Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 475
Filtrar
1.
J Neurol Sci ; 460: 122995, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38583391

RESUMEN

BACKGROUND AND PURPOSE: We previously reported that nerve enlargement assessment by nerve ultrasonography of the intermediate upper limb is applicable for distinguishing demyelinating Charcot-Marie-Tooth disease (CMT) from chronic inflammatory demyelinating polyneuropathy (CIDP). However, differences in the severity and distribution patterns of lower extremity nerve enlargement have not been established for either disease. Therefore, we examined the utility of lower extremity nerve ultrasonography for differentiating between CMT and CIDP. METHODS: Twelve patients with demyelinating CMT and 17 patients with CIDP were evaluated. The median, ulnar, tibial, and fibular nerves were evaluated in three regions: the distal upper extremity, intermediate upper extremity, and lower extremity. Of the 14 selected screening sites, the number of sites that exhibited nerve enlargement (enlargement site number, ESN) in each region was determined. RESULTS: The screening ESNs in the intermediate region and lower extremities were greater in patients with demyelinating CMT than in patients with CIDP and greater than the ESN in the distal region (p = 0.010, p = 0.001, and p = 0.101, respectively). The ESNs in the intermediate region and lower extremities significantly differed among patients with typical CIDP, CIDP variants, and demyelinating CMT (p = 0.084 and p < 0.001). Among the 14 selected screening sites, the combined upper and lower extremity ESNs exhibited the highest AUC (0.92; p < 0.001). CONCLUSIONS: Combining the upper and lower extremities for ultrasonographic nerve measurement more accurately distinguishes CIDP from demyelinating CMT.


Asunto(s)
Enfermedad de Charcot-Marie-Tooth , Extremidad Inferior , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante , Ultrasonografía , Humanos , Enfermedad de Charcot-Marie-Tooth/diagnóstico por imagen , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico por imagen , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Ultrasonografía/métodos , Adulto , Anciano , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/inervación , Diagnóstico Diferencial , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/patología , Adulto Joven
2.
Ann Surg ; 280(1): 35-45, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38328975

RESUMEN

OBJECTIVE: To evaluate the effect of nerve decompression on pain in patients with lower extremity painful diabetic peripheral neuropathy (DPN). BACKGROUND: Currently, no treatment provides lasting relief for patients with DPN. The benefits of nerve decompression remain inconclusive. METHODS: This double-blinded, observation and same-patient sham surgery-controlled randomized trial enrolled patients aged 18 to 80 years with lower extremity painful DPN who failed 1 year of medical treatment. Patients were randomized to nerve decompression or observation group (2:1). Decompression-group patients were further randomized and blinded to nerve decompression in either the right or left leg and sham surgery in the opposite leg. Pain (11-point Likert score) was compared between decompression and observation groups and between decompressed versus sham legs at 12 and 56 months. RESULTS: Of 2987 screened patients, 78 were randomized. At 12 months, compared with controls (n=37), both the right-decompression group (n=22) and left-decompression group (n=18) reported lower pain (mean difference for both: -4.46; 95% CI: -6.34 to -2.58 and -6.48 to -2.45, respectively; P < 0.0001). Decompressed and sham legs equally improved. At 56 months, compared with controls (n=m 14), pain was lower in both the right-decompression group (n=20; mean difference: -7.65; 95% CI: -9.87 to -5.44; P < 0.0001) and left-decompression group (n=16; mean difference: -7.26; 95% CI: -9.60 to -4.91; P < 0.0001). The mean pain score was lower in decompressed versus sham legs (mean difference: 1.57 95% CI: 0.46 to 2.67; P =0.0002). CONCLUSIONS: Although nerve decompression was associated with reduced pain, the benefit of surgical decompression needs further investigation as a placebo effect may be responsible for part or all of these effects.


Asunto(s)
Descompresión Quirúrgica , Neuropatías Diabéticas , Extremidad Inferior , Dimensión del Dolor , Humanos , Descompresión Quirúrgica/métodos , Neuropatías Diabéticas/cirugía , Neuropatías Diabéticas/complicaciones , Masculino , Persona de Mediana Edad , Femenino , Método Doble Ciego , Anciano , Adulto , Resultado del Tratamiento , Extremidad Inferior/inervación , Extremidad Inferior/cirugía , Anciano de 80 o más Años , Adolescente , Adulto Joven
3.
Ann Plast Surg ; 92(2): 212-221, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38170967

