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Sample records for acute brachial neuritis

  1. Human Rabies with Initial Manifestations that Mimic Acute Brachial Neuritis and Guillain-Barré Syndrome

    PubMed Central

    Mader, Edward C.; Maury, Joaquin S.; Santana-Gould, Lenay; Craver, Randall D.; El-Abassi, Rima; Segura-Palacios, Enrique; Sumner, Austin J.

    2012-01-01

    Introduction Human rabies can be overlooked in places where this disease is now rare. Its diagnosis is further confused by a negative history of exposure (cryptogenic rabies), by a Guillain-Barré syndrome (GBS) type of presentation, or by symptoms indicating another diagnosis, eg, acute brachial neuritis (ABN). Case presentation A 19-year-old Mexican, with no past health problems, presented with a two-day history of left shoulder, arm, and chest pain. He arrived in Louisiana from Mexico five days prior to admission. Of particular importance is the absence of a history of rabies exposure and immunization. On admission, the patient had quadriparesis, areflexia, and elevated protein in the cerebrospinal fluid, prompting a diagnosis of GBS. However, emerging neurological deficits pointed towards acute encephalitis. Rabies was suspected on hospital day 11 after common causes of encephalitis (eg, arboviruses) have been excluded. The patient tested positive for rabies IgM and IgG. He died 17 days after admission. Negri bodies were detected in the patient’s brain and rabies virus antigen typing identified the vampire bat as the source of infection. Conclusion Rabies should be suspected in every patient with a rapidly evolving GBS-like illness—even if there is no history of exposure and no evidence of encephalitis on presentation. The patient’s ABN-like symptoms may be equivalent to the pain experienced by rabies victims near the inoculation site. PMID:22577299

  2. Brachial neuritis following a corticosteroid injection.

    PubMed

    Robinson, Matthew; Fulcher, Mark

    2014-01-01

    This report presents a case of brachial neuritis following a subacromial corticosteroid injection. The patient developed an anterior interosseous neuropathy shortly after the injection, with no other trigger being identified. This neuropathy has unfortunately not shown any sign of recovery at 2 years. The authors propose that corticosteroid injection be added to the list of possible triggering events of brachial neuritis and highlight the frequent use of oral corticosteroids in its treatment. (1) The injection of local anaesthetic and corticosteroid should be considered as a potential trigger for brachial neuritis. (2) Brachial neuritis should be considered in the differential diagnosis for patients presenting with severe arm pain and weakness. (3) The nerves originating from the upper trunk of the brachial plexus are most commonly affected. (4) The anterior interosseous nerve is involved in one-third of cases. PMID:24596414

  3. Idiopathic brachial neuritis in a child: A case report and review of the literature

    PubMed Central

    Jain, Shikha; Bhatt, Girish Chandra; Rai, Nirendra; Bhan, Bhavna Dhingra

    2014-01-01

    Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2½-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies. PMID:25624937

  4. Idiopathic brachial neuritis in a child: A case report and review of the literature.

    PubMed

    Jain, Shikha; Bhatt, Girish Chandra; Rai, Nirendra; Bhan, Bhavna Dhingra

    2014-01-01

    Brachial neuritis is a rare disease in children, affecting mainly the lower motor neurons of the brachial plexus and/or individual nerves or nerve branches. We report a case of idiopathic brachial plexus neuritis in a 2½-year-old female child admitted with acute respiratory distress and given antibiotic therapy following which she developed weakness of the left hand. She was diagnosed as a case of idiopathic brachial plexus neuritis and was given supportive care. Although, the association with antibiotic therapy in this case could be incidental, indeed it is intriguing and requires further studies. PMID:25624937

  5. Acute optic neuritis

    PubMed Central

    Galetta, Steven L.; Villoslada, Pablo; Levin, Netta; Shindler, Kenneth; Ishikawa, Hiroshi; Parr, Edward; Cadavid, Diego

    2015-01-01

    Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON. PMID:26236761

  6. Idiopathic brachial plexus neuritis after laparoscopic treatment of endometriosis: a complication that may mimic position-related brachial plexus injury.

    PubMed

    Minas, Vasileios; Aust, Thomas

    2013-01-01

    We report the case of a 37-year-old woman who developed idiopathic brachial plexus neuritis, also referred to as Parsonage-Turner syndrome, after laparoscopic excision of endometriosis. The differential diagnosis between this non-position-related neuritis and brachial plexus injury is discussed. The aim of this report was to raise awareness on this distressing postoperative complication. PMID:24183278

  7. Brachial Plexus Neuritis Associated With Streptococcus agalactiae Infection: A Case Report.

    PubMed

    Seo, Yu Jung; Lee, Yu Jin; Kim, Joon Sung; Lim, Seong Hoon; Hong, Bo Young

    2014-08-01

    Brachial plexus neuritis is reportedly caused by various factors; however, it has not been described in association with Streptococcus agalactiae. This is a case report of a patient diagnosed with brachial plexus neuritis associated with pyogenic arthritis of the shoulder. A 57-year-old man visited the hospital complaining of sudden weakness and painful swelling of the left arm. The diagnosis was pyogenic arthritis of the left shoulder, and the patient was treated with open irrigation and debridement accompanied by intravenous antibiotic therapy. S. agalactiae was isolated from a wound culture, and an electrodiagnostic study showed brachial plexopathy involving the left upper and middle trunk. Nine weeks after onset, muscle strength improved in most of the affected muscles, and an electrodiagnostic study showed signs of reinnervation. In conclusion, S. agalactiae infection can lead to various complications including brachial plexus neuritis. PMID:25229037

  8. Brachial Plexus Neuritis Associated With Streptococcus agalactiae Infection: A Case Report

    PubMed Central

    Seo, Yu Jung; Lee, Yu Jin; Kim, Joon Sung; Lim, Seong Hoon

    2014-01-01

    Brachial plexus neuritis is reportedly caused by various factors; however, it has not been described in association with Streptococcus agalactiae. This is a case report of a patient diagnosed with brachial plexus neuritis associated with pyogenic arthritis of the shoulder. A 57-year-old man visited the hospital complaining of sudden weakness and painful swelling of the left arm. The diagnosis was pyogenic arthritis of the left shoulder, and the patient was treated with open irrigation and debridement accompanied by intravenous antibiotic therapy. S. agalactiae was isolated from a wound culture, and an electrodiagnostic study showed brachial plexopathy involving the left upper and middle trunk. Nine weeks after onset, muscle strength improved in most of the affected muscles, and an electrodiagnostic study showed signs of reinnervation. In conclusion, S. agalactiae infection can lead to various complications including brachial plexus neuritis. PMID:25229037

  9. Unusual association of epidemic dropsy with brachial neuritis and palatal palsy.

    PubMed

    Sahoo, Sushama; Bandyopadhyay, Arindam; Mahapatra, Nepal Chandra

    2013-05-01

    Epidemic dropsy (ED) results from accidental ingestion of adulterated mustard oil with argemone oil. Chief organs involved in this disease are heart, subcutaneous tissue, eyes and kidneys. Nervous system involvement is very rare. Objective manifestation of neurological involvement is even rarer. The authors report two cases from the same family, who were victims of epidemic dropsy along with their parents. One of them showed objective neurologic involvement in the form of brachial neuritis and another showed palatal palsy. PMID:22231775

  10. Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease

    PubMed Central

    Subash, Meera; Patel, Gaurav; Welker, John

    2014-01-01

    Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. “Sniff” test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis. PMID:26425609

  11. Brachial Neuritis With Phrenic Nerve Involvement in a Patient With a Possible Connective Tissue Disease.

    PubMed

    Subash, Meera; Patel, Gaurav; Welker, John; Nugent, Kenneth

    2014-01-01

    Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. "Sniff" test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis. PMID:26425609

  12. Serial Magnetization Transfer Imaging in Acute Optic Neuritis

    ERIC Educational Resources Information Center

    Hickman, S. J.; Toosy, A. T.; Jones, S. J.; Altmann, D. R.; Miszkiel, K. A.; MacManus, D. G.; Barker, G. J.; Plant, G. T.; Thompson, A. J.; Miller, D.H.

    2004-01-01

    In serial studies of multiple sclerosis lesions, reductions in magnetization transfer ratio (MTR) are thought to be due to demyelination and axonal loss, with later rises due to remyelination. This study followed serial changes in MTR in acute optic neuritis in combination with clinical and electrophysiological measurements to determine if the MTR…

  13. The afferent pupillary defect in acute optic neuritis.

    PubMed Central

    Ellis, C J

    1979-01-01

    Twenty-two patients with acute optic neuritis were studied by the techniques of infrared pupillometry and visual evoked responses (VER) to pattern reversal. A relative afferent pupillary defect was found in all cases and the magnitude of this defect was found to be related to the amplitude, but not to the latency, of the VER. During follow-up the afferent defect was found to remain persistently abnormal while other methods of clinical evaluation could not demonstrate abnormality reliably. The amplitude of the VER also remained low. PMID:501365

  14. Brachial Plexopathy due to Myeloid Sarcoma in a Patient With Acute Myeloid Leukemia After Allogenic Peripheral Blood Stem Cell Transplantation.

    PubMed

    Ha, Yumi; Sung, Duk Hyun; Park, Yoonhong; Kim, Du Hwan

    2013-04-01

    Myeloid sarcoma is a solid, extramedullary tumor comprising of immature myeloid cells. It may occur in any organ; however, the invasion of peripheral nervous system is rare. Herein, we report the case of myeloid sarcoma on the brachial plexus. A 37-year-old woman with acute myelogenous leukemia achieved complete remission after chemotherapy. One year later, she presented right shoulder pain, progressive weakness in the right upper extremity and hypesthesia. Based on magnetic resonance images (MRI) and electrophysiologic study, a provisional diagnosis of brachial plexus neuritis was done and hence steroid pulse therapy was carried out. Three months later the patient presented epigastric pain. After upper gastrointestinal endoscopy, myeloid sarcoma of gastrointestinal tract was confirmed pathologically. Moreover, 18-fluoride fluorodeoxyglucose positron emission tomography showed a fusiform shaped mass lesion at the brachial plexus overlapping with previous high signal lesion on the MRI. Therefore, we concluded the final diagnosis as brachial plexopathy due to myeloid sarcoma. PMID:23705126

  15. Normal Caloric Responses during Acute Phase of Vestibular Neuritis

    PubMed Central

    Lee, Sun-Uk; Park, Seong-Ho; Kim, Hyo-Jung; Koo, Ja-Won

    2016-01-01

    Background and Purpose We report a novel finding of caloric conversion from normal responses into unilateral paresis during the acute phase of vestibular neuritis (VN). Methods We recruited 893 patients with a diagnosis of VN at Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014 after excluding 28 patients with isolated inferior divisional VN (n=14) and those without follow-up tests despite normal caloric responses initially (n=14). We retrospectively analyzed the neurotological findings in four (0.5%) of the patients who showed a conversion from initially normal caloric responses into unilateral paresis during the acute phase. Results In those four patients, the initial caloric tests were performed within 2 days of symptom onset, and conversion into unilateral caloric paresis was documented 1–4 days later. The clinical and laboratory findings during the initial evaluation were consistent with VN in all four patients except for normal findings in bedside head impulse tests in one of them. Conclusions Normal findings in caloric tests should be interpreted with caution during the acute phase of suspected VN. Follow-up evaluation should be considered when the findings of the initial caloric test are normal, but VN remains the most plausible diagnosis. PMID:26932259

  16. Re-evaluating the treatment of acute optic neuritis

    PubMed Central

    Bennett, Jeffrey L; Nickerson, Molly; Costello, Fiona; Sergott, Robert C; Calkwood, Jonathan C; Galetta, Steven L; Balcer, Laura J; Markowitz, Clyde E; Vartanian, Timothy; Morrow, Mark; Moster, Mark L; Taylor, Andrew W; Pace, Thaddeus W W; Frohman, Teresa; Frohman, Elliot M

    2015-01-01

    Clinical case reports and prospective trials have demonstrated a reproducible benefit of hypothalamic-pituitary-adrenal (HPA) axis modulation on the rate of recovery from acute inflammatory central nervous system (CNS) demyelination. As a result, corticosteroid preparations and adrenocorticotrophic hormones are the current mainstays of therapy for the treatment of acute optic neuritis (AON) and acute demyelination in multiple sclerosis. Despite facilitating the pace of recovery, HPA axis modulation and corticosteroids have failed to demonstrate long-term benefit on functional recovery. After AON, patients frequently report visual problems, motion perception difficulties and abnormal depth perception despite ‘normal’ (20/20) vision. In light of this disparity, the efficacy of these and other therapies for acute demyelination require re-evaluation using modern, high-precision paraclinical tools capable of monitoring tissue injury. In no arena is this more amenable than AON, where a new array of tools in retinal imaging and electrophysiology has advanced our ability to measure the anatomic and functional consequences of optic nerve injury. As a result, AON provides a unique clinical model for evaluating the treatment response of the derivative elements of acute inflammatory CNS injury: demyelination, axonal injury and neuronal degeneration. In this article, we examine current thinking on the mechanisms of immune injury in AON, discuss novel technologies for the assessment of optic nerve structure and function, and assess current and future treatment modalities. The primary aim is to develop a framework for rigorously evaluating interventions in AON and to assess their ability to preserve tissue architecture, re-establish normal physiology and restore optimal neurological function. PMID:25355373

  17. Re-evaluating the treatment of acute optic neuritis.

    PubMed

    Bennett, Jeffrey L; Nickerson, Molly; Costello, Fiona; Sergott, Robert C; Calkwood, Jonathan C; Galetta, Steven L; Balcer, Laura J; Markowitz, Clyde E; Vartanian, Timothy; Morrow, Mark; Moster, Mark L; Taylor, Andrew W; Pace, Thaddeus W W; Frohman, Teresa; Frohman, Elliot M

    2015-07-01

    Clinical case reports and prospective trials have demonstrated a reproducible benefit of hypothalamic-pituitary-adrenal (HPA) axis modulation on the rate of recovery from acute inflammatory central nervous system (CNS) demyelination. As a result, corticosteroid preparations and adrenocorticotrophic hormones are the current mainstays of therapy for the treatment of acute optic neuritis (AON) and acute demyelination in multiple sclerosis.Despite facilitating the pace of recovery, HPA axis modulation and corticosteroids have failed to demonstrate long-term benefit on functional recovery. After AON, patients frequently report visual problems, motion perception difficulties and abnormal depth perception despite 'normal' (20/20) vision. In light of this disparity, the efficacy of these and other therapies for acute demyelination require re-evaluation using modern, high-precision paraclinical tools capable of monitoring tissue injury.In no arena is this more amenable than AON, where a new array of tools in retinal imaging and electrophysiology has advanced our ability to measure the anatomic and functional consequences of optic nerve injury. As a result, AON provides a unique clinical model for evaluating the treatment response of the derivative elements of acute inflammatory CNS injury: demyelination, axonal injury and neuronal degeneration.In this article, we examine current thinking on the mechanisms of immune injury in AON, discuss novel technologies for the assessment of optic nerve structure and function, and assess current and future treatment modalities. The primary aim is to develop a framework for rigorously evaluating interventions in AON and to assess their ability to preserve tissue architecture, re-establish normal physiology and restore optimal neurological function. PMID:25355373

  18. Diffusion fMRI detects white-matter dysfunction in mice with acute optic neuritis

    PubMed Central

    Lin, Tsen-Hsuan; Spees, William M.; Chiang, Chia-Wen; Trinkaus, Kathryn; Cross, Anne H.; Song, Sheng-Kwei

    2014-01-01

    Optic neuritis is a frequent and early symptom of multiple sclerosis (MS). Conventional magnetic resonance (MR) techniques provide means to assess multiple MS-related pathologies, including axonal injury, demyelination, and inflammation. A method to directly and non-invasively probe white-matter function could further elucidate the interplay of underlying pathologies and functional impairments. Previously, we demonstrated a significant 27% activation-associated decrease in the apparent diffusion coefficient of water perpendicular to the axonal fibers (ADC⊥) in normal C57BL/6 mouse optic nerve with visual stimulation using diffusion fMRI. Here we apply this approach to explore the relationship between visual acuity, optic nerve pathology, and diffusion fMRI in the experimental autoimmune encephalomyelitis (EAE) mouse model of optic neuritis. Visual stimulation produced a significant 25% (vs. baseline) ADC⊥ decrease in sham EAE optic nerves, while only a 7% (vs. baseline) ADC⊥ decrease was seen in EAE mice with acute optic neuritis. The reduced activation-associated ADC⊥ response correlated with post-MRI immunohistochemistry determined pathologies (including inflammation, demyelination, and axonal injury). The negative correlation between activation-associated ADC⊥ response and visual acuity was also found when pooling EAE-affected and sham groups under our experimental criteria. Results suggest that reduction in diffusion fMRI directly reflects impaired axonal-activation in EAE mice with optic neuritis. Diffusion fMRI holds promise for directly gauging in vivo white-matter dysfunction or therapeutic responses in MS patients. PMID:24632420

  19. Optic neuritis

    MedlinePlus

    Retro-bulbar neuritis; Multiple sclerosis - optic neuritis; Optic nerve - optic neuritis ... The exact cause of optic neuritis is unknown. The optic nerve carries visual information from your eye to the brain. The nerve can swell when ...

  20. Optic neuritis

    MedlinePlus

    ... pneumonia and other common upper respiratory tract infections Multiple sclerosis ... have optic neuritis without a disease such as multiple sclerosis have a good chance of recovery. Optic neuritis ...

  1. Brachial plexopathy.

    PubMed

    Khadilkar, Satish V; Khade, Snehaldatta S

    2013-01-01

    Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise. PMID:23661957

  2. Brachial plexopathy

    PubMed Central

    Khadilkar, Satish V.; Khade, Snehaldatta S.

    2013-01-01

    Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise. PMID:23661957

  3. Serial Diffusion Tensor Imaging of the Optic Radiations after Acute Optic Neuritis

    PubMed Central

    van der Walt, Anneke; Butzkueven, Helmut; Klistorner, Alexander; Egan, Gary F.; Kilpatrick, Trevor J.

    2016-01-01

    Previous studies have reported diffusion tensor imaging (DTI) changes within the optic radiations of patients after optic neuritis (ON). We aimed to study optic radiation DTI changes over 12 months following acute ON and to study correlations between DTI parameters and damage to the optic nerve and primary visual cortex (V1). We measured DTI parameters [fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD)] from the optic radiations of 38 acute ON patients at presentation and 6 and 12 months after acute ON. In addition, we measured retinal nerve fibre layer thickness, visual evoked potential amplitude, optic radiation lesion load, and V1 thickness. At baseline, FA was reduced and RD and MD were increased compared to control. Over 12 months, FA reduced in patients at an average rate of −2.6% per annum (control = −0.51%; p = 0.006). Change in FA, RD, and MD correlated with V1 thinning over 12 months (FA: R = 0.450, p = 0.006; RD: R = −0.428, p = 0.009; MD: R = −0.365, p = 0.029). In patients with no optic radiation lesions, AD significantly correlated with RNFL thinning at 12 months (R = 0.489, p = 0.039). In conclusion, DTI can detect optic radiation changes over 12 months following acute ON that correlate with optic nerve and V1 damage. PMID:27555964

  4. Impaired mental rotation in benign paroxysmal positional vertigo and acute vestibular neuritis

    PubMed Central

    Candidi, Matteo; Micarelli, Alessandro; Viziano, Andrea; Aglioti, Salvatore M.; Minio-Paluello, Ilaria; Alessandrini, Marco

    2013-01-01

    Vestibular processing is fundamental to our sense of orientation in space which is a core aspect of the representation of the self. Vestibular information is processed in a large subcortical–cortical neural network. Tasks requiring mental rotations of human bodies in space are known to activate neural regions within this network suggesting that vestibular processing is involved in the control of mental rotation. We studied whether mental rotation is impaired in patients suffering from two different forms of unilateral vestibular disorders (vestibular neuritis – VN – and Benign Paroxysmal positional Vertigo – BPPV) with respect to healthy matched controls (C). We used two mental rotation tasks in which participants were required to: (i) mentally rotate their own body in space (egocentric rotation) thus using vestibular processing to a large extent and (ii) mentally rotate human figures (allocentric rotation) thus using own body representations to a smaller degree. Reaction times and accuracy of responses showed that VN and BPPV patients were impaired in both tasks with respect to C. Significantly, the pattern of results was similar in the three groups suggesting that patients were actually performing the mental rotation without using a different strategy from the control individuals. These results show that dysfunctional vestibular inflow impairs mental rotation of both own body and human figures suggesting that unilateral acute disorders of the peripheral vestibular input massively affect the cerebral processes underlying mental rotations. PMID:24324422

  5. Pediatric Stinger Syndrome: Acute Brachial Plexopathy After Minor Trauma.

    PubMed

    Quong, Whitney L; Hynes, Sally L; Arneja, Jugpal S

    2015-11-01

    The "stinger" or "burner" is a form of transient brachial plexopathy termed for its characteristic knife-like pain extending from the neck to the fingertips. Muscle weakness and paresthesia are oftentimes associated symptoms and are similarly temporary. Commonly observed in athletes of contact sports, the stinger results from high force trauma causing either traction/direct compression to the brachial plexus or extension/compression of the cervical nerve roots. We describe a pediatric case of a stinger in a 14-year-old boy, which was caused by a relatively low force trauma accident. Our management strategy and recommendations are discussed. PMID:26893985

  6. Optic neuritis

    PubMed Central

    Pau, D; Al Zubidi, N; Yalamanchili, S; Plant, G T; Lee, A G

    2011-01-01

    Aims The aim of this study is to provide a clinical update on optic neuritis (ON), its association with multiple sclerosis (MS), and neuromyelitis optica (NMO). Methods This study included a PubMed review of the literature written in the English language. Results ON in adults is typically idiopathic or demyelinating, and is characterised by unilateral, subacute, painful loss of vision that is not associated with any systemic or other neurological symptoms. Demyelinating ON is associated with MS, and we review the key studies of ON including the ON treatment trial and several other MS treatment trials and NMO. Conclusion Acute demyelinating ON can occur in isolation or be associated with MS. Typical ON does not require additional evaluation other than cranial magnetic resonance imaging. NMO is likely a separate disorder from MS and the ON in NMO has a different treatment and prognosis. Methodology The authors conducted an English language search using Pubmed from the years 1964 to 2010 using the search terms ‘ON', ‘MS' and ‘NMO'. The authors included original articles, review articles, and case reports, which revealed new aspects as far as epidemiology, histopathology, clinical manifestations, imaging, genetics, and treatment of ON. Titles were reviewed for topicality and full references were obtained. Letters to the editor, unpublished work, and abstracts were not included in this review. PMID:21527960

  7. Brachial plexopathy

    MedlinePlus

    Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage Turner syndrome; Pancoast syndrome ... dysfunction (brachial plexopathy) is a form of peripheral neuropathy . It occurs when there is damage to the ...

  8. 25-Hydroxyvitamin D levels in acute monosymptomatic optic neuritis: relation to clinical severity, paraclinical findings and risk of multiple sclerosis.

    PubMed

    Pihl-Jensen, Gorm; Frederiksen, Jette Lautrup

    2015-07-01

    Optic neuritis (ON) is a common first symptom of MS and only few studies have thus far investigated vitamin D at this early stage of MS. The objectives of the study were to examine total 25-hydroxyvitamin D levels (25HVITDL) in patients in acute (A) ON and to determine whether 25HVITD levels in AON (1) predict risk of RRMS and (2) are associated with visual tests of ON severity. A cross-sectional study was conducted of mean 25HVITDL differences between ON (n = 164) and MS (n = 948) patients and of prevalence of 25HVITDL deficiency (<50 nmol/L) in ON and MS (two-sample t test, χ (2) test). Associations between 25HVITDL and (1) clinical ON severity, (2) paraclinical findings suggestive of MS [logistic regression (LRA), Spearman correlation] and (3) hazard of MS development [Cox (C) RA] in ON patients were assessed. 25HVITDL were deseasonalized before analysis. The mean levels were 47.6 (ON) and 63.9 (MS) nmol/L (p < 0.0001), and a significantly higher prevalence of 25HVITD deficiency in ON (56 %; 35 %) (p < 0.0001), most pronounced in females, was shown. Associations were found between 25HVITDL and both CSF leukocyte count (ρ = -0.177, p = 0.028) and IgG index elevation (OR 0.980, p = 0.031). Forty-one ON patients developed MS during the study. Multivariate CRA showed no effect on hazard of MS (HR: 0.991, p 0.284). No association was found between 25HVITDL and visual tests (acuity, contrast vision) or OCT RNFL or GCL thickness. The study indicates a high prevalence of 25HVITD deficiency in AON. 25HVITDL was significantly associated with CSF leukocyte count, but not ON severity. The study indicates a possible role of vitamin D in the early stages of MS, but does not support the use of 25HVITDL as a predictor of MS development in acute ON. PMID:25929657

  9. A low energy paediatric clavicle fracture associated with acute brachial plexus injury and subclavian artery compression.

    PubMed

    Gill, I; Quayle, J; Fox, M

    2013-03-01

    Paediatric clavicle fractures are common injuries presenting to orthopaedic surgeons. The majority of these represent midshaft low energy fractures, which in the vast majority of cases are treated non-operatively and recover rapidly. The main indications to consider operative intervention include high energy of injury, >2 cm shortening, open fractures and associated vascular or neurological injuries. Brachial plexus (BP) injuries are uncommon with variable outcomes. They often result from high energy motorcycle related accidents with potentially fatal associated injuries such as vascular disruption. Their management is complex, requiring expertise, and they are therefore usually managed in supraregional centres. We present a unique case of a low energy midshaft clavicle fracture in a paediatric patient in whom there was an acute BP injury and subclavian artery compression that has not been described previously. PMID:23484977

  10. Post-Plasmodium vivax malaria cerebellar ataxia and optic neuritis: A new form of delayed cerebellar ataxia or cerebellar variant of acute disseminated encephalomyelitis?

    PubMed Central

    Kasundra, Gaurav M.; Bhargava, Amita Narendra; Bhushan, Bharat; Shubhakaran, Khichar; Sood, Isha

    2015-01-01

    Acute disseminated encephalomyelitis (ADEM) is commonly seen after viral and bacterial infections, immunization, and Plasmodium falciparum (PF) malaria. Plasmodium vivax (PV) rarely causes ADEM. We report a 14-year-old female patient who presented with acute onset bilateral cerebellar ataxia and optic neuritis, 2 weeks after recovery from PV. Magnetic resonance imaging showed bilateral cerebellar hyperintensities suggestive of ADEM. No specific viral etiology was found on cerebrospinal fluid examination. Patient responded well to treatment without any sequelae. Thus, PV too is an important cause of ADEM along with PF. Two of the previously reported cases had co-infection with falciparum malaria. The only other two reported cases, as also this patient, are from Asia. A geographical or racial predisposition needs to be evaluated. Also, a possibility of post-PV delayed cerebellar ataxia, which is classically described post-PF infection, may be considered as it may be clinically, radiologically, and prognostically indistinguishable from a milder presentation of ADEM. PMID:25878748

  11. [A Patient with Acute Limbic Encephalitis Associated with Anti-Glutamate Receptor Antibodies and Subsequent Optic Neuritis].

    PubMed

    Murakami, Aya; Nakamura, Masataka; Kaneko, Satoshi; Takahashi, Yukitoshi; Kusaka, Hirofumi

    2016-03-01

    A 19-year-old woman presented with headache and fever. Cerebrospinal fluid (CSF) analysis revealed increased pressure (>200 mmH2O) and pleocytosis. Brain MRI showed high intensity in the medial part of the right temporal lobe, insular regions, and basal ganglia of the right hemisphere on fluid attenuated inversion recovery images. Based on a tentative diagnosis of limbic encephalitis caused by viral infection, acyclovir therapy was started. However, 10 days after admission, a right superior temporal quadrantanopia developed in the left eye. MRI detected abnormal intensity in the left optic nerve on short tau inversion recovery images. After three courses of steroid pulse therapy, the optic neuritis quickly improved and the patient was maintained on subsequent oral administration of prednisolone, without relapse for one year. The CSF was positive for anti-glutamate receptor (GluR) antibodies (GluN2B, GluN1, and GluD2); however, anti-N-methyl-D-aspartate receptor antibody was not detected in both serum and CSF with cell-based asseys. Compared to previously reported anti-GluR positive cases combined with optic neuritis, the clinical outcome of our patient was short, with good prognosis. Our results indicate that an autoimmune mechanism involving anti-GluR antibodies contributes to the pathogenesis of optic neuritis as well as limbic encephalitis. PMID:27001777

  12. Brachial plexopathy

    MedlinePlus

    Neuropathy - brachial plexus; Brachial plexus dysfunction; Parsonage Turner syndrome; Pancoast syndrome ... or post-viral brachial plexus disease called Parsonage Turner syndrome. Tests that may be done to diagnose ...

  13. Hereditary Neuropathy with Liability to Pressure Palsy Presenting as an Acute Brachial Plexopathy: A Lover's Palsy

    PubMed Central

    Wedderburn, Sarah; Pateria, Puraskar; Panegyres, Peter K.

    2014-01-01

    It is generally regarded that patients with hereditary neuropathy to pressure palsies, due to a deletion in the PMP22 gene, show recurrent pressure palsy and generalised peripheral neuropathy (pes cavus and hammer toes sometimes develop). Brachial plexopathy is rarely identified as a first presentation of hereditary neuropathy to pressure palsies. We describe a young man who developed a painless flail upper limb with a clinical diagnosis of a brachial plexopathy after his partner slept on his arm – a PMP22 deletion was found. His father, who had a symmetrical polyneuropathy without recurrent mononeuropathies, shared the PMP22 deletion. PMID:25685136

  14. Multiple Sclerosis Risk after Optic Neuritis: Final Optic Neuritis Treatment Trial Follow-Up

    PubMed Central

    2008-01-01

    Objective Assess the risk of developing MS after optic neuritis and factors predictive of high and low risk Design Optic Neuritis Treatment Trial (ONTT) subjects enrolled between 1988 and 1991 were followed prospectively for 15 years with final examination in 2006. Setting Neurologic and ophthalmologic exams at 13 clinical sites Participants Three hundred eighty-nine subjects with acute optic neuritis Main Outcome Measure(s) Development of MS and neurologic disability assessment Results The cumulative probability of developing MS by 15 years was 50% (95% confidence interval 44% to 56%) and strongly related to presence of lesions on a non-contrast enhanced baseline brain MRI. Twenty-five percent of patients with no baseline brain MRI lesions developed MS during follow-up compared with 72% of patients with one or more lesions. After 10 years, the risk of developing MS was very low for patients without baseline lesions but remained substantial for those with lesions. Among patients without MRI lesions, baseline factors associated with a substantially lower risk of MS included male gender, optic disc swelling, and certain atypical features for optic neuritis. Conclusions The presence of brain MRI abnormalities at the time of an optic neuritis attack is a strong predictor of the 15-year risk of MS. In the absence of MRI lesions, male gender, optic disc swelling and atypical clinical features of optic neuritis are associated with a low likelihood of developing MS. This natural history information is important when considering prophylactic treatment for MS at the time of a first acute optic neuritis attack. PMID:18541792

  15. Atypical Optic Neuritis.

    PubMed

    Gaier, Eric D; Boudreault, Katherine; Rizzo, Joseph F; Falardeau, Julie; Cestari, Dean M

    2015-12-01

    Classic demyelinative optic neuritis is associated with multiple sclerosis and typically carries a good prognosis for visual recovery. This disorder is well characterized with respect to its presentation and clinical features by baseline data obtained through the optic neuritis treatment trial and numerous other studies. Atypical optic neuritis entails clinical manifestations that deviate from this classic pattern of features. Clinical signs and symptoms that deviate from the typical presentation should prompt consideration of less common etiologies. Atypical features to consider include lack of pain, simultaneous or near-simultaneous onset, lack of response to or relapse upon tapering from corticosteroids, or optic nerve head or peripapillary hemorrhages. The most important alternative etiologies to consider and the steps towards their respective diagnostic evaluations are suggested for these atypical features. PMID:26467052

  16. Brachial plexus

    MedlinePlus

    The brachial plexus is a group of nerves that run from the lower neck through the upper shoulder area. These ... Damage to the brachial plexus nerves can cause muscle and sensation problems that are often associated with pain in the same area. Symptoms may ...

  17. Optic Nerve Sheath Meningioma Masquerading as Optic Neuritis

    PubMed Central

    Alroughani, R.; Behbehani, R.

    2016-01-01

    Optic neuritis is a common presentation of demyelinating disorders such as multiple sclerosis. It typically presents with acute painful monocular vision loss, whereas chronic optic neuropathy can be caused by compressive lesions along the anterior visual pathway, genetic, toxic, or nutritional causes. We report an unusual presentation mimicking optic neuritis, which was subsequently diagnosed as optic nerve sheath meningioma (ONSM). Misinterpretation of white matter lesions on MRI of brain and the failure to image the optic nerves at the time of acute loss of vision led to the misdiagnosis of optic neuritis in this case. A comprehensive accurate history and ordering the appropriate imaging modality remain paramount in diagnosing progressive visual deterioration. PMID:26904329

  18. Optic Nerve Sheath Meningioma Masquerading as Optic Neuritis.

    PubMed

    Alroughani, R; Behbehani, R

    2016-01-01

    Optic neuritis is a common presentation of demyelinating disorders such as multiple sclerosis. It typically presents with acute painful monocular vision loss, whereas chronic optic neuropathy can be caused by compressive lesions along the anterior visual pathway, genetic, toxic, or nutritional causes. We report an unusual presentation mimicking optic neuritis, which was subsequently diagnosed as optic nerve sheath meningioma (ONSM). Misinterpretation of white matter lesions on MRI of brain and the failure to image the optic nerves at the time of acute loss of vision led to the misdiagnosis of optic neuritis in this case. A comprehensive accurate history and ordering the appropriate imaging modality remain paramount in diagnosing progressive visual deterioration. PMID:26904329

  19. [Pharyngeal-cervical-brachial syndrome: A rare form of Guillain-Barré syndrome with severe acute bulbar palsy].

    PubMed

    Lametery, E; Dubois-Teklali, F; Millet, A; Manel, V

    2016-02-01

    The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome is rare in children. It is characterized by oropharyngeal, neck, and upper limb muscle involvement, without ataxia and disturbed consciousness. Although associated with anti-GT1a antibodies, there is no single clinical or serological marker of PCB syndrome. We report on two cases in a 14-year-old and a 15-year-old females. The first symptom was acute dysphonia followed by severe bulbar palsy with deglutition disorders, associated with involvement of other cranial nerves and arm and leg weakness. One of the girls had normal deep tendon reflexes. Both had normal cerebral imaging and normal cerebrospinal fluid. No sign of neuropathy was found on nerve conduction studies. The diagnosis of PCB syndrome was established based on the presence of antiganglioside antibodies. Both adolescents had IgG anti-GT1a antibodies. Anti-GQ1b and anti-GT1b antibodies were associated in the first case, anti-GM1 and anti-GD1a in the second case. Clinical improvement was fast after treatment with intravenous immunoglobulin therapy. Recovery was complete. Only a few cases of children and adolescents with PCB syndrome have been reported. The main differential diagnoses were excluded with brain MRI. The neurophysiological findings in PCB syndrome are axonal neuropathy rather than demyelinating neuropathy, which might be normal in the early stages of the disease. Positivity of anti-GT1a IgG antibodies is very helpful for the diagnosis of PCB syndrome. In atypical cases of bulbar palsy with other cranial nerve involvement and normal brain MRI, diagnosis of PCB syndrome should be considered. Recognizing the atypical cases of Guillain-Barré syndrome enables anticipatory monitoring for disease complications and identifies therapeutic options. The short- and long-term outcome of the PCB syndrome after intravenous immunoglobulin treatment seems favorable. PMID:26697812

  20. Corticosteroids for treating optic neuritis

    PubMed Central

    Gal, Robin L; Vedula, Satyanarayana S; Beck, Roy

    2014-01-01

    Background Optic neuritis is an inflammatory disease of the optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this condition. In certain patients, no underlying cause can be found. Objectives To assess the effects of corticosteroids on visual recovery of patients with acute optic neuritis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 21 February 2012. We also searched reference lists of identified trial reports to find additional trials. Selection criteria We included randomized trials that evaluated corticosteroids, in any form, dose or route of administration, in people with acute optic neuritis. Data collection and analysis Two authors independently extracted the data on methodological quality and outcomes for analysis. Main results We included six randomized trials which included a total of 750 participants. Two trials evaluated low dose oral corticosteroids while one trial evaluated low dose intravenous corticosteroids across two treatment arms and two trials evaluated a higher dose of intravenous corticosteroids. One three-arm trial evaluated low-dose oral corticosteroids and high-dose intravenous corticosteroids against placebo. Trials evaluating oral

  1. Masquerading optic neuritis.

    PubMed

    McVeigh, Katherine; Vakros, Georgios; Girgis, Rafik

    2015-01-01

    A 54-year-old woman presented to the ophthalmology emergency department with a 10-day history of blurred vision. The best-corrected visual acuities and Ishihara colour vision were bilaterally reduced with a left relative afferent pupillary defect. Slit-lamp examination was otherwise normal. Retrobulbar optic neuritis (ON) was presumed as she had suffered with this previously and was known to have multiple sclerosis (MS). She was recalled the following week for visual field (VF) testing, which was not available at the time of presentation. VFs demonstrated an incongruous left homonymous hemianopia. She was immediately referred to the medical team to investigate for a stroke, which was subsequently excluded. Thereafter, a trial of pulsed methylprednisolone was commenced, resulting in near complete resolution of the hemianopia. This case demonstrates not only the importance of VF testing, but also how ON may present with any field defect, including mimicking a stroke, a point valuable to ophthalmologists and medics alike. PMID:26240099

  2. Brachial Plexus Injuries

    MedlinePlus

    ... Diversity Find People About NINDS NINDS Brachial Plexus Injuries Information Page Synonym(s): Erb's Palsy Table of Contents ( ... done? Clinical Trials Organizations What are Brachial Plexus Injuries? The brachial plexus is a network of nerves ...

  3. Pediatric optic neuritis.

    PubMed

    Yeh, E Ann; Graves, Jennifer S; Benson, Leslie A; Wassmer, Evangeline; Waldman, Amy

    2016-08-30

    Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions. PMID:27572862

  4. A case of relapsing-remitting facial palsy and ipsilateral brachial plexopathy caused by HSV-1.

    PubMed

    Alstadhaug, Karl B; Kvarenes, Hanne W; Prytz, Jan; Vedeler, Christian

    2016-05-01

    The etiologies of Bell's palsy and brachial neuritis remain uncertain, and the conditions rarely co-occur or reoccur. Here we present a woman in her twenties who had several relapsing-remitting episodes with left-sided facial palsy and brachial neuropathy. The episodes always started with painful left-sided oral blisters. Repeat PCRs HSV-1 DNA from oral vesicular lesions were positive. Extensive screening did not reveal any other underlying cause. Findings on MRI T2-weighted brachial plexus STIR images, using a 3.0-Tesla scanner during an episode, were compatible with brachial plexus neuritis. Except a mannose-binding lectin deficiency, a congenital complement deficiency that is frequently found in the general Caucasian population, no other immunodeficiency was demonstrated in our patient. In vitro resistance to acyclovir was tested negative, but despite prophylactic treatment with the drug in high doses, relapses recurred. To our knowledge, this is the first ever reported documentation of relapsing-remitting facial and brachial plexus neuritis caused by HSV-1. PMID:26991053

  5. Peripheral neuritis due to isoniazid*

    PubMed Central

    Devadatta, S.; Gangadharam, P. R. J.; Andrews, R. H.; Fox, Wallace; Ramakrishnan, C. V.; Selkon, J. B.; Velu, S.

    1960-01-01

    It is well known that in the treatment of tuberculosis with isoniazid the complication of peripheral neuritis may arise. This complication is normally rare when small dosages of the drug are used, but a high incidence of the neuropathy has recently been observed in East Africa in a group of malnourished tuberculous patients receiving isoniazid in comparatively low dosage (4-6 mg/kg body-weight daily). The present paper reports on 20 cases of peripheral neuritis encountered in Madras, India, among 338 poorly nourished tuberculous patients during a trial of four isoniazid regimens, two of low and two of high dosage (3.9-5.5 and 7.8-9.6 mg/kg body-weight daily, respectively). Nineteen of the 20 cases occurred in the two groups of patients receiving the high dosage and these 19 patients were found to have a higher mean serum level of free isoniazid than the patients in the same groups who did not develop the complication. The authors consider that dosages of 7.8-9.6 mg/kg body-weight daily should not be used for the mass therapy of poorly nourished patients unless steps are taken to prevent the development of peripheral neuritis. Pyridoxine has been reported to be an effective preventive, but is too expensive for use on a large scale. This study indicates, however, that administration of the cheaper vitamin B complex might give satisfactory results and warrants further investigation. PMID:13722334

  6. Brachial plexus (image)

    MedlinePlus

    The brachial plexus is a group of nerves that originate from the neck region and branch off to give rise ... movement in the upper limb. Injuries to the brachial plexus are common and can be debilitating. If the ...

  7. Brachial Plexus Injuries

    MedlinePlus

    ... to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves. Symptoms ... sensation in the arm or hand Brachial plexus injuries can occur as a result of shoulder trauma, ...

  8. [Case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion].

    PubMed

    Fujii, Takayuki; Santa, Yo; Akutagawa, Noriko; Nagano, Sukehisa; Yoshimura, Takeo

    2012-01-01

    A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T₂ weighted imaging (T₂WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T₂WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction. PMID:22790805

  9. Optic neuritis in pediatric population: a review in current tendencies of diagnosis and management.

    PubMed

    Pérez-Cambrodí, Rafael José; Gómez-Hurtado Cubillana, Aránzazu; Merino-Suárez, María L; Piñero-Llorens, David P; Laria-Ochaita, Carlos

    2014-01-01

    Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA. PMID:25000867

  10. Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Complex in Patients with Optic Neuritis or Neuromyelitis Optica Spectrum Disorders Using Optical Coherence Tomography in a Chinese Cohort

    PubMed Central

    Tian, Guohong; Li, Zhenxin; Zhao, Guixian; Feng, Chaoyi; Li, Mengwei; Huang, Yongheng; Sun, Xinghuai

    2015-01-01

    We evaluate a cohort of optic neuritis and neuromyelitis optica (NMO) spectrum disorders patients in a territory hospital in China. The peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were measured using spectral-domain OCT after 6 months of acute onset. The results showed that both the peripapillary RNFL and macular GCC were significantly thinner in all optic neuritis subtypes compared to controls. In addition, the recurrent optic neuritis and NMO groups showed more severe damage on the RNFL and GCC pattern. PMID:26649191

  11. 38 CFR 4.123 - Neuritis, cranial or peripheral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...

  12. 38 CFR 4.123 - Neuritis, cranial or peripheral.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...

  13. 38 CFR 4.123 - Neuritis, cranial or peripheral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...

  14. 38 CFR 4.123 - Neuritis, cranial or peripheral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...

  15. 38 CFR 4.123 - Neuritis, cranial or peripheral.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Neuritis, cranial or....123 Neuritis, cranial or peripheral. Neuritis, cranial or peripheral, characterized by loss of... the scale provided for injury of the nerve involved, with a maximum equal to severe,...

  16. Intravenous immunoglobulin and interferon: successful treatment of optic neuritis in pediatric multiple sclerosis.

    PubMed

    Spalice, Alberto; Properzi, Enrico; Lo Faro, Valentina; Acampora, Barbara; Iannetti, Paola

    2004-08-01

    Optic neuritis is a common clinical condition that causes loss of vision. It can be clinically isolated or can occur as one of the manifestations of multiple sclerosis. Multiple sclerosis is a severe disabling demyelinating disease of the central nervous system, which is rare among children. The treatment of optic neuritis has been investigated in several trials, the results of which have shown that corticosteroids speed up the recovery of vision without affecting the final visual outcome. Treatment of neurologic disorders with intravenous immunoglobulin is an increasing feature of our practice for an expanding range of indications, including multiple sclerosis. Owing to its anti-inflammatory properties, intravenous immunoglobulin can be beneficial in the treatment of acute relapses and in the prevention of new relapses of multiple sclerosis. To our knowledge, there is only one experience of treatment of optic neuritis with intravenous immunoglobulin in multiple sclerosis, even if therapeutic trials are used in the therapy of multiple sclerosis. We report on a girl with optic neuritis and multiple sclerosis in whom treatment with intravenous immunoglobulin at first alone and subsequently associated with interferon achieved great improvement in visual acuity. PMID:15605474

  17. Prospective Study on Retinal Nerve Fibre Layer Thickness Changes in Isolated Unilateral Retrobulbar Optic Neuritis

    PubMed Central

    Yau, Gordon S. K.; Lee, Jacky W. Y.; Lau, Patrick P. K.; Tam, Victor T. Y.; Wong, Winnie W. Y.; Yuen, Can Y. F.

    2013-01-01

    Purpose. To investigate the retinal nerve fibre layer (RNFL) thickness after unilateral acute optic neuritis using optical coherence tomography (OCT). Patients and Methods. This prospective cohort study recruited consecutive patients with a first episode of isolated, unilateral acute optic neuritis. RNFL thickness and visual acuity (VA) of the attack and normal fellow eye were measured at presentation and 3 months in both the treatment and nontreatment groups. Results. 11 subjects received systemic steroids and 9 were treated conservatively. The baseline RNFL thickness was similar in the attack and fellow eye (P ≥ 0.4). At 3 months, the attack eye had a thinner temporal (P = 0.02) and average (P = 0.05) RNFL compared to the fellow eye. At 3 months, the attack eye had significant RNFL thinning in the 4 quadrants and average thickness (P ≤ 0.0002) compared to baseline. The RNFL thickness between the treatment and nontreatment groups was similar at baseline and 3 months (P ≥ 0.1). Treatment offered better VA at 3 months (0.1 ± 0.2 versus 0.3 ± 0.2 LogMAR, P = 0.04). Conclusion. Generalized RNFL thinning occurred at 3 months after a first episode of acute optic neuritis most significantly in the temporal quadrant and average thickness. Visual improvement with treatment was independent of RNFL thickness. PMID:24459442

  18. Lipoic Acid Decreases Inflammation and Confers Neuroprotection in Experimental Autoimmune Optic Neuritis

    PubMed Central

    Chaudhary, Priya; Marracci, Gail; Yu, Xiaolin; Galipeau, Danielle; Morris, Brooke; Bourdette, Dennis

    2016-01-01

    Lipoic acid (LA) is an antioxidant that is effective in treating experimental autoimmune encephalomyelitis (EAE), a model for multiple sclerosis (MS). C57BL/6 mice with EAE develop experimental autoimmune optic neuritis (EAON), which models acute optic neuritis in humans. Here we determined whether LA is therapeutically effective in EAON. We immunized C57BL/6 mice with MOG 35–55 peptide. Mice received either daily subcutaneous injections of LA (100 mg/kg) or saline in early or late suppression paradigms. In the early suppression paradigm, optic nerve cross sections showed 14.9 ± 3.8% (mean ± SEM) damage in mice receiving saline (n = 7) and 2.0 ± 0.4 % damage in mice given LA (n = 7, p = 0.001). In the late suppression paradigm, optic nerve sections showed 24.6 ± 3.5% damage in mice treated with saline (n = 7) and 8.4 ± 2.5% in mice treated with LA (n = 7, p = 0.004). Thus a dramatic reduction in axonal injury was seen after LA administration in both experimental paradigms. Compared with saline treated mice with EAON, optic nerves from mice receiving LA had significantly fewer CD4+ and CD11b+ cells in both paradigms. This study provides a rationale for investigating the therapeutic efficacy of LA in acute optic neuritis in humans. PMID:21215462

  19. Brachial artery pseudoaneurysm

    PubMed Central

    Kemp, Katie; Radwan, Rami; Shingler, Guy; Davies, Chris

    2014-01-01

    We describe a case of an elderly man who presented with an upper arm swelling that had developed following a humeral fracture 8 months previously. The swelling was painless but associated with significantly diminished motor function of his right hand and concurrent paraesthaesia. On examination, a large pulsatile mass was identified and CT angiography confirmed the presence of an 11×7 cm brachial artery pseudoaneurysm. The patient underwent surgical repair in which a fragment of the humerus was found to have punctured the brachial artery resulting in a pseudoaneurysm. The patient had an uncomplicated postoperative period and was discharged 2 days later having regained some motor function in his right hand. PMID:24859555

  20. Dimethyl Fumarate Ameliorates Lewis Rat Experimental Autoimmune Neuritis and Mediates Axonal Protection

    PubMed Central

    Pitarokoili, Kalliopi; Ambrosius, Björn; Meyer, Daniela; Schrewe, Lisa; Gold, Ralf

    2015-01-01

    Background Dimethyl fumarate is an immunomodulatory and neuroprotective drug, approved recently for the treatment of relapsing-remitting multiple sclerosis. In view of the limited therapeutic options for human acute and chronic polyneuritis, we used the animal model of experimental autoimmune neuritis in the Lewis rat to study the effects of dimethyl fumarate on autoimmune inflammation and neuroprotection in the peripheral nervous system. Methods and Findings Experimental autoimmune neuritis was induced by immunization with the neuritogenic peptide (amino acids 53–78) of P2 myelin protein. Preventive treatment with dimethyl fumarate given at 45 mg/kg twice daily by oral gavage significantly ameliorated clinical neuritis by reducing demyelination and axonal degeneration in the nerve conduction studies. Histology revealed a significantly lower degree of inflammatory infiltrates in the sciatic nerves. In addition, we detected a reduction of early signs of axonal degeneration through a reduction of amyloid precursor protein expressed in axons of the peripheral nerves. This reduction correlated with an increase of nuclear factor (erythroid derived 2)-related factor 2 positive axons, supporting the neuroprotective potential of dimethyl fumarate. Furthermore, nuclear factor (erythroid derived 2)-related factor 2 expression in Schwann cells was only rarely detected and there was no increase of Schwann cells death during EAN. Conclusions We conclude that immunmodulatory and neuroprotective dimethyl fumarate may represent an innovative therapeutic option in human autoimmune neuropathies. PMID:26618510

  1. Lightning strike-induced brachial plexopathy

    PubMed Central

    Bhargava, Amita N.; Kasundra, Gaurav M.; Khichar, Subhakaran; Bhushan, Bharat S. K.

    2014-01-01

    We describe a patient who presented with a history of lightning strike injury. Following the injury, he sustained acute right upper limb weakness with pain. Clinically, the lesion was located to the upper and middle trunk of the right brachial plexus, and the same confirmed with electrophysiological studies. Nerve damage due to lightning injuries is considered very rare, and a plexus damage has been described infrequently, if ever. Thus, the proposed hypothesis that lightning rarely causes neuropathy, as against high-voltage electric current, due to its shorter duration of exposure not causing severe burns which lead to nerve damage, needs to be reconsidered. PMID:25288846

  2. A case of multiple evanescent white dot syndrome misdiagnosed as optic neuritis: Differential diagnosis for the neurologist

    PubMed Central

    Pellegrini, Francesco; Interlandi, Emanuela

    2016-01-01

    A 25-year-old female presented to a local hospital for acute onset of a central scotoma in the left visual field. She was visited by the neurologist, and a diagnosis of left retrobulbar optic neuritis was made. Magnetic resonance imaging scan was normal. Ophthalmic examination revealed a multiple evanescent white dot syndrome. After a description of the case, a brief differential diagnosis between these two entities is made. The neurologist should be aware of this uncommon condition. PMID:27114663

  3. Vertical eye movements during horizontal head impulse test: a new clinical sign of superior vestibular neuritis.

    PubMed

    D'Onofrio, F

    2013-12-01

    In some patients suffering from acute unilateral peripheral vestibular deficit, the head impulse test performed towards the affected side reveals the typical catch-up saccade in the horizontal plane, and an oblique, mostly vertical, upward catch-up saccade after the rotation of the head towards the healthy side. Three cases are reported herein, which have been studied using slow motion video analysis of the eye movements captured by a high-speed webcam (90 fps). The clinical evidence is discussed and a pathophysiological explanation is proposed, consisting in a selective hypofunction of the superior semicircular canal during superior vestibular neuritis. PMID:24376299

  4. Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial—study protocol

    PubMed Central

    Diem, Ricarda; Molnar, Fanni; Beisse, Flemming; Gross, Nikolai; Drüschler, Katharina; Heinrich, Sven P; Joachimsen, Lutz; Rauer, Sebastian; Pielen, Amelie; Sühs, Kurt-Wolfram; Linker, Ralf Andreas; Huchzermeyer, Cord; Albrecht, Philipp; Hassenstein, Andrea; Aktas, Orhan; Guthoff, Tanja; Tonagel, Felix; Kernstock, Christoph; Hartmann, Kathrin; Kümpfel, Tania; Hein, Katharina; van Oterendorp, Christian; Grotejohann, Birgit; Ihorst, Gabriele; Maurer, Julia; Müller, Matthias; Volkmann, Martin; Wildemann, Brigitte; Platten, Michael; Wick, Wolfgang; Heesen, Christoph; Schiefer, Ulrich; Wolf, Sebastian; Lagrèze, Wolf A

    2016-01-01

    Introduction Optic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of recovery but does not prevent neurodegeneration and persistent visual impairment. In a phase II trial performed in preparation of this study, we have shown that erythropoietin protects global retinal nerve fibre layer thickness (RNFLT-G) in acute optic neuritis; however, the preparatory trial was not powered to show effects on visual function. Methods and analysis Treatment of Optic Neuritis with Erythropoietin (TONE) is a national, randomised, double-blind, placebo-controlled, multicentre trial with two parallel arms. The primary objective is to determine the efficacy of erythropoietin compared to placebo given add-on to methylprednisolone as assessed by measurements of RNFLT-G and low-contrast visual acuity in the affected eye 6 months after randomisation. Inclusion criteria are a first episode of optic neuritis with decreased visual acuity to ≤0.5 (decimal system) and an onset of symptoms within 10 days prior to inclusion. The most important exclusion criteria are history of optic neuritis or multiple sclerosis or any ocular disease (affected or non-affected eye), significant hyperopia, myopia or astigmatism, elevated blood pressure, thrombotic events or malignancy. After randomisation, patients either receive 33 000 international units human recombinant erythropoietin intravenously for 3 consecutive days or placebo (0.9% saline) administered intravenously. With an estimated power of 80%, the calculated sample size is 100 patients. The trial started in September 2014 with a planned recruitment period of 30 months. Ethics and dissemination TONE has been approved by the Central Ethics Commission in Freiburg (194/14) and the German Federal Institute for Drugs and Medical Devices (61-3910-4039831). It complies with the Declaration of Helsinki

  5. Permeability of the blood–brain barrier predicts conversion from optic neuritis to multiple sclerosis

    PubMed Central

    Modvig, Signe; Simonsen, Helle J.; Frederiksen, Jette L.; Larsson, Henrik B. W.

    2015-01-01

    Optic neuritis is an acute inflammatory condition that is highly associated with multiple sclerosis. Currently, the best predictor of future development of multiple sclerosis is the number of T2 lesions visualized by magnetic resonance imaging. Previous research has found abnormalities in the permeability of the blood–brain barrier in normal-appearing white matter of patients with multiple sclerosis and here, for the first time, we present a study on the capability of blood–brain barrier permeability in predicting conversion from optic neuritis to multiple sclerosis and a direct comparison with cerebrospinal fluid markers of inflammation, cellular trafficking and blood–brain barrier breakdown. To this end, we applied dynamic contrast-enhanced magnetic resonance imaging at 3 T to measure blood–brain barrier permeability in 39 patients with monosymptomatic optic neuritis, all referred for imaging as part of the diagnostic work-up at time of diagnosis. Eighteen healthy controls were included for comparison. Patients had magnetic resonance imaging and lumbar puncture performed within 4 weeks of onset of optic neuritis. Information on multiple sclerosis conversion was acquired from hospital records 2 years after optic neuritis onset. Logistic regression analysis showed that baseline permeability in normal-appearing white matter significantly improved prediction of multiple sclerosis conversion (according to the 2010 revised McDonald diagnostic criteria) within 2 years compared to T2 lesion count alone. There was no correlation between permeability and T2 lesion count. An increase in permeability in normal-appearing white matter of 0.1 ml/100 g/min increased the risk of multiple sclerosis 8.5 times whereas having more than nine T2 lesions increased the risk 52.6 times. Receiver operating characteristic curve analysis of permeability in normal-appearing white matter gave a cut-off of 0.13 ml/100 g/min, which predicted conversion to multiple sclerosis with a

  6. A case of retrobulbar optic neuritis caused by duloxetine.

    PubMed

    Bicer, Tolga; Kosker, Mustafa; Celikay, Osman; Gurdal, Canan

    2016-09-01

    Psychotropic medications may cause many ocular adverse effects including toxic optic neuropathy. We present a unique case of a 44-year-old woman using duloxetine who presented with unilateral visual loss due to retrobulbar neuritis. Physicians and patients should be alerted to this potential side effect. To the best of our knowledge, this is the first case of developing retrobulbar neuritis related to duloxetine usage. PMID:26362493

  7. Paraneoplastic optic neuritis as the first manifestation of periampullary carcinoma

    PubMed Central

    Paul, Rudrajit; Ghosh, Asim K; Sinha, Avirup; Bhattacharya, Raja

    2015-01-01

    Paraneoplastic optic neuritis is a rare phenomenon that often presents as a diagnostic challenge. It has been mostly reported with small cell cancers or thymoma. Prompt treatment of the malignancy is the only effective therapy for the condition. Visual loss, once established usually becomes irreversible. We here report a case of paraneoplastic optic neuritis in a 40-year-old female with periampullary carcinoma. This is probably the first report of this association in the medical literature. PMID:25664276

  8. Brachial plexus injury in newborns

    MedlinePlus

    ... and vascular disorders. In: Fenichel GM, ed. Neonatal Neurology . 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2006: ... CB, Kratz JR, Jelin AC, Gelfand AA. Child neurology: brachial plexus birth injury: what every neurologist needs ...

  9. Relationship of optic neuritis to disease of the paranasal sinuses.

    PubMed

    Rothstein, J; Maisel, R H; Berlinger, N T; Wirtschafter, J D

    1984-11-01

    The relationship of paranasal sinusitis to optic neuritis remains an intriguing curiosity to both the otolaryngologist and the ophthalmologist. The literature is replete with anecdotal case reports of patients whose sinusitis appears to have caused optic neuritis. There is much speculation about the pathophysiological mechanisms which relate these two distinct disease entities. Five new cases are described which highlight distinct pathophysiologic routes through which paranasal sinus disease has caused optic neuritis. These include compressive optic neuropathy secondary to mucoceles and/or pyoceles; direct extension of sinus infection to the optic nerve from suppurative paranasal sinusitis; and, in one case, from osteomyelitis of the ethmoid and sphenoid sinuses. The usefulness of computerized axial tomography of the orbits and paranasal sinuses to evaluate optic neuritis and to elucidate in detail the pathophysiology of its relationship to disease of the paranasal sinuses is emphasized. Currently, optic neuritis is felt to be a rare complication of paranasal sinusitis. Paranasal sinus surgery is advocated in those cases where sinus suppuration is suspected, or when a compressive optic neuropathy is caused by a sinus mucocele or pyocele. Since in most cases, however, optic neuritis is self-limited, it is difficult to evaluate the results of surgery in circumstances other than those mentioned already. Continued careful evaluation, management, and documentation of this group of patients is necessary to help better define the relationship between these two disease entities. PMID:6492975

  10. Postural control in patients after a recent vestibular neuritis with hyperhomocysteinemia.

    PubMed

    Raponi, G; Teggi, R; Gatti, O; Giordano, L; Bussi, M

    2013-04-01

    To assess the possible role of hyperhomocysteinemia (HyHcy) in delaying recovery after acute vestibular neuritis. In our retrospective study, 90 subjects were evaluated within 7 days from the beginning of an acute vertigo. All subjects had high plasma levels of homocysteine (Hcy). 46 patients were treated with homocysteine lowering therapy and betahistine for 1 month, while 44 subjects received only betahistine. Subjective symptoms were evaluated with the Dizziness Handicap Inventory (DHI) questionnaire, administered 7 days after the beginning of vertigo and again after 1 month. Moreover, postural control performed at 1 month' control was studied with static stabilometry in a subgroup of 21 non-treated and 20 treated patients. DHI total score decreased significantly more in the subgroup of subjects treated with homocysteine lowering therapy. Moreover, posturographic data were significantly increased in non-treated compared with treated subjects. Our data support the possibility of a role of HyHcy in preventing recovery after a recent vestibular neuritis. A microvascular disorder or the neurotoxic effect of HyHcy have been considered as possible causal factors. Although not conclusive, our data are not inconsistent with the hypothesis of a poorer adaptation in patients with untreated HyHcy. PMID:24427555

  11. True aneurysm of brachial artery.

    PubMed

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  12. Occurrence of Optic Neuritis and Cervical Cord Schwannoma with Charcot-Marie-Tooth Type 4B1 Disease

    PubMed Central

    Scott, Patrick; Bruwer, Zandre; Al-Kharusi, Khalsa; Meftah, Douja; Al-Murshedi, Fathiya

    2016-01-01

    Charcot-Marie-Tooth neuropathy type 4B1 (CMT4B1) disease is a rare subtype of CMT4 with reported association of facial weakness, vocal cord paresis, chest deformities, and claw hands. We report the unusual occurrence of optic neuritis and cervical cord schwannoma in a male individual with confirmed CMT4B1 disease. Sequencing of the MTMR2 gene revealed a novel nonsense homozygous mutation c.1768C>T (p.Gln590*). The mutation was identified in affected relatives of the proband and a second, apparently unrelated, family. The rare association of optic neuritis or schwannoma with genetically confirmed CMT1A has been individually observed, but never with recessive CMT. To the best of our knowledge, the occurrence of optic neuritis and cervical cord schwannoma in the same patient has never been reported with any form of CMT including CMT4B1. In similar cases, we recommend immediate medical attention to rule out the possibility of schwannomas in patients with all demyelinating CMT subtypes in case of the development of focal neurological signs or acute worsening of clinical status. PMID:27162595

  13. Cauda Equina Neuritis: A Chronic Idiopathic Polyneuritis in Two Horses

    PubMed Central

    Rousseaux, C. G.; Futcher, K. G.; Clark, E. G.; Naylor, J. M.

    1984-01-01

    Two cases of cauda equina neuritis are compared and contrasted. Neurological deficits of the tail and perineum were noted and functional deficits were seen in gait, urination, defecation and cranial nerve function. Lesions consisted of nonsuppurative inflammation of the nerve trunks and proliferation of the perineurium of the cauda equina. Cranial nerve involvement in one case supported a diagnosis of polyneuritis equi rather than cauda equina neuritis. The possible etiologies and pathogenesis of this disease are discussed. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:17422405

  14. Risk Factors for Idiopathic Optic Neuritis Recurrence

    PubMed Central

    Zhang, Yu-Jiao; Li, Kaijun; He, Jian-Feng

    2014-01-01

    Background Approximately 30–50% of idiopathic optic neuritis (ION) patients experience one or multiple episodes of recurrence. The aim of this study was to search for risk factors for ION recurrence. Methods Clinical data on hospitalized patients diagnosed with ION between January 2003 and January 2011 at the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. Univariate and multivariate analyses were performed on factors that might cause ION recurrence. In total, 115 ION cases (32 recurrent and 83 non-recurrent cases) with complete data were analyzed. The length of the follow-up period ranged from 12 to 108 months (median: 42 months). Results The univariate analysis showed that the recurrence rate for unilateral ION was higher than that for bilateral ION (40% vs. 12%, p = 0.001). Underlying diseases had a significant impact on recurrence (p<0.001): the recurrence rates due to neuromyelitis optica (NMO), multiple sclerosis (MS), demyelinating lesions alone of the central nervous system, and unknown causes were 89%, 70%, 41%, and 8.7%, respectively. The multivariate analysis showed that the factors causing relatively high recurrence rates included NMO (odds ratio [OR], 73.5; 95% confidence interval [CI], 7.3 to 740.9), MS (OR, 33.9; 95% CI, 5.2 to 222.2), and demyelinating lesions alone (OR, 8.9; 95% CI, 2.3 to 34.4), unilateral involvement (OR, 5.7; 95% CI, 1.5 to 21.3), relatively low initial glucocorticoid dosage (equivalent to ≤100 mg prednisone/day) (OR, 4.3; 95% CI, 1.0 to 17.9). Conclusion Underlying diseases, laterality (unilateral or bilateral), and initial glucocorticoid dosage are important risk factors of ION recurrence. Clinical physicians are advised to treat ION patients with a sufficient dose of glucocorticoid in the initial treatment stage to reduce the recurrence risk. PMID:25255372

  15. Bilateral optic neuritis in a boy - More than the eyes.

    PubMed

    Loh, M A; Alex Khoo, P C; Chong, M F

    2016-04-01

    Neuromyelitis optica (NMO) is a rare disorder in children with variable presentation. We report a 7-year-old boy who presented with bilateral retrobulbar optic neuritis and responded very well to treatment. He was also positive for aquaporin 4 (AQP4) antibodies, which is part of an emerging endophenotype within autoimmune neurological disorders in childhood. PMID:27326949

  16. Plasma exchange response in 34 patients with severe optic neuritis.

    PubMed

    Deschamps, Romain; Gueguen, Antoine; Parquet, Nathalie; Saheb, Samir; Driss, Francoise; Mesnil, Malcie; Vignal, Catherine; Aboab, Jennifer; Depaz, Raphael; Gout, Olivier

    2016-05-01

    Optic neuritis could lead to severe visual impairment despite corticosteroids. Our aim was to evaluate the rate of visual improvement in patients treated with plasma exchange (PLEX) for severe steroid unresponsive optic neuritis and to identify predictive factors of outcome. Thirty-four patients (41 optic nerves damaged) with remaining visual acuity of 0.1 or less despite steroid pulse therapy were treated with PLEX from September 2010 to May 2015. Demographic and clinical neuro-ophthalmic findings, and spectral domain-optical coherence tomography data before PLEX treatment were analyzed. The mean symptom duration before PLEX was 34.6 days (median 28 days; range 6-92 days). After PLEX, the median final visual acuity was 0.8 and in 56 % of cases, final acuity was 0.5 or better. Past history of ipsilateral optic neuritis was associated significantly with poor outcome defined as final acuity less than 0.5. No significant difference in the visual outcome after PLEX was found between multiple sclerosis and neuromyelitis optica. In conclusion, this observational study showed that PLEX as second-line therapy led to a functionally important visual recovery in more than half patients with severe optic neuritis. PMID:26964539

  17. Is Vestibular Neuritis an Immune Related Vestibular Neuropathy Inducing Vertigo?

    PubMed Central

    Greco, A.; Macri, G. F.; Gallo, A.; Fusconi, M.; De Virgilio, A.; Pagliuca, G.; Marinelli, C.; de Vincentiis, M.

    2014-01-01

    Objectives. To review the current knowledge of the aetiology of vestibular neuritis including viral infections, vascular occlusion, and immunomediated mechanisms and to discuss the pathogenesis with relevance to pharmacotherapy. Systematic Review Methodology. Relevant publications on the aetiology and treatment of vestibular neuritis from 1909 to 2013 were analysed. Results and Conclusions. Vestibular neuritis is the second most common cause of peripheral vestibular vertigo and is due to a sudden unilateral loss of vestibular function. Vestibular neuronitis is a disorder thought to represent the vestibular-nerve equivalent of sudden sensorineural hearing loss. Histopathological studies of patients who died from unrelated clinical problems have demonstrated degeneration of the superior vestibular nerve. The characteristic signs and symptoms include sudden and prolonged vertigo, the absence of auditory symptoms, and the absence of other neurological symptoms. The aetiology and pathogenesis of the condition remain unknown. Proposed theories of causation include viral infections, vascular occlusion, and immunomediated mechanisms. The management of vestibular neuritis involves symptomatic treatment with antivertiginous drugs, causal treatment with corticosteroids, and physical therapy. Antiviral agents did not improve the outcomes. PMID:24741601

  18. Case-centered Analysis of Optic Neuritis After Vaccines.

    PubMed

    Baxter, Roger; Lewis, Edwin; Fireman, Bruce; DeStefano, Frank; Gee, Julianne; Klein, Nicola P

    2016-07-01

    We evaluated the risk of optic neuritis (ON) after vaccines, using a case-centered analysis, comparing the time since vaccination for the patients with ON with that for all similar vaccinees in a large integrated health plan population. We did not detect any association between ON and receipt of any type of vaccine. PMID:27069066

  19. Q fever as a possible cause of bilateral optic neuritis.

    PubMed Central

    Schuil, J; Richardus, J H; Baarsma, G S; Schaap, G J

    1985-01-01

    A 59-year-old farmer developed a bilateral optic neuritis in the course of an infection with Coxiella burnetii (Q fever), resulting in a lasting unilateral blindness. A complete medical (including neurological) evaluation gave no evidence of other possible causes. A possible source of infection was cattle. Images PMID:4016056

  20. SIRT1 Activation Confers Neuroprotection in Experimental Optic Neuritis

    PubMed Central

    Shindler, Kenneth S.; Ventura, Elvira; Rex, Tonia S.; Elliott, Peter; Rostami, Abdolmohamad

    2007-01-01

    Purpose Axonal damage and loss of neurons correlate with permanent vision loss and neurologic disability in patients with optic neuritis and multiple sclerosis (MS). Current therapies involve immunomodulation, with limited effects on neuronal damage. The authors examined potential neuroprotective effects in optic neuritis by SRT647 and SRT501, two structurally and mechanistically distinct activators of SIRT1, an enzyme involved in cellular stress resistance and survival. Methods Experimental autoimmune encephalomyelitis (EAE), an animal model of MS, was induced by immunization with proteolipid protein peptide in SJL/J mice. Optic neuritis developed in two thirds of eyes with significant retinal ganglion cell (RGC) loss detected 14 days after immunization. RGCs were labeled in a retrograde fashion with fluorogold by injection into superior colliculi. Optic neuritis was detected by inflammatory cell infiltration of the optic nerve. Results Intravitreal injection of SIRT1 activators 0, 3, 7, and 11 days after immunization significantly attenuated RGC loss in a dose-dependent manner. This neuroprotective effect was blocked by sirtinol, a SIRT1 inhibitor. Treatment with either SIRT1 activator did not prevent EAE or optic nerve inflammation. A single dose of SRT501 on day 11 was sufficient to limit RGC loss and to preserve axon function. Conclusions SIRT1 activators provide an important potential therapy to prevent the neuronal damage that leads to permanent neurologic disability in optic neuritis and MS patients. Intravitreal administration of SIRT1 activators does not suppress inflammation in this model, suggesting that their neuroprotective effects will be additive or synergistic with current immunomodulatory therapies. PMID:17652729

  1. Myelitis and optic neuritis induced by a long course of etanercept in a patient with rheumatoid arthritis

    PubMed Central

    Yokoyama, Waka; Takada, Kazuki; Miyasaka, Nobuyuki; Kohsaka, Hitoshi

    2014-01-01

    A 64-year-old woman presented with an acute onset of myelitis and optic neuritis after 47 months of etanercept use for rheumatoid arthritis. Etanercept was discontinued and pulse methylprednisolone therapy (1000 mg/day for 3 days) was started, followed by a quick and complete resolution. Demyelination associated with antitumor necrosis factor agents, reported to develop mostly from 1 week to 12 months after the initiation of the agents, could develop after a few years and thus warrants vigilant monitoring. PMID:25085953

  2. Role of Vegetarianism, Smoking, and Hydroxocobalamin in Optic Neuritis

    PubMed Central

    Wadia, N. H.; Desai, M. M.; Quadros, E. V.; Dastur, D. K.

    1972-01-01

    Only 20 patients with optic neuritis of unknown aetiology could be collected in Bombay over a period of two and a half years. Only six of them were smokers and only three (one a non-smoker) had bilateral centrocaecal scotomata similar to those found in tobacco amblyopia. In 11 untreated patients the serum vitamin B12 and plasma thiocyanate levels were estimated and found to show no significant differences from those in normal control subjects. Treatment with hydroxocobalamin in the majority of cases and with cyanocobalamin, corticotrophin, or prednisolone in the rest showed equally good results; spontaneous improvement was seen in one case. No significant role could be assigned to smoking (cyanide) or to vegetarianism in the production of optic neuritis in these patients; nor was there any evidence of depletion of total (cyanide-extracted) B12 or of an increase in the proportion of non-cyanide-extracted B12 in the serum. PMID:4339973

  3. Mucocele After Orbital Fracture Repair Masquerading as Optic Neuritis.

    PubMed

    Park, Jongyeop; Kim, Jinhyun; Choi, Jinsu; Kim, Hochang

    2016-06-01

    The authors report a patient of mucocele formation after orbital wall fracture repair masquerading as optic neuritis.A 38-year-old man with a history of medial orbital wall fracture repair with an alloplastic implant 10 years previously, presented with left visual disturbance and mild ocular pain with movement of the left eye of 3-day duration, and a relative afferent papillary defect in his left eye. He reported having cold symptoms 2 weeks before presentation. His symptoms were typical of retrobulbar optic neuritis. Under suspicion of optic neuritis, computed tomography and magnetic resonance imaging were performed and revealed a large cyst in the sphenoid sinus and ethmoid sinus, just behind the alloplastic implant, that was compressing the medial rectus muscle and optic nerve of the left eye. The patient underwent endoscopic marsupialization of the cyst. Subsequent histologic examinations revealed a cyst lined with ciliated pseudostratified columnar epithelium. The patient had an uncomplicated postoperative course and the visual disturbance resolved. For patients who present solely with optic neuropathy after orbital fracture repair, it is important to be vigilant of potentially rare cause, mucocele formation. PMID:27171955

  4. Unilateral syphilitic perioptic neuritis in a patient coinfected with human immunodeficiency virus type 1

    PubMed Central

    Basta, Medhat S T; Sankar, K Nathan; Dayan, Margaret

    2007-01-01

    Perioptic neuritis caused by secondary syphilis is a rare ophthalmic manifestation in the HIV‐infected host. Early diagnosis and treatment of this condition is required to prevent further visual damage. We report a case of unilateral syphilitic perioptic neuritis in a patient coinfected with HIV‐1. PMID:17569719

  5. The First Case of Vestibulocochlear Neuritis in a Patient with Acquired Immunodeficiency Syndrome in Korea

    PubMed Central

    Park, Hyun Joo; Cho, Chin Saeng; Kim, Nak Min; Yun, Su A

    2016-01-01

    The incidence of human immunodeficiency virus (HIV) infections continue to increase throughout the world. Although neurologic complications are frequent in individuals with HIV infection or acquired immunodeficiency syndrome (AIDS), vestibulocochlear neuritis is still a relatively rare manifestation. We report the first case of vestibulocochlear neuritis occurring in an AIDS patient in Korea. PMID:27433384

  6. 'The worm that got away': parainfectious atypical optic neuritis associated with schistosomiasis infection.

    PubMed

    Osman, Chinar; Hannigan, Sally; Ditchfield, Adam; Harden, Stephen; Marshall, Ben; Pinto, Ashwin Arnold

    2016-06-01

    Although optic neuritis is commonly associated with multiple sclerosis, patients with atypical optic neuritis require further investigations to exclude other associated conditions. We report a woman presenting with cough, fatigue, atypical optic neuritis with chiasmitis. She responded partially to corticosteroids and we subsequently found she had a ground-glass lung nodule. Follow-up CT scan of thorax at 12 months showed new parenchymal lung lesions that suggested schistosomiasis. Further questioning by a respiratory physician identified, in retrospect, a previous exposure history; serological testing confirmed schistosoma infection. She was treated with praziquantel and slowly improved clinically, with radiological improvement in the optic chiasm, regression of the parenchymal lung lesions but with the ground glass nodule unchanged. We diagnosed parainfectious optic neuritis associated with schistosomiasis, based upon exposure history, serological confirmation and radiological features, together with the response to treatment, and having excluded other causes of an atypical optic neuritis. PMID:26888797

  7. Myelin-specific Th17 cells induce severe relapsing optic neuritis with irreversible loss of retinal ganglion cells in C57BL/6 mice

    PubMed Central

    Larabee, Chelsea M.; Hu, Yang; Desai, Shruti; Georgescu, Constantin; Wren, Jonathan D.; Axtell, Robert C.

    2016-01-01

    Purpose Optic neuritis affects most patients with multiple sclerosis (MS), and current treatments are unreliable. The purpose of this study was to characterize the contribution of Th1 and Th17 cells to the development of optic neuritis. Methods Mice were passively transferred myelin-specific Th1 or Th17 cells to induce experimental autoimmune encephalomyelitis (EAE), a model of neuroautoimmunity. Visual acuity was assessed daily with optokinetic tracking, and 1, 2, and 3 weeks post-induction, optic nerves and retinas were harvested for immunohistochemical analyses. Results Passive transfer experimental autoimmune encephalomyelitis elicits acute episodes of asymmetric visual deficits and is exacerbated in Th17-EAE relative to Th1-EAE. The Th17-EAE optic nerves contained more inflammatory infiltrates and an increased neutrophil to macrophage ratio. Significant geographic degeneration of the retinal ganglion cells accompanied Th17-EAE but not Th1. Conclusions Th17-induced transfer EAE recapitulates pathologies observed in MS-associated optic neuritis, namely, monocular episodes of vision loss, optic nerve inflammation, and geographic retinal ganglion cell (RGC) degeneration. PMID:27122964

  8. Bilateral optic neuritis in a patient with Behçet's disease who respond to therapeutic plasma exchange.

    PubMed

    Erdoğan, Seyda; Sorgun, Mine Hayriye; Yalçındağ, Nilüfer; Atilla, Huban; Yücesan, Canan

    2015-01-01

    Bilateral optic neuritis has been reported very rarely as a manifestation of neuro-Behçet's disease. We present a 50 year old woman who had 20-year history of Behçet's disease presented with acutely blurred vision associated with orbital pain in both eyes. Visual acuity was 0.4 in the right eye and light perception in the left eye; afferent pupillary defect was detected in the left eye. Bilateral swelling of the optic disk was found. The cerebrospinal fluid sample tests were within normal limits. Brain magnetic resonance imaging, magnetic resonance venography and fundus fluorescein angiography were normal. She was diagnosed with bilateral optic neuritis and treated with intravenous methyl prednisolone for 10 days. As there was no response to the treatment, therapeutic plasma exchange was started and the patient's visual acuities improved moderately. We suggest that when high dose steroid is failed to treat ON in BD, treatment with TPE may be considered. PMID:26586983

  9. Neurinomas of the brachial plexus: case report.

    PubMed

    Forte, A; Gallinaro, L S; Bertagni, A; Montesano, G; Prece, V; Illuminati, G

    1999-01-01

    Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves, a low proportion of which arise from the brachial plexus. Authors report a case of an ancient schwannoma arising from the brachial plexus. The tumour, usually asymptomatic, may cause sensory radicular symptoms, or rarely motor deficits in the involved arm. Enucleation of the tumour from the nerve without damage to any of the fascicles is the correct treatment. PMID:10710825

  10. Parallel Changes in Structural and Functional Measures of Optic Nerve Myelination after Optic Neuritis

    PubMed Central

    van der Walt, Anneke; Kolbe, Scott; Mitchell, Peter; Wang, Yejun; Butzkueven, Helmut; Egan, Gary; Yiannikas, Con; Graham, Stuart; Kilpatrick, Trevor; Klistorner, Alexander

    2015-01-01

    Introduction Visual evoked potential (VEP) latency prolongation and optic nerve lesion length after acute optic neuritis (ON) corresponds to the degree of demyelination, while subsequent recovery of latency may represent optic nerve remyelination. We aimed to investigate the relationship between multifocal VEP (mfVEP) latency and optic nerve lesion length after acute ON. Methods Thirty acute ON patients were studied at 1,3,6 and 12 months using mfVEP and at 1 and 12 months with optic nerve MRI. LogMAR and low contrast visual acuity were documented. By one month, the mfVEP amplitude had recovered sufficiently for latency to be measured in 23 (76.7%) patients with seven patients having no recordable mfVEP in more than 66% of segments in at least one test. Only data from these 23 patients was analysed further. Results Both latency and lesion length showed significant recovery during the follow-up period. Lesion length and mfVEP latency were highly correlated at 1 (r = 0.94, p = <0.0001) and 12 months (r = 0.75, p < 0.001). Both measures demonstrated a similar trend of recovery. Speed of latency recovery was faster in the early follow-up period while lesion length shortening remained relatively constant. At 1 month, latency delay was worse by 1.76ms for additional 1mm of lesion length while at 12 months, 1mm of lesion length accounted for 1.94ms of latency delay. Conclusion A strong association between two putative measures of demyelination in early and chronic ON was found. Parallel recovery of both measures could reflect optic nerve remyelination. PMID:26020925

  11. True Aneurysm of the Proximal Brachial Artery

    PubMed Central

    Ramakrishna, Pinjala; Mahapatra, Sandeep; Rajesh, Ratna

    2013-01-01

    A 35-year-old farmer presented with complaints of pain in the right upper limb for 1 month and bluish discoloration of the right-hand finger tips with tingling and numbness. He sustained injury to the right upper limb while lifting a heavy object 1 mo previously. There was an ovoid swelling of 4 × 2 cm on the medial aspect of the right arm, 12 cm above the medial epicondyle at the level of the armpit with visible pulsations. There was distal neurovascular deficit. Duplex scan of the right upper limb arterial system revealed a pseudoaneurysm of the proximal right brachial artery, with dampened monophasic flow in the ulnar artery and no flow in the radial artery. Spiral computed tomography angiogram showed the presence of an echogenic periarterial lesion in the proximal brachial artery suggestive of pseudoaneurysm or an extrinsic compression by hematoma. Distal brachial artery was found to have filled with thrombus, with non-opacification of the radial and the distal ulnar artery. The patient was posted for excision of the aneurysmal arterial segment. A 5-cm-long reversed segment of vein graft was interposed in between the cut ends of the brachial artery. Histopathology: Specimen shows a part of the vessel wall composed of intimal, medial, and adventitial layers with intraluminal thrombus showing evidence of recanalization suggestive of true aneurysm of the brachial artery. PMID:26798692

  12. Amiloride Clinical Trial In Optic Neuritis (ACTION) protocol: a randomised, double blind, placebo controlled trial

    PubMed Central

    McKee, Justin B; Elston, John; Evangelou, Nikos; Gerry, Stephen; Fugger, Lars; Kennard, Christopher; Kong, Yazhuo; Palace, Jacqueline; Craner, Matthew

    2015-01-01

    Introduction Neurodegeneration is a widely accepted contributor to the development of long-term disability in multiple sclerosis (MS). While current therapies in MS predominantly target inflammation and reduce relapse rate they have been less effective at preventing long-term disability. The identification and evaluation of effective neuroprotective therapies within a trial paradigm are key unmet needs. Emerging evidence supports amiloride, a licenced diuretic, as a neuroprotective agent in MS through acid sensing ion channel blockade. Optic neuritis (ON) is a common manifestation of MS with correlates of inflammation and neurodegeneration measurable within the visual pathways. Amiloride Clinical Trial In Optic Neuritis (ACTION) will utilise a multimodal approach to assess the neuroprotective efficacy of amiloride in acute ON. Methods and analysis 46 patients will be recruited within 28 days from onset of ON visual symptoms and randomised on a 1:1 basis to placebo or amiloride 10 mg daily. Double-blinded treatment groups will be balanced for age, sex and visual loss severity by a random-deterministic minimisation algorithm. The primary objective is to demonstrate that amiloride is neuroprotective in ON as assessed by scanning laser polarimetry of the peripapillary retinal nerve fibre layer (RNFL) thickness at 6 months in the affected eye compared to the unaffected eye at baseline. RNFL in combination with further retinal measures will also be assessed by optical coherence tomography. Secondary outcome measures on brain MRI will include cortical volume, diffusion-weighted imaging, resting state functional MRI, MR spectroscopy and magnetisation transfer ratio. In addition, high and low contrast visual acuity, visual fields, colour vision and electrophysiology will be assessed alongside quality of life measures. Ethics and dissemination Ethical approval was given by the south central Oxford B research ethics committee (REC reference: 13/SC/0022). The findings

  13. Endovascular Treatment of Infected Brachial Pseudoaneurysm in an Intravenous Drug Abuser: A Case Report.

    PubMed

    Boieru, Raluca; Georg, Yannick; Ramlugun, Dharmesh; Martinot, Martin; Camin, Amelie; Matysiak, Lucien; Kretz, Benjamin

    2015-10-01

    We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound. PMID:26142880

  14. Robot-assisted surgery of the shoulder girdle and brachial plexus.

    PubMed

    Facca, Sybille; Hendriks, Sarah; Mantovani, Gustavo; Selber, Jesse C; Liverneaux, Philippe

    2014-02-01

    New developments in the surgery of the brachial plexus include the use of less invasive surgical approaches and more precise techniques. The theoretical advantages of the use of robotics versus endoscopy are the disappearance of physiological tremor, three-dimensional vision, high definition, magnification, and superior ergonomics. On a fresh cadaver, a dissection space was created and maintained by insufflation of CO2. The supraclavicular brachial plexus was dissected using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA). A segment of the C5 nerve root was grafted robotically. A series of eight clinical cases of nerve damage around the shoulder girdle were operated on using the da Vinci robot. The ability to perform successful microneural repair was confirmed in both the authors' clinical and experimental studies, but the entire potential of robotically assisted microneural surgery was not realized during these initial cases because an open incision was still required. Robotic-assisted surgery of the shoulder girdle and brachial plexus is still in its early stages. It would be ideal to have even finer and more suitable instruments to apply fibrin glue or electrostimulation in nerve surgery. Nevertheless, the prospects of minimally invasive techniques would allow acute and subacute surgical approach of traumatic brachial plexus palsy safely, without significant and cicatricial morbidity. PMID:24872778

  15. Unusual Presentation of Unilateral Isolated Probable Lyme Optic Neuritis

    PubMed Central

    Burakgazi, Ahmet Z.; Henderson, Carl S.

    2016-01-01

    Optic neuritis (ON) is one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme ON is an exceedingly rare ocular manifestation of Lyme disease (LD) and only a few cases have been published in the literature. Lyme ON is very rare but should be included in the differential diagnosis in unexplained cases, particularly in Lyme endemic areas. Careful and detailed examination and investigation are warranted to make the diagnosis. We report this case to increase awareness of clinicians to include Lyme disease in differential diagnosis of ON for unexplained cases of ON. Herein we present a unique case with a unilateral ON caused by LD along with pre- and posttreatment findings and literature review. PMID:26953086

  16. Unusual Presentation of Unilateral Isolated Probable Lyme Optic Neuritis.

    PubMed

    Burakgazi, Ahmet Z; Henderson, Carl S

    2016-01-01

    Optic neuritis (ON) is one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme ON is an exceedingly rare ocular manifestation of Lyme disease (LD) and only a few cases have been published in the literature. Lyme ON is very rare but should be included in the differential diagnosis in unexplained cases, particularly in Lyme endemic areas. Careful and detailed examination and investigation are warranted to make the diagnosis. We report this case to increase awareness of clinicians to include Lyme disease in differential diagnosis of ON for unexplained cases of ON. Herein we present a unique case with a unilateral ON caused by LD along with pre- and posttreatment findings and literature review. PMID:26953086

  17. Herpetic Brachial Plexopathy: Application of Brachial Plexus Magnetic Resonance Imaging and Ultrasound-Guided Corticosteroid Injection.

    PubMed

    Kim, Jeong-Gil; Chung, Sun G

    2016-05-01

    Herpes zoster, commonly known as shingles, is an infectious viral disease characterized by painful, unilateral skin blisters occurring in specific sensory dermatomes. Motor paresis is reported in 0.5% to 5% of patients. Although the mechanism of zoster paresis is still unclear, the virus can spread from the dorsal root ganglia to the anterior horn cell or anterior spinal nerve roots. It rarely involves the brachial plexus. We report a case of brachial plexitis following herpes zoster infection in which pathological lesions were diagnosed using brachial plexus magnetic resonance imaging and treated with ultrasound-guided perineural corticosteroid injection. PMID:26829085

  18. Brachial Artery Injury Accompanying Closed Elbow Dislocations

    PubMed Central

    Harnarayan, Patrick; Cawich, Shamir O.; Harnanan, Dave; Budhooram, Steve

    2014-01-01

    Introduction Brachial artery injuries from elbow dislocations are uncommon, but they may lead to disastrous consequences if the diagnosis is delayed. Presentation of case We report a case of a patient who sustained a fall onto the elbow, with dislocation and brachial artery injury, despite an ipsilateral radial pulse being palpable. Discussion Clinicians should maintain a high index of suspicion for brachial injury when patients present with a fall onto the elbow coupled with signs suggestive of fracture-dislocation, nerve injury and/or signs of limb ischemia. Frank ischamia, however, is uncommon as there is a rich collateral anastomosis in the upper limb. Conclusion A high index of suspicion should be maintained in order to make the diagnosis early. Exploration with excision of the injured segment and reverse vein interposition grafting is the treatment of choice in these cases. PMID:25644552

  19. Multimodality evoked potentials and electrically elicited blink reflex in optic neuritis.

    PubMed

    Tackmann, W; Ettlin, T; Strenge, H

    1982-01-01

    Pattern shift visual evoked potentials, brain stem auditory evoked potentials, spinal and scalp recorded somatosensory evoked potentials, and electrically elicited blink reflexes were investigated in 32 patients with isolated optic neuritis. Eleven patients were shown to have one additional lesion in the central nervous system outside the optic nerve. Therefore, cases with optic neuritis of unknown origin should be considered as possible cases of multiple sclerosis. PMID:6181223

  20. Brachial plexus variations during the fetal period.

    PubMed

    Woźniak, Jowita; Kędzia, Alicja; Dudek, Krzysztof

    2012-12-01

    The brachial plexus is an important nervous system structure. It can be injured during the perinatal period and by postnatal damage. The goal of this study was to assess human fetal brachial plexus variability. A total of 220 brachial plexuses were surgically prepared from 110 human fetuses aged 14-32 weeks of fetal life (50 females and 60 males) ranging in CRL from 80 to 233 mm. The study incorporated the following methods: dissectional and anthropological, digital image acquisition, digital image processing using Image J and GIMP software, and statistical methods (Statistica 9.0). Symmetry and sexual dimorphism were examined. Anomalies of the brachial plexuses were observed in 117 (53.18 %) cases. No sexual dimorphism was found. It was observed that cord variations occurred more often on the left side. Division variants (33.64 %) occurred most often, but also cords (18.18 %) as well as root nerves and terminal ramifications (15.90 %) were found. Trunk anomalies were rare and occurred in only 5.45 % of plexuses. Three height types of median nerve roots in combination with the nerve were distinguished. In one-third of cases, median nerve root connections were found below the axillary fossa and even half in the proximal part of the humerus. In conclusion, the brachial plexus was characterized for anatomical structural variability. Most often division and cord variations were observed. Anomalies occurred regardless of sex or body side except for cord variants. Brachial plexus variation recognition is significant from the neurosurgical and traumatological point of view. PMID:22945314

  1. Temporal pattern of pulse wave velocity during brachial hyperemia reactivity

    NASA Astrophysics Data System (ADS)

    Graf, S.; Valero, M. J.; Craiem, D.; Torrado, J.; Farro, I.; Zócalo, Y.; Valls, G.; Bía, D.; Armentano, R. L.

    2011-09-01

    Endothelial function can be assessed non-invasively with ultrasound, analyzing the change of brachial diameter in response to transient forearm ischemia. We propose a new technique based in the same principle, but analyzing a continuous recording of carotid-radial pulse wave velocity (PWV) instead of diameter. PWV was measured on 10 healthy subjects of 22±2 years before and after 5 minutes forearm occlusion. After 59 ± 31 seconds of cuff release PWV decreased 21 ± 9% compared to baseline, reestablishing the same after 533 ± 65 seconds. There were no significant changes observed in blood pressure. When repeating the study one hour later in 5 subjects, we obtained a coefficient of repeatability of 4.8%. In conclusion, through analysis of beat to beat carotid-radial PWV it was possible to characterize the temporal profiles and analyze the acute changes in response to a reactive hyperemia. The results show that the technique has a high sensitivity and repeatability.

  2. Resting Doppler ankle brachial pressure index measurement: a literature review.

    PubMed

    Sihlangu, Dorcus; Bliss, Julie

    2012-07-01

    Peripheral vascular disease (PVD) is under-diagnosed in primary and acute settings. The use of Doppler ankle brachial pressure index (ABPI) is effective in diagnosing PVD , aid in determining aetiology of leg ulcers and is cost efficient in reducing the effects of atherosclerosis and cardiovascular events. The aim of this literature review was to review practitioners' experience in using Doppler ABPI, different skills used to measure ABPI and to examine practitioners' confidence in ABPI. The findings identified variation in method for Doppler measurement: including position of the artery, arm measurement, resting period and type of equipment for measuring blood pressure, variations in practitioners' training and experience have demonstrated variability in ABPI results. Although limited in number, the studies have demonstrated knowledge gap, and the need for training among health professionals. PMID:22875182

  3. In vivo detection of experimental optic neuritis by pupillometry.

    PubMed

    Shindler, Kenneth S; Revere, Karen; Dutt, Mahasweta; Ying, Gui-Shuang; Chung, Daniel C

    2012-07-01

    Optic neuritis is an inflammatory demyelination of optic nerve often occurring in multiple sclerosis (MS) patients. Mice with experimental autoimmune encephalomyelitis (EAE), an MS model, develop optic neuritis, but it is detected histologically after sacrifice, limiting the ability to monitor progression or treatment in vivo. We examined whether pupillary light responses measured by pupillometry can identify eyes with optic neuritis in EAE mice. C57BL/6 mice were exposed to unilateral light flashes of increasing intensity at 10 s intervals (4.7, 37, and 300 μW/cm(2)). Pupillary responses were recorded with a commercially available pupillometer. EAE was then induced by immunization with myelin oligodendrocyte glycoprotein. Pupillometry was repeated up to 17 days post-immunization, and responses were correlated with optic nerve inflammation. By day 17 post-immunization, 90% of EAE eyes had optic nerve inflammation. EAE eyes had significantly reduced pupillary constriction compared to control eyes. Mice exhibited more than a 25% decrease in pupillary constriction in at least one eye by days 13-15 post-immunization. In some eyes, pupil responses decreased prior to onset of detectable inflammation. Results show that pupillometry detects decreased optic nerve function in experimental optic neuritis, even in the absence of histological detection. Measuring pupillary constriction allows in vivo identification and functional assessment of eyes with optic neuritis that will be useful in evaluating potential therapies over time. Furthermore, results demonstrate that decreased visual function occurs early in optic neuritis, before optic nerve inflammation reaches its peak level. PMID:22561341

  4. Magnetic resonance neurography of the brachial plexus

    PubMed Central

    Upadhyaya, Vaishali; Upadhyaya, Divya Narain; Kumar, Adarsh; Pandey, Ashok Kumar; Gujral, Ratni; Singh, Arun Kumar

    2015-01-01

    Magnetic Resonance Imaging (MRI) is being increasingly recognised all over the world as the imaging modality of choice for brachial plexus and peripheral nerve lesions. Recent refinements in MRI protocols have helped in imaging nerve tissue with greater clarity thereby helping in the identification, localisation and classification of nerve lesions with greater confidence than was possible till now. This article on Magnetic Resonance Neurography (MRN) is based on the authors’ experience of imaging the brachial plexus and peripheral nerves using these protocols over the last several years. PMID:26424974

  5. What has changed in brachial plexus surgery?

    PubMed Central

    de Rezende, Marcelo Rosa; Silva, Gustavo Bersani; de Paula, Emygdio José Leomil; Junior, Rames Mattar; de Camargo, Olavo Pires

    2013-01-01

    Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes. In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury. PMID:23644864

  6. Magnetic resonance imaging in brachial plexus injury.

    PubMed

    Caranci, F; Briganti, F; La Porta, M; Antinolfi, G; Cesarano, E; Fonio, P; Brunese, L; Coppolino, F

    2013-08-01

    Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac. PMID:23949940

  7. Ultrasonography in distinguishing optic neuritis from nonarteritic anterior ischemic optic neuropathy

    PubMed Central

    Dehghani, Alireza; Giti, Masoomeh; Akhlaghi, Mohamad Reza; Karami, Mehdi; Salehi, Fatemeh

    2012-01-01

    Background and Objectives: Optic neuritis (ON) and nonarteritic anterior ischemic optic neuropathy (NAION) have some overlapping clinical profiles. We evaluated the usefulness of B-scan ultrasonography in distinguishing ON from NAION by measuring diameter of the optic nerve. Materials and Methods: Consecutive patients with an acute noncompressive unilateral optic neuropathy with relative afferent pupillary defect and onset of visual loss during the last 2 weeks were included. Diagnosis of ON was based on age ≤ 35 years, orbital pain associated with eye movement, and no disk edema, and diagnosis of NAION was based on age ≥ 60 years, no orbital pain associated with eye movement, and presence of disk edema. Age- and gender-matched subjects without ocular disease were selected for comparison. The diameter of the optic nerve was measured by a single radiologist with B-scan ultrasonography. Results: In ON patients, the mean diameter of the affected nerve was significantly larger than that of the unaffected nerve and also larger than that of the right nerve of young controls; P < 0.05. In NAION patients, however, there was no significant difference between the mean diameter of the affected nerve and of the unaffected nerve or the right nerve of elderly controls; P > 0.05. Also, the diameter of the affected nerve was significantly larger in ON than in AION patients; P < 0.05. Conclusion: B-scan ultrasonography is helpful in the early stages of optic neuropathy to distinguish ON from NAION in those cases for which the diagnosis is still uncertain after clinical evaluation. PMID:23210062

  8. Retrobulbar optic neuritis and meningoencephalitis following progressive outer retinal necrosis due to CMV in a patient with AIDS.

    PubMed

    Park, K H; Bang, J H; Park, W B; Kim, H B; Kim, N J; Ahn, J K; Chang, K H; Oh, M D; Choe, K W

    2008-10-01

    We report on a 34-year-old male patient with AIDS who developed retrobulbar optic neuritis and meningoencephalitis following bilateral progressive outer retinal necrosis (PORN) caused by cytomegalovirus (CMV). This case documents the presumed association of PORN with retrobulbar optic neuritis, and CMV meningoencephalitis in an AIDS patient. PMID:18574556

  9. Unilateral Optic Neuritis: A Rare Complication after Measles-Mumps-Rubella Vaccination in a 30-Year-Old Woman.

    PubMed

    De Giacinto, Chiara; Guaglione, Elvira; Leon, Pia E; D'Aloisio, Rossella; Vattovani, Odilla; Ravalico, Giuseppe; Tognetto, Daniele

    2016-01-01

    Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination. Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone. Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS). PMID:27195163

  10. Unilateral Optic Neuritis: A Rare Complication after Measles-Mumps-Rubella Vaccination in a 30-Year-Old Woman

    PubMed Central

    De Giacinto, Chiara; Guaglione, Elvira; Leon, Pia E.; D'Aloisio, Rossella; Vattovani, Odilla; Ravalico, Giuseppe; Tognetto, Daniele

    2016-01-01

    Purpose. To report a case of unilateral optic neuritis following Measles-Mumps-Rubella (MMR) vaccination. Methods. A 30-year-old female developed unilateral optic neuritis five days after a Measles-Mumps-Rubella (MMR) booster vaccination. The patient displayed unilateral involvement, with severe visual loss. However, visual acuity improved significantly after four days of intravenous steroid therapy with 500 mg/day of methylprednisolone. Conclusions. Optic neuritis is one of the rare complications associated with the mumps, measles, and rubella vaccine. It may be a toxic reaction to the nonviral component of the vaccine, but the exact etiology is unknown. Postvaccination neuritis is generally bilateral and usually affects children. In adults, unilateral optic neuritis is usually correlated with multiple sclerosis (MS). PMID:27195163

  11. Axillary brachial plexus blockade in moyamoya disease?

    PubMed Central

    Yalcin, Saban; Cece, Hasan; Nacar, Halil; Karahan, Mahmut Alp

    2011-01-01

    Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture. PMID:21712873

  12. Axillary brachial plexus blockade in moyamoya disease?

    PubMed

    Yalcin, Saban; Cece, Hasan; Nacar, Halil; Karahan, Mahmut Alp

    2011-03-01

    Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture. PMID:21712873

  13. The pathogenesis of optic neuritis caused by Angiostrongylus cantonensis in BALB/c mice

    PubMed Central

    2014-01-01

    Background One of the most common causes of meningitis in South East Asia is angiostrongyliasis or infection by the parasitic nematode Angiostrongyliasis cantonensis. Although this nematode usually resides in the pulmonary arteries of rats, its incidental occurence in other hosts such as humans can cause optic neuritis and lead to serious vision sequelae. Nevertheless, there are currently no systematic studies conducted in this area. Methods In order to study the pathogenesis of optic neuritis, mice were tried as a new animal model to study and challenge with A. cantonensis on 7d, 14d and 21d, respectively. Electroretinogram (ERG), visual evoked potential (VEP), ophthalmoscopy and histology were examined on day 7d, 14d and 21d and tribendimidine (TBD) was later used to treat optic neuritis on day 14d for a week to evaluate its therapeutic effects. Results Infection of A. cantonensis caused obvious inflammatory cell infiltration in the retina and optic nerve adventitia in day 14d and 21d followed by optic nerve fiber demyelination and retinal ganglion swelling at day 21d in the challenged mice. Prolonged VEP latency and decreased ERG amplitude were also observed on day 21. After treatment of TBD in the infected mice, retinal and optic nerve inflammation were alleviated, but VEP latency and ERG amplitude did not improve on day 21d and 28d. Conclusions The current study provides evidence that A. cantonensis can cause optic neuritis along with optic nerve demyelination and retinal ganglion cell damage in a mouse model. TBD alone treatment can improve the symptoms of optic neuritis, but does not aid in vision recovery, suggesting that both neuroprotective agents and Dexamethasone should be administered, along with treatment for the infection, to protect the optic nerve and ganglion cells. Furthermore, as the symptoms of optic neuritis caused by A. cantonensis in mice are similar to the optic neuritis in multiple sclerosis (MS) human patients, we suggest that the BALB

  14. Bilateral optic neuritis in a child following Epstein-Barr virus infection.

    PubMed

    Pahor, Dusica

    2005-01-01

    A rare case of bilateral optic neuritis is presented in a child with no light perception. Ophthalmic examination revealed dilated pupils without reaction to the light, swollen optic discs with small peripapillary hemorrhages in both eyes. Serology revealed evidence of recent Epstein-Barr virus infection. After treatment with high dose of corticosteroid visual acuity gradually improved. After four months visual acuity was normal despite complete pallor of the optic disc. Ebstein-Barr virus infection should be considered in the differential diagnosis of bilateral optic neuritis in a child with severe bilateral visual loss. PMID:16193695

  15. Neuroprotective effect of melatonin in experimental optic neuritis in rats.

    PubMed

    Aranda, Marcos L; González Fleitas, María F; De Laurentiis, Andrea; Keller Sarmiento, María I; Chianelli, Mónica; Sande, Pablo H; Dorfman, Damián; Rosenstein, Ruth E

    2016-04-01

    Optic neuritis (ON) is an inflammatory, demyelinating, and neurodegenerative condition of the optic nerve, which might induce permanent vision loss. Currently, there are no effective therapies for this disorder. We have developed an experimental model of primary ON in rats through a single microinjection of 4.5 μg of bacterial lipopolysaccharide (LPS) into the optic nerve. Since melatonin acts as a pleiotropic therapeutic agent in various neurodegenerative diseases, we analyzed the effect of melatonin on LPS-induced ON. For this purpose, LPS or vehicle were injected into the optic nerve from adult male Wistar rats. One group of animals received a subcutaneous pellet of 20 mg melatonin at 24 hr before vehicle or LPS injection, and another group was submitted to a sham procedure. Melatonin completely prevented the decrease in visual evoked potentials (VEPs), and pupil light reflex (PLR), and preserved anterograde transport of cholera toxin β-subunit from the retina to the superior colliculus. Moreover, melatonin prevented microglial reactivity (ED1-immunoreactivity, P < 0.01), astrocytosis (glial fibrillary acid protein-immunostaining, P < 0.05), demyelination (luxol fast blue staining, P < 0.01), and axon (toluidine blue staining, P < 0.01) and retinal ganglion cell (Brn3a-immunoreactivity, P < 0.01) loss, induced by LPS. Melatonin completely prevented the increase in nitric oxide synthase 2, cyclooxygenase-2 levels (Western blot) and TNFα levels, and partly prevented lipid peroxidation induced by experimental ON. When the pellet of melatonin was implanted at 4 days postinjection of LPS, it completely reversed the decrease in VEPs and PLR. These data suggest that melatonin could be a promising candidate for ON treatment. PMID:26882296

  16. Non-union of a clavicle fracture: lateral fragment excision for brachial artery embolism

    PubMed Central

    Burgess, Elizabeth; Sangars, Bheem; Perricone, Vittorio; Charalambous, Charalambos P

    2014-01-01

    A 67-year-old motorcyslist was admitted to hospital following a high-speed road traffic collision and found to have a left midshaft clavicle fracture and multiple ipsilateral rib fractures. He was treated conservatively and went on to have non-union of the clavicle. The non-union was managed non-operatively. The patient then re-attended the hospital with an acute ischaemic left hand 3 years after the original injury date. An arterial duplex scan confirmed a embolus to the brachial artery. A brachial embolectomy was urgently performed. A computed tomography scan showed non-union of the clavicle fracture and an inflammatory mass compressing the left subclavian artery, which was the focus of the embolic event. The clavicle non-union was managed operatively with lateral half claviculectomy. Immediately after clavicle excision, the vascular team performed reconstruction of the brachial artery. At follow-up,there was normal shoulder and hand function at outpatient clinic. A duplex scan confirmed good triphasic waveforms throughout the arteries of the left upper limb.

  17. Bilateral Retrobulbar Optic Neuritis Caused by Varicella Zoster Virus in a Patient with AIDS

    PubMed Central

    Duda, Jose F.; Castro, Jose G.

    2015-01-01

    Aims To report on a case of bilateral retrobulbar optic neuritis in a patient with acquired immune deficiency syndrome (AIDS) caused by varicella-zoster virus (VZV); and to review the literature focusing on: cases reported, epidemiology, pathophysiology, diagnosis and treatment. Presentation of Case A 38-year-old woman with AIDS presented with a 10-day history of progressive bilateral visual loss and ocular pain. She had bilateral dilated pupils with no light perception; the fundoscopic examination was normal. Facial herpes zoster lesions appeared on the second day of hospitalization Magnetic resonance imaging (MRI) findings were compatible with a bilateral optic neuritis; the cerebrospinal fluid (CSF) showed pleocytosis, increased proteins and a positive VZV-DNA PCR. She was treated with intravenous acyclovir and corticosteroids and was able, when discharged 2 weeks after admission, to carry out activities of daily living. Discussion VZV retrobulbar optic neuritis has previously been reported in 12 patients with AIDS, more than half of the cases had concomitant herpes zoster and an associated retinopathy. A positive VZV-DNA in the CSF is indicative of VZV infection, initial use of intravenous acyclovir is recommended, and the concomitant use of corticosteroids would be a prudent choice; the duration of antiviral therapy remains undefined. Conclusion VZV retrobulbar optic neuritis in AIDS patients can occur with or without herpes zoster. It is a sight-threatening infectious and inflammatory process requiring the advice of specialists in infectious diseases, ophthalmology, neurology and viral microbiology. PMID:26740936

  18. Aquaporin 4 antibody [NMO Ab] status in patients with severe optic neuritis in India.

    PubMed

    Ambika, Selvakumar; Balasubramanian, Mahalakshmi; Theresa, Lily; Veeraputhiran, Akila; Arjundas, Deepak

    2015-12-01

    Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system that causes attacks of optic neuritis and transverse myelitis. The discovery of a specific serum marker for NMO-IgG antibody [aquaporin 4 antibody/AQP4 Ab] has revolutionised the treatment of demyelinating diseases. Severe vision loss can be seen in optic neuritis (ON) associated with both multiple sclerosis (MS) and NMO. Identifying this antibody in optic neuritis patients can help us to establish the likelihood of these patients developing NMO (Jarius et al. Neurol Sci 298:158-162, 2010). It is important to differentiate these two entities as the treatment strategies of MS and NMO are different. To the best of our knowledge, there is no published literature regarding the importance of identifying this antibody in severe optic neuritis in Indian patients. Hence we decided to screen our severe optic neuritis patients for this AQP4 Ab. To investigate the presence of aquaporin 4 antibody and determine its prognostic value for visual and neurological outcome, in patients with bilateral and recurrent [severe] ON without any previous neurological manifestations presenting to a neuro-ophthalmology clinic in India. Single centre, prospective study. 40 patients (27 female patients and 13 male) with severe optic neuritis [patients with no visual improvement by 4 weeks from onset of vision loss] who presented either as recurrent attacks or as bilateral and severe optic neuritis between January 2010 and June 2011 were enrolled. Clinical features, visual outcome and sequential neurological events were compared between the seropositive and the seronegative groups. Aquaporin 4 antibodies were detected from serum using ELISA technique and IIF technique. Presence of this antibody in the serum was considered to be seropositive status and patients who did not have this antibody were considered seronegatives. AQP4 antibodies were detected in 8 of the 40 patients with severe ON (20 %).The

  19. Central Adaptation following Brachial Plexus Injury.

    PubMed

    Simon, Neil G; Franz, Colin K; Gupta, Nalin; Alden, Tord; Kliot, Michel

    2016-01-01

    Brachial plexus trauma (BPT) often affects young patients and may result in lasting functional deficits. Standard care following BPT involves monitoring for clinical and electrophysiological evidence of muscle reinnervation, with surgical treatment decisions based on the presence or absence of spontaneous recovery. Data are emerging to suggest that central and peripheral adaptation may play a role in recovery following BPT. The present review highlights adaptive and maladaptive mechanisms of central and peripheral nervous system changes following BPT that may contribute to functional outcomes. Rehabilitation and other treatment strategies that harness or modulate these intrinsic adaptive mechanisms may improve functional outcomes following BPT. PMID:26409073

  20. Shoulder pain and isolated brachial plexopathy.

    PubMed

    Kishan, Amar U; Syed, Sana; Fiorito-Torres, Franchesca; Thakore-James, Manisha

    2012-01-01

    Pancoast syndrome, classically considered as a constellation of (1) pain along the C8-T2 dermatomes, (2) weakness and atrophy of the hand and (3) Horner's syndrome, often presents a diagnostic challenge. In fact, it may manifest as a singular orthopaedic complaint, prompting a futile barrage of tests and referrals. The authors present the case of an elderly man who initially presented with severe shoulder pain. Due to progressive pain and weakness, he was referred to rheumatology and was treated with corticosteroid injections for a presumed musculoskeletal lesion. Ultimately, he manifested gross muscular atrophy and worsening pain, prompting a referral to neurology. An electromyogram (EMG) suggested a lower brachial plexopathy, and a follow-up brachial plexus MRI identified a large Pancoast tumour. Unfortunately, his disease was rapidly progressive, and he passed away within 2 months. While the MRI remains the gold standard for diagnosing Pancoast syndrome, an EMG can facilitate diagnosis in difficult cases such as this one. PMID:22744250

  1. Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography

    PubMed Central

    Papa, Eduardo D. E.; Helber, Izo; Ehrlichmann, Manes R.; Alves, Claudia Maria Rodrigues; Makdisse, Marcia; Matos, Livia N.; Borges, Jairo Lins; Lopes, Renato D.; Stefanini, Edson; Carvalho, Antonio Carlos

    2013-01-01

    OBJECTIVES: To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease. METHODS: We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease. RESULTS: The patients' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold. CONCLUSION: In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events. PMID:24473504

  2. Importance of spontaneous nystagmus detection in the differential diagnosis of acute vertigo.

    PubMed

    Pavlin-Premrl, Davor; Waterston, John; McGuigan, Sean; Infeld, Bernard; Sultana, Ron; O'Sullivan, Richard; Gerraty, Richard P

    2015-03-01

    Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. We enrolled consecutive consenting patients arriving at a single emergency department with acute vertigo. There was no declared protocol for the emergency department staff. A standardized history and examination was conducted by the investigators. Observation for spontaneous nystagmus, its response to visual fixation, and testing the vestibulo-ocular reflex with the horizontal head impulse test were the chief examination components. MRI was obtained within 24 hours. Clinical criteria and MRI were used to reach the final diagnosis. The investigators' physical findings and final neurological diagnosis were compared with the initial emergency department examination findings and the referral diagnosis. There were 28 patients, 15 with vestibular neuritis, six with benign paroxysmal positional vertigo, one with stroke, suspected clinically, and three with migraine. In three the diagnosis remained uncertain. Spontaneous nystagmus was seen in all 15 patients with vestibular neuritis, fixation-suppressed in eight of 11 tested for this. The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo. PMID:25537400

  3. Brachial plexus injuries in neonates: an osteopathic approach.

    PubMed

    Mason, David C; Ciervo, Carman A

    2009-02-01

    Neonates and infants with brachial plexus injuries are typically treated using splinting, range-of-motion exercise, and, in more severe cases, nerve reconstruction. However, myofascial release--a common osteopathic manipulative treatment technique that has been used to manage thoracic outlet syndrome in adults--may provide effective, noninvasive management of brachial plexus injuries in neonates and infants. While emphasizing the importance of good communication with parents of affected patients, the authors review brachial plexus anatomy, describe diagnostic examinations, and outline a comprehensive treatment strategy. PMID:19269939

  4. [Measurement ofthe ankle-brachial pressure index (ABPI)].

    PubMed

    Kulisić, Sandra Marinović

    2012-10-01

    Measurement of the ankle-brachial pressure index, also known as ankle-brachial index or ankle-arm index is a ratio of the ankle blood pressure and brachial blood pressure. It is easy to perform and allows for diagnosis and further definition of the severity of peripheral arterial disease with sensitivity 90% and specificity 98%. The test is not appropriate for mild arterial changes as in case of comorbidity. Its further objectives are to identify patients at an higher risk of cardiovascular events. PMID:23193828

  5. Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

    PubMed Central

    Masaki, Hisao; Yunoki, Yasuhiro; Tabuchi, Atushi; Morita, Ichiro; Mohri, Satoshi; Tanemoto, Kazuo

    2015-01-01

    Objective: To clarify the characteristics of ankle-brachial index (ABI), toe-brachial index (TBI), and pulse volume recording (PVR) of the ankle with brachial-ankle pulse wave velocity (baPWV) in healthy young adults. Material and Methods: We analyzed ABI, TBI, baPWV, and PVR in the ankle of healthy adults aged 20 to 25 years (median, 20 years) using an automatic oscillometric device between 2002 and 2013. The ABI, baPWV, and PVR in 1282 legs of 641 subjects (301 men and 340 women) and the TBI in 474 toes of 237 subjects (117 men and 120 women) were evaluated. Results: The measured values showed no bilateral differences. ABI and baPWV were higher in men than in women, but TBI was similar in both sexes. ABI <1.0 was observed in 18.1% of the legs in men and in 25.6% in women. TBI <0.7 was observed in 16.2% of the toes in men and 19.1% in women. For ankle PVR, the % mean arterial pressure was higher in women than in men. The upstroke time was <180 ms in most subjects. Conclusions: For young people, ABI <1.0 or TBI <0.7 may not always indicate vascular abnormalities. When evaluating circulatory indexes, age and sex should be considered. PMID:26421072

  6. Birth brachial plexus palsy: a race against time.

    PubMed

    Patra, Sambeet; Narayana Kurup, Jayakrishnan K; Acharya, Ashwath M; Bhat, Anil K

    2016-01-01

    A 5-year-old child presented to us with weakness of the left upper limb since birth. With the given history of obstetric trauma and limb examination, a diagnosis of birth brachial plexus palsy was made. Brachial plexus exploration along with microsurgery was performed at the same time which included extrinsic neurolysis of the roots and trunks and nerve transfer for better shoulder external rotation and elbow flexion. Both the movements were severely restricted previously due to co-contractures with the shoulder internal rotators and triceps. The problem of birth brachial plexus palsy is proving to be a global health burden both in developed countries and in developing countries such as India. The lack of awareness among the general public and primary healthcare providers and inadequate orthopaedic and neurosurgeons trained to treat the condition have worsened the prognosis. This case lays stress on the delayed complications in birth brachial palsy and its effective management. PMID:27402656

  7. Cutaneous larva migrans, sacroileitis, and optic neuritis caused by an unidentified organism acquired in Thailand.

    PubMed

    Potasman, I; Feiner, M; Arad, E; Friedman, Z

    1998-12-01

    We report the case of a 32-year-old pregnant woman with an unidentified intraocular parasite. The parasite, which had been acquired in Thailand, caused cutaneous larva migrans, sacroileitis, and 2 years later optic neuritis and panuveitis. The patient was successfully treated with ivermectin and albendazole. The diagnostic possibilities of this peculiar presentation are discussed. Parasitic infections are a leading cause of medical problems in travelers to tropical countries.1 While most parasites cause gastrointestinal problems, some may migrate throughout the body and lodge in critical organs. Ocular parasitic infections may occur by direct inoculation onto the eye,2 or incidentally during systemic migration. Subconjunctival parasites are easily diagnosed by removal and careful microscopic examination.3 Parasites, which lodge within the eye, are more difficult to diagnose, especially if not removed. In this report we describe a patient who presented with an intraocular parasite causing optic neuritis and panuveitis, 2 years after travel to Thailand. PMID:9876201

  8. [Myxoid/round cell liposarcoma of the brachial plexus].

    PubMed

    Giner, Javier; Isla, Alberto; Hernández, Borja; Nistal, Manuel

    2014-01-01

    Myxoid/round cell liposarcoma is a soft tissue sarcoma that is extremely rare in the brachial plexus. We report a case of a myxoid/round cell liposarcoma originating in the brachial plexus that was surgically resected and evolved well, with no deficit or recurrence after 2 years of follow-up. To date, there has been no other case of this sarcoma in the literature. PMID:25126709

  9. Noninvasive Assessments of Optic Nerve Neurodegeneration in Transgenic Mice With Isolated Optic Neuritis

    PubMed Central

    Talla, Venu; Yang, Cui; Shaw, Gerry; Porciatti, Vittorio; Koilkonda, Rajeshwari D.; Guy, John

    2013-01-01

    Purpose. To determine if phosphorylated neurofilament heavy chain (pNF-H) released into the bloodstream and the pattern ERG are noninvasive indicators of neurodegeneration in experimental optic neuritis. Methods. Serum from Myelin oligodendrocyte glycoprotein (MOG)-specific T cell receptor–positive (TCR+) transgenic mice that develop isolated optic neuritis usually without any other characteristic lesions of inflammation or demyelination in the spinal cord and littermates negative for the transgene were assayed for the presence of serum phosphorylated neurofilament H (pNF-H). In vivo measurements of optic nerve and retinal ganglion cell injury were assessed by magnetic resonance imaging (MRI), optical coherence tomography (OCT), and pattern electroretinogram (PERG). Automated two dimensional fluorescence differential in-gel electrophoresis (2D-DIGE) of pooled optic nerve samples, light, and transmission electron micrographs were used to evaluate optic atrophy postmortem. Results. We found an almost 3-fold elevation in serum pNF-H levels in MOG+ mice relative to MOG-littermates (P = 0.02). 2D-DIGE revealed a 3-fold reduction in optic nerve neurofilaments. Visual function assessed by the PERG was reduced by one-quarter (P = 0.033) and latencies increased by 38% (P = 0.036). MOG+ mice with the lowest PERG amplitudes had optic nerve atrophy visualized by MRI. Optic nerve diameters were reduced by one-third (P = 0.0001) and axon counts reduced by more than two-thirds. Histopathology of the spinal cords was normal. Conclusions. Elevated serum pNF-H levels and the PERG are useful markers of neurodegeneration of the optic nerve in isolated experimental optic neuritis. Our findings suggest that elevations of this axonal protein in patients with optic neuritis who had a poor visual outcome are likely also due to demise of optic nerve axons. PMID:23722393

  10. Limb preference in children with obstetric brachial plexus palsy.

    PubMed

    Yang, Lynda J-S; Anand, Praveen; Birch, Rolfe

    2005-07-01

    Brachial plexus palsy affects children differently than adults. In children with obstetric brachial plexus palsy, motor development must depend on nervous system adaptation. Previous studies report sensory plasticity in these children. This noninvasive study provides support for neural plasticity (the general ability of the brain to reorganize neural pathways based on new experiences) in children with obstetric brachial plexus palsy by considering upper limb preference. As in the general population, we expect that 90% of children would prefer their right upper limb. However, only 17% of children affected by right obstetric brachial plexus palsy prefer the right upper limb for overall movement; children with left obstetric brachial plexus palsy did not significantly differ from the general population in upper limb preference. This study also provides the first evidence of a significant correlation between actual task performance and select obstetric brachial plexus palsy outcome measurement systems, thereby justifying the routine use of these outcome measurement systems as a reflection of the practical utility of the affected limb to the patient. PMID:15876521

  11. Thymic epithelium determines a spontaneous chronic neuritis in Icam1(tm1Jcgr)NOD mice.

    PubMed

    Meyer zu Horste, Gerd; Mausberg, Anne K; Cordes, Steffen; El-Haddad, Houda; Partke, Hans-Joachim; Leussink, Verena I; Roden, Michael; Martin, Stephan; Steinman, Lawrence; Hartung, Hans-Peter; Kieseier, Bernd C

    2014-09-15

    The NOD mouse strain spontaneously develops autoimmune diabetes. A deficiency in costimulatory molecules, such as B7-2, on the NOD genetic background prevents diabetes but instead triggers an inflammatory peripheral neuropathy. This constitutes a shift in the target of autoimmunity, but the underlying mechanism remains unknown. In this study, we demonstrate that NOD mice deficient for isoforms of ICAM-1, which comediate costimulatory functions, spontaneously develop a chronic autoimmune peripheral neuritis instead of diabetes. The disease is transferred by CD4(+) T cells, which infiltrate peripheral nerves together with macrophages and B cells and are autoreactive against peripheral myelin protein zero. These Icam1(tm1Jcgr)NOD mice exhibit unaltered numbers of regulatory T cells, but increased IL-17-producing T cells, which determine the severity, but not the target specificity, of autoimmunity. Ab-mediated ICAM-1 blockade triggers neuritis only in young NOD mice. Thymic epithelium from Icam1(tm1Jcgr)NOD mice features an altered expression of costimulatory molecules and induces neuritis and myelin autoreactivity after transplantation into nude mice in vivo. Icam1(tm1Jcgr)NOD mice exhibit a specifically altered TCR repertoire. Our findings introduce a novel animal model of chronic inflammatory neuropathies and indicate that altered expression of ICAM-1 on thymic epithelium shifts autoimmunity specifically toward peripheral nerves. This improves our understanding of autoimmunity in the peripheral nervous system with potential relevance for human diseases. PMID:25108020

  12. Brimonidine suppresses loss of retinal neurons and visual function in a murine model of optic neuritis.

    PubMed

    Guo, Xiaoli; Namekata, Kazuhiko; Kimura, Atsuko; Noro, Takahiko; Azuchi, Yuriko; Semba, Kentaro; Harada, Chikako; Yoshida, Hiroshi; Mitamura, Yoshinori; Harada, Takayuki

    2015-04-10

    Optic neuritis is inflammation of the optic nerve and is strongly associated with multiple sclerosis (MS), an inflammatory demyelinating syndrome of the central nervous system. It leads to retinal ganglion cell (RGC) death and can cause severe vision loss. Brimonidine (BMD) is a selective α2-adrenergic receptor agonist that is used clinically for the treatment of glaucoma. BMD lowers intraocular pressure, but recent evidence suggests that its therapeutic efficacy may also mediate through mechanisms independent of modulation of intraocular pressure. In this study, we examined the effects of topical administration of BMD on retinal degeneration during optic neuritis in experimental autoimmune encephalomyelitis (EAE), an animal model of MS. EAE was induced with MOG35-55 in C57BL/6J mice and BMD eyedrops were applied daily. In the EAE retina, the number of RGCs was significantly decreased and this effect was suppressed with BMD treatment. Consistent with histological analyses, the visual impairment observed in EAE mice was inhibited with BMD treatment, indicating the functional significance of the neuroprotective effect of BMD. Furthermore, BMD increased the expression level of basic fibroblast growth factor in the EAE retina, particularly in Müller glial cells and RGCs. Our findings suggest that topical administration of BMD may be available for RGC protection during optic neuritis, as well as for glaucoma. PMID:25736951

  13. Respiratory arrest in patients undergoing arteriovenous graft placement with supraclavicular brachial plexus block: a case series.

    PubMed

    Afonso, Anoushka; Beilin, Yaakov

    2013-06-01

    Supraclavicular brachial plexus block is commonly used for upper extremity surgery. Respiratory arrest in three patients with end-stage renal disease after ultrasound-guided supraclavicular brachial plexus block for creation of an arteriovenous graft over a 6-month period is presented. Patients with renal failure may represent a group at particular risk for respiratory failure following supraclavicular brachial plexus block. PMID:23830847

  14. Permanent upper trunk plexopathy after interscalene brachial plexus block.

    PubMed

    Avellanet, Merce; Sala-Blanch, Xavier; Rodrigo, Lidia; Gonzalez-Viejo, Miguel A

    2016-02-01

    Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia. PMID:25744163

  15. Retinal Vascular Caliber and Brachial Flow-Mediated Dilation

    PubMed Central

    Nguyen, Thanh T.; Islam, F.M. Amirul; Farouque, H.M. Omar; Klein, Ronald; Klein, Barbara E.K.; Cotch, Mary Frances; Herrington, David M.; Wong, Tien Yin

    2010-01-01

    Background and Purpose Retinal vascular caliber changes have been shown to predict stroke, but the underlying mechanism of this association is unknown. We examined the relationship between retinal vascular caliber with brachial flow-mediated dilation (FMD), a measure of systemic endothelial function. Methods The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based study of persons 45 to 84 years of age residing in 6 US communities free of clinical cardiovascular disease at baseline. Brachial FMD data were collected at baseline (July 2000 to June 2002), and retinal vascular caliber was measured from digital retinal photographs at the second examination, immediately after the first (August 2002 to January 2004). Data were available for 2851 participants for analysis. Results The mean brachial FMD was 4.39±2.79%. After adjusting for age and gender, brachial FMD was reduced in persons with wider retinal venular caliber (changes in FMD −0.25, 95% CI, −0.36, − 0.13; P<0.001, per SD increase in venular caliber). This relationship persists after adjusting for systolic blood pressure, serum total cholesterol, use of lipid-lowering and antihypertensive medication, body mass index, current smoking status, and hemoglobinA1C (−0.18; 95% CI −0.30, − 0.06; P=0.004, per SD increase in venular caliber). Brachial FMD was not associated with retinal arteriolar caliber. Conclusions Persons with wider retinal venules have reduced brachial FMD, independent of other vascular risk factors. This suggests that retinal venular caliber, previously shown to predict stroke, may be a marker of underlying systemic endothelial dysfunction. PMID:20508189

  16. A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up.

    PubMed Central

    Francis, D A; Compston, D A; Batchelor, J R; McDonald, W I

    1987-01-01

    One hundred and one of 146 patients presenting with isolated idiopathic optic neuritis, previously reviewed in 1978, were reassessed clinically, and retyped for HLA antigens and Factor B alleles, after a mean follow-up of 11.6 years. Fifty eight patients (57%) had developed multiple sclerosis at the time of reassessment in the present study, of whom 51 (88%) had clinically definite disease. This compared with 40% of the original group, in 1978, of whom 62% then had clinically definite multiple sclerosis. When the life-table method of analysis was used, the probability of developing multiple sclerosis was 75%, 15 years after the initial episode of optic neuritis. The frequencies of HLA-DR2 and the recently defined D-region antigen, DQw1, were significantly increased in patients with isolated optic neuritis and those who subsequently developed multiple sclerosis compared with normal controls, but neither allele appears to influence progression from optic neuritis to multiple sclerosis. Patients with optic neuritis who were HLA-DR3 positive had an increased risk for the development of multiple sclerosis (RR = 2.8) and this risk was further enhanced when DR3 occurred in combination with DR2 (RR = 6.7). The overall increased risk of developing multiple sclerosis for patients with this combination was 26 times that for the normal population. When the patients' original tissue-typing was considered BT 101 no longer influenced conversion of optic neuritis to multiple sclerosis. This may partly be explained by improved methods of tissue-typing, since not all BT 101 patients were subsequently found to be positive for HLA-DR2 or HLA-DQw1 and vice versa and by extended follow-up as multiple sclerosis conversion in HLA-DR2 negative individuals increased with time. All 101 patients were typed for Factor B alleles. No significant differences in frequencies were found between individuals with isolated optic neuritis or those who progressed to multiple sclerosis compared with the

  17. Electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies.

    PubMed

    Simmons, Zachary

    2013-02-01

    This article describes the normal anatomy of the brachial plexus and its major terminal branches, as well as the major causes and clinical presentations of lesions of these structures. An approach to electrodiagnosis of brachial plexopathies and proximal upper extremity neuropathies is provided, with an emphasis on those nerve conduction studies and portions of the needle examination, which permit localization of lesions to specific trunks, cords, and terminal branches. The importance of specific sensory nerve conduction studies for differentiating plexopathies from radiculopathies and mononeuropathies is emphasized. PMID:23177028

  18. [Demyelinating diseases in children with acute neurological symptoms].

    PubMed

    Olofsson, Isa Amalie; Skov, Liselotte; Miranda, Maria Jose

    2015-12-01

    Demyelinating diseases in children is a broad group of illnesses, which affect the central nervous system. Demyelinating diseases can be monophasic or chronic and comprise acute disseminated encephalomyelitis, optic neuritis, transverse myelitis, multiple sclerosis and neuromyelitis optica. Demyelinating diseases are rare, but it is important for the physician to recognize these diseases, as well as to understand the differential diagnoses. This review summarizes the current knowledge of demyelinating disorders in children, focusing on an approach to diagnosis and management. PMID:26651911

  19. Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

    PubMed Central

    2009-01-01

    Introduction Although several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients. Methods We conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased ≥ 15% after VE. The respiratory variation in Vpeakbrach (ΔVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (ΔPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (ΔSVVigileo), were also calculated. Results VE increased SVi by ≥ 15% in 19 patients (responders). At baseline, ΔVpeakbrach, ΔPPrad and ΔSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A ΔVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A ΔPPrad value >10% and a ΔSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively. Conclusions Respiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure. Trial Registration

  20. [Brachial plexus. Long lasting neurological deficit following interscalene blockade of the brachial plexus].

    PubMed

    Funk, W; Angerer, M; Sauer, K; Altmeppen, J

    2000-07-01

    An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. Paraesthesia and a sensory and motor innervation deficit affected mainly the dorsal fascicle, but also areas innervated by the median and lateral fascicles. The deficit did not completely disappear for 18 month. The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty. PMID:10969388

  1. Dual gene therapy with extracellular superoxide dismutase and catalase attenuates experimental optic neuritis

    PubMed Central

    Qi, Xiaoping; Hauswirth, William W.

    2007-01-01

    Purpose To ameliorate experimental optic neuritis by combining scavenging of superoxide by germ line increases in the extracellular superoxide dismutase (ECSOD) and hydrogen peroxide by viral-mediated gene transfer of the human catalase gene. Methods The human catalase gene inserted into recombinant adeno-associated virus (rAAV) was injected into the right eyes of transgenic mice overexpressing human ECSOD and wild-type littermates. Animals were simultaneously sensitized for experimental autoimmune encephalomyelitis (EAE) and then sacrificed one month later. The effects of antioxidant genes (ECSOD and catalase) on the histologic lesions of EAE were measured by computerized analysis of myelin area, optic disc area, extent of the cellular infiltrate, cerium derived H2O2 reaction product and extravasation of serum albumin detected by immunogold. Results Combined scavenging of H2O2 and superoxide with ECSOD and catalase suppressed demyelination by 72%, 54% due to catalase, and 19% due to ECSOD. Disruption of the blood-brain barrier was reduced 63% by the combined effects of catalase and ECSOD, 35% due to catalase and 29% due to ECSOD. Conclusions Transgene modulation of antioxidant enzyme defenses against both superoxide and its metabolite H2O2 provide a substantial suppressive effect against EAE in the optic nerve that may be a new therapeutic strategy for suppression of optic neuritis and multiple sclerosis. PMID:17242675

  2. Axillary Brachial Plexus Blockade for the Reflex Sympathetic Dystrophy Syndrome.

    ERIC Educational Resources Information Center

    Ribbers, G. M.; Geurts, A. C. H.; Rijken, R. A. J.; Kerkkamp, H. E. M.

    1997-01-01

    Reflex sympathetic dystrophy syndrome (RSD) is a neurogenic pain syndrome characterized by pain, vasomotor and dystrophic changes, and often motor impairments. This study evaluated the effectiveness of brachial plexus blockade with local anaesthetic drugs as a treatment for this condition. Three patients responded well; three did not. (DB)

  3. General intravenous anesthesia for brachial plexus surgery in the rabbit.

    PubMed

    Reichert, P; Rutowski, R; Kielbowicz, Z; Kuryszko, J; Kielbowicz, M

    2013-01-01

    The rabbit is a good experimental model for brachial plexus surgery. The risks of death during anesthesia were significantly greater in rabbits than cats or dogs. This article presents the protocol of injectable anesthesia for a short surgical procedure, safe for the rabbit patient and convenient for the surgeon. PMID:24597314

  4. Disrupted functional connectivity of the default mode network due to acute vestibular deficit

    PubMed Central

    Klingner, Carsten M.; Volk, Gerd F.; Brodoehl, Stefan; Witte, Otto W.; Guntinas-Lichius, Orlando

    2014-01-01

    Vestibular neuritis is defined as a sudden unilateral partial failure of the vestibular nerve that impairs the forwarding of vestibular information from the labyrinth. The patient suffers from vertigo, horizontal nystagmus and postural instability with a tendency toward ipsilesional falls. Although vestibular neuritis is a common disease, the central mechanisms to compensate for the loss of precise vestibular information remain poorly understood. It was hypothesized that symptoms following acute vestibular neuritis originate from difficulties in the processing of diverging sensory information between the responsible brain networks. Accordingly an altered resting activity was shown in multiple brain areas of the task-positive network. Because of the known balance between the task-positive and task-negative networks (default mode network; DMN) we hypothesize that also the DMN is involved. Here, we employ functional magnetic resonance imaging (fMRI) in the resting state to investigate changes in the functional connectivity between the DMN and task-positive networks, in a longitudinal design combined with measurements of caloric function. We demonstrate an initially disturbed connectedness of the DMN after vestibular neuritis. We hypothesize that the disturbed connectivity between the default mode network and particular parts of the task-positive network might be related to a sustained utilization of processing capacity by diverging sensory information. The current results provide some insights into mechanisms of central compensation following an acute vestibular deficit and the importance of the DMN in this disease. PMID:25379422

  5. Retinal Nerve Fibre Layer Thinning in Patients with Clinically Isolated Optic Neuritis and Early Treatment with Interferon-Beta

    PubMed Central

    Sühs, Kurt-Wolfram; Hein, Katharina; Pehlke, Jens R.; Käsmann-Kellner, Barbara; Diem, Ricarda

    2012-01-01

    Background Optic neuritis is associated with neurodegeneration leading to chronic impairment of visual functions. Objective This study investigated whether early treatment with interferon beta (IFN-β) slows retinal nerve fibre layer (RNFL) thinning in clinically isolated optic neuritis. Methods Twenty patients with optic neuritis and visual acuity decreased to ≤0.5 (decimal system) were included into this prospective, open-label, parallel group 4-month observation. After methylprednisolone pulse therapy, 10 patients received IFN-β from week 2 onwards. This group was compared to 10 patients free of any disease