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1.
Unfallchirurg ; 123(6): 496-500, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32140813

RESUMO

This article reports the case of a 42-year-old male patient, who sustained a gluteal compartment syndrome after drug-induced immobilization with subsequent rhabdomyolysis and sciatic nerve palsy. Unlike compartment syndrome of the forearm or lower leg, this is a rare condition. After immediate surgical decompression and installation of negative pressure wound treatment, hemofiltration in acute renal failure could be averted using forced diuresis. The sensorimotor function of the lower extremity improved already after the first treatment and secondary wound closure was possible after 1 week. The patient was discharged 11 days after admission with complete recovery of sensorimotor and renal functions.


Assuntos
Lesão Renal Aguda/prevenção & controle , Nádegas/lesões , Nádegas/cirurgia , Síndromes Compartimentais/cirurgia , Transtornos Relacionados ao Uso de Opioides/terapia , Lesão Renal Aguda/etiologia , Adulto , Síndromes Compartimentais/etiologia , Descompressão Cirúrgica , Diurese , Diuréticos/uso terapêutico , Humanos , Masculino , Tratamento de Ferimentos com Pressão Negativa , Transtornos Relacionados ao Uso de Opioides/complicações , Recuperação de Função Fisiológica , Rabdomiólise/etiologia , Rabdomiólise/cirurgia , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia , Técnicas de Fechamento de Ferimentos
2.
PLoS One ; 14(10): e0223443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584985

RESUMO

Polyethylene glycol repair (PEG-fusion) of severed sciatic axons restores their axoplasmic and membrane continuity, prevents Wallerian degeneration, maintains muscle fiber innervation, and greatly improves recovery of voluntary behaviors. We examined alterations in spinal connectivity and motoneuron dendritic morphology as one potential mechanism for improved behavioral function after PEG-fusion. At 2-112 days after a single-cut or allograft PEG-fusion repair of transected or ablated sciatic nerves, the number, size, location, and morphology of motoneurons projecting to the tibialis anterior muscle were assessed by retrograde labeling. For both lesion types, labeled motoneurons were found in the appropriate original spinal segment, but also in inappropriate segments, indicating mis-pairings of proximal-distal segments of PEG-fused motor axons. Although the number and somal size of motoneurons was unaffected, dendritic distributions were altered, indicating that PEG-fusion preserves spinal motoneurons but reorganizes their connectivity. This spinal reorganization may contribute to the remarkable behavioral recovery seen after PEG-fusion repair.


Assuntos
Neurônios Motores/metabolismo , Condução Nervosa , Neuropatia Ciática/etiologia , Neuropatia Ciática/metabolismo , Potenciais de Ação , Aloenxertos , Animais , Contagem de Células , Dendritos/metabolismo , Modelos Animais de Doenças , Fenômenos Eletrofisiológicos , Feminino , Imuno-Histoquímica , Neurônios Motores/citologia , Regeneração Nervosa , Polietilenoglicóis , Ratos , Recuperação de Função Fisiológica , Neuropatia Ciática/reabilitação
3.
Neurochem Res ; 44(9): 2123-2138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31376053

RESUMO

Number of ligations made in the chronic constriction injury (CCI) neuropathic pain model has raised serious concerns. We compared behavioural responses, nerve morphology and expression of pain marker, c-fos among CCI models developed with one, two, three and four ligations. The numbers of ligation(s) on sciatic nerve shows no significant difference in displaying mechanical and cold allodynia, and mechanical and thermal hyperalgesia throughout 84 days. All groups underwent similar levels of nerve degeneration post-surgery. Similar c-fos level in brain cingulate cortex, parafascicular nuclei and amygdala were observed in all CCI models compared to sham-operated group. Therefore, number of ligations does not impact intensity of pain symptoms, pathogenesis and neuronal activation. A single ligation is sufficient to develop neuropathic pain, in contrast to the established model of four ligations. This study dissects and characterises the CCI model, ascertaining a more uniform animal model to surrogate actual neuropathic pain condition.