RESUMEN

BACKGROUND: Patients suffering from polyneuropathy often complain of pain, tingling, and numbness sensations, as well as an increased risk of falling with the corresponding subsequent complications. If symptoms persist after conservative treatment options have been exhausted, nerve decompression in the lower extremity, as described by Dellon, can bring about an improvement in symptoms in many patients. Dellon originally reported that this surgery led to very successful outcomes in patients with diabetic polyneuropathy. In this study, we compare our postsurgical results in patients with diabetic versus idiopathic polyneuropathy. METHODS: Thirty-three patients with idiopathic or diabetic polyneuropathy who had undergone Dellon nerve decompression in the lower extremity between 2011 and 2013 were included in the retrospective study. Pain (numeric rating scale [NRS] 0-10; 0, no pain; 10, worst imaginable pain), tingling, numbness, Hoffmann-Tinel sign, and Semes-Weinstein monofilament were assessed in 20 patients with diabetic polyneuropathy and in 13 patients with idiopathic polyneuropathy. RESULTS: Three months after surgery, a significant reduction in pain was evident in patients with diabetic polyneuropathy, from a preoperative level of NRS 4.9 (minimum, 0; maximum, 10) to 2 (minimum, 0; maximum, 8; P = 0.005). Ninety percent of patients complained of tingling ( P = 0.000) before surgery and 18% after surgery, whereas 100% complained of numbness before surgery and 41% ( P = 0.000) after surgery. One hundred percent of patients had no measurable surface sensitivity before surgery (measured with the Semes-Weinstein monofilament), whereas 3 months after surgery, only 24% of patients still had no measurable surface sensitivity ( P = 0.000). A positive Hoffmann-Tinel sign was recorded in 85% of patients before surgery and only in 11% 3 months after surgery ( P = 0.000). In the case of patients with idiopathic polyneuropathy, a reduction in pain was evident 3 months after surgery, from a preoperative level of NRS 3.9 (minimum, 0; maximum, 9) to 2.2 (minimum, 0; maximum, 9; P = 0.058). Seventy-seven percent of patients complained of tingling before surgery and 42% after surgery ( P = 0.111), whereas 92% complained of numbness before surgery and 50% after surgery ( P = 0.030). Seventy-seven percent of patients had no measurable surface sensitivity before surgery (measured with the Semes-Weinstein monofilament), whereas 3 months after surgery, only 33% of patients still had no measurable surface sensitivity ( P = 0.047). A positive Hoffmann-Tinel sign was recorded in 62% of patients before surgery and only in 17% 3 months after surgery ( P = 0.041). CONCLUSIONS: Not only patients with diabetic polyneuropathy but also those with idiopathic polyneuropathy benefit from Dellon nerve decompression surgery in the lower extremities.


Asunto(s)
Diabetes Mellitus , Neuropatías Diabéticas , Polineuropatías , Humanos , Pierna , Neuropatías Diabéticas/complicaciones , Neuropatías Diabéticas/cirugía , Estudios Retrospectivos , Hipoestesia/etiología , Hipoestesia/cirugía , Extremidad Inferior/cirugía , Extremidad Inferior/inervación , Dolor/etiología , Polineuropatías/cirugía , Polineuropatías/complicaciones , Descompresión Quirúrgica/métodos , Resultado del Tratamiento , Diabetes Mellitus/cirugía
4.
Radiol Clin North Am ; 61(2): 381-392, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36739152

RESUMEN

Continued advancements in magnetic resonance (MR) neurography and ultrasound have made both indispensable tools for the workup of peripheral neuropathy. Ultrasound provides high spatial resolution of superficial nerves, and techniques such as "sonopalpation" and dynamic maneuvers can improve accuracy. Superior soft tissue contrast, ability to evaluate both superficial and deep nerves with similar high resolution, and reliable characterization of denervation are strengths of MR neurography. Nevertheless, familiarity with normal anatomy, anatomic variants, and common sites of nerve entrapment is essential for radiologists to use both MR neurography and ultrasound effectively.


Asunto(s)
Síndromes de Compresión Nerviosa , Enfermedades del Sistema Nervioso Periférico , Humanos , Imagen por Resonancia Magnética/métodos , Nervios Periféricos/diagnóstico por imagen , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/inervación , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen
5.
BMJ Open ; 13(2): e060349, 2023 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-36764711

RESUMEN

OBJECTIVES: Randomised controlled trial of the effect of a perineural infusion of levobupivacaine on moderate/severe phantom limb pain 6 months after major lower limb amputation. SETTING: Single-centre, UK university hospital. PARTICIPANTS: Ninety patients undergoing above-knee and below-knee amputation for chronic limb threatening ischaemia under general anaesthesia. Exclusion criteria were patients having surgery under neuraxial anaesthesia; inability to operate a patient-controlled analgesia device or complete a Visual Analogue Scale; amputation for trauma or malignancy; or contraindication to levobupivacaine. INTERVENTIONS: Either levobupivacaine 0.125% or saline 0.9% (10 mL bolus, infusion of 8 mL/hour for 96 hours) via a sciatic or posterior tibial nerve sheath catheter placed under direct vision during surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the presence of phantom limb pain, residual limb pain and phantom limb sensations up to 6 months after amputation. Secondary outcome measures included early postoperative pain and morphine requirements after surgery. RESULTS: Data from 81 participants were analysed; 6-month follow-up data were available for 62 patients. Pain and morphine requirements varied widely before and after amputation in both groups. The incidences of moderate/severe phantom limb pain, residual limb pain and phantom limb sensations were low from 6 weeks with no significant differences between groups in phantom limb pain at rest (OR 0.56, 95% CI 0.14 to 2.14, p=0.394) or movement (OR 0.58, 95% CI 0.15 to 2.21, p=0.425) at 6 months. Early postoperative pain scores were low in both groups with no between-group differences in residual limb pain or phantom limb sensations (rest or movement) at any time point. High postoperative morphine consumption was associated with worsening phantom limb pain both at rest (-17.51, 95% CI -24.29 to -10.74; p<0.001) and on movement (-18.54, 95% CI -25.58 to -11.49; p<0.001). The incidence of adverse effects related to the study was low in both groups: postoperative nausea, vomiting and sedation scores were similar, and there were no features of local anaesthetic toxicity. CONCLUSIONS: Long-term phantom limb pain, residual limb pain and phantom limb sensations were not reduced significantly by perineural infusion of levobupivacaine, although the study was underpowered to show significant differences in the primary outcome. The incidence of phantom limb pain was lower than previously reported, possibly attributable to frequent assessment and early intervention to identify and treat postoperative pain when it occurred. There were large variations in postoperative pain scores, high requirements for analgesics before and after surgery and some problems maintaining recruitment and long -term follow-up. Knowledge of these potential problems should inform future research in this group of patients. Further work should investigate the association between perioperative morphine requirements and late phantom limb pain. TRIAL REGISTRATION NUMBERS: EudraCT 2007-000619-27; ISRCTN68691928.


