[Functional reconstruction of the extremities in cases with definitive peripheral nerve lesions]. / Funkcionalna rekonstrukcija ekstremiteta u slucajevima definitivnih lezija perifernih nerava.

Deficit if the functional integrity of the limbs as a consequence of the definitive lesions of the peripheral nerves necessitates surgical treatment aimed at regaining of the optimal mobility and strength of the parts of the limbs or whole limbs. Our study was aimed at presenting our experience in functional reconstruction of the extremities, evaluation of significance of primary and delayed microsurgical reconstruction of the injured nerves with respect to further course of treatment and presenting innovative modifications of certain surgical techniques. The total of 101 surgical procedures were performed in 91 patients, out of which 76 were at the level of the shoulder, elbow and hand and 29 were on the feet. Depending on the local findings, the following techniques were applied: transposition of the muscles and tendons, transfer of the free microneurovascular muscle flaps and surgical fusion of the joints. Functional improvement was achieved in 98.7% of the cases. Increased range of movements and strength depended on the applied technique and preoperative findings. Primary and delayed microsurgical reconstruction of nerves increases the probability for choice of adequate surgical techniques. Muscle and tendon transfers are the methods of choice in most of the patients. Free microneurovascular muscle flaps are applied in the most complicated cases.

Uric acid levels in sera from patients with multiple sclerosis.

The levels of uric acid (UA), a natural peroxynitrite scavenger, were measured in sera from 240 patients with multiple sclerosis (MS) and 104 sex- and age-matched control patients with other neurological diseases (OND). The mean serum UA concentration was lower in the MS than in the OND group, but the difference did not reach the level of statistical significance (P = 0.068). However, the mean serum UA level from patients with active MS (202.6 + 67.1 mumol/l) was significantly lower than that in inactive MS patients (226.5 + 78.6 mumol/l; P = 0.046) and OND controls (P = 0.007). We found a significant inverse correlation of serum UA concentration with female gender (P = 0.0001), disease activity (P = 0.012) and duration (P = 0.017), and a trend towards an inverse correlation with disability as assessed by EDSS score, which did not reach statistical significance (P = 0.067). Finally, multivariate linear regression analyses showed that UA concentration was independently correlated with gender (P = 0.0001), disease activity (P = 0.014) and duration of the disease (P = 0.043) in MS patients. These findings suggest that serum UA might serve as a possible marker of disease activity in MS. They also provide support to the potential beneficial therapeutic effect of radical-scavenging substances in MS.