Assuntos
Modelos Animais de Doenças , Camundongos Endogâmicos ICR , Neuralgia , Tonsila do Cerebelo/metabolismo , Tonsila do Cerebelo/patologia , Tonsila do Cerebelo/fisiopatologia , Animais , Constrição Patológica/complicações , Giro do Cíngulo/metabolismo , Giro do Cíngulo/patologia , Hiperalgesia/metabolismo , Hiperalgesia/fisiopatologia , Núcleos Intralaminares do Tálamo/metabolismo , Núcleos Intralaminares do Tálamo/patologia , Ligadura , Masculino , Neuralgia/etiologia , Neuralgia/metabolismo , Neuralgia/patologia , Neuralgia/fisiopatologia , Medição da Dor , Proteínas Proto-Oncogênicas c-fos/metabolismo , Nervo Isquiático/lesões , Nervo Isquiático/patologia , Neuropatia Ciática/etiologia , Neuropatia Ciática/metabolismo , Neuropatia Ciática/patologia , Neuropatia Ciática/fisiopatologia
4.
A A Pract ; 13(5): 173-175, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31265445

RESUMO

Neurologic complications following neuraxial anesthesia for cesarean delivery are rare. We present a 33-year-old parturient who developed prolonged lower extremity weakness following a single-shot subarachnoid block for cesarean delivery. After neurologic evaluation, she was diagnosed with bilateral sciatic neuropathies due to prolonged positioning for the anesthetic. We review the incidence of nerve injury associated with neuraxial anesthesia and risk factors for developing peripheral nerve injury in this context. We offer a solution to prevent this complication from occurring.


Assuntos
Bloqueio Nervoso/efeitos adversos , Nervo Isquiático/lesões , Neuropatia Ciática/etiologia , Adulto , Anestesia Obstétrica/efeitos adversos , Cesárea , Feminino , Humanos , Gravidez
5.
World Neurosurg ; 129: 170-171, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181364

RESUMO

Intraneural hematomas are an uncommon cause of a focal mononeuropathy. When they do occur, it is usually in the setting of inherited or iatrogenic coagulopathies or as a consequence of injections targeting nerves. We report a man aged 68 years on warfarin therapy for a prior pulmonary embolism who presented with a 6-month history of progressive weakness of knee flexion and ankle movement, excruciating pain, and dense numbness in his posterior left thigh and below the knee, consistent with a severe high sciatic palsy. Imaging depicted a contiguous cystic mass of mixed T1 and T2 intensities involving the left sciatic nerve in the thigh, which was radiologically interpreted as a hip arthroplasty-associated pseudotumor. The patient underwent surgical exploration, which revealed a thick hemorrhagic pseudocompartment within the sciatic nerve. The histopathologic diagnosis was consistent with chronic hemorrhage. These impressive lesions should be included in the differential diagnosis of nerve masses.


Assuntos
Hematoma/patologia , Neuropatia Ciática/patologia , Idoso , Anticoagulantes/efeitos adversos , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Embolia Pulmonar/tratamento farmacológico , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia , Varfarina/efeitos adversos
6.
J Clin Neurosci ; 64: 35-37, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30967313

RESUMO

Alcohol consumption and subsequent sleeping in unusual positions often causes compression neuropathies. In this case, we experienced a unique case of bilateral leg palsy after sleeping in a forward bending position that was photographed by his colleague. We expected that prolonged blockage of the circulation of the femoral arteries resulted in bilateral thigh compartment syndromes (TCSs), leading to sciatic nerve damage. The muscle MRI and needle EMG support this hypothesis. A couple of similar cases have been reported, but the causes of TCS was undetermined due to lack of medical history. This case illustrates that atraumatic compartment syndrome with sciatic nerve palsy can be occurred by prolonged unusual positions.


