Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 295
Filtrar
1.
J Cardiothorac Surg ; 15(1): 54, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228645

RESUMO

BACKGROUND: The first reported case of cardiac herniation was in 1948 and occurred following pericardiectomy during a lung cancer resection. Although rare, this potentially fatal surgical complication may occur following any operation in which a pericardial incision or resection is performed. The majority of literature on cardiac herniation involves case reports after intrapericardial pneumonectomy. Currently, there are no reports of cardiac herniation after thymectomy with pericardial resection. CASE PRESENTATION: A 44-year-old Asian female with symptomatic myasthenia gravis was referred for thymectomy. Originally thought to have Bell's Palsy, her symptoms began with right eyelid drooping and facial weakness. Over time, she developed difficulty holding her head up, upper extremity weakness, difficulty chewing and dysarthria. These symptoms worsened with activity. She was found to have positive acetylcholine receptor binding antibody on her myasthenia gravis panel. A preoperative CT scan demonstrated a 3.5 cm × 2 cm anterior mediastinal mass along the right heart border and phrenic nerve. A complete thymectomy, via right-sided robotic-assisted approach was performed en bloc with a portion of the right phrenic nerve and a 4 cm × 4 cm portion of pericardium overlying the right atrium and superior right ventricle. Upon undocking of the robot and closure of the port sites, the patient became acutely hypotensive (lowest recorded blood pressure 43/31 mmHg). The camera was reinserted and demonstrated partial cardiac herniation through the anterior pericardial defect toward the right chest. An emergent midline sternotomy was performed and the heart was manually reduced. The patient's hemodynamics stabilized. A vented Gore-Tex 6 cm × 6 cm patch was sewn along the pericardial edges with interrupted 4-0 prolene to close the pericardial defect. CONCLUSION: This potentially fatal complication, although rare, should always be considered whenever there is hemodynamic instability entry or resection of the pericardium during surgery. We now routinely sew in a pericardial patch using our robotic surgical system for any defect over 3 cm × 3 cm that extends from the mid- to inferior portions of the heart.


Assuntos
Cardiopatias/etiologia , Pericardiectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Timectomia/efeitos adversos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Cardiopatias/cirurgia , Humanos , Miastenia Gravis/complicações , Pericárdio/cirurgia , Nervo Frênico/cirurgia , Complicações Pós-Operatórias/cirurgia , Esternotomia , Timectomia/métodos , Timoma/diagnóstico por imagem , Timo/diagnóstico por imagem , Timo/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Reg Anesth Pain Med ; 44(5): 561-564, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30867276

RESUMO

BACKGROUNDS AND OBJECTIVES: The anterior approach to the subomohyoid suprascapular (SOS) nerve is a new, technically easy and reliable regional anesthesia technique for postoperative shoulder analgesia. However, due to its proximity, the injectate may spread to the brachial plexus and phrenic nerve. The goal of this anatomic study with dye injection in the subomohyoid space and subsequent cadaver dissection was to establish the likely spread of local anesthesia and the extent of brachial plexus and phrenic nerve involvement resulting from ultrasound-guided SOS nerve block. METHODS: The suprascapular nerve (SSN) under the inferior belly of omohyoid muscle in the posterior triangle of the neck was identified. Using a contrast dye, 10 ultrasound-guided SOS nerve injections of 5 mL were done bilaterally, in five fresh cadavers. The area was then dissected to evaluate the spread of the contrast dye in the immediate proximity of the brachial plexus, phrenic and SSN. RESULTS: The SSN and omohyoid muscle were easily identified on each cadaver. SOS nerve staining with contrast dye was seen in 90% of dissections. The superior trunk was stained in 90% and the middle trunk was stained in 80% of dissections. The inferior trunk was stained in 20% of dissections. A spread of dye around the SSN was observed in 90% and the phrenic nerve was mildly stained in 20% of the dissections. CONCLUSION: In-plane ultrasound-guided needle injection with a 5 mL volume for SOS block was sufficient to stain the SSN. This conservative volume involved other parts of the brachial plexus and may potentially spread to the phrenic nerve. Further clinical studies are required for confirmation.


