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1.
Top Companion Anim Med ; 36: 1-3, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31472722

RESUMO

This study aimed to evaluate femoral nerve latency time recorded from both vastus lateralis and vastus medialis muscles, in clinically healthy dogs. Eighteen adult dogs were distributed into 2 distinct body mass ranges (Group 1: 1-4.1 kg, n= 9; Group 2: 4.2-13 kg, n= 8), according to the median body mass (4.1 kg). Distal motor latencies for the femoral nerve were obtained in right- and left hind limbs. Platinum surface electrodes were used to record the latency of femoral nerve from the vastus lateralis muscle, whereas coaxial needle electrodes were used to record the latency from the vastus medialis muscle. The distal motor nerve latencies were 1.52 ± .23 milliseconds and 1.69 ± .42 milliseconds, respectively, for vastus lateralis and vastus medialis muscles. There were no significant differences of distal motor nerve latencies between vastus lateralis and vastus medialis muscles. Hind limb length of Group 1 was significant shorter than Group 2. There were no significant differences of latencies between Groups 1 and 2. No significant correlations were observed between latency and body mass, and between latency and hind limb length for dogs of both groups. In conclusion, the femoral motor latency measurement was easy to obtain and may supply additional data in the examination of diseases that affect the hind limbs. Latency values of vastus lateralis longer than 1.52 ± .23 milliseconds in small/medium-sized breeds may be considered as suggestive of a femoral neuropathy.


Assuntos
Cães/fisiologia , Nervo Femoral/fisiologia , Extremidade Inferior/inervação , Músculo Quadríceps/inervação , Animais , Peso Corporal , Feminino , Extremidade Inferior/anatomia & histologia , Masculino , Condução Nervosa/fisiologia
2.
Best Pract Res Clin Anaesthesiol ; 33(1): 57-66, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31272654

RESUMO

The fascia iliaca compartment block has been promoted as a valuable regional anesthesia and analgesia technique for lower limb surgery. Numerous studies have been performed, but the evidence on the true benefits of the fascia iliaca compartment block is still limited. Recent anatomical, radiological, and clinical research has demonstrated the limitations of the landmark infrainguinal technique. Nevertheless, this technique is still valuable in situations where ultrasound cannot be used because of lack of equipment or training. With the introduction of ultrasound, a new suprainguinal approach of the fascia iliaca has been described. Research has demonstrated that this technique leads to a more reliable block of the target nerves than the infrainguinal techniques. However, more research is needed to determine the place of this technique in clinical practice.


Assuntos
Fáscia/diagnóstico por imagem , Plexo Lombossacral/diagnóstico por imagem , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/inervação , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/prevenção & controle
3.
Exp Brain Res ; 237(7): 1793-1803, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053895

RESUMO

Transcutaneous spinal cord stimulation (tSCS) is a useful technique for the clinical assessment of neurological disorders. However, the characteristics of the spinal cord circuits activated by tSCS are not yet fully understood. In this study, we examined whether remote muscle contraction enhances the spinal reflexes evoked by tSCS in multiple lower-limb muscles. Eight healthy men participated in the current experiment, which required them to grip a dynamometer as fast as possible after the presentation of an auditory cue. Spinal reflexes were evoked in multiple lower-limb muscles with different time intervals (50-400 ms) after the auditory signals. The amplitudes of the spinal reflexes in all the recorded leg muscles significantly increased at 50-250 ms after remote muscle activation onset. This suggests that remote muscle contraction simultaneously facilitates the spinal reflexes in multiple lower-limb muscles. In addition, eight healthy men performed five different tasks (i.e., rest, hand grip, pinch grip, elbow flexion, and shoulder flexion). Compared to control values recorded just before each task, the spinal reflexes evoked at 250 ms after the auditory signals were significantly enhanced by the above tasks except for the rest task. This indicates that such facilitatory effects are also induced by remote muscle contractions in different upper-limb areas. The present results demonstrate the existence of a neural interaction between remote upper-limb muscles and spinal reflex circuits activated by tSCS in multiple lower-limb muscles. The combination of tSCS and remote muscle contraction may be useful for the neurological examination of spinal cord circuits.