Assuntos
Síndromes Compartimentais/etiologia , Neuropatia Ciática/etiologia , Postura Sentada , Coxa da Perna , Adulto , Humanos , Masculino , Necrose/etiologia , Síndromes de Compressão Nervosa/etiologia , Coxa da Perna/irrigação sanguínea , Coxa da Perna/patologia
7.
Muscle Nerve ; 59(3): 309-314, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30414322

RESUMO

INTRODUCTION: In this study we sought to characterize etiologies and features of sciatic neuropathy unrelated to penetrating nerve trauma. METHODS: This investigation was a retrospective review of 109 patients with electrodiagnostically confirmed sciatic neuropathies. RESULTS: Hip replacement surgery represented the most common (34.9%) etiology, whereas inflammatory sciatic neuropathy was seen in 7.3%. Electrodiagnostic testing revealed an axonal neuropathy in 95.4% and a demyelinating neuropathy in 4.6%. Predominant involvement of the peroneal division was seen in 39.4% and was tibial in 5.5%. Nine of 31 (29.0%) patients who had MRI or neuromuscular ultrasound study showed abnormalities within the sciatic nerve. At the final visit, 46.4% of patients required assistance for ambulation. Young age, lack of severe initial weakness, and presence of tibial compound muscle action potential or sural sensory nerve action potential were predictors of favorable outcome. DISCUSSION: Sciatic neuropathies are usually axonal on electrodiagnostic testing, affect preferentially the peroneal division, and are commonly associated with incomplete recovery. Muscle Nerve 59:309-314, 2019.


Assuntos
Eletrodiagnóstico/métodos , Neuropatia Ciática/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Axônios/patologia , Doenças Desmielinizantes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/complicações , Modalidades de Fisioterapia , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Neuropatia Ciática/diagnóstico por imagem , Neuropatia Ciática/etiologia , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
8.
J Med Case Rep ; 12(1): 391, 2018 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-30593288

RESUMO

BACKGROUND: Projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object. CASE PRESENTATION: A 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4-5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy. CONCLUSIONS: An acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.


Assuntos
Nádegas/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Neuropatia Ciática/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto , Nádegas/patologia , Discotomia , Feminino , Corpos Estranhos/complicações , Humanos , Vértebras Lombares , Metais , Microscopia Acústica , Microscopia Eletrônica de Varredura , Neuropatia Ciática/etiologia , Neuropatia Ciática/patologia , Análise Espectral , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações
9.
Medicine (Baltimore) ; 97(36): e12254, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200159

RESUMO

RATIONALE: Sciatic neuropathy has various causes; however, cases in which a pressure ulcer led to sciatic neuropathy have not been reported to date. PATIENT CONCERNS: A 33-year-old woman with no pre-existing mobility problems visited our department with the chief complaint of an extensive pressure ulcer and necrosis in her right buttock. She had a medical history of being bedridden for 2 days while in a coma due to a drug overdose 2 months previously. Physical examination revealed loss of sensation and foot drop in the right foot. DIAGNOSIS: Physical examination, magnetic resonance imaging, and nerve conduction studies were conducted; the patient was diagnosed with a common peroneal branch injury of the right sciatic nerve. INTERVENTIONS: The necrotic tissue was debrided and sciatic nerve decompression was performed, followed by frequent dressing changes. In addition, psychiatric treatment and physical therapy were performed simultaneously. OUTCOMES: The pressure ulcer decreased in size and healed to some extent with granulation tissue. However, gait disorders, accompanied by symptoms of sciatic neuropathy, continued. The patient was transferred to the department of gastroenterology for the treatment of toxic hepatitis, which occurred during her inpatient treatment. LESSONS: Physicians should be aware that sciatic neuropathy may occur during the treatment of patients with a pressure ulcer who exhibit no symptoms of paraplegia or quadriplegia. To prevent neuropathy, aggressive treatment of the pressure ulcer is necessary.