Assuntos
Anestesia por Condução/métodos , Plexo Braquial/diagnóstico por imagem , Corantes , Bloqueio Nervoso/métodos , Nervo Frênico/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Plexo Braquial/cirurgia , Cadáver , Feminino , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/cirurgia , Masculino , Nervo Frênico/cirurgia
3.
Laryngoscope ; 129(11): 2669-2673, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30756404

RESUMO

OBJECTIVE: To evaluate the extent of airway improvement and voice quality in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery. METHODS: Seven patients with BVFP caused by thyroid surgeries were enrolled. They underwent selective laryngeal reinnervation surgery. Videostroboscopy data, voice perceptual data (grade [G]), acoustic data, laryngeal electromyography data, and pulmonary function test data were obtained preoperatively and postoperatively. RESULTS: Videostroboscopic videos showed that six patients could achieve moderate-to-maximal abduction in the bilateral vocal folds during inspiration, whereas all patients achieved adduction in the bilateral vocal folds during phonation at 4 to 7 months postoperatively. G score was decreased significantly versus preoperative values (P < 0.05), and vocal functional parameters were improved significantly at 12 months postoperatively (P < 0.05). The aerodynamic parameter of maximum phonation time was significantly longer than the preoperative value (P < 0.05). Most parameters in pulmonary function test recovered to normal reference levels as early as 3 months postoperatively, whereas maximal inspiratory pressure (PImax) values were still slightly lower than normal levels 12 months after surgery. All of these parameters improved significantly versus preoperative values. Electromyographic data at 12 months postoperatively showed full interference potentials in bilateral posterior cricoarytenoid muscles during inspiration and full interference potentials in bilateral thyroarytenoid muscles during phonation in all patients. Moderate electric potentials were seen in left interarytenoid muscle in one failed patient. CONCLUSION: This new selective laryngeal reinnervation procedure can achieve physiological movements of the bilateral vocal folds in selected patients with BVFP. LEVEL OF EVIDENCE: 4. Laryngoscope, 129:2669-2673, 2019.


Assuntos
Nervo Hipoglosso/cirurgia , Regeneração Nervosa , Nervo Frênico/cirurgia , Complicações Pós-Operatórias/cirurgia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Adulto , Feminino , Humanos , Nervo Hipoglosso/fisiopatologia , Músculos Laríngeos/inervação , Músculos Laríngeos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação , Nervo Frênico/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Nervo Laríngeo Recorrente , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Estroboscopia , Tireoidectomia/efeitos adversos , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/inervação , Prega Vocal/fisiopatologia , Qualidade da Voz
4.
Cir. Esp. (Ed. impr.) ; 97(2): 103-107, feb. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-181118

RESUMO

En procedimientos quirúrgicos de las regiones supraclaviculares y laterales cervicales, así como en cirugías cardíacas y mediastínicas, la función diafragmática puede comprometerse desde la base del riesgo de lesión del nervio frénico y/o la raíz C4. Son escasas las publicaciones que tratan la estimulación intraoperatoria de estas estructuras nerviosas para evaluar su funcionalidad y, en nuestro conocimiento, hasta ahora no se ha hipotetizado acerca de si es posible reducir las tasas de lesión situadas en hasta el 26% en algunos estudios de cirugía cardíaca. Describimos la técnica empleada para la monitorización neurofisiológica del nervio frénico. Asimismo, se discute su utilidad y ventajas respecto a otras técnicas. Concluimos que con la incorporación creciente de la monitorización neurofisiológica intraoperatoria en los últimos años, es posible su aplicación al nervio frénico en los procedimientos en los que se considere que existe riesgo de lesión del mismo y, con ella, puede ser factible la reducción de las tasas de lesión iatrógena


