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1.
Physiol Rep ; 11(1): e15567, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36636780

RESUMO

The speed of pellet propulsion through the isolated guinea pig distal colon in vitro significantly exceeds in vivo measurements, suggesting a role for inhibitory mechanisms from sources outside the gut. The aim of this study was to investigate the effects of sympathetic nerve stimulation on three different neurogenic motor behaviors of the distal colon: transient neural events (TNEs), colonic motor complexes (CMCs), and pellet propulsion. To do this, segments of guinea pig distal colon with intact connections to the inferior mesenteric ganglion (IMG) were set up in organ baths allowing for simultaneous extracellular suction electrode recordings from smooth muscle, video recordings for diameter mapping, and intraluminal manometry. Electrical stimulation (1-20 Hz) of colonic nerves surrounding the inferior mesenteric artery caused a statistically significant, frequency-dependent inhibition of TNEs, as well as single pellet propulsion, from frequencies of 5 Hz and greater. Significant inhibition of CMCs required stimulation frequencies of 10 Hz and greater. Phentolamine (3.6 µM) abolished effects of colonic nerve stimulation, consistent with a sympathetic noradrenergic mechanism. Sympathetic inhibition was constrained to regions with intact extrinsic nerve pathways, allowing normal motor behaviors to continue without modulation in adjacent extrinsically denervated regions of the same colonic segments. The results demonstrate differential sensitivities to sympathetic input among distinct neurogenic motor behaviors of the colon. Together with findings indicating CMCs activate colo-colonic sympathetic reflexes through the IMG, these results raise the possibility that CMCs may paradoxically facilitate suppression of pellet movement in vivo, through peripheral sympathetic reflex circuits.


Assuntos
Gânglios Simpáticos , Sistema Nervoso Simpático , Cobaias , Animais , Gânglios Simpáticos/fisiologia , Reflexo/fisiologia , Colo/inervação , Atividade Motora , Estimulação Elétrica
2.
Sci Rep ; 13(1): 243, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604521

RESUMO

To investigate the effects of different anesthetic methods on postoperative immune function in patients undergoing gastrointestinal tumor resection. Ninety patients undergoing laparoscopic gastrointestinal tumor resection were divided into 3 groups. Patients in the GA group were anesthetized by total intravenous anesthesia. The GE group was anesthetized by general anesthesia combined with epidural anesthesia. The GN group was anesthetized by general anesthesia combined with bilateral Transversus Abdominis Plane block (TAP) and rectus sheath nerve blocks. General anesthesia is total intravenous anesthesia in all three groups. Blood samples were taken to test the changes of peripheral lymphocyte subtype analysis, and levels of plasma cortisol, epinephrine, norepinephrine. Also, the dosage of anesthetic drugs, recovery time, and visual analog scale (VAS) scores were recorded. Postoperative immune indexes, including CD4 count, CD8 count, B, and NK cells, in the GE group were significantly higher than those in NA and GA groups (P < 0.01). Perioperative stress indices, including epinephrine levels, norepinephrine level and aldosterone level, in the GE group were significantly lower than in the GA group and GN group (P < 0.01). The intraoperative/total sufentanil dosage and remifentanil dosage in the GE group were significantly lower than those in the GA and GN groups (P < 0.01). The VAS scores in the GE group were significantly better than those in GA and GN groups (P < 0.01). General anesthesia combined with epidural anesthesia attenuates the increase in inflammatory mediators. Its possible mechanisms include reducing perioperative stress response and reducing perioperative opioid use.


