nerve transection technique
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BACKGROUND: Spinal cord injury (SCI) leads to spinal nerve fiber tract damage resulting in functional impairments. Volumetric muscle loss (VML), a skeletal muscle volume abnormal reduction, is represented by atrophy below the injury level. The strategies for VML management included personalized approaches, and no definite indications are available. OBJECTIVE: To identify the rehabilitation effects of VML in subjects with SCI (humans and animals). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched to identify longitudinal observational studies with individuals affected by traumatic SCI as participants; rehabilitation treatment as intervention; no control, sham treatment, and electrical stimulation programs as control; total lean body and lower limb lean mass, cross-sectional area, functional gait recovery, muscle thickness, and ultrasound intensity, as outcome. RESULTS: Twenty-four longitudinal observational studies were included, evaluating different rehabilitation approaches' effects on the VML reduction in subjects affected by SCI. The data showed that electrical stimulation and treadmill training are effective in reducing the VML in this population. CONCLUSION: This systematic review underlines the need to treat subjects with traumatic SCI (humans and animals) with different rehabilitation approaches to prevent VML in the subacute and chronic phases. Further clinical observations are needed to overcome the bias and to define the intervention's timing and modalities.
- MeSH
- chůze (způsob) MeSH
- kosterní svaly MeSH
- lidé MeSH
- obnova funkce MeSH
- poranění míchy * rehabilitace MeSH
- techniky fyzikální terapie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
KEY POINTS: Spinal treatment can restore diaphragm function in all animals 1 month following C2 hemisection induced paralysis. Greater recovery occurs the longer after injury the treatment is applied. Through advanced assessment of muscle mechanics, innovative histology and oxygen tension modelling, we have comprehensively characterized in vivo diaphragm function and phenotype. Muscle work loops reveal a significant deficit in diaphragm functional properties following chronic injury and paralysis, which are normalized following restored muscle activity caused by plasticity-induced spinal reconnection. Injury causes global and local alterations in diaphragm muscle vascular supply, limiting oxygen diffusion and disturbing function. Restoration of muscle activity reverses these alterations, restoring oxygen supply to the tissue and enabling recovery of muscle functional properties. There remain metabolic deficits following restoration of diaphragm activity, probably explaining only partial functional recovery. We hypothesize that these deficits need to be resolved to restore complete respiratory motor function. ABSTRACT: Months after spinal cord injury (SCI), respiratory deficits remain the primary cause of morbidity and mortality for patients. It is possible to induce partial respiratory motor functional recovery in chronic SCI following 2 weeks of spinal neuroplasticity. However, the peripheral mechanisms underpinning this recovery are largely unknown, limiting development of new clinical treatments with potential for complete functional restoration. Utilizing a rat hemisection model, diaphragm function and paralysis was assessed and recovered at chronic time points following trauma through chondroitinase ABC induced neuroplasticity. We simulated the diaphragm's in vivo cyclical length change and activity patterns using the work loop technique at the same time as assessing global and local measures of the muscles histology to quantify changes in muscle phenotype, microvascular composition, and oxidative capacity following injury and recovery. These data were fed into a physiologically informed model of tissue oxygen transport. We demonstrate that hemidiaphragm paralysis causes muscle fibre hypertrophy, maintaining global oxygen supply, although it alters isolated muscle kinetics, limiting respiratory function. Treatment induced recovery of respiratory activity normalized these effects, increasing oxygen supply, restoring optimal diaphragm functional properties. However, metabolic demands of the diaphragm were significantly reduced following both injury and recovery, potentially limiting restoration of normal muscle performance. The mechanism of rapid respiratory muscle recovery following spinal trauma occurs through oxygen transport, metabolic demand and functional dynamics of striated muscle. Overall, these data support a systems-wide approach to the treatment of SCI, and identify new targets to mediate complete respiratory recovery.
- MeSH
- bránice * MeSH
- kinetika MeSH
- krysa rodu rattus MeSH
- kyslík MeSH
- lidé MeSH
- mícha MeSH
- nervus phrenicus MeSH
- obnova funkce MeSH
- poranění míchy * MeSH
- potkani Sprague-Dawley MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: The potential to utilize the lower subscapular nerve for brachial plexus surgery has been suggested in many anatomical studies. However, we know of no studies in the literature describing the use of the lower subscapular nerve for axillary nerve reconstruction to date. This study aimed to examine the effectiveness of this nerve transfer in patients with upper brachial plexus palsy. METHODS: Of 1340 nerve reconstructions in 568 patients with brachial plexus injury performed by the senior author (P.H.), a subset of 18 patients underwent axillary nerve reconstruction using the lower subscapular nerve and constitutes the patient group for this study. The median age was 48 years, and the median time between trauma and surgery was 6 months. A concomitant radial nerve injury was found in 8 patients. RESULTS: Thirteen patients completed a minimum follow-up period of 24 months. Successful deltoid recovery was defined as (1) muscle strength MRC grade ≥ 3, (2) electromyographic signs of reinnervation, and (3) increase in deltoid muscle mass. Axillary nerve reconstruction was successful in 9 of 13 patients, which represents a success rate of 69.2%. No significant postoperative weakness of shoulder internal rotation or adduction was observed after transecting the lower subscapular nerve. CONCLUSIONS: The lower subscapular nerve can be used as a safe and effective neurotization tool for upper brachial plexus injury, having a success rate of 69.2% for axillary nerve repair. Our technique presents a suitable alternative for patients with concomitant radial nerve injury.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka chirurgie MeSH
- nervový transfer škodlivé účinky metody MeSH
- neuropatie brachiálního plexu chirurgie MeSH
- paralýza chirurgie MeSH
- plexus brachialis zranění chirurgie MeSH
- pooperační komplikace epidemiologie MeSH
- předškolní dítě MeSH
- rameno patologie chirurgie MeSH
- regenerace nervu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Hemicorporectomy or translumbar amputation is an extensive surgical procedure consisting in removing the lower portion of the body. Thakur et al. found a total of 71 hemicorporectomies described in literature before 2017. In the form of a case study we present the case of our patient with terminal pelvic osteomyelitis, in whom hemicorporectomy was subsequently performed, namely from the spine surgery perspective. The man, 19 years old, was exposed to high-voltage electricity and fell down from a height of 4 meters. He suffered an instable comminuted fracture of T10 (AO A3.3.) with paraplegia (Frankel A) and multiple third-degree burns affecting 25% of his total body surface area. Subsequently, the patient underwent a total of 16 surgical procedures performed by medical experts in various specialties (orthopaedic surgery, general surgery, plastic surgery, urology, vascular surgery), but in spite of that the extensive pelvic osteomyelitis has not been successfully managed. At first, urine and stool diversion were performed. After 3 weeks, i.e. 18 months after the injury, the removal of the lower portion of the body was scheduled. The hemicorporectomy was divided into 4 stages. The surgery started by posterior transecting the spine at L4-L5 segment with nerve root and dural sac ligation and treating the bleeding venous plexus in the spinal canal. After turning the patient to the supine position, the second stage of the operation followed, consisting in transecting large vessels and harvesting a musculocutaneous flap from the right thigh. During the third stage of the surgery the separation of the L4-L5 motion segment was completed by the transaction of the anterior longitudinal ligament and m. psoas major, subsequently followed by the amputation of the lower portion of the body. During the last stage of the surgery, the wound was closed by musculocutaneous flap from the fight thigh with preserved a. femoralis. The patient was discharged to home in a generally good condition 127 days after the amputation of the lower portion of the body. Now, 1 year after the surgery, the patient enjoys good physical as well as mental health. Hemicorporectomy is an extensive surgical technique, which can despite multiple complications be offered to patients with otherwise unmanageable condition. Terminal pelvic osteomyelitis is currently the most frequent diagnostic indication and the resulting condition makes possible a long-term survival of the patient in a satisfactory condition. The spinal surgeon is an irreplaceable member of the multidisciplinary team performing the surgical procedure, the primary treatment of the spinal column considerably limits blood losses. Key words: hemicorporectomy, en bloc sacrectomy, terminal pelvic osteomyelitis, sacral tumors.
- MeSH
- amputace MeSH
- dospělí MeSH
- fraktury páteře komplikace MeSH
- lidé MeSH
- mladý dospělý MeSH
- ortopedické výkony * MeSH
- osteomyelitida * chirurgie MeSH
- pánev MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Objective. Experimental lesions in the inferior alveolar nerve (IAN) are used for the study of peripheral and central alterations. The objective of our study was to contribute to a more precise description of the approach to the IAN and creating a lesion. Material and methods. Twenty-six males of Wistar laboratory rats were used for the study. The animals were divided into three groups: control group (6 rats), experimental group (12 rats - a part of the bone above the mandibular canal was removed under general anaesthesia using extraoral approach, after exposing a part of the IAN, the nerve was excised in a length of 3 mm), and a sham group (8 rats - the nerve was only dissected but not transected). Persisting denervation was verified using surgical revision and histological and immunohistochemical analysis after the observation period (4 weeks). Results. No evidence of re-innervation after 4 weeks. We found no statistically significant differences in mean weight gains between individual groups during the observation period. Conclusion. The described technique used in the study is one of the possible ways to create a nerve lesion at the site of the main trunk of the nerve. At the same time, the study provides a more precise description of the anatomical situation and approach to the IAN in the mandibular canal.
To assess the potential role of IL-6 in sciatic nerve injury-induced activation of a pro-regenerative state in remote dorsal root ganglia (DRG) neurons, we compared protein levels of SCG-10 and activated STAT3, as well as axon regeneration in IL-6 knockout (IL-6ko) mice and their wild-type (WT) counterparts. Unilateral sciatic nerve compression and transection upregulated SCG-10 protein levels and activated STAT3 in DRG neurons not only in lumbar but also in cervical segments of WT mice. A pro-regenerative state induced by prior sciatic nerve lesion in cervical DRG neurons of WT mice was also shown by testing for axon regeneration in crushed ulnar nerve. DRG neurons from IL-6ko mice also displayed bilaterally increased levels of SCG-10 and STAT3 in both lumbar and cervical segments after sciatic nerve lesions. However, levels of SCG-10 protein in lumbar and cervical DRG of IL-6ko mice were significantly lower than those of their WT counterparts. Sciatic nerve injury induced a lower level of SCG-10 in cervical DRG of IL-6ko than WT mice, and this correlates with significantly shorter regeneration of axons distal to the crushed ulnar nerve. These results suggest that IL-6 contributes, at the very least, to initiation of the neuronal regeneration program in remote DRG neurons after unilateral sciatic nerve injury.
- MeSH
- imunohistochemie MeSH
- interleukin-6 analýza nedostatek metabolismus MeSH
- intracelulární signální peptidy a proteiny analýza MeSH
- myši inbrední C57BL MeSH
- myši knockoutované MeSH
- myši MeSH
- neurony chemie cytologie metabolismus patologie MeSH
- poranění periferního nervu metabolismus patologie chirurgie MeSH
- regenerace nervu * MeSH
- spinální ganglia cytologie metabolismus patologie chirurgie MeSH
- transkripční faktor STAT3 analýza MeSH
- western blotting MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Práce je zaměřena na poruchy čichu u pacientů s olfaktoriálními meningiomy (OGM). Přesné klinické vyšetření pacientů s OGM, včetně pre- a pooperačního zhodnocení čichu, je nezbytné pro hodnocení provedené chirurgické resekce. Článek poskytuje základní přehled recentních sérií OGM světových autorů. Jen malý zlomek z nich však dokumentuje přesné vyšetření čichu. Standardní vyšetření čichu by mělo stanovit čichovou detekci, diskriminaci a identifikaci pomocí jednoho z užívaných testů (např. University of Pennsylvania Smell Identification Test [UPSIT], The Single Staircase Odor Detection Treshold Test, Sniffin’ Sticks Test). Metodami vyšetření čichu, které jsou zatím využívány pro výzkum, zůstávají elektro-olfaktogram, čichové evokované potenciály a funkční magnetická rezonance. Zlatým standardem léčby OGM je chirurgická resekce. Volba vhodného operačního přístupu je stále kontroverzní a mezi jednotlivými autory nepanuje shoda. Nejčastěji se používá frontolaterální a pterionální přístup. Alternativou je endoskopická resekce, jejíž indikace jsou však omezené. Pooperační zachování čichu představuje zatím obtížný úkol.
This review summarizes dysfunction of olfaction in patients with olfactory groove meningiomas (OGM). Clinical examination, including pre-operative and post-operative assessment of olfaction, is indispensable for the evaluation of the surgical outcome in patients with OGM. Review of a recent series of OGM documents showed a lack of the olfaction assessment in most of the studies. Psychophysical tests determining olfactory detection, discrimination and identification (e. g. University of Pennsylvania Smell Identification Test [UPSIT], The Single Staircase Odor Detection Threshold Test, Siffin’ Sticks Test) should be used to reveal olfactory dysfunction. Specialized examination techniques such as electro-olfactogram, olfactory evoked potentials and functional magnetic resonance imaging are being used in research. Standard treatment of OGM is a surgical resection. Controversy exists among the authors regarding the selection of a convenient surgical approach. Commonly, the uni-frontal and pterional approaches are being performed. Endoscopic resection, olfactory groove meningiomas, represents an alternative approach yet its indications are still limited. Postoperative olfaction preservation remains a difficult task even today.
- Klíčová slova
- olfaktoriální meningiom,
- MeSH
- baze lební chirurgie MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- meningeální nádory diagnóza chirurgie patofyziologie MeSH
- meningeom * diagnóza chirurgie patofyziologie MeSH
- nemoci čichového nervu diagnóza etiologie MeSH
- nervus olfactorius MeSH
- neurochirurgické výkony * metody škodlivé účinky MeSH
- olfaktometrie MeSH
- pooperační komplikace MeSH
- poranění čichového nervu etiologie MeSH
- poruchy čichu * diagnóza etiologie chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Úvod: Tyreoidektomie patří k nejčastěji prováděným výkonům v endokrinologické chirurgii. Operace jsou potenciálně spojeny s rizikem komplikací, které mohou způsobovat celoživotní zdravotní následky. Cílem studie bylo analyzovat incidenci pooperačních paréz zvratného nervu a hypokalcemií. Materiál a metody: Retrospektivní analýza operovaných za období deseti let, kde kromě pohlaví, věku, zastoupení benigních onemocnění a maligních nádorů, počtu provedených operací, byla sledována incidence pooperační parézy zvratného nervu (NLR) a hypokalcemie. K objektivnímu porovnání výsledků chirurgické léčby z hlediska incidence paréz NLR byl stanoven index IRI (index of recurrent injury). Podle počtu provedených operací byli operatéři zařazeni do 4 skupin, (A-D) a v každé skupině byla analyzována incidence pooperační parézy zvratného nervu a hypokalcemie. Výsledky: Operováno bylo 1334 pacientů s průměrným věkem 52,2 let; žen bylo 1113 (83,4 %). Maligní nádory byly diagnostikovány u 227 operovaných (17 %), z toho bylo 222 karcinomů (97,8 %). Totální tyreoidektomie byla provedena u 1067 operovaných (80,0 %) a hemityreoidektomie u 267 operovaných (20,0 %). Trvalou jednostrannou parézu zvratného nervu má 1,4 % operovaných s maligním nádorem a 0,7 % pacientů s benigním onemocněním (p=0,045). Permanentní hypokalcemii mají 2 % pacientů s maligním nádorem a 0,7 % s benigním onemocněním (p=0,011). Nejvyšší incidence komplikací byla u skupiny středně pokročilých chirurgů, permanentní hypokalcemii mělo 4,2 %, jednostrannou parézu zvratného nervu u 2,8 % operovaných. Závěr: Výsledky analýzy potvrzují, že pooperační komplikace jsou srovnatelné s velkými renomovanými centry. Znalosti a zkušenosti tyreoidálního chirurga jsou větší zárukou bezpečnosti výkonu než volba minimální radikality.
Introduction: Thyroidectomy belongs to most frequently performed operations in endocrinology surgery. The operations and potentially associated with the risk of complications, which may cause lifelong health consequences. The aim of the study was to analyze incidence of postoperative pareses of recurrent nerve and hypocalcemia. Material and methods: Retrospective analysis of patients operated on over the period of ten years included, in addition to sex, age, representation of benign diseases and malignant tumors, the number of performed operations, also the incidence of postoperative paresis of recurrent nerve (NLR) and hypocalcemia. For an objective comparison of the results of surgical therapy from the standpoint of incidence of NLP pareses the index of recurrent injury (IRI index) was determined. The surgeons were divided into four groups according to number of performed operations and the incidence of complications was analyzed there. Results: A total of 1334 patients at the average age of 52.5 years, 1113 of them were women (83.4%). Malignant tumors were diagnosed in 227 patients (17%), 222 of them were carcinomas (97.8%). Total thyroidectomy was performed in 1067 patients (80%) and hemithyroidectomy included 267 patients (20.0%). A unilateral paresis of recurrent nerve affected 1.4% of patients with malignant tumors and 0.7% of those with a benign disease (p=0.045). Permanent hypocalcemia affected 2% of patients with malignant tumors and 0.7% of those with a benign disease (p=0.011). The highest incidence of complications were encountered with medium advanced surgeons, permanent hypocalcemia affected 4.2% of the patients and unilateral paresis of recurrent nerve in 2.8% of the patients undergoing surgery. Conclusion: Results of the analysis confirm that postoperative complications are comparable with the large respected centers. The knowledge and experience of a thyroidal surgeon represent a higher guarantee of the intervention safety than the selection of a minimally radical surgery.
- MeSH
- dospělí MeSH
- hyperkalcemie * MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory štítné žlázy chirurgie komplikace MeSH
- paréza MeSH
- pooperační komplikace * chirurgie MeSH
- poranění nervus laryngeus recurrens * epidemiologie chirurgie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statistika jako téma MeSH
- tyreoidektomie * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- diagnostické techniky oftalmologické klasifikace MeSH
- lidé MeSH
- nemoci zrakového nervu * diagnóza klasifikace terapie MeSH
- nervus opticus anatomie a histologie patofyziologie MeSH
- oftalmoskopie metody MeSH
- poranění nervus opticus diagnóza klasifikace terapie MeSH
- poruchy zraku diagnóza klasifikace terapie MeSH
- tractus opticus * anatomie a histologie patofyziologie MeSH
- věkové faktory MeSH
- zraková ostrost fyziologie MeSH
- zraková pole fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