In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies. We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed. We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible


Assuntos
Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Nervo Frênico/cirurgia , Processo Xifoide/cirurgia , Procedimentos Cirúrgicos Cardíacos , Procedimentos Cirúrgicos Operatórios
5.
Bull Exp Biol Med ; 166(3): 310-312, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30627906

RESUMO

Application of mild irritants (1 M NaCl; pH 2.0) on the gastric mucosa potentiates the protective secretion of bicarbonates by epithelial cells. This response is mainly mediated by capsaicin-sensitive afferent nerve endings located in the submucosa. It was shown that activation of vanilloid type 1 receptors (TRPV1) induced by exogenous acidification of GM is not sufficient to potentiate the production of HCO3, including production depending on neuronal NO synthase. However, the effect of exogenous acid on TRPV1 leads to activation of endothelial NO synthase that restrict the gastric secretion of [Formula: see text].


Assuntos
Bicarbonatos/metabolismo , Mucosa Gástrica/efeitos dos fármacos , Óxido Nítrico Sintase Tipo III/genética , Óxido Nítrico Sintase Tipo I/genética , Cloreto de Sódio/farmacologia , Estômago/efeitos dos fármacos , Canais de Cátion TRPV/genética , Amilorida/farmacologia , Animais , Capsaicina/análogos & derivados , Capsaicina/farmacologia , Mucosa Gástrica/inervação , Mucosa Gástrica/metabolismo , Regulação da Expressão Gênica , Concentração de Íons de Hidrogênio , Indazóis/farmacologia , Masculino , Óxido Nítrico Sintase Tipo I/antagonistas & inibidores , Óxido Nítrico Sintase Tipo I/metabolismo , Óxido Nítrico Sintase Tipo III/antagonistas & inibidores , Óxido Nítrico Sintase Tipo III/metabolismo , Nitroarginina/farmacologia , Concentração Osmolar , Perfusão , Nervo Frênico/cirurgia , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Estômago/inervação , Canais de Cátion TRPV/antagonistas & inibidores , Canais de Cátion TRPV/metabolismo , Vagotomia
6.
Pulmonology ; 25(4): 223-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30509855

RESUMO

The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.


Assuntos
Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/terapia , Ultrassonografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/inervação , Diafragma/cirurgia , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Fluoroscopia/métodos , Humanos , Microcirurgia/métodos , Nervo Frênico/lesões , Nervo Frênico/patologia , Nervo Frênico/cirurgia , Radiografia/métodos , Respiração Artificial/métodos , Respiração Artificial/tendências , Testes de Função Respiratória/métodos , Paralisia Respiratória/etiologia , Estimulação Elétrica Nervosa Transcutânea/métodos
7.
Ann Thorac Surg ; 107(3): 878-884, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30336118

RESUMO

BACKGROUND: Phrenic nerve infiltration has been described in as many as 33% of advanced thymomas; en bloc resection causes diaphragmatic loss of function, with detrimental effects on pulmonary function. We report the outcomes of selected patients operated on for invasive thymoma with a nerve-sparing technique. METHODS: From 1990 to 2015 we used nerve-sparing surgery with the intention to treat all patients with advanced stage thymomas without preoperative evidence of hemidiaphragmatic palsy, but with macroscopic evidence of phrenic nerve involvement. All patients underwent adjuvant radiotherapy (45 to 60 Gy) with or without chemotherapy. Long-term outcomes and the pattern of recurrence were retrospectively analyzed. RESULTS: Among 140 patients with stage III and IVa operated on during the study period, 19 women and 18 men with a median age of 52 years received a nerve-sparing resection. Myasthenia gravis was associated in 25 cases. In 12 patients, phrenic palsy was observed postoperatively, and eventually 4 of them recovered. Recurrence was found in 10 patients (7 stage IVa, 3 stage III) requiring additional therapies. Three patients died of cancer-related causes, with an overall survival of 265.4 months and a disease-free survival of 233.2 months. CONCLUSIONS: Phrenic nerve preservation in cases of invasive thymomas is feasible and may warrant an acceptable local control of disease, if associated with radiotherapy. According to these results, this technique could be proposed to all patients with invasive thymoma, especially in those affected by severe comorbidities or with a poor performance status.