Asunto(s)
Miembro Fantasma , Humanos , Levobupivacaína , Miembro Fantasma/tratamiento farmacológico , Miembro Fantasma/etiología , Amputación Quirúrgica/efectos adversos , Anestésicos Locales , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Morfina , Extremidad Inferior/cirugía , Extremidad Inferior/inervación , Analgésicos Opioides/uso terapéutico , Método Doble Ciego
8.
Plast Reconstr Surg ; 148(5): 1135-1145, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34705790

RESUMEN

BACKGROUND: The costs and health effects associated with lower extremity complications in diabetes mellitus are an increasing burden to society. In selected patients, lower extremity nerve decompression is able to reduce symptoms of neuropathy and the concomitant risks of diabetic foot ulcers and amputations. To estimate the health and economic effects of this type of surgery, the cost-effectiveness of this intervention compared to current nonsurgical care was studied. METHODS: To estimate the incremental cost-effectiveness of lower extremity nerve decompression over a 10-year period, a Markov model was developed to simulate the onset and progression of diabetic foot disease in patients with diabetes and neuropathy who underwent lower extremity nerve decompression surgery, compared to a group undergoing current nonsurgical care. Mean survival time, health-related quality of life, presence or risk of lower extremity complications, and in-hospital costs were the outcome measures assessed. Data from the Rotterdam Diabetic Foot Study were used as current care, complemented with information from international studies on the epidemiology of diabetic foot disease, resource use, and costs, to feed the model. RESULTS: Lower extremity nerve decompression surgery resulted in improved life expectancy (88,369.5 life-years versus 86,513.6 life-years), gain of quality-adjusted life-years (67,652.5 versus 64,082.3), and reduced incidence of foot complications compared to current care (490 versus 1087). The incremental cost-effectiveness analysis was -€59,279.6 per quality-adjusted life-year gained, which is below the Dutch critical threshold of less than €80,000 per quality-adjusted life-year. CONCLUSIONS: Decompression surgery of lower extremity nerves improves survival, reduces diabetic foot complications, and is cost saving and cost-effective compared with current care, suggesting considerable socioeconomic benefit for society.


Asunto(s)
Tratamiento Conservador/economía , Análisis Costo-Beneficio , Descompresión Quirúrgica/economía , Neuropatías Diabéticas/cirugía , Amputación Quirúrgica/economía , Amputación Quirúrgica/estadística & datos numéricos , Tratamiento Conservador/estadística & datos numéricos , Descompresión Quirúrgica/estadística & datos numéricos , Pie Diabético/economía , Pie Diabético/epidemiología , Pie Diabético/prevención & control , Neuropatías Diabéticas/economía , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Extremidad Inferior/inervación , Extremidad Inferior/cirugía , Cadenas de Markov , Persona de Mediana Edad , Modelos Económicos , Países Bajos/epidemiología , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Resultado del Tratamiento
9.
J Sport Health Sci ; 10(5): 585-593, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34293496

RESUMEN

BACKGROUND: Balance impairment is one of the strongest risk factors for falls. Proprioception, cutaneous sensitivity, and muscle strength are 3 important contributors to balance control in older adults. The relationship that dynamic and static balance control has to proprioception, cutaneous sensitivity, and muscle strength is still unclear. This study was performed to investigate the relationship these contributors have to dynamic and static balance control. METHODS: A total of 164 older adults (female = 89, left dominant = 15, age: 73.5 ± 7.8 years, height: 161.6 ± 7.1 cm, weight: 63.7 ± 8.9 kg, mean ± SD) participated in this study. It tested the proprioception of their knee flexion/extension and ankle dorsi/plantarflexion, along with cutaneous sensitivity at the great toe, first and fifth metatarsals, arch, and heel, and the muscle strength of their ankle dorsi/plantarflexion and hip abduction. The Berg Balance Scale (BBS) and the root mean square (RMS) of the center of pressure (CoP) were collected as indications of dynamic and static balance control. A partial correlation was used to determine the relationship between the measured outcomes variables (BBS and CoP-RMS) and the proprioception, cutaneous sensitivity, and muscle strength variables. RESULTS: Proprioception of ankle plantarflexion (r = -0.306, p = 0.002) and dorsiflexion (r = -0.217, p = 0.030), and muscle strength of ankle plantarflexion (r = 0.275, p = 0.004), dorsiflexion (r = 0.369, p < 0.001), and hip abduction (r = 0.342, p < 0.001) were weakly to moderately correlated with BBS. Proprioception of ankle dorsiflexion (r = 0.218, p = 0.020) and cutaneous sensitivity at the great toe (r = 0.231, p = 0.041) and arch (r = 0.285, p = 0.002) were weakly correlated with CoP-RMS in the anteroposterior direction. Proprioception of ankle dorsiflexion (r = 0.220, p = 0.035), knee flexion (r = 0.308, p = 0.001) and extension (r = 0.193, p = 0.040), and cutaneous sensitivity at the arch (r = 0.206, p = 0.028) were weakly to moderately correlated with CoP-RMS in the mediolateral direction. CONCLUSION: There is a weak-to-moderate relationship between proprioception and dynamic and static balance control, a weak relationship between cutaneous sensitivity and static balance control, and a weak-to-moderate relationship between muscle strength and dynamic balance control.


