos dos Nervos Periféricos/diagnóstico , Retorno ao Trabalho/economia , Estados Unidos , Adulto Jovem
17.
Exp Neurol ; 321: 113037, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31425689

RESUMO

Avulsion of spinal nerve roots is a severe proximal peripheral nerve lesion. Despite neurosurgical repair, recovery of function in human patients is disappointing, because spinal motor neurons degenerate progressively, axons grow slowly and the distal Schwann cells which are instrumental to supporting axon extension lose their pro-regenerative properties. We have recently shown that timed GDNF gene therapy (dox-i-GDNF) in a lumbar plexus injury model promotes axon regeneration and improves electrophysiological recovery but fails to stimulate voluntary hind paw function. Here we report that dox-i-GDNF treatment following avulsion and re-implantation of cervical ventral roots leads to sustained motoneuron survival and recovery of voluntary function. These improvements were associated with a twofold increase in motor axon regeneration and enhanced reinnervation of the hand musculature. In this cervical model the distal hand muscles are located 6,5 cm from the reimplantation site, whereas following a lumber lesion this distance is twice as long. Since the first signs of muscle reinnervation are observed 6 weeks after the lesion, this suggests that regenerating axons reached the hand musculature before a critical state of chronic denervation has developed. These results demonstrate that the beneficial effects of timed GDNF-gene therapy are more robust following spinal nerve avulsion lesions that allow reinnervation of target muscles within a relatively short time window after the lesion. This study is an important step in demonstrating the potential of timed GDNF-gene therapy to enhance axon regeneration after neurosurgical repair of a severe proximal nerve lesion.


Assuntos
Neuropatias do Plexo Braquial , Terapia Genética/métodos , Fator Neurotrófico Derivado de Linhagem de Célula Glial/administração & dosagem , Regeneração Nervosa/fisiologia , Recuperação de Função Fisiológica , Animais , Feminino , Fator Neurotrófico Derivado de Linhagem de Célula Glial/genética , Radiculopatia , Ratos , Ratos Wistar , Recuperação de Função Fisiológica/fisiologia
18.
Medicine (Baltimore) ; 98(31): e16694, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374058

RESUMO

RATIONALE: Although most complications of herpes zoster (HZ) are associated with the spread of varicella-zoster virus from the initially involved sensory ganglion, motor nerve impairment, such as limb weakness, is a rare but severe complication that is difficult to treat. PATIENT CONCERN: A 73-year-old female presented with sudden left upper limb pain and weakness after HZ. DIAGNOSIS: Brachial plexopathy following HZ (postherpetic brachial plexopathy). INTERVENTION: Despite alleviation of the vesicles with antiviral treatments, the left upper limb weakness and neuropathic pain did not improve. After obtaining patient's consent, ultrasound-guided polydeoxyribonucleotide (PDRN) injection was performed around the left brachial plexus. OUTCOMES: The patient showed marked improvement in left arm pain from numerical rating scale (NRS) 9 to 4, 1 day after PDRN injection. Subsequently, the pain improved to NRS 3, and motor weakness improved to Medical Research Council grade 2 to 4. LESSONS: PDRN can be considered a viable substitute for corticosteroid injection in treatment of motor weakness and neuropathic pain after HZ.


Assuntos
Neuropatias do Plexo Braquial/tratamento farmacológico , Neuropatias do Plexo Braquial/etiologia , Herpes Zoster/complicações , Polidesoxirribonucleotídeos/administração & dosagem , Idoso , Feminino , Humanos , Medição da Dor , Resultado do Tratamento , Ultrassonografia de Intervenção
19.
Plast Reconstr Surg ; 144(5): 1105-1114, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31441804

RESUMO

BACKGROUND: Loss of elbow flexion commonly occurs following acute brachial plexus injury. The double fascicular transfer is often used in acute C5-C6 and C5-C7 root injuries, but is rarely applied in cases involving concomitant C8 or T1 root injury. The authors designed a rat model using varying severities of lower trunk injury to determine whether partial injury to the lower trunk affects nerve transfers for elbow flexion. METHODS: There were four different rat groups in which 0, 25, 75, or 100 percent of the donor lower trunk remained intact. One-fourth of the cross-sectional area of the ulnar nerve was then transferred to the musculocutaneous nerve immediately. The authors assessed outcomes using a grooming test, muscle mass, retrograde labeling of sensory/motor neurons that regenerated axons, and immunohistochemical stain of regenerated axons. RESULTS: Five months after nerve transfer, rats that underwent partial injury of the lower trunk fared significantly worse than the rats in whom the donor lower trunk remained 100 percent intact, but significantly better than the rats with 0 percent intact lower trunk. Rats with 25 or 75 percent of the lower trunk intact recovered equivalent function, at both the donor and recipient sites. CONCLUSIONS: Although relatively weak compared with the 100 percent intact donor lower trunk group, the partially injured donor nerve was still functional; even though the nerve sustained a partial injury, the residual axons reinnervated the target muscles. The power of the muscles following either 25 percent or 75 percent injuries was equal after the recovery. Resorting to this approach may be useful in cases in which no alternatives are available.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Articulação do Cotovelo/inervação , Regeneração Nervosa/fisiologia , Transferência de Nervo/métodos , Doença Aguda , Animais , Plexo Braquial/cirurgia , Modelos Animais de Doenças , Articulação do Cotovelo/fisiologia , Seguimentos , Masculino , Distribuição Aleatória , Amplitude de Movimento Articular/fisiologia , Ratos , Ratos Sprague-Dawley , Fatores de Risco , Estatísticas não Paramétricas , Resultado do Tratamento
20.
Transpl Infect Dis ; 21(5): e13157, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31394027

RESUMO

Brachial plexus neuropathy is a rare, but underdiagnosed condition, characterized by intense analgesic-resistant shoulder pain, followed by brachial plexus paresis and sensory symptoms. We present a case of brachial plexus neuropathy, induced by Toxoplasma gondii (T. gondii) 17 days after allogeneic hematopoietic stem cell transplantation (alloHSCT) in a patient with acute myeloid leukemia. The diagnosis was made based on the clinical presentation, magnetic resonance imaging (MRI) of the brachial plexus, and positive T. gondii polymerase chain reaction (PCR) in cerebrospinal fluid. The patient was treated with pyrimethamine, sulfadiazine, and levofolinic acid during 6 weeks, with a positive outcome.


Assuntos
Neuropatias do Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/parasitologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Toxoplasmose/diagnóstico , Transplante Homólogo/efeitos adversos , Idoso , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/parasitologia , Feminino , Humanos , Imagem por Ressonância Magnética , Toxoplasma/genética , Toxoplasmose/complicações
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