Assuntos
Lesão por Pressão/complicações , Neuropatia Ciática/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Lesão por Pressão/diagnóstico por imagem , Lesão por Pressão/patologia , Lesão por Pressão/terapia , Neuropatia Ciática/diagnóstico por imagem , Neuropatia Ciática/patologia , Neuropatia Ciática/terapia
10.
Injury ; 49(10): 1841-1847, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30100247

RESUMO

AIM: The aim of this study was to evaluate the long-term clinical outcomes and complications following an acetabular fracture associated with a posterior hip dislocation compared to those without dislocation. PATIENTS & METHODS: A retrospective cohort study of 113 patients (mean age 42 (14-95), 77% male) with acetabular fracture dislocations compared to 367 patients with acetabular fractures without dislocation (mean age 54 (16-100), 66% male) treated from 1988 to 2010. Patient characteristics, complications, reoperations, and conversion to total hip arthroplasty (THA) were recorded. Long term patient reported outcomes (Oxford Hip Score and SF-12) were measured at mean follow up 9.7 years (5-26). RESULTS: At long-term follow up 12/113 (11%) patients had died and 22/113 (19%) were lost. Isolated posterior wall fracture was the most common fracture associated with dislocation. Patients with dislocation were more likely to be younger and male with higher Injury Severity Scores (ISS). There was no significant difference in radiographic post-traumatic osteoarthritis development between fractures with and without dislocation (p = 0.246). Sciatic nerve palsy (12% Vs 1%, p < 0.001) and avascular necrosis (AVN) (11% Vs 1%, p < 0.001) were more common when dislocation was present. AVN was associated with increasing age and hypotension on arrival to the emergency department. Ten-year native hip survival was worse following fracture dislocations compared to fractures without dislocation: 75.1% (65.7-84.5 95% CI) Vs 90.7% (87.0-94.4), p < 0.001. Significant predictors of THA requirement were older age, particularly age >55 years at fracture, and increased ISS. Long-term OHS was worse in fractures with dislocations (33.6 ± 13.1 Vs 37.0 ± 14.0, p = 0.016). CONCLUSION: Acetabular fractures with an associated dislocation have worse long-term functional outcomes with higher rates of complications and conversion to late THA compared to acetabular fractures without a dislocation.


Assuntos
Acetábulo/lesões , Artroplastia de Quadril/estatística & dados numéricos , Luxação do Quadril/cirurgia , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias , Acetábulo/fisiopatologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Necrose da Cabeça do Fêmur/etiologia , Seguimentos , Luxação do Quadril/fisiopatologia , Fraturas do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Neuropatia Ciática/etiologia , Resultado do Tratamento , Adulto Jovem
11.
Biochim Biophys Acta Mol Basis Dis ; 1864(10): 3418-3437, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30076959

RESUMO

It has been suggested that CXCR3 is important for nociception. Our experiments were conducted to evaluate involvement of CXCR3 and its ligands (CXCL4, CXCL9, CXCL10, CXCL11/CCL21) in neuropathic pain. Our studies give new evidence that intrathecal administration of each CXCR3 ligand induces pain-like behaviour in naive mice that occurs shortly after injection due to its location of neurons, which is confirmed by immunofluorescent staining. Moreover, intrathecal administrations of CXCL9, CXCL10, CCL21 neutralizing antibodies diminished pain-related behaviour. RT-PCR/Western blot analysis unprecedentedly showed spinal elevated levels of CXCR3 after chronic constriction injury of the sciatic nerve in rats in parallel with different time-course changes of its endogenous ligands. Initially, on day 2 we observed spinal increased levels of CXCL10 and CXCL11 indicating that these chemokines have important roles in triggering neuropathy. Then, on day 7, we observed increased levels of CXCL4, CXCL9, CXCL10. Interestingly, changes in CXCL9 level persisted until day 28, suggesting that these chemokines are responsible for long-term, persistent neuropathy. Additionally, in DRG the CXCL4, CXCL9 were elevated. The results obtained from primary glial cultures, suggests that all CXCR3 ligands can be produced in microglia, but also, except for CXCL4, in astrocytes. We provide the first evidence that in neuropathy chronic intrathecal administration of CXCR3 antagonist, (±)-NBI-74330, attenuates hypersensitivity with concomitant occurrence of microglial and some of CXCR3 ligands activation observed in the spinal cord and/or DRG level. This paper underlies the significance of CXCR3 in neuropathic pain and shows therapeutic potential of its blockade for enhancement of morphine analgesia as the major novelty of this work.