Assuntos
Neoplasias Gastrointestinais , Bloqueio Nervoso , Humanos , Dor Pós-Operatória , Músculos Abdominais/inervação , Bloqueio Nervoso/métodos , Anestesia Geral/métodos , Neoplasias Gastrointestinais/cirurgia , Epinefrina , Norepinefrina , Imunidade
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 26(1): 68-74, 2023 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-36650002

RESUMO

Colorectal cancer is one of the most common cancers in the world, and surgery is the mainstage treatment. Urogenital and sexual dysfunction after radical resection of rectal cancer has become an important problem for patients, which seriously affects the quality of life. Some patients give up radical surgery for rectal cancer because of the concerns about sexual and urinary dysfunction. The cause of this problem is intraoperative of injury pelvic autonomic nerve. The preservation of the hypogastric nerve during the surgery is important for the male ejaculation. Pelvic splanchnic nerves are mainly responsible for the male erection. The anatomical origin, distribution, and urogenital function of these two nerves are detailed described in this article. At the same time, this article introduces the classification, key points of the operation and the evaluation of autonomic nerve preservation surgery. With the rapid development of minimally invasive surgery, performing radical surgery for rectal cancer is important, we also need to fully understand the anatomical concept of pelvic autonomic nerves, and apply modern minimally invasive surgical techniques to preserve the patient's pelvic autonomic nerves as well. It is an compulsory course and an important manifestation for the standardization of rectal cancer surgery.


Assuntos
Neoplasias Retais , Humanos , Masculino , Qualidade de Vida , Vias Autônomas/cirurgia , Neoplasias Retais/cirurgia , Pelve/cirurgia , Pelve/inervação
4.
Life Sci Alliance ; 6(3)2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36625204

RESUMO

Baroreceptors are nerve endings located in the adventitia of the carotid sinus and aortic arch. They act as a mechanoelectrical transducer that can sense the tension stimulation exerted on the blood vessel wall by the rise in blood pressure and transduce the mechanical force into discharge of the nerve endings. However, the molecular identity of mechanical signal transduction from the vessel wall to the baroreceptor is not clear. We discovered that exogenous integrin ligands, such as RGD, IKVAV, YIGSR, PHSRN, and KNEED, could restrain pressure-dependent discharge of the aortic nerve in a dose-dependent and reversible manner. Perfusion of RGD at the baroreceptor site in vivo can block the baroreceptor reflex. An immunohistochemistry study showed the binding of exogenous RGD to the nerve endings under the adventitia of the rat aortic arch, which may competitively block the binding of integrins to ligand motifs in extracellular matrix. These findings suggest that connection of integrins with extracellular matrix plays an important role in the mechanical coupling process between vessel walls and arterial baroreceptors.


Assuntos
Mecanotransdução Celular , Pressorreceptores , Ratos , Animais , Pressorreceptores/fisiologia , Aorta/inervação , Artérias
5.
Anesthesiology ; 138(2): 209-215, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36629464

RESUMO

Cerebral Function and Muscle Afferent Activity Following Intravenous Succinylcholine in Dogs Anesthetized with Halothane: The Effects of Pretreatment with a Defasciculating Dose of Pancuronium. By WL Lanier, PA Iaizzo, and JH Milde. Anesthesiology 1989; 71:87-95. Reprinted with permission. By the mid-1980s, it was widely assumed that if the depolarizing muscle relaxant, succinylcholine, given IV, produced increases in intracranial pressure, it did so because fasciculations produced increases in intrathoracic and central venous pressures that were transferred to the brain; however, there was no direct evidence that this was true. In contrast, we explored the possibility that the succinylcholine effect on the brain was explained by the afferentation theory of cerebral arousal, which predicts that agents or maneuvers that stimulate muscle stretch receptors will tend to stimulate the brain. Our research in tracheally intubated, lightly anesthetized dogs discovered that IV succinylcholine (which does not cross the blood-brain barrier) produced a doubling of cerebral blood flow that lasted for 30 min and corresponded to activation of the electroencephalogram and increases in intracranial pressure. Later, in our Classic Paper, we were able to assess simultaneously cerebral physiology and afferent nerve traffic emanating from muscle stretch receptors (primarily muscle spindles). We affirmed that the cerebral arousal response to succinylcholine was indeed driven by muscle afferent traffic and was independent of fasciculations or increases in intrathoracic or central venous pressures. Later research in complementary models demonstrated that endogenous movement (e.g., coughing, hiccups) produced a cerebral response very similar to IV succinylcholine, apparently as a result of the same muscle afferent mechanisms, independent of intrathoracic and central venous pressures. Thus, the importance of afferentation theory as a driver of the cerebral state of arousal and cerebral physiology during anesthesia was affirmed.