Assuntos
Previsões , Estadiamento de Neoplasias , Nervo Frênico/cirurgia , Paralisia Respiratória/prevenção & controle , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Resultado do Tratamento
9.
J Hand Surg Asian Pac Vol ; 23(4): 496-500, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30428802

RESUMO

BACKGROUND: To report the results of restoring the elbow flexion and extension in patients with total brachial root avulsion injuries by simultaneous transfer of the phrenic nerve to the nerve to the biceps and three intercostal nerves to the nerve of the long head of the triceps. METHODS: Ten patients with total brachial root avulsion injuries underwent the spinal accessory nerve transfer to the suprascapular nerve for shoulder reconstruction. Simultaneous transfer of the phrenic nerve to the nerve to the biceps via the sural nerve graft and three intercostal nerves to the nerve of the long head of the triceps was done for restoration of the elbow flexion and extension. Trunk flexion exercise program was used for all patients postoperatively. The mean follow up period was 36 months. RESULTS: For elbow flexion, there were two M4, seven M3, and one M1. For elbow extension, there were three M4, four M3, two M2, and one M1. No patient demonstrated a respiratory problem clinically postoperatively. The average FVC% decreased to 61% of the predicted value at 24 months after surgery. CONCLUSIONS: The simultaneous nerve transfer using the phrenic nerve to the nerve to the biceps and 3 intercostal nerves to the nerve of the long head of the triceps with postoperative trunk flexion exercise provide a comparable result for restoration of elbow function in total brachial plexus root avulsion injury. The patients who appear to have a respiratory problem and are unable to comply with the post-operative respiratory muscles training should be contraindicated for this simultaneous transfer.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Articulação do Cotovelo/inervação , Transferência de Nervo/métodos , Nervo Acessório/cirurgia , Adolescente , Adulto , Plexo Braquial/lesões , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Nervos Intercostais/cirurgia , Masculino , Nervo Frênico/cirurgia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Adulto Jovem
10.
Paediatr Anaesth ; 28(11): 963-973, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30251310