Assuntos
Acetamidas/administração & dosagem , Analgésicos Opioides/administração & dosagem , Neuralgia/tratamento farmacológico , Pirimidinas/administração & dosagem , Receptores CXCR3/antagonistas & inibidores , Neuropatia Ciática/complicações , Acetamidas/farmacologia , Analgésicos Opioides/uso terapêutico , Animais , Modelos Animais de Doenças , Sinergismo Farmacológico , Injeções Espinhais , Ligantes , Masculino , Camundongos , Neuralgia/etiologia , Neuralgia/metabolismo , Pirimidinas/farmacologia , Ratos , Ratos Wistar , Neuropatia Ciática/etiologia
12.
Medicine (Baltimore) ; 97(23): e11051, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879074

RESUMO

RATIONALE: Peripheral neuropathy is a rare complication of carbon monoxide intoxication. Peripheral neuropathy following carbon monoxide intoxication is known to completely recover within a few months. PATIENT CONCERNS: A 40-year-old man complained of motor weakness and hypoesthesia of the right lower extremity with swelling of his right thigh after carbon monoxide intoxication resulting from a suicide attempt. DIAGNOSES: Following nerve conduction and electromyographic studies, the patient was diagnosed with sciatic neuropathy with severe axonopathy. Clinical and laboratory findings led to a diagnosis of rhabdomyolysis. INTERVENTIONS: The patient was treated conservatively for rhabdomyolysis and underwent comprehensive rehabilitation for sciatic neuropathy during hospitalization. OUTCOMES: After discharge, he underwent serial follow-up tests with nerve conduction and electromyographic studies, which showed prolonged persistence of sciatic neuropathy; however, he showed significant improvement at his 26-month post-discharge follow-up. LESSON: Patients presenting with peripheral neuropathy secondary to carbon monoxide intoxication may show variable recovery periods; however, a favorable prognosis can be expected regardless of the concomitant occurrence of rhabdomyolysis and/or compartment syndrome.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Monóxido de Carbono/toxicidade , Rabdomiólise/etiologia , Neuropatia Ciática/etiologia , Adulto , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Eletromiografia/métodos , Humanos , Masculino , Condução Nervosa/fisiologia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Neuropatia Ciática/fisiopatologia , Neuropatia Ciática/reabilitação , Tentativa de Suicídio/psicologia , Resultado do Tratamento
13.
JBJS Case Connect ; 8(1): e3, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29319657

RESUMO

CASE: A 68-year-old woman who had undergone a right total hip arthroplasty presented with a right posterior hip dislocation, and subsequently developed an ipsilateral sciatic nerve palsy after closed reduction. Magnetic resonance imaging (MRI) with metal suppression demonstrated sciatic nerve entanglement around the prosthetic femoral neck. A sciatic nerve release was performed, resulting in poor early neurologic recovery. CONCLUSION: Sciatic nerve entanglement following closed reduction of a dislocated total hip prosthesis is a rare injury. Assessment of neurovascular status before and after reduction is imperative. We recommend prompt MRI with metal suppression in patients with acute neurologic symptoms following reduction of a dislocated hip prosthesis to evaluate for acute nerve pathology and assess the need for emergency surgery.