Assuntos
Anestesia , Succinilcolina , Animais , Cães , Succinilcolina/farmacologia , Fasciculação , Halotano/farmacologia , Músculos/inervação
6.
Sci Rep ; 13(1): 884, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650212

RESUMO

Vagus nerve stimulation (VNS) has become a promising therapy especially for drug resistant epilepsy and other pathologies. Side effects or missing therapeutic success are observed due to cuff electrodes that are too narrow or too wide. Preoperative high-resolution ultrasound is used to evaluate the size of the cervical vagus nerve (CVN) to estimate the size of cuff electrodes for VNS. It remains unclear how precise ultrasound reflects the CVN dimensions, which has been the objective of this study. CVN cross-sections and diameters were investigated in 23 sides from 12 bodies, using ultrasound, histology, and CVN casting in situ as a reference. Morphometric data were obtained including fascicle count and nerve composition in histology. CVN yielded significant side-, age-, and BMI-related differences. CVN cross-sections were smaller in ultrasound when compared to casting and histology (1.5 ± 0.4 vs. 3.1 ± 0.9 vs. 2.3 ± 0.7 mm2). With the given setting in ultrasound, CVN cross-sections were consistently underestimated when compared to casting. Ultrasound-based cross-section measurements are related to a biased estimation of CVN size. A factor to correct for method related differences may help to adjust for accurate cuff electrode sizes for patient needs and to reduce undesired effects and potentially material consumption.


Assuntos
Epilepsia Resistente a Medicamentos , Estimulação do Nervo Vago , Humanos , Nervo Vago/fisiologia , Estimulação do Nervo Vago/métodos , Ultrassonografia , Pescoço/inervação , Epilepsia Resistente a Medicamentos/patologia
7.
Elife ; 122023 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-36607222

RESUMO

Afferents of peripheral mechanoreceptors innervate the skin of vertebrates, where they detect physical touch via mechanically gated ion channels (mechanotransducers). While the afferent terminal is generally understood to be the primary site of mechanotransduction, the functional properties of mechanically activated (MA) ionic current generated by mechanotransducers at this location remain obscure. Until now, direct evidence of MA current and mechanically induced action potentials in the mechanoreceptor terminal has not been obtained. Here, we report patch-clamp recordings from the afferent terminal innervating Grandry (Meissner) corpuscles in the bill skin of a tactile specialist duck. We show that mechanical stimulation evokes MA current in the afferent with fast kinetics of activation and inactivation during the dynamic phases of the mechanical stimulus. These responses trigger rapidly adapting firing in the afferent detected at the terminal and in the afferent fiber outside of the corpuscle. Our findings elucidate the initial electrogenic events of touch detection in the mechanoreceptor nerve terminal.


Assuntos
Percepção do Tato , Tato , Animais , Tato/fisiologia , Mecanotransdução Celular/fisiologia , Mecanorreceptores/fisiologia , Pele/inervação
8.
J Neural Eng ; 20(1)2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36535037

RESUMO

Objective.Although electrical vagus nerve stimulation has been shown to augment parasympathetic control of the heart, the effects of electrical conduction block have been less rigorously characterized. Previous experiments have demonstrated that direct current (DC) nerve block can be applied safely and effectively in the autonomic system, but additional information about the system dynamics need to be characterized to successfully deploy DC nerve block to clinical practice.Approach.The dynamics of the heart rate (HR) from DC nerve block of the vagus nerve were measured by stimulating the vagus nerve to lower the HR, and then applying DC block to restore normal rate. DC block achieved rapid, complete block, as well as partial block at lower amplitudes.Main Results. Complete block was also achieved using lower amplitudes, but with a slower induction time. The time for DC to induce complete block was significantly predicted by the amplitude; specifically, the amplitude expressed as a percentage of the current required for a rapid, 60 s induction time. Recovery times after the cessation of DC block could occur both instantly, and after a significant delay. Both blocking duration and injected charge were significant in predicting the delay in recovery to normal conduction.Significance. While these data show that broad features such as induction and recovery can be described well by the DC parameters, more precise features of the HR, such as the exact path of the induction and recoveries, are still undefined. These findings show promise for control of the cardiac autonomic nervous system, with potential to expand to the sympathetic inputs as well.