Asunto(s)
Extremidad Inferior/inervación , Extremidad Inferior/fisiología , Fuerza Muscular/fisiología , Equilibrio Postural/fisiología , Propiocepción/fisiología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino
10.
Spine (Phila Pa 1976) ; 46(12): E694-E700, 2021 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-34027929

RESUMEN

STUDY DESIGN: Prospective multicenter observational study. OBJECTIVE: To evaluate transcranial motor-evoked potentials (Tc-MEPs) baseline characteristics of lower limb muscles and to determine the accuracy of Tc-MEPs monitoring based on preoperative motor status in surgery for high-risk spinal disease. SUMMARY OF BACKGROUND DATA: Neurological complications are potentially serious side effects in surgery for high-risk spine disease. Intraoperative spinal neuromonitoring (IONM) using Tc-MEPs waveforms can be used to identify neurologic deterioration, but cases with preoperative motor deficit tend to have poor waveform derivation. METHODS: IONM was performed using Tc-MEPs for 949 patients in high-risk spinal surgery. A total of 4454 muscles in the lower extremities were chosen for monitoring. The baseline Tc-MEPs was recorded immediately after exposure of the spine. The derivation rate was defined as muscles detected/muscles prepared for monitoring. A preoperative neurological grade was assigned using the manual muscle test (MMT) score. RESULTS: The 949 patients (mean age 52.5 ±â€Š23.3 yrs, 409 males [43%]) had cervical, thoracic, thoracolumbar, and lumbar lesions at rates of 32%, 40%, 26%, and 13%, respectively. Preoperative severe motor deficit (MMT ≤3) was present in 105 patients (11%), and thoracic ossification of the posterior longitudinal ligament (OPLL) was the most common disease in these patients. There were 32 patients (3%) with no detectable waveform in any muscles, and these cases had mostly thoracic lesions. Baseline Tc-MEPs responses were obtained from 3653/4454 muscles (82%). Specificity was significantly lower in the severe motor deficit group. Distal muscles had a higher waveform derivation rate, and the abductor hallucis (AH) muscle had the highest derivation rate, including in cases with preoperative severe motor deficit. CONCLUSION: In high-risk spinal surgery, Tc-MEPs collected with multi-channel monitoring had significantly lower specificity in cases with preoperative severe motor deficit. Distal muscles had a higher waveform derivation rate and the AH muscle had the highest rate, regardless of the severity of motor deficit preoperatively.Level of Evidence: 3.


Asunto(s)
Potenciales Evocados Motores/fisiología , Monitorización Neurofisiológica Intraoperatoria , Enfermedades de la Columna Vertebral/cirugía , Adulto , Anciano , Femenino , Humanos , Extremidad Inferior/inervación , Extremidad Inferior/fisiología , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Periodo Preoperatorio , Estudios Prospectivos
11.
Minerva Med ; 112(4): 492-499, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34056884

RESUMEN

BACKGROUND: The neurologic complications of rheumatic diseases (RDs) are highly variable, and their manifestations are linked to the pathogenesis and clinical phenotype of the specific RDs. In rheumatoid arthritis, for example, the peripheral nervous system is most commonly involved and mononeuritis multiplex, nerve entrapment and vasculitic sensorimotor neuropathies are not uncommon. Often the therapy for these disorders is not easy and is characterized by the use of different drugs. Palmitoylethanolamide (PEA) has been tested in a wide variety of animal models and has been evaluated in several clinical studies for nerve compression syndromes, demonstrating that PEA acts as an effective and safe analgesic compound. Acetyl-L-Carnitine (ALC) has also been shown to be an effective and safe treatment in painful peripheral neuropathy. In the last years the synergistic effect between PEA and ALC has been demonstrated. The aim of our study was to evaluate the efficacy of supplementation of standard therapy (STh) with Kalanit® (Chiesi Italia Spa; Parma, Italy) in patients with peripheral neuropathy secondary to RDs. METHODS: Patients at the time of enrollment were affected by RDs with neuropathy from <12 months, documented by electromyography. The analyzed patients were treated with the STh chosen according to their rheumatic disease (RA or SpA) and for their neuropathy (e.g. analgesic, NSAIDs, pregabalin or gabapentin) as per clinical practice. The sample was divided into 2 groups: group 1, patients treated with STh, to which a fixed combination of PEA (600 mg) + ALC (500 mg) (Kalanit®) was added twice a day for 2 weeks and then once a day for 6 months; group 2, patients treated only with STh. Each patient underwent clinical evaluations and questionnaires were administered in order to evaluate their neuropathy and the efficacy of the therapy. RESULTS: In group 1, 18 patients suffering from sciatic pain, 16 patients from carpal tunnel syndrome and 8 patients with peripheral neuropathy of the lower limbs were included and PEA + ALC FC was added to STh. These patients were compared with patients from group 2, who had the same pathology and demographic characteristics: 20 patients with sciatic pain, 15 with carpal tunnel syndrome and 5 with peripheral neuropathy of the lower limbs, respectively; this group was treated with STh only. Patients treated with PEA + ALC FC had a significant improvement in pain VAS compared to patients treated with group 2 in all the diseases analyzed (P value: sciatic pain 0.032, carpal tunnel syndrome 0.025 and lower limbs neuropathy 0.041). Patients in group 1 showed a significant improvement compared to patients treated in group 2 also from a specific score. Specifically, LBP-IQ showed significant improvement in group one (P value: 0.031), as did CHFD (P=0.011) and NPQ (P=0.025). CONCLUSIONS: The synergistic effect of PEA and ALC seems to have a further advantage in the treatment of this type of pathology, including the anti-inflammatory effect but also in terms of therapy optimization and therefore of better adherence to treatments. Our study shows that it is important to identify the type of pain to follow an accurate diagnostic algorithm, considering the clinical characteristics of the patient and carefully evaluate the indication, preferring a multimodal approach.