Assuntos
Luxação do Quadril/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Imagem por Ressonância Magnética , Nervo Isquiático/diagnóstico por imagem , Neuropatia Ciática/diagnóstico por imagem , Acidentes por Quedas , Idoso , Feminino , Luxação do Quadril/cirurgia , Humanos , Metais , Nervo Isquiático/cirurgia , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia
14.
Eur J Orthop Surg Traumatol ; 28(2): 305-308, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28840398

RESUMO

A 47-year-old man presented three months post-hamstring injury with posterior thigh and buttock pain, paraesthesia over the lateral part of the leg and dorsum of the foot and a foot drop. MRI identified a hamstring muscle injury with a lesion surrounding 20 cm of the proximal sciatic nerve consistent with an extensive haematoma. Surgical debridement and release was planned; however, his signs spontaneously resolved with rest, physiotherapy and splintage prior to surgery. There have been no other reports of a sciatic nerve lesion with neurological signs resolving without surgical exploration.


Assuntos
Músculos Isquiossurais/lesões , Hematoma/complicações , Síndromes de Compressão Nervosa/etiologia , Neuropatia Ciática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/terapia , Modalidades de Fisioterapia , Descanso , Neuropatia Ciática/diagnóstico , Neuropatia Ciática/terapia
15.
Vet Rec ; 182(5): 140, 2018 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-29097603

RESUMO

Sciatic nerve damage in cattle could lead to pain, paralysis and lameness, creating welfare and productivity issues. Damage following intramuscular injection is highlighted in some clinical texts although there is no indication of prevalence. This cross-sectional study investigated the anatomical size and position of the sciatic nerve in four dairy cattle type cadavers. To evaluate the risk of iatrogenic damage, 54 participants placed needles in the dorsal gluteal region of two cadavers each, as per their routine intramuscular injection method. The distance from needle tip to the sciatic nerve was estimated for each. Sixty-nine per cent of injections were placed within 5 cm of the sciatic nerve. Direct nerve puncture occurred in the cadaver in poorest body condition. A short questionnaire revealed that 70 per cent of the participants regularly used the dorsal gluteal region for intramuscular injection and 50 per cent commonly used a volume of ≥20 mL at a single site. It is concluded that the sciatic nerve is at considerable risk of iatrogenic damage. The neck should be promoted as the optimum site for intramuscular injection and improved guidelines are required if the gluteal region is to remain in common use. A lateral site, between the tuber coxae and tuber ischium, is recommended.


Assuntos
Nervo Isquiático/lesões , Neuropatia Ciática/veterinária , Animais , Nádegas , Cadáver , Bovinos , Estudos Transversais , Humanos , Doença Iatrogênica/veterinária , Injeções Intramusculares/efeitos adversos , Injeções Intramusculares/veterinária , Risco , Nervo Isquiático/anatomia & histologia , Neuropatia Ciática/etiologia
16.
Hip Int ; 28(2): 210-217, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29027186

RESUMO

INTRODUCTION: Sciatic nerve injury (SNI) is a potentially devastating complication after total hip arthroplasty (THA). Intraoperative neural monitoring has been found in several studies to be useful in preventing SNI, but can be difficult to implement. In this study, we examine the results of using a handheld nerve stimulator for intraoperative sciatic nerve (SN) monitoring during complex THA requiring limb lengthening and/or significant manipulation of the SN. METHODS: A consecutive series of 11 cases (9 patients, 11 hips) with either severe developmental dysplasia of the hip (Crowe 3-4) or other underlying conditions requiring complex hip reconstruction involving significant leg lengthening and/or nerve manipulation. SN function was monitored intraoperatively by obtaining pre- and post-reduction thresholds during component trialing. The results of nerve stimulation were then used to influence intraoperative decision-making. RESULTS: No permanent postoperative SN complications occurred, with an average increase of 28.5 mm in limb length, range (6-51 mm). In 2 out of 11 cases, a change in nerve response was identified after trial reduction, which resulted in an alternate surgical plan (femoral shortening osteotomy and downsizing femoral head). In the remaining cases, the stimulator demonstrated a response consistent with the baseline assessment, assuring that the appropriate lengthening was achieved without SNI. 1 patient had a transient motor and sensory peroneal nerve palsy, which resolved within 2 weeks. CONCLUSIONS: The intraoperative use of a handheld nerve stimulator facilitates surgical decision-making and can potentially prevent SNI. The real-time assessment of nerve function allows immediate corrective action to be taken before nerve injury occurs.