Assuntos
Estimulação do Nervo Vago , Nervo Vago , Ratos , Animais , Frequência Cardíaca/fisiologia , Nervo Vago/fisiologia , Coração/inervação , Coração/fisiologia , Estimulação do Nervo Vago/métodos
9.
J Hypertens ; 41(2): 326-335, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36583358

RESUMO

OBJECTIVE: Central (abdominal) obesity is associated with elevated adrenergic activity and arterial blood pressure (BP). Therefore, we tested the hypothesis that transduction of spontaneous muscle sympathetic nerve activity (MSNA) to BP, that is, sympathetic transduction, is augmented in abdominal obesity (increased waist circumference) and positively related to prevailing BP. METHODS: Young/middle-aged obese (32 ±â€Š7 years; BMI: 36 ±â€Š5 kg/m2, n = 14) and nonobese (29 ±â€Š10 years; BMI: 23 ±â€Š4 kg/m2, n = 14) without hypertension (24-h ambulatory average BP < 130/80 mmHg) were included. MSNA (microneurography) and beat-to-beat BP (finger cuff) were measured continuously and the increase in mean arterial pressure (MAP) during 15 cardiac cycles following MSNA bursts of different patterns (single, multiples) and amplitude (quartiles) was signal-averaged over a 10 min baseline period. RESULTS: MSNA burst frequency was not significantly higher in obese vs. nonobese (21 ±â€Š3 vs. 17 ±â€Š3 bursts/min, P = 0.34). However, resting supine BP was significantly higher in obese compared with nonobese (systolic: 127 ±â€Š3 vs. 114 ±â€Š3; diastolic: 76 ±â€Š2 vs. 64 ±â€Š1 mmHg, both P < 0.01). Importantly, obese showed greater increases in MAP following multiple MSNA bursts (P = 0.02) and MSNA bursts of higher amplitude (P = 0.02), but not single MSNA bursts (P = 0.24), compared with nonobese when adjusting for MSNA burst frequency. The increase in MAP following higher amplitude bursts among all participants was associated with higher resting supine systolic (R = 0.48; P = 0.01) and diastolic (R = 0.48; P = 0.01) BP when controlling for MSNA burst frequency, but not when also controlling for waist circumference (P > 0.05). In contrast, sympathetic transduction was not correlated with 24-h ambulatory average BP. CONCLUSION: Sympathetic transduction to BP is augmented in abdominal obesity and positively related to higher resting supine BP but not 24-h ambulatory average BP.


Assuntos
Pressão Arterial , Hipertensão , Pessoa de Meia-Idade , Humanos , Pressão Sanguínea/fisiologia , Obesidade Abdominal , Frequência Cardíaca/fisiologia , Sistema Nervoso Simpático , Músculo Esquelético/inervação , Obesidade/complicações
10.
Instr Course Lect ; 72: 595-609, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36534882

RESUMO

Nerve compression syndromes of the upper extremity are among the most common pathologies encountered in orthopaedic surgery. Symptoms can be debilitating for patients-affecting their work, activity level, sleep patterns, and overall quality of life. The community orthopaedic specialist should be familiar with the anatomy, etiology, and presentation of upper extremity nerve entrapment. Furthermore, knowledge of current evidence surrounding the management of these common syndromes can prove valuable for treating clinicians. Treatment ranges from nonsurgical (including medication and splinting) to surgical (when symptoms are severe). Although the gold standard treatment for nerve compression syndromes of the upper extremity is typically surgical release, nonsurgical methods should also be reviewed and understood because these can play an important role for patients as well. Community orthopaedic specialists should be well aware of the risks and complications associated with surgical releases.