Asunto(s)
Acetilcarnitina/uso terapéutico , Amidas/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Etanolaminas/uso terapéutico , Ácidos Palmíticos/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Enfermedades Reumáticas/complicaciones , Acetilcarnitina/administración & dosificación , Anciano , Amidas/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Síndrome del Túnel Carpiano/tratamiento farmacológico , Síndrome del Túnel Carpiano/etiología , Esquema de Medicación , Combinación de Medicamentos , Etanolaminas/administración & dosificación , Femenino , Humanos , Extremidad Inferior/inervación , Masculino , Persona de Mediana Edad , Neuralgia/tratamiento farmacológico , Ácidos Palmíticos/administración & dosificación , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades Reumáticas/tratamiento farmacológico , Neuropatía Ciática/tratamiento farmacológico , Neuropatía Ciática/etiología
12.
Muscle Nerve ; 63(6): 890-896, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33797086

RESUMEN

INTRODUCTION/AIMS: Cross-sectional area (CSA) reference values using ultrasonography vary widely for lower extremity peripheral nerves. In addition, there is a lack of data on the muscular branches of the tibial nerve and the anatomical variations of the sural nerve. We aimed to evaluate the ultrasonographic reference values for lower extremity peripheral nerves considering different anatomical variations and physical factors. METHODS: The CSA of the lower extremity nerve was measured at 10 sites. In addition to establishing reference values, differences in the CSA owing to anatomical variations were verified. The relationship between CSA and physical factors, such as age, height, weight, body mass index, and ankle circumference, was also examined. RESULTS: A total of 100 healthy Japanese volunteers were recruited. The mean CSA of the sural nerve significantly differed depending on its formation pattern (1.4-1.8 mm2 ). The mean decreases in CSAs from the proximal to distal tibial and fibular nerves within the popliteal region significantly differed based on the fine branching pattern. The maximum value of the mean decreases in CSAs in the tibial and fibular nerves reached 7.2 and 2.5 mm2 , respectively. With respect to physical factors, age and ankle circumferences were associated with CSA at several measurement sites. DISCUSSION: Fine branching from the tibial and fibular nerves and sural nerve formation may affect CSA measurements. The establishment of accurate CSA reference values requires consideration of anatomical variations in the peripheral nerves of the lower extremity.


Asunto(s)
Variación Anatómica , Extremidad Inferior/diagnóstico por imagen , Nervio Peroneo/diagnóstico por imagen , Nervio Sural/diagnóstico por imagen , Nervio Tibial/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Extremidad Inferior/inervación , Masculino , Persona de Mediana Edad , Valores de Referencia , Ultrasonografía , Adulto Joven
13.
Neurosci Lett ; 754: 135884, 2021 05 29.
Artículo en Inglés | MEDLINE | ID: mdl-33862144

RESUMEN

Transcranial magnetic stimulation (TMS) is a technique used to probe and measure cortico-motor responses of the nervous system. However, lower extremity (LE) specific methodology has been slow to develop. In this retrospective analysis, we investigated what motor evoked potential metric, amplitude (MEPamp) or latency (MEPlat), best distinguished the motor-cortical target, i.e. hotspot, of the tibialis anterior and soleus post-stroke. Twenty-three participants with stroke were included in this investigation. Neuronavigation was used to map hotspots, derived via MEPamp and MEPlat, over a 3cm × 5cm grid. Distances between points with the greatest response within a session and between days were compared. Both criterion, amplitude and latency, provided poor identification of locations between trials within a session, and between multiple visits. Identified hotspots were similar only 15 % and 8% of the time between two assessments within the same session, for amplitude and latency respectively. However, MEPamp was more consistent in identifying hotspots, evidenced by locations being less spatially distant from each other (Amplitude: 1.4 cm (SD 0.10) Latency: 1.7 (SD 1.04), P = 0.008) within a session and between days (Amplitude: 1.3 cm (SD 0.95), Latency 1.9 cm (SD 1.14), P = 0.004). While more work is needed to develop LE specific methodology for TMS, especially as it applies to investigating gait impairments, MEPamp appears to be a more consistent criterion for hotspot identification when compared to MEPlat. It is recommended that future works continue to use MEPamp when identifying tibialis anterior and soleus hotspots using neuronavigation.