Assuntos
Artroplastia de Quadril/métodos , Luxação Congênita de Quadril/cirurgia , Monitorização Intraoperatória/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Nervo Isquiático/fisiopatologia , Neuropatia Ciática/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Neuropatia Ciática/etiologia , Neuropatia Ciática/fisiopatologia , Adulto Jovem
17.
Turk Neurosurg ; 28(3): 474-478, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28585677

RESUMO

AIM: To analyze the cases discussed at the High Health Council (HHC) and to determine the solutions for problems related to gluteal intramuscular injection (IMI) applications. MATERIAL AND METHODS: In a 10-year period, the cases of IMI-related sciatic nerve injury (SNI) referred for an opinion from the HHC of Turkey were reviewed. The cases were analyzed based on demographic features, degree of nerve damage, side of gluteal injection, injected drugs, primary disease, appropriateness of parenteral therapy indications, and management. RESULTS: There were 107 SNIs from gluteal IMI during the 103 months. Eight of the 107 cases were male and 99 female. The mean age was 28 years. The left sciatic nerve was more commonly injured (41 right, 65 left side). SNI was partial in 48.5% of the cases. The most commonly injected drug was diclofenac sodium (29.9%), and 23.3% of cases were injected more than one drug together. Conservative management was performed in all cases, except one. CONCLUSION: Based on our findings, indications of parenteral therapies were exaggerated and nurses injected the drug while the patient"s position was inappropriate for IMI. However, an IMI into the gluteal region is potentially devastating. For those reasons, we conclude that physicians should be restricted in their indications for IMI, and continuous education courses should be organized for nurses. Injured patients should be managed according to their neurological damage.


Assuntos
Registros Eletrônicos de Saúde , Nervo Isquiático/lesões , Neuropatia Ciática/epidemiologia , Neuropatia Ciática/etiologia , Adolescente , Adulto , Idoso , Nádegas/patologia , Criança , Pré-Escolar , Feminino , Humanos , Injeções Intramusculares/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Nervo Isquiático/patologia , Neuropatia Ciática/terapia , Turquia/epidemiologia , Adulto Jovem
18.
JBJS Case Connect ; 7(1): e9, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29244691

RESUMO

CASE: A large surgical correction was required for severe hip dysplasia, which was associated with a delayed-onset sciatic nerve injury in an adolescent patient. A cortical bone spur on the outside of the acetabular fragment produced an indirect injury that became symptomatic during mobilization of the patient. CONCLUSION: The risk of direct injury to the sciatic nerve during a periacetabular osteotomy is quite low when the osteotomy is executed in extension with abduction of the hip and flexion of the knee to reduce tension on the sciatic nerve. Reported injuries have been attributed to direct damage from excessive soft-tissue retraction or during osseous ischial, supra-acetabular, and/or retroacetabular osteotomies.