Assuntos
Síndromes de Compressão Nervosa , Ortopedia , Humanos , Qualidade de Vida , Extremidade Superior/inervação , Extremidade Superior/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Descompressão Cirúrgica/efeitos adversos
11.
Ann Plast Surg ; 90(1): 67-70, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36534103

RESUMO

BACKGROUND: Anterior branch of the obturator nerve transfer has been proven as an effective method for femoral nerve injuries, but the patient still has difficulty in rising and squatting, up and downstairs. Here, we presented a novel neurotization procedure of selectively repairing 3 motor branches of the femoral nerve by transferring motor branches of the obturator nerve in the thigh level and assessing its anatomical feasibility. METHODS: Eight adult cadavers (16 thighs) were dissected. The nerve overlap distance between the gracilis branch and the rectus femoris (RF) branch, the adductor longus (AL) branch and the vastus medialis (VM) branch, as well as the adductor magnus (AM) branch and the vastus intermedius (VI) branch were measured. Also, the axon counts of the donor and recipient nerve were evaluated by histological evaluation. RESULTS: In all specimens, nerve overlap of at least 2.1 cm was observed in all 16 dissected thighs between the donor and recipient nerve branches, and the repair appeared to be without tension. There is no significant difference in the axon counts between gracilis branch (598 ± 83) and the RF branch (709 ± 151). The axon counts of the AL branch (601 ± 93) was about half of axon counts of the VM branch (1423 ± 189), and the axon counts of AM branch (761 ± 110) was also about half of the VI branch (1649 ± 281). CONCLUSIONS: This novel technique of the combined nerve transfers below the inguinal ligament, specifically the gracilis branch to the RF branch, the AL branch to the VM branch, and the AM branch to the VI branch, is anatomically feasible. It provides a promising alternative in the repair of femoral nerve injuries and an anatomical basis for the clinical application of motor branches of the obturator nerve transfer to repair the motor portion of the injured femoral nerve.


Assuntos
Nervo Femoral , Transferência de Nervo , Adulto , Humanos , Nervo Obturador/anatomia & histologia , Estudos de Viabilidade , Coxa da Perna , Músculo Esquelético/inervação , Transferência de Nervo/métodos , Cadáver
12.
Surg Radiol Anat ; 45(1): 3-9, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36522468

RESUMO

PURPOSE: Spasticity is the result of a variety of lesions to the central nervous system and one of the most common causes of disability worldwide. Selective peripheral neurectomy (SPN) is a surgical procedure that permanently decreases focal spasticity. The authors' objective is to provide recommendations, in terms of probabilities, for locating terminal motor entry points to muscles of the thigh, as alternatives for proximal incision sites to SPN. METHODS: The femoral, obturator, and sciatic nerves, and its corresponding motor rami, were systematically dissected on cadaveric specimens, and terminal motor entry points to each muscle of the thigh were located and carefully measured, relative to the length of the thigh. Measurement distributions were obtained and normal transformations were used when necessary. RESULTS: In 23 adult cadaveric specimens, 779 motor rami were dissected. Entry points' locations are presented as a percentage of the length of the thigh in means and standard deviations, which roughly corresponds to 64 and 95% probability of finding a motor entry point. CONCLUSION: Alternative incisions directly over the motor entry points, for the muscles of the thigh, may be helpful when considering SPN as treatment for focal spasticity. A prior degree of certainty of the location of the nerve to be severed may simplify surgical approach.


Assuntos
Músculo Esquelético , Coxa da Perna , Humanos , Adulto , Coxa da Perna/cirurgia , Músculo Esquelético/cirurgia , Músculo Esquelético/inervação , Denervação/métodos , Espasticidade Muscular/cirurgia , Cadáver
13.
Plast Reconstr Surg ; 151(1): 202-206, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36576827

RESUMO

SUMMARY: One goal of an ideal phallic reconstruction is achieving tactile and erogenous sensation. Traditionally, the most common flap used in phalloplasty has been the radial forearm flap, where the medial and lateral antebrachial cutaneous nerves are coapted to meet this goal. The purpose of this article is to draw attention to the lesser-known posterior antebrachial cutaneous nerve (PABC) as an alternative or additional nerve for coaptation that innervates a majority of the shaft, where sensation is most desired. The presence, anatomical location, and territory of innervation of the antebrachial cutaneous nerves were assessed in a series of 12 consecutive in vivo radial forearm phalloplasties. A literature review was conducted to establish which nerves have traditionally been used for sensory reinnervation of the phallus. The PABC was the first nerve encountered on the radial border of the flap lying on the fascia in the interval between the brachioradialis and extensor carpi radials longus. The posterior and lateral antebrachial cutaneous nerves innervated the phallic shaft, whereas the anterior branch of the medial antebrachial cutaneous nerve innervated the phallic urethra. There were no articles in our review that used PABC for nerve coaptation in radial forearm phalloplasty. The skin innervated by the PABC represents a significant portion of the phallic shaft when using the standard template for radial forearm phalloplasty. Despite this, its use is not described in the literature. The authors introduce the PABC as an alternative or additional nerve for coaptation in radial forearm phalloplasty.


Assuntos
Antebraço , Humanos , Antebraço/cirurgia , Antebraço/inervação , Rádio (Anatomia)/cirurgia , Retalhos Cirúrgicos/cirurgia , Nervo Radial/cirurgia
16.
PLoS One ; 17(12): e0279477, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36548285

RESUMO

During submaximal isometric contraction, there are two different load types: maintenance of a constant limb angle while supporting an inertial load (position task) and maintenance of a constant force by pushing against a rigid restraint (force task). Previous studies demonstrated that performing the position task requires more proprioceptive information. The purpose of this study was to investigate whether there would be a difference in cutaneous information processing between the position and force tasks by assessing the gating effect, which is reduction of amplitude of somatosensory evoked potentials (SEPs), and cutaneomuscular reflex (CMR). Eighteen healthy adults participated in this study. They contracted their right first dorsal interosseous muscle by abducting their index finger to produce a constant force against a rigid restraint that was 20% maximum voluntary contraction (force task), or to maintain a target position corresponding to 10° abduction of the metacarpophalangeal joint while supporting a load equivalent to 20% maximum voluntary contraction (position task). During each task, electrical stimulation was applied to the digital nerves of the right index finger, and SEPs and CMR were recorded from C3' of the International 10-20 system and the right first dorsal interosseous muscle, respectively. Reduction of the amplitude of N33 component of SEPs was significantly larger during the force than position task. In addition, the E2 amplitude of CMR was significantly greater for the force than position task. These findings suggest that cutaneous information processing differs with load type during static muscle contraction.


Assuntos
Dedos , Músculo Esquelético , Adulto , Humanos , Músculo Esquelético/fisiologia , Dedos/fisiologia , Contração Muscular/fisiologia , Reflexo/fisiologia , Pele/inervação , Contração Isométrica/fisiologia , Eletromiografia
17.
Biomed Res Int ; 2022: 1784572, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36567904

RESUMO

This study investigated the thickness of the deltoid muscle and the location of the anterior branch of the axillary nerve (AAN) and posterior circumflex humeral artery (PCHA), with the goal of maximizing the effectiveness of deltoid injections. Forty specimens from 22 adult Korean cadavers were used. A reference line was identified, connecting the anterior point of the deltoid muscle (AP) and the posterior point of the deltoid muscle (PP) on the surface. The midpoint between the AP and PP was used as the origin point (OP). The line connecting the OP and the lowest point of the deltoid tuberosity (DP) was used as the y-axis. The mean distance of the reference line from the AP to PP was 4.7 ± 0.7 cm. The vertical mean length of the deltoid muscle from the OP and DP was 16.1 ± 1.0 cm. At the 3, 5, and 7 cm sites, the thickness of the deltoid muscle was 0.62 ± 0.9, 0.73 ± 0.7, and 1.3 ± 1.1 cm, respectively. Most of the branches of the axillary nerve were concentrated in the third section (4-6 cm, 51%), while the branches of the PCHA were predominantly found in the fourth section (6-8 cm, 69%). The peripheral branches of the AAN entering the muscle were distributed between 2.2 and 9.8 cm from the acromion. The mean number of the peripheral branches of the AAN was 9.6 ± 3.4. In the deltoid muscle, the mean number of peripheral branches of the PCHA was 8.2 ± 2.8. Administering deltoid injections 5-6 cm below the OP is recommended to avoid axillary nerve injury.


Assuntos
Músculo Deltoide , Ombro , Humanos , Axila , Músculo Deltoide/inervação , Artéria Axilar , Cadáver , Úmero
18.
J Hand Surg Asian Pac Vol ; 27(6): 1000-1007, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36550081

RESUMO

Background: There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Methods: Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. Results: A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Conclusions: Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level of Evidence: Level III (Therapeutic).


Assuntos
Transferência de Nervo , Neuropatia Radial , Humanos , Punho/cirurgia , Transferência de Nervo/métodos , Dedos/cirurgia , Dedos/inervação , Articulação do Punho/fisiologia , Neuropatia Radial/cirurgia , Paralisia/cirurgia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 25(12): 1065-1072, 2022 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-36562229

RESUMO

Fecal incontinence is one of the common diseases in the field of colorectal and anal surgery. Its etiology is complex, the treatment response is suboptimal, and there are controversies in clinical care. There is no consensus on the clinical practice of fecal incontinence in China currently. Launched by Anorectal Branch of Chinese Medical Doctor Association, Expert Committee on Anorectal Disease of Anorectal Branch of Chinese Medical Doctor Association, and Clinical Guidelines Committee of Anorectal Branch of Chinese Medical Doctor Association, and organized by the editorial board of Chinese Journal of Gastrointestinal Surgery, Chinese experts on this field were convened to write the Chinese expert consensus on clinical practice of fecal incontinence based on relevant references. After rounds of discussion, the final consensus combines the latest evidence and experts' clinical experience. This expert group suggested that a comprehensive assessment of fecal incontinence should be conducted before treatment, including medical history, relevant scales, physical examination and special examinations. Special examinations include anorectal endoscopy, anorectal manometry, transrectal ultrasound, magnetic resonance, rectal sensation and compliance, balloon ejection test, pelvic floor electromyography, defecography, colonoscopy and pudendal nerve terminal motor latency. Treatment methods include life style modification, medication, surgery, traditional Chinese medicine and other treatments. This consensus aims to standardize the algorithm of fecal incontinence management and improve therapeutic efficacy.


Assuntos
Incontinência Fecal , Doenças Retais , Humanos , Incontinência Fecal/diagnóstico , Incontinência Fecal/terapia , Incontinência Fecal/etiologia , Manometria/efeitos adversos , Doenças Retais/complicações , Canal Anal/cirurgia , Canal Anal/inervação
20.
Cir. mayor ambul ; 27(1): 18-21, oct.- dic. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-212650

RESUMO

El bloqueo de tobillo ecoguiado resulta una técnica anestésica segura y eficaz en la cirugía de pie bajo régimen ambulatorio. Su principal ventaja respecto a otras técnicas regionales, como el bloqueo del nervio ciático, es la ausencia de bloqueo motor proximal al tobillo, permitiendo una deambulación precoz tras la cirugía. Se presenta el caso clínico de un paciente con síndrome de Ledderhose, en el cual se realiza fasciectomía plantar subtotal mediante bloqueo ecoguiado del pie en régimen ambulatorio (AU)


The ultrasound-guided ankle block is a safe and effective anesthetic technique for outpatient foot surgery. Its main advantage over other regional techniques such as sciatic nerve block is the absence of motor block proximal to the ankle, allowing early ambulation after surgery. We report a case of a patient with Ledderhose Syndrome, in which we perform subtotal plantar fasciectomy on an outpatient basis (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ambulatórios , Fibromatose Plantar/cirurgia , Fasciotomia/métodos , Tornozelo/inervação , Tornozelo/cirurgia
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