Asunto(s)
Mapeo Encefálico/métodos , Extremidad Inferior/fisiopatología , Corteza Motora/fisiopatología , Músculo Esquelético/fisiopatología , Accidente Cerebrovascular/diagnóstico , Adulto , Anciano , Estudios Transversales , Potenciales Evocados Motores/fisiología , Femenino , Humanos , Extremidad Inferior/inervación , Masculino , Persona de Mediana Edad , Músculo Esquelético/inervación , Estudios Retrospectivos , Accidente Cerebrovascular/fisiopatología , Estimulación Magnética Transcraneal/métodos
14.
Ann Vasc Surg ; 76: 399-405, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33895258

RESUMEN

BACKGROUND: Despite progress in perioperative care standards, there has not been a significant risk reduction in morbidity and mortality rates of lower extremity amputations, an intermediate risk surgery performed on high risk patients. The single-shot peripheral nerve block has shown equivocal impact on postoperative course following lower extremity amputation. Hence, we assessed the potential of preemptive use of continuous catheter-based peripheral nerve block in lower extremity amputations for reduction in pulmonary complications, acute post-operative pain scores, and opioid use in post-operative period. METHODS: A retrospective review of a quality improvement project initiated in 2018 was conducted to compare outcomes amongst general anesthesia in combination with a catheter-based peripheral nerve block (catheter group) and general anesthesia alone in patients receiving lower extremity amputation. The rate of postoperative pulmonary complications was identified as a primary endpoint. The secondary outcomes assessed were acute post-operative pain scores and opioid consumption up to 48 hours. Our analysis was adjusted for potential confounding variables inclusive of demographics, medical comorbidities, type of surgical procedure and smoking status. RESULTS: Ninety-six patients were included in the study (61 in the general anesthesia group, 35 in the catheter group). After adjusting for baseline demographics, comorbidities, surgical technique and smoking status, the odds of postoperative pulmonary complications were significantly lower with catheter-based peripheral nerve block in comparison to general anesthesia alone, OR 0.11 [95% CI, 0.01- 0.88] (P = 0.048). The decrease in acute pain scores was also observed in the catheter group when compared to general anesthesia alone, OR 0.72 [95% CI, 0.56 - 0.93] (P = 0.012). Similarly, the opioid consumption was also lower in the catheter group in comparison to general anesthesia alone, OR 0.97 [95% CI, 0.95 - 0.99] (P = 0.025). CONCLUSION: Preemptive use of continuous peripheral nerve block in patients undergoing lower extremity amputation reduces the incidence of pulmonary complications, acute postoperative pain scores and narcotic use in post-operative period.


Asunto(s)
Amputación Quirúrgica/efectos adversos , Anestesia General , Extremidad Inferior/cirugía , Enfermedades Pulmonares/prevención & control , Bloqueo Nervioso , Manejo del Dolor , Dolor Postoperatorio/prevención & control , Anciano , Analgésicos Opioides/uso terapéutico , Anestesia General/efectos adversos , Bases de Datos Factuales , Femenino , Humanos , Extremidad Inferior/inervación , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/etiología , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Manejo del Dolor/efectos adversos , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
15.
J Stroke Cerebrovasc Dis ; 30(7): 105807, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33895428

RESUMEN

BACKGROUND: Robot-assisted gait training has been confirmed to have beneficial effect on the rehabilitation of stroke patients. An exoskeleton robot, named BEAR-H1, is designed to help stroke patients with walking disabilities. METHODS: 17 subjects in experimental group and 15 subjects in control group completed the study. The experimental group received 30 minutes of BEAR-H1 assisted gait training(BAGT), and the control group received 30 minutes of conventional training, 5 times/week for 4weeks. All subjects were evaluated with 6-minute walk test (6MWT), Fugl-Meyer Assessment for lower extremity (FMA-LE), Functional Ambulatory Classification (FAC), Modified Ashworth Scale (MAS), and gait analysis at baseline and after 4 weeks intervention. RESULTS: The improvements of 6MWT, FMA-LE, gait speed, cadence, step length and cycle duration in BAGT group were more noticeable than in the control group. However, there was no difference in the assessment of MAS between two groups. CONCLUSIONS: Our results showed that BAGT is an effective intervention to improve the motor and walking ability during 4 weeks training for subacute stroke patients.