Assuntos
Luxação do Quadril/cirurgia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Nervo Isquiático/lesões , Neuropatia Ciática/etiologia , Acetábulo/cirurgia , Criança , Feminino , Humanos , Fatores de Tempo
19.
Biomed Res Int ; 2017: 8361071, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29270435

RESUMO

Sciatic nerve palsies are rare but potentially devastating complications, accounting for more than 90% of neurologic injuries following total hip replacement. A systematic literature screening was carried out searching papers evaluating an exclusive population of postarthroplasty sciatic nerve palsies to ascertain (1) the influence of limb lengthening itself on sciatic nerve palsy, (2) the most important risk factors, (3) the long-term prognosis, and (4) the outcomes of different treatments. Fourteen manuscripts were finally included. The wide prevalence of retrospective case series decreased the global methodological quality of the retrieved papers. A hazardous lengthening threshold cannot be surely identified. Developmental dysplasia of the hip and previous hip surgeries are the most frequently recognized risk factors. Rate of full nerve function restoration approximates two-thirds of the cases, independently of the extent of initial neural damage. Poor evidences are available about the best treatment strategy. Well-structured multicentric prospective comparative studies are needed to substantiate or contrast the finding of this review. Anyway, since the onset of palsies is probably due to a combination of individual factors, risk of nerve damage and potential for nerve recovery should be evaluated on an individual basis.


Assuntos
Artroplastia de Quadril/efeitos adversos , Alongamento Ósseo/efeitos adversos , Neuropatia Ciática/fisiopatologia , Extremidades/fisiopatologia , Extremidades/cirurgia , Feminino , Quadril/fisiopatologia , Quadril/cirurgia , Humanos , Masculino , Fatores de Risco , Neuropatia Ciática/etiologia
20.
Glia ; 65(10): 1682-1696, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28699206

RESUMO

The molecular mechanisms that regulate Schwann cell (SC) plasticity and the role of the Nrg1/ErbB-induced MEK1/ERK1/2 signalling pathway in SC dedifferentiation or in myelination remain unclear. It is currently believed that different levels of MEK1/ERK1/2 activation define the state of SC differentiation. Thus, the identification of new regulators of MEK1/ERK1/2 signalling could help to decipher the context-specific aspects driving the effects of this pathway on SC plasticity. In this perspective, we have investigated the potential role of KIAA1199, a protein that promotes ErbB and MEK1/ERK1/2 signalling in cancer cells, in SC plasticity. We depleted KIAA1199 in the SC-derived MSC80 cell line with RNA-interference-based strategy and also generated Tamoxifen-inducible and conditional mouse models in which KIAA1199 is inactivated through homologous recombination, using the Cre-lox technology. We show that the invalidation of KIAA1199 in SC decreases the expression of cJun and other negative regulators of myelination and elevates Krox20, driving them towards a pro-myelinating phenotype. We further show that in dedifferentiation conditions, SC invalidated for KIAA1199 exhibit lower myelin clearance as well as increased myelination capacity. Finally, the Nrg1-induced activation of the MEK/ERK/1/2 pathway is severely reduced when KIAA1199 is absent, indicating that KIAA1199 promotes Nrg1-dependent MEK1 and ERK1/2 activation in SCs. In conclusion, this work identifies KIAA1199 as a novel regulator of MEK/ERK-induced SC dedifferentiation and contributes to a better understanding of the molecular control of SC dedifferentiation.


Assuntos
Diferenciação Celular/fisiologia , Proteínas/metabolismo , Células de Schwann/fisiologia , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Diferenciação Celular/genética , Modelos Animais de Doenças , Embrião de Mamíferos , Gânglios Espinais/citologia , Proteínas Hedgehog/genética , Proteínas Hedgehog/metabolismo , Hialuronoglucosaminidase , Proteínas Luminescentes/genética , Proteínas Luminescentes/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteína Proteolipídica de Mielina/genética , Proteína Proteolipídica de Mielina/metabolismo , Neuregulina-1/metabolismo , Neurônios/fisiologia , Neurônios/ultraestrutura , Proteínas/genética , Desempenho Psicomotor/fisiologia , RNA Interferente Pequeno/genética , RNA Interferente Pequeno/metabolismo , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/genética , Células de Schwann/ultraestrutura , Neuropatia Ciática/etiologia , Neuropatia Ciática/genética , Neuropatia Ciática/fisiopatologia
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