Assuntos
Retroalimentação Sensorial/fisiologia , Extremidade Inferior/fisiologia , Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Reflexo/fisiologia , Estimulação da Medula Espinal/métodos , Adulto , Humanos , Extremidade Inferior/inervação , Masculino , Adulto Jovem
4.
Am J Case Rep ; 20: 668-673, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31073115

RESUMO

BACKGROUND Acute flaccid myelitis is an emerging polio-like illness mostly affecting young children, characterized by rapid onset of extremity weakness and paralysis in 1 or more limbs. Certain viruses, including enteroviruses such as EV-68, EV-71, poliovirus, and West Nile virus, can cause this disorder. The largest known outbreak of EVD68 in the United States was in the summer of 2014, causing severe respiratory illness and acute flaccid myelitis, mainly in young children. Furthermore, the US Centers for Disease Control and Prevention noted an increase in the number of patients with clinical symptoms of acute flaccid myelitis in 2018, and 134 confirmed cases by December 2018 were reported in the USA. CASE REPORT The patient in our present study was a 5-year-old female who had significant weakness and paralysis in all 4 extremities due to acute flaccid myelitis. EV-D68 had caused this disorder in this patient in August 2014. Conservative management had not helped her condition. Specific areas of concern were both shoulders and biceps, and the femoral and peroneal nerves in both sides. Of these, the right shoulder function was the worst, at less than grade 3. The patient also had marked atrophy and weakness of the right quadricep muscles. The patient underwent surgical treatment and had steady improvements in all 4 extremity functional movements. CONCLUSIONS We demonstrated that decompression, neurolysis, and nerve transfer surgical procedures can be used successfully to correct the paralyzed upper and lower extremity movements in acute flaccid myelitis patients.


Assuntos
Descompressão Cirúrgica , Mielite/cirurgia , Bloqueio Nervoso , Transferência de Nervo , Paralisia/cirurgia , Pré-Escolar , Enterovirus Humano D , Infecções por Enterovirus/complicações , Feminino , Humanos , Extremidade Inferior/inervação , Mielite/virologia , Paralisia/virologia , Extremidade Superior/inervação
5.
J Stroke Cerebrovasc Dis ; 28(6): e66-e67, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930242

RESUMO

Fibrocartilaginous embolism (FCE) is an uncommon cause of spinal cord infarction often misdiagnosed as transverse myelitis. The mechanism of ischemia is suspected to be due to retrograde embolization of nucleus pulposus material originating from Schmorl's nodes to the spinal vessels following acute disk herniation. We describe the clinical and imaging findings of FCE in 3 healthy young women with history of trivial spinal cord trauma, and recommend that FCE should be considered in the differential diagnosis of acute myelopathy.


Assuntos
Doenças das Cartilagens/complicações , Embolia/complicações , Infarto/etiologia , Extremidade Inferior/inervação , Isquemia do Cordão Espinal/etiologia , Medula Espinal/irrigação sanguínea , Extremidade Superior/inervação , Adolescente , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/terapia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Embolia/diagnóstico por imagem , Embolia/terapia , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/fisiopatologia , Infarto/terapia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/terapia , Resultado do Tratamento , Adulto Jovem
6.
Acupunct Med ; 37(1): 3-15, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30900484