Asunto(s)
Dispositivo Exoesqueleto , Marcha , Extremidad Inferior/inervación , Actividad Motora , Robótica/instrumentación , Rehabilitación de Accidente Cerebrovascular/instrumentación , Accidente Cerebrovascular/terapia , Adulto , China , Femenino , Estado Funcional , Análisis de la Marcha , Humanos , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Estudios Prospectivos , Recuperación de la Función , Método Simple Ciego , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Prueba de Paso
16.
J Bone Joint Surg Am ; 103(8): 681-687, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-33849050

RESUMEN

BACKGROUND: Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) procedures have been shown to improve patient-reported outcomes for the treatment of symptomatic neuromas after amputation; however, the specific indications and comparative outcomes of each are unclear. The primary research questions were what complement of nerves most frequently requires secondary pain intervention after conventional amputation, whether this information can guide the focused application of TMR and RPNI to the primary amputation setting, and how the outcomes compare in both settings. METHODS: We performed a retrospective review of records for patients who had undergone lower-extremity TMR and/or RPNI at our institution. Eighty-seven procedures were performed: 59 for the secondary treatment of symptomatic neuroma pain after amputation and 28 for primary prophylaxis during amputation. We reviewed records for the amputation level, TMR and/or RPNI timing, pain scores, patient-reported resolution of nerve-related symptoms, and complications or revisions. We evaluated the relationship between the amputation level and the frequency with which each transected nerve required neurologic intervention for pain symptoms. RESULTS: The mean pain score decreased after delayed TMR or RPNI procedures from 4.3 points to 1.7 points (p < 0.001), and the mean final pain score (and standard deviation) was 1.0 ± 1.9 points at the time of follow-up for acute procedures. Symptom resolution was achieved in 92% of patients. The sciatic nerve most commonly required intervention for symptomatic neuroma above the knee, and the tibial nerve and common or superficial peroneal nerve were most problematic following transtibial amputation. None of our patients required a revision pain treatment procedure after primary TMR targeting these commonly symptomatic nerves. Failure to address the tibial nerve during a delayed procedure was associated with an increased risk of unsuccessful TMR, resulting in a revision surgical procedure (odds ratio, 26 [95% confidence interval, 1.8 to 368]; p = 0.02). CONCLUSIONS: There is a consistent pattern of symptomatic nerves that require secondary surgical intervention for the management of pain after amputation. TMR and RPNI were translated to the primary amputation setting by using this predictable pattern to devise a surgical strategy that prevents symptomatic neuroma pain. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Amputación Quirúrgica , Extremidad Inferior/cirugía , Neoplasias de los Músculos/cirugía , Músculo Esquelético/inervación , Transferencia de Nervios/métodos , Neuroma/cirugía , Complicaciones Posoperatorias/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Extremidad Inferior/inervación , Masculino , Neoplasias de los Músculos/diagnóstico , Neoplasias de los Músculos/etiología , Músculo Esquelético/cirugía , Neuroma/diagnóstico , Neuroma/etiología , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/cirugía , Nervio Peroneo/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Nervio Tibial/cirugía , Resultado del Tratamiento
17.
J Clin Neurosci ; 86: 276-283, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33775342

RESUMEN

We aimed to establish the cross-sectional area (CSA) reference values for peripheral nerves of lower extremities in a healthy Chinese population, and to determine their diagnostic values for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and Charcot-Marie-Tooth disease type1A (CMT1A). One hundred eleven healthy subjects, 15-70 years of age, as well as 104 CIDP patients and 26 CMT1A patients were recruited. CSA at predetermined sites of the tibial, fibular, sciatic and sural nerves was measured. The CSA of the tibial nerve ranged from 10.2 ± 1.9 to 20.7 ± 3.6 mm2, and for fibular nerve from 8.4 ± 1.8 to 9.5 ± 1.9 mm2. 86% CIDP patients had upper limb nerve enlargement, while only 67% had lower limb nerve enlargement. In CIDP patients with normal upper limb ultrasound, 56% (5/9) would have lower limb nerve enlargement. All CMT1A patients had both upper and lower limb nerve enlargement. Addition of lower limb nerve ultrasound showed no added value in diagnosis of CMT1A, but could be supplementary for CIDP when upper limb ultrasound is normal.


Asunto(s)
Enfermedad de Charcot-Marie-Tooth/diagnóstico por imagen , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/inervación , Nervios Periféricos/diagnóstico por imagen , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico por imagen , Ultrasonografía/normas , Adolescente , Adulto , Anciano , Enfermedad de Charcot-Marie-Tooth/epidemiología , Niño , China/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nervio Peroneo/diagnóstico por imagen , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/epidemiología , Estudios Prospectivos , Valores de Referencia , Nervio Tibial/diagnóstico por imagen , Adulto Joven
18.
Plast Reconstr Surg ; 147(2): 279e-283e, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33565835

RESUMEN

SUMMARY: Targeted muscle reinnervation is a contemporary technique designed to enhance an amputee's ability to operate a myoelectric prosthesis. This technique has been shown to decrease neuropathic pain, including neuroma and phantom limb pain. In certain amputations, especially forequarter and hindlimb levels, there may be no nearby recipient muscle sites, or the residual nerve may be too short to perform targeted muscle reinnervation. Applying the spare parts concept can help solve this problem by providing nerve autograft or additional muscle recipient sites within the spare parts flap for successful targeted muscle reinnervation surgery procedures. A retrospective review of all patients that underwent spare parts targeted muscle reinnervation reconstructions between 2016 and 2019 at two institutions was performed. Patients were assessed for healing, neuroma and phantom limb pain, and function. Twelve patients underwent targeted muscle reinnervation during spare parts reconstruction; eight were male and four were female. The mean patient age was 55.3 years (range, 16 to 72 years). For those with known soft-tissue deficit size, the surface area of the donor site spared by using spare parts reconstruction ranged from 216 to 856 cm2. None of the 12 patients subsequently experienced neuroma, and 75 percent had no phantom limb pain after 3 months. Three patients have obtained insurance-approved myoelectric prosthetics, and all three demonstrated intuitive control of targeted muscles. Using a spare parts reconstruction in conjunction with targeted muscle reinnervation may optimize reconstructive efforts in the setting of major limb amputations and aid in decreasing phantom limb and neuroma pain, and facilitate the possibility of functional prosthetic and/or myoelectric prosthesis use. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Amputación Quirúrgica/efectos adversos , Miembros Artificiales/efectos adversos , Músculo Esquelético/inervación , Transferencia de Nervios/métodos , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Extremidad Inferior/inervación , Extremidad Inferior/cirugía , Masculino , Persona de Mediana Edad , Músculo Esquelético/cirugía , Colgajo Miocutáneo/trasplante , Neuroma/etiología , Neuroma/prevención & control , Miembro Fantasma/etiología , Miembro Fantasma/prevención & control , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
19.
J Orthop Surg (Hong Kong) ; 29(1): 2309499021989102, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33626984