RESUMO

BACKGROUND: Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation are rare neurocristopathies characterized by autonomic dysregulation including bradyarrhythmias, abnormal temperature control, and most significantly, abnormal control of breathing leading to tracheostomy and ventilator dependence as life support. Surgical advancements have made phrenic nerve-diaphragm pacemakers available, to eliminate the tether to a mechanical ventilator for 12-15 hours each day. The thoracoscopic approach to implantation has allowed for a less invasive approach which may have implications for pain control and recovery time. However, thoracoscopic implantation of these devices presents several challenges to the anesthesiologist in these complex ventilator-dependent patients, including, but not limited to, sequential lung isolation, prevention of hypothermia, and management of arrhythmias. Postoperative challenges may also include strategies to treat hemodynamic instability, managing the ventilator following lung derecruitment, and providing adequate pain control. AIMS: We aimed to describe the anesthetic management of Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation patients undergoing thoracoscopic phrenic nerve-diaphragm pacemaker implantation and the nature and incidence of perioperative complications. METHODS: A retrospective chart review was performed of 14 children with Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation undergoing phrenic nerve-diaphragm pacemaker implantation at a single academic pediatric hospital between 2009 and 2017. Demographic information, intraoperative management, and perioperative complications were analyzed from patient records. RESULTS: Twelve of 14 patients (86%) underwent an inhalational induction via tracheostomy. Lung isolation was achieved via fiberoptic guidance of a single lumen endotracheal tube sequentially into the right or left mainstem bronchi for 12 patients (86%). Double lumen endotracheal tubes were utilized in two patients (7%) and bronchial blockers in two patients (7%) for lung isolation. Anesthesia was maintained using a balanced technique of volatile agents (sevoflurane/isoflurane) and opioids (fentanyl). Bradyarrhythmias developed in six patients (43%) during surgery, 5 (36%) responded to anticholinergics and one patient (7%) required backup cardiac pacing using a previously implanted bipolar cardiac pacemaker. Intraoperative hypothermia (<35.5°C) was present in five patients (36%) despite the use of warming devices. Hypercarbia (>50 mm Hg) during lung isolation was present in eight patients (57%) and hemoglobin desaturation (<90%) in four patients (29%). Postoperatively, oxygen desaturation was a common complication with nine patients (64%) requiring supplemental oxygen administration via mechanical ventilator or manual bag ventilation. Opioids via patient-controlled analgesia devices (12 patients, 86%) or intermittent injection (two patients, 14%) were administered to all patients for postoperative pain control. Phrenic nerve-diaphragm pacemaker placement was successful thoracoscopically in all patients with no perioperative mortality. CONCLUSION: The main anesthetic challenges in patients with Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation include hemodynamic instability, the propensity to develop hypothermia, hypercarbia/hypoxemia, and the need to perform bilateral sequential lung isolation requisite to the thoracoscopic implantation technique. Most anesthetic agents can be used safely in these patients; however, adequate knowledge of the susceptibility to complications, coupled with adequate preparation and understanding of the innate disease characteristics, are necessary to treat anticipated complications.


Assuntos
Anestésicos/uso terapêutico , Hipoventilação/congênito , Marca-Passo Artificial , Nervo Frênico/cirurgia , Apneia do Sono Tipo Central/terapia , Adolescente , Anestesia/métodos , Criança , Pré-Escolar , Diafragma/cirurgia , Terapia por Estimulação Elétrica/métodos , Humanos , Doenças Hipotalâmicas/fisiopatologia , Hipoventilação/fisiopatologia , Hipoventilação/terapia , Lactente , Obesidade Pediátrica/fisiopatologia , Assistência Perioperatória/métodos , Estudos Retrospectivos , Apneia do Sono Tipo Central/fisiopatologia , Síndrome , Traqueostomia
11.
J Neurosurg Spine ; 29(4): 470-480, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29979142

RESUMO

The authors studied restoration of respiratory function in rabbits, using the recurrent laryngeal nerve to restore function after the phrenic nerve had been severed. The results of this animal study are encouraging and suggest that a similar technique could possibly be used to help patients with severe cervical spinal cord injuries.


Assuntos
Nervo Frênico/cirurgia , Recuperação de Função Fisiológica/fisiologia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Nervo Laríngeo Recorrente/cirurgia , Anastomose Cirúrgica/métodos , Animais , Diafragma/fisiopatologia , Eletromiografia/métodos , Nervo Frênico/fisiopatologia , Coelhos , Nervo Laríngeo Recorrente/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia
12.
J Plast Reconstr Aesthet Surg ; 71(9): 1245-1251, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29980455