RESUMO

OBJECTIVE: To examine evidence for acupuncture interventions in the management of diabetes-related peripheral neuropathy (DPN) symptoms. METHODS: Five electronic databases were searched up to June 2017 for studies that included participants with symptoms of DPN, used an acupuncture intervention, and reported before-and-after DPN-related outcome measures. Two reviewers independently performed the data extraction. The level of homogeneity was assessed, and studies were appraised using the Cochrane Risk of Bias tool, the STRICTA guidelines for acupuncture reporting and the NICMAN scale for acupuncture quality. RESULTS: Ten studies with 432 participants were included: three randomised controlled trials (RCTs), two pilot RCTs, three uncontrolled clinical trials, one quasi-RCT and one prospective case series. Improvements in DPN pain symptoms were reported by all studies. Heterogeneity of outcome measures prevented a meta-analysis. Variations were found in needle retention time and point selection, as well as total number and frequency of treatments. Common acupuncture point selections were ST36 and SP6. Half of the studies used local point selection. Studies conducted outside China had better acupuncture reporting and quality according to the STRICTA checklist and NICMAN scales, respectively. Risk of bias was high or unclear in the majority of studies for all domains except attrition bias. CONCLUSIONS: Acupuncture for DPN appears to improve symptoms. However, the application of acupuncture varies greatly, and the quality of included studies was generally low. Available studies have varying methodologies and different outcome measures. Further, suitably powered studies using appropriate DPN outcome measures are required.


Assuntos
Terapia por Acupuntura , Neuropatias Diabéticas/terapia , Extremidade Inferior/inervação , Pontos de Acupuntura , Terapia por Acupuntura/normas , Ensaios Clínicos como Assunto , Neuropatias Diabéticas/fisiopatologia , Humanos , Extremidade Inferior/fisiopatologia , Resultado do Tratamento
7.
J Vasc Surg ; 70(1): 23-30, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30626551

RESUMO

OBJECTIVE: Placement of large sheaths in the iliac system during fenestrated endovascular aneurysm repair (FEVAR) leads to lower extremity (LE) ischemia that can be associated with serious neurologic complications. We sought to determine the effect of LE ischemic time on neurologic impairment after FEVAR. METHODS: Consecutive patients who underwent FEVAR at a single institution were analyzed. LE ischemic time was calculated from the time of large sheath (≥18F) insertion to the time of sheath removal from the iliac arteries that led to continuous LE ischemia. The primary outcome was neurologic impairment defined as any new sensory or motor deficit in either LE. Outcomes were analyzed using descriptive statistics and modeled with logistic regression with interaction terms. Each individual LE was used as a unit of analysis. RESULTS: We examined 101 patients (202 lower extremities) who underwent FEVAR over a 5-year period. The median LE ischemic time was 2.75 hours (range, 0.8-5.2 hours). Neurologic impairment developed in 18 extremities (9%). Of those, 12 (67%) developed mild sensory loss, 6 (33%) complete sensory loss, 4 (22%) loss of proprioception, and 2 (11%) motor dysfunction. Sensory deficit was permanent in four limbs (2%) and motor dysfunction in one limb (0.5%). In all other cases, the neurologic examination returned to baseline by postoperative day 15. Duration of LE ischemic time (odds ratio, 6.3; 95% confidence interval, 3.1-12.4; P < .001) and common iliac artery (CIA) stenosis to a lumen of 8 mm or less (odds ratio, 2.7; 95% confidence interval, 1.5-7.3; P = .002) were independent predictors for the development of neurologic impairment. An interaction term between LE ischemic time and CIA stenosis was statistically significant (P = .042), indicating that the presence of CIA stenosis modifies the effect of LE ischemic time. In those with CIA stenosis to a lumen of 8 mm or less, the risk of neurologic impairment increased rapidly after 2.5 hours of LE ischemia, and became nearly certain after 4 hours of ischemic time. By contrast, patients without CIA stenosis tolerated longer ischemic times and demonstrated a less steep increase in the risk for LE neurologic impairment. CONCLUSIONS: LE neurologic impairment after FEVAR is strongly associated with LE ischemic time and CIA occlusive disease to a lumen of 8 mm or less. Our data indicate that, when the LE ischemic time is expected to exceed 2.5 hours (in patients with CIA stenosis) or 3 hours (in patients without CIA stenosis), measures to ensure LE perfusion should be given consideration.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/complicações , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Artéria Ilíaca , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/inervação , Doenças do Sistema Nervoso/etiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Isquemia/diagnóstico , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/fisiopatologia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Physiother Theory Pract ; 35(4): 401-408, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29474100

RESUMO

INTRODUCTION: The patient was referred to an outpatient physical therapy clinic for lumbar radiculopathy by a primary care physician and subsequently referred for imaging due to suspicion of cervical myelopathy. The case highlights the clinical reasoning of the physical therapist differentiating between lumbar stenosis, cervical myelopathy, and upper cervical instability. To the author's knowledge, this is the only case report in the literature to describe the mechanism that could underpin a false positive Sharp-Purser test (SPT). The case also highlights the importance of interpreting the outcomes of special tests cautiously. CASE DESCRIPTION: A 55-year-old female was referred to outpatient physical therapy for lumbar radiculopathy. The patient's complaint was a one-year history of intermittent bilateral lower buttock paresthesias radiating to the bilateral posterior thighs. She reported a three-month history of bilateral anterior thigh numbness that would present after sitting for 30 minutes. Lumbar stenosis was initially suspected, however the patient's failure to improve but rather worsen with flexed postures suggested this diagnosis was improbable. The patient experienced bilateral anterior thigh numbness with active cervical flexion, and had a reduction in symptoms with the SPT. OUTCOMES: Magnetic resonance imaging revealed multi-focal disc-osteophyte complexes with central canal stenosis from C4-7. The patient underwent an anterior cervical discectomy and fusion with a good outcome. DISCUSSION: A large disc herniation causing central canal stenosis could underpin a false positive SPT. Special tests should always be used with caution, as they can lead to inaccurate diagnoses if there is a false positive.


Assuntos
Vértebras Cervicais/fisiopatologia , Hipestesia/diagnóstico , Extremidade Inferior/inervação , Parestesia/diagnóstico , Estenose Espinal/diagnóstico , Vértebras Cervicais/cirurgia , Discotomia , Reações Falso-Positivas , Feminino , Humanos , Hipestesia/etiologia , Hipestesia/fisiopatologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/fisiopatologia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Fusão Vertebral , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do Tratamento
12.
Neurosci Lett ; 692: 77-82, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30391322

RESUMO

Higher motor centers and central pattern generators (CPGs) interact in the control of coordinated leg movements during locomotion throughout the animal kingdom. The subesophageal ganglion (SEG) is one of the insect head ganglia reported to have a role in the control of walking behavior. Here we explored the functional relations between the SEG and the thoracic leg CPGs in the desert locust. Backfill staining revealed about 300 SEG descending interneurons (DINs) altogether. Recordings from an in-vitro isolated chain of thoracic ganglia, with intact or severed connections to the SEG, during pharmacological activation were used to determine how the SEG affects the centrally generated motor output to the legs. The SEG was demonstrated to both activate leg CPGs and synchronize their bilateral activity. The role of the SEG in insect locomotion is discussed in light of these findings.


Assuntos
Geradores de Padrão Central/fisiologia , Gânglios dos Invertebrados/fisiologia , Gafanhotos/fisiologia , Extremidade Inferior/fisiologia , Neurônios Motores/fisiologia , Animais , Interneurônios/fisiologia , Extremidade Inferior/inervação , Masculino , Caminhada
13.
Ann Vasc Surg ; 57: 48.e13-48.e17, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30218834

RESUMO

Perforation of inferior vena cava (IVC) filter struts is a common incidental finding on postoperative computed tomography (CT) scans that is not associated with bleeding or major complications. However, in rare circumstances, it can be associated with hemorrhage requiring immediate removal. We present a case of a 62-year-old man who developed abdominal pain and right lower extremity weakness 2 weeks after treatment of a pulmonary embolism with IVC filter placement and anticoagulation. A CT scan revealed a large right-sided retroperitoneal hematoma with active extravasation from the IVC filter struts that had perforated the IVC wall. He underwent a hybrid operation with endovascular retrieval of the IVC filter and concomitant IVC primary repair combined with evacuation of the hematoma, causing nerve compression. Postoperatively, he regained normal sensory and motor function. Perforation of IVC filter struts is usually asymptomatic, but in rare circumstances, it can cause hemorrhage requiring immediate removal and IVC repair. Surgical intervention is indicated in the setting of a large hematoma with nerve or vessel compression and may require a combined endovascular and open approach.


Assuntos
Hematoma/etiologia , Extremidade Inferior/inervação , Debilidade Muscular/etiologia , Síndromes de Compressão Nervosa/etiologia , Lesões do Sistema Vascular/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Flebografia/métodos , Espaço Retroperitoneal , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
14.
J Neurosurg Spine ; 30(2): 268-278, 2018 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-30497147

RESUMO

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.


Assuntos
Nervos Intercostais/cirurgia , Transferência de Nervo , Nervos Periféricos/cirurgia , Traumatismos da Medula Espinal/cirurgia , Adulto , Animais , Cadáver , Cães , Estudos de Viabilidade , Feminino , Humanos , Extremidade Inferior/inervação , Extremidade Inferior/cirurgia , Plexo Lombossacral/cirurgia , Masculino , Transferência de Nervo/métodos , Medula Espinal/cirurgia
15.
BMC Musculoskelet Disord ; 19(1): 433, 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522482

RESUMO

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DW-MRI) of skeletal muscle has the potential to be a sensitive diagnostic and/or prognostic tool in complex, enigmatic neuromusculoskeletal conditions such as spinal cord injury and whiplash associated disorder. However, the reliability and reproducibility of clinically accessible DW-MRI parameters in skeletal muscle remains incompletely characterized - even in individuals without neuromusculoskeletal injury - and these parameters have yet to be characterized for many clinical populations. Here, we provide normative measures of the apparent diffusion coefficient (ADC) in healthy muscles of the lower limb; assess the rater-based reliability and short- and long-term reproducibility of the ADC in the same muscles; and quantify ADC of these muscles in individuals with motor incomplete spinal cord injury. METHODS: Twenty individuals without neuromusculoskeletal injury and 14 individuals with motor incomplete spinal cord injury (SCI) participated in this investigation. We acquired bilateral diffusion-weighted MRI of the lower limb musculature in all participants at 3 T using a multi-shot echo-planar imaging sequence with b-values of 0, 100, 300 and 500 s/mm2 and diffusion-probing gradients applied in 3 orthogonal directions. Outcome measures included: (1) average ADC in the lateral and medial gastrocnemius, tibialis anterior, and soleus of individuals without neurological or musculoskeletal injury; (2) intra- and inter-rater reliability, as well as short and long-term reproducibility of the ADC; and (3) estimation of average muscle ADC in individuals with SCI. RESULTS: Intra- and inter-rater reliability of the ADC averaged 0.89 and 0.79, respectively, across muscles. Least significant change, a measure of temporal reproducibility, was 4.50 and 11.98% for short (same day) and long (9-month) inter-scan intervals, respectively. Average ADC was significantly elevated across muscles in individuals with SCI compared to individuals without neurological or musculoskeletal injury (1.655 vs. 1.615 mm2/s, respectively). CONCLUSIONS: These findings provide a foundation for future studies that track longitudinal changes in skeletal muscle ADC of the lower extremity and/or investigate the mechanisms underlying ADC changes in cases of known or suspected pathology.


Assuntos
Imagem de Difusão por Ressonância Magnética , Extremidade Inferior/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Feminino , Humanos , Extremidade Inferior/inervação , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Valores de Referência , Reprodutibilidade dos Testes , Adulto Jovem
16.
Radiol Clin North Am ; 56(6): 997-1012, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30322495

RESUMO

Entrapment neuropathies of the lower extremity are commonly encountered and present a diagnostic challenge. Historical diagnostic workhorses-the physical examination combined with electrodiagnostic studies-are now frequently supplemented by MR neurography. MR neurography is a high-resolution, noninvasive, and operator-independent imaging modality that has proven useful in diagnosis, disease severity assessment, and informing treatment decisions in the management of lower extremity entrapment neuropathies. Currently, the assessment of the peripheral nerves relies heavily on reader identification of morphologic nerve changes; however, emerging innovative MR sequences and PET/MR imaging hold the potential to provide noninvasive means of functional assessment.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/inervação , Imagem por Ressonância Magnética/métodos , Síndromes de Compressão Nervosa/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Diagnóstico Diferencial , Humanos
17.
Medicine (Baltimore) ; 97(40): e12581, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30290622

RESUMO

BACKGROUND: This study aims to evaluate the effectiveness and safety of lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation in hip surgery in the elderly. METHODS: Thirty elderly patients who underwent hip surgery under the lower limb nerve block were randomly divided into 2 groups: slow induction of light general anesthesia and tracheal intubation group (group M), and laryngeal mask light general anesthesia group (group H). After undergoing total intravenous anesthesia without muscle relaxants, all patients received sciatic nerve, lumbar plexus, and paravertebral nerve blocks. The hemodynamic situations, dosage of anesthetics, time for awakening and extubation (or laryngeal mask removal), and incidence of respiratory adverse reactions in the induction period were recorded. RESULTS: Compared with baseline levels, the difference in mean arterial pressure (MAP) value at each time point after intubation/laryngeal mask removal in both groups was not statistically significant (P > .05). Furthermore, the time for awakening and extubation/laryngeal mask removal, and anesthetic dosage were significantly decreased in group M, when compared with group H (P < .05). For the incidence of adverse reactions, the incidence of poor sealing and hypoxia was significantly lower in group M than in group H (P < .05), and the incidence of sore throat was significantly lower in group H than in group M (P < .05). CONCLUSION: Lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation was associated with smaller anesthetic dosage, and shorter duration of anesthesia induction and extubation/laryngeal mask after surgery.


Assuntos
Anestesia Geral/métodos , Artroplastia de Quadril/métodos , Intubação Intratraqueal/métodos , Extremidade Inferior/inervação , Bloqueio Nervoso/métodos , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Feminino , Hemodinâmica , Humanos , Máscaras Laríngeas , Plexo Lombossacral , Masculino , Postura , Nervo Isquiático , Nervos Torácicos
18.
Medicine (Baltimore) ; 97(37): e12399, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30213013

RESUMO

BACKGROUND: Over the last decade, surgical decompression procedures have been commonly used in the treatment of diabetic peripheral neuropathy (DPN). However, the effectiveness of them remains to be proved. METHODS: A comprehensive literature search of databases including PubMed-Medline, Ovid-Embase, and Cochrane Library was performed to collect the related literatures. The Medical Subject Headings used were "diabetic neuropathy," "surgical decompression," and "outcomes." The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Analyses were performed with Review Manager (Version 5.3, The Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, 2014). RESULTS: A total of 12 literatures (including 8 prospective and 4 retrospective) encompassing 1825 patients with DPN were included in the final analysis. Only 1 literature was identified as a randomized-controlled trial. The remaining 11 literatures were observational studies; 7 of them were classified as upper-extremity nerve decompression group and 4 of them were classified as lower-extremity nerve decompression group. Meta-analysis shows that Boston questionnaire symptom severity and functional status of upper extremities, and distal motor latency and sensory conduction velocity of median nerve of DPN patients are significantly improved after carpal tunnel release. Besides, visual analog scale and 2-point discrimination are considered clinically and statistically significant in lower extremities after operation. CONCLUSIONS: The findings from our review have shown the efficacy of surgical decompression procedures in relieving the neurologic symptoms and restoring the sensory deficits in DPN patients. As there are few high-quality randomized-controlled trials or well-designed prospective studies, more data are needed to elucidate the role of surgical procedures for DPN treatment in the future.


Assuntos
Descompressão Cirúrgica/métodos , Neuropatias Diabéticas/cirurgia , Ossos do Carpo/inervação , Humanos , Extremidade Inferior/inervação , Extremidade Inferior/cirurgia , Nervo Mediano/cirurgia , Recuperação de Função Fisiológica , Resultado do Tratamento , Extremidade Superior/inervação , Extremidade Superior/cirurgia
19.
Intern Med ; 57(23): 3463-3465, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30101916

RESUMO

Neurolymphomatosis is a rare form of extranodal malignant lymphoma defined as the infiltration of malignant lymphocytes into the central or peripheral nerve. We herein report a case of neurolymphomatosis in the cauda equina diagnosed by an open surgical biopsy. He presented with muscle weakness, atrophy, numbness and hypoesthesia in the bilateral lower extremities with the accumulation of 18fluoro-2-deoxyglucose (FDG) in the bilateral cauda equina. Cerebrospinal fluid cytology (three times) and flow cytometry (two times) and biopsies of the left sural nerve, bone marrow, paranasal sinus and left testis were all negative for malignancy, so finally we performed a surgical open biopsy of the cauda equina by laminectomy and diagnosed him with diffuse large B-cell lymphoma in the cauda equina. He was successfully treated with the disappearance of the FDG accumulation for a long time. The present case suggested that an early open biopsy of the cauda equina may be considered for cases of suspected neurolymphomatosis in the cauda equina for a good outcome.


Assuntos
Biópsia/métodos , Cauda Equina/patologia , Linfoma Difuso de Grandes Células B/patologia , Neurolinfomatose/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Cauda Equina/cirurgia , Humanos , Laminectomia , Extremidade Inferior/inervação , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Atrofia Muscular/etiologia , Neurolinfomatose/cirurgia , Parestesia/etiologia , Neoplasias do Sistema Nervoso Periférico/cirurgia
20.
Int J Rehabil Res ; 41(4): 343-348, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30067555

RESUMO

The elastic-taping method of the proprioceptive neuromuscular facilitation (PNF) concept is nonexistent. Therefore, our study aimed to investigate the effect of treadmill training (TT) using PNF lower-leg taping (PNFLT) on walking and balance ability in patients with stroke. There were a total of 27 patients: a stroke allocated control group (n=13) and an experimental group (n=14). The control group performed the TT and the experimental group performed the TT using PNF taping five times a week for 6 weeks. Walking and balance ability were measured using the 6-min walk test (6MWT), the 10-m walking test (10MWT), and the timed up and go test (TUG). Before and after the intervention, a paired t-test was performed to compare different within-group differences. Independent t-tests were performed to compare different between-group differences. All statistical significance levels were set at α of 0.05. After intervention, 6MWT, 10MWT and TUG improved significantly in PNFLT-TT and TT group (P<0.01). After intervention, the PNFLT-TT group showed more effective changes that the TT group in 6MWT, 10MWT, and TUG (P<0.05 and <0.01) between PNFLT-TT and TT group. The intervention of PNFLT-TT was effective in improving walking and balance ability in patients with stroke. Basic elastic tape for the PNF concept and TT may be useful interventions as a program to improve walking and balance ability in patients with stroke.


Assuntos
Bandagens Compressivas , Hemiplegia/reabilitação , Limitação da Mobilidade , Junção Neuromuscular/fisiopatologia , Propriocepção/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Terapia por Exercício/instrumentação , Feminino , Hemiplegia/fisiopatologia , Humanos , Extremidade Inferior/inervação , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Teste de Caminhada , Caminhada/fisiologia
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