RESUMEN

PURPOSE: The purpose of this study is to examine the clinical effects and results of lower-extremity surgery under ultrasound-guided nerve block; time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, visual analog scale (VAS) satisfaction score, and anesthetic-related complications. METHODS: A total of 3312 cases (2597 patients) from January 2010 to April 2015 were analyzed retrospectively. A senior author performed ultrasound-guided nerve block of the lateral femoral cutaneous nerve (LFCN, 630 cases), femoral nerve (FN, 2503 cases), obturator nerve (ON, 366 cases), sciatic nerve (SN, 3271 cases), or posterior femoral cutaneous nerve (PFCN, 222 cases) depending on the type of surgery. Time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, VAS satisfaction score, and anesthetic-related complications were analyzed. RESULTS: The mean times required were 1.1 min for SN block, 2.5 min for FN/SN block (1762 cases), and 4.8 min for FN/SN/LFCN/ON block. The mean anesthesia onset time was 48 min. The mean durations of anesthesia were 4.5 h for FN dermatome and 5.6 h for SN dermatome. The mean duration of analgesia was 11.5 h. The mean tolerable tourniquet times after were 35, 51, and 84 min after SN block, FN/SN block, and FN/SN/LFCN/ON block, respectively. The mean VAS satisfaction score was 9.3. There were no anesthetic-related complications, such as infection, hematoma, paralysis, or nerve irritation. CONCLUSION: Selective block of the LFCN, FN, ON, SN, and PFCN based on the locations of lesions and type of surgery showed favorable clinical results with high efficacy. Ultrasound-guided nerve block may be a good option for anesthesia and analgesia in lower-extremity surgery.


Asunto(s)
Extremidad Inferior/cirugía , Bloqueo Nervioso , Ultrasonografía Intervencional , Adulto , Anciano , Analgesia , Femenino , Nervio Femoral , Humanos , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/inervación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Nervio Ciático , Muslo , Ultrasonografía
20.
Med Sci Monit ; 27: e928209, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33434188

RESUMEN

BACKGROUND Primary lower-extremity hyperhidrosis (PLEH) can be treated by CT-guided lumbar sympathetic nerve modulation using absolute ethanol. However, doses of ethanol that are too high can cause nerve injury, and doses that are too low have suboptimal results. The present study aimed to investigate the dose-effect relationship of CT-guided lumbar sympathetic nerve modulation with absolute ethanol for PLEH. MATERIAL AND METHODS The study was conducted at the First Affiliated Hospital of Jiaxing University between 07/2014 and 02/2017. Twenty participants were enrolled in each group. The doses of absolute ethanol were 2.0 ml in the R1 group, 2.5 ml in the R2 group, 3.0 ml in the R3 group, 3.5 ml in the R4 group, and 4.0 ml in the R5 group. Treatment effectiveness was assessed according to the time to complete hyperhidrosis relief: <10 min, effective; ≥10 min, non-effective. RESULTS The patient characteristics among the 5 groups were not statistically different (P>0.05). The onset time and time to complete hyperhidrosis relief decreased significantly with increasing dose of absolute ethanol (P<0.05). The effective rates in the 5 groups were 15.0%, 35.0%, 60.0%, 90.0%, and 100.0%, respectively. The ED50 and ED95 were 2.306 ml (95% CI: 2.003-2.512 ml) and 3.343 ml (95% CI: 3.051-3.962 ml), respectively. CONCLUSIONS This was the first dose-effect pilot study of consecutive PLEH patients treated by CT-guided lumbar sympathetic nerve modulation. CT-guided lumbar sympathetic nerve modulation with 2.306 ml (ED50) and 3.343 ml (ED95) of absolute ethanol showed treatment efficacy for PLEH. No complications were seen.


Asunto(s)
Bloqueo Nervioso Autónomo/métodos , Etanol/farmacología , Hiperhidrosis/terapia , Extremidad Inferior/fisiopatología , Adulto , Relación Dosis-Respuesta a Droga , Etanol/administración & dosificación , Etanol/uso terapéutico , Femenino , Humanos , Extremidad Inferior/inervación , Plexo Lumbosacro/diagnóstico por imagen , Plexo Lumbosacro/efectos de los fármacos , Masculino , Tomografía Computarizada por Rayos X/métodos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...