RESUMO

The widely used nerve transfer sources for elbow flexion in patients with upper brachial plexus avulsion (UBPA) include partial ulnar nerve, phrenic nerve, and intercostal nerves. A retrospective review of 21 patients treated with phrenic and partial ulnar nerve transfers for elbow flexion after UBPA was carried out. In the phrenic nerve transfer group, the phrenic nerve was transferred to the anterolateral bundle of the anterior division of the upper trunk; in the partial ulnar nerve transfer group, one fascicle of the ulnar nerve was transferred to the biceps branch. The British Medical Research Council (MRC) grading system, angle of elbow flexion, electromyography (EMG), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scoring were used to evaluate the recovery of elbow flexion at least 3 years postoperatively. The efficiency of motor function in phrenic nerve transfer group was 82%, whereas it was 80% in partial ulnar nerve transfer group. The outstanding rates of angle of elbow flexion were 64% and 70% in phrenic and partial ulnar nerve transfer groups, respectively. The DASH scores after surgery were significantly lower than those before surgery in the two groups. There was no statistical difference between the two groups in the changes of DASH scores before and after surgery. Both of phrenic and partial ulnar nerve transfers had good prognosis for elbow flexion in patients with UBPA.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/cirurgia , Articulação do Cotovelo/fisiopatologia , Transferência de Nervo/métodos , Nervo Frênico/cirurgia , Recuperação de Função Fisiológica , Nervo Ulnar/cirurgia , Adolescente , Adulto , Neuropatias do Plexo Braquial/fisiopatologia , Articulação do Cotovelo/inervação , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
13.
J Cardiothorac Surg ; 13(1): 86, 2018 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986737

RESUMO

BACKGROUND: Combined resection of a phrenic nerve is occasionally required in T3 primary lung carcinomas invading the phrenic nerve to completely remove a malignant tumour, resulting in diaphragmatic paralysis. We describe the first case of thoracoscopic lobectomy and diaphragmatic plication as a one-stage surgery for lung cancer invading the phrenic nerve. CASE PRESENTATION: A 56-year-old woman with a T3N0M0 primary adenosquamous carcinoma in the left upper lobe presented with suspicious invasion to the anterior mediastinal fat tissue and left phrenic nerve and underwent left upper lobectomy, node dissection, and partial resection of the anterior mediastinal fat tissue with the left phrenic nerve. Furthermore, thoracoscopic diaphragmatic plication was performed as a concomitant procedure. The patient's postoperative course was favourable, without any complications, and respiratory function was preserved for 1 year postoperatively. CONCLUSIONS: Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer invading the phrenic nerve is effective for preservation of postoperative pulmonary function.


Assuntos
Carcinoma Adenoescamoso/cirurgia , Diafragma/cirurgia , Neoplasias Pulmonares/cirurgia , Nervo Frênico/cirurgia , Pneumonectomia/métodos , Carcinoma Adenoescamoso/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Nervo Frênico/patologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Paralisia Respiratória/prevenção & controle , Resultado do Tratamento
14.
Med Sci Monit ; 24: 4832-4840, 2018 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-30001299

RESUMO

BACKGROUND Brachial plexus injury (BPI), a severe nervous system injury, is a leading cause of functional damages of the affected upper limb. Patients with BPI manifested with motor weakness or paralysis, sensory deficits, and pain. We established a BPI rat model to explore the in vivo effect of end-to-side screw anastomosis (ETSSA) of phrenic nerve on the recovery of limb function after BPI. MATERIAL AND METHODS After modeling, rats were treated with end-to-side anastomosis (ETSA) and ETSSA respectively. After 1 and 3 months, the behavioral changes of rats were observed using the Terzis grooming test, and the compound muscle action potential (CMAP) and muscle tension of biceps brachii were detected. The muscle weight recovery rate (MWRR) and cross-sectional area recovery rate (CARR) were calculated. Toluidine blue staining was used to observe the myelinated nerve fibers in the proximal phrenic nerve and distal musculocutaneous nerve of suture. The ratio of regenerated nerve traversing rate (NTR) was counted and motor endplate area of biceps brachii was measured. RESULTS The rats treated with ETSA and ETSSA exhibited elevated grading of Terzis grooming test with time. Although both the ETSSA and ETSA can reduce the MWRR, CARR and motor endplate area in BPI rats, ETSSA showed a better influence on the latency delayed rate (LDR) and amplitude recovery rate (ARR) of CMAP, muscular tension recovery rate (MTRR), MWRR, number of regenerated myelinated nerve fibers, NTR, and motor endplate area in BPI rats. CONCLUSIONS Our study provided evidence that ETSSA can restore the limb function recovery to a greater extent, and accelerate the regeneration of nerve fibers in rats with BPI; the effect of ETSSA was better than that of ETSA.


Assuntos
Anastomose Cirúrgica/métodos , Plexo Braquial/cirurgia , Nervo Frênico/cirurgia , Animais , Parafusos Ósseos , Masculino , Neurônios Motores , Músculo Esquelético/inervação , Regeneração Nervosa/fisiologia , Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos , Ratos , Ratos Sprague-Dawley
16.
J Plast Surg Hand Surg ; 52(3): 185-188, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29179656

RESUMO

The phrenic nerve being transferred to the posterior division of the lower trunk with end-to-end neurorrhaphy is reported to be effective in restoring the function of digit extension in literature. However, the phrenic nerve is extremely important in respiration. We designed an animal experiment to discover whether the phrenic nerve being transferred to the posterior division of the lower trunk with end-to-side neurotization was feasible and provided the theoretical basis. A sum of 36 Sprague-Dawley rats was randomly assigned to one of two groups. In Group A, the phrenic nerve was transferred to the posterior division of the lower trunk with end-to-side neurotization. In Group B, the posterior division of the lower trunk was directly sutured. The results of behavioral assessment, electrophysiology, histology and nerve fiber count and muscle weight at 12 weeks postoperatively were recorded. In Group A, none of the rats experienced tachypnea. The motion of slight toe extension was observed. The results of electrophysiology, histology and nerve fiber count and muscle weight in Group A were not as well as those of Group B, but gradually improved with time. The phrenic nerve being transferred to the posterior division of lower trunk with end-to-side neurotization can partially restore the function of toe extension in a rat model. Whether the function of digit extension can be restored by the phrenic nerve with end-to-side neurotization in humans still needs more practice in clinic.


Assuntos
Microcirurgia/métodos , Transferência de Nervo/métodos , Nervo Frênico/cirurgia , Dedos do Pé/inervação , Animais , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Eletrofisiologia , Modelos Animais , Músculo Esquelético/patologia , Fibras Nervosas Mielinizadas/patologia , Tamanho do Órgão , Distribuição Aleatória , Ratos Sprague-Dawley , Dedos do Pé/fisiologia
17.
Ann Plast Surg ; 79(2): 180-182, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28570440

RESUMO

OBJECTIVE: Our objective in this study was to extend diaphragmatic pacing therapy to include paraplegic patients with high cervical spinal cord injuries between C3 and C5. INTRODUCTION: Diaphragmatic pacing has been used in patients experiencing ventilator-dependent respiratory failure due to spinal cord injury as a means to reduce or eliminate the need for mechanical ventilation. However, this technique relies on intact phrenic nerve function. Recently, phrenic nerve reconstruction with intercostal nerve grafting has expanded the indications for diaphragmatic pacing. Our study aimed to evaluate early outcomes and efficacy of intercostal nerve transfer in diaphragmatic pacing. METHODS: Four ventilator-dependent patients with high cervical spinal cord injuries were selected for this study. Each patient demonstrated absence of phrenic nerve function via external neck stimulation and laparoscopic diaphragm mapping. Each patient underwent intercostal to phrenic nerve grafting with implantation of a phrenic nerve pacer. The patients were followed, and ventilator dependence was reassessed at 1 year postoperatively. RESULTS: Our primary outcome was measured by the amount of time our patients tolerated off the ventilator per day. We found that all 4 patients have tolerated paced breathing independent of mechanical ventilation, with 1 patient achieving 24 hours of tracheostomy collar. CONCLUSIONS: From this study, intercostal to phrenic nerve transfer seems to be a promising approach in reducing or eliminating ventilator support in patients with C3 to C5 high spinal cord injury.


Assuntos
Diafragma/inervação , Nervos Intercostais/transplante , Transferência de Nervo/métodos , Paraplegia/complicações , Nervo Frênico/cirurgia , Insuficiência Respiratória/cirurgia , Traumatismos da Medula Espinal/complicações , Adulto , Vértebras Cervicais , Seguimentos , Humanos , Masculino , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Resultado do Tratamento
18.
Ann Thorac Surg ; 104(1): e9-e11, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28633275

RESUMO

A 49-year-old man with left phrenic nerve paralysis caused by mediastinal tumor resection 28 years earlier was found to have a nodule in the right upper lobe. The right phrenic nerve was severed during right upper lobectomy but was reconstructed along with bilateral plication of the diaphragm. The patient was weaned from the ventilator during the daytime on postoperative day 13 and was discharged home on postoperative day 48. Three months postoperatively, chest fluoroscopic imaging showed recovery of movement of the right diaphragm. Nerve conduction studies showed improvement of function of the reconstructed right phrenic nerve.


Assuntos
Diafragma/cirurgia , Neoplasias Pulmonares/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Nervo Frênico/cirurgia , Pneumonectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Paralisia Respiratória/cirurgia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Diafragma/inervação , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Nervo Frênico/lesões , Radiografia Torácica , Paralisia Respiratória/diagnóstico , Paralisia Respiratória/etiologia , Tomografia Computadorizada por Raios X
19.
Chest ; 151(4): e69-e71, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28390638

RESUMO

Diaphragm flutter is a rare disorder defined by dyspnea and often thoracoabdominal pain associated with rapid rhythmic involuntary contractions of the diaphragm with no effective treatment. A 35-year-old woman's flutter was triggered by increasing the depth of breathing and by (electrical) stimulation of the diaphragm. Medical therapy, phrenic nerve crush, and diaphragm pacer stimulation were ineffective. Since increasing diaphragm activity was a trigger, resting the diaphragm was tried. A manual resuscitator and, subsequently, mouthpiece and nasal noninvasive ventilatory support (NVS) instantaneously halted the flutter for 3 months and almost instantaneously for another 6 months. For 16 months, it has continued to halt flutter with rare episodes when getting out of bed that resolve with up to 40 minutes of NVS. To our knowledge, this is the first case of idiopathic diaphragmatic flutter for which diaphragm rest was used as successful treatment with no adverse effects. This should be tried for future cases.


Assuntos
Diafragma/fisiopatologia , Mioclonia/diagnóstico , Mioclonia/terapia , Músculos Respiratórios/fisiopatologia , Adulto , Diagnóstico Diferencial , Diafragma/inervação , Eletromiografia , Feminino , Fluoroscopia , Humanos , Nervo Frênico/fisiopatologia , Nervo Frênico/cirurgia
20.
Artigo em Chinês | MEDLINE | ID: mdl-28441799

RESUMO

Objective: To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods. Methods: One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n=52) or laser arytenoidectomy(laser group, n=65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y. Results: Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference(P>0.05), while laser group showed a significant deterioration in voice quality postoperative1y(P<0.05). The two groups showed significant difference in voice quality postoperative1y(P<0.05). Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P<0.05). But the amplitude in nerve group was larger than that in laser group (P<0.05). 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group (P>0.05), while showed various increment in laser group(P<0.05). Differences between the two groups were statistically significant(P<0.05). The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decannulation rate were 88.5% and 81.5% in nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration. Conclusions: Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.


Assuntos
Músculos Laríngeos/inervação , Transferência de Nervo/métodos , Nervo Frênico/cirurgia , Paralisia das Pregas Vocais/cirurgia , Cartilagem Aritenoide , Eletromiografia , Feminino , Humanos , Músculos Laríngeos/cirurgia , Laringoscopia , Terapia a Laser , Masculino , Fonação , Período Pós-Operatório , Qualidade de Vida , Resultado do Tratamento , Prega Vocal/fisiopatologia , Prega Vocal/cirurgia , Qualidade da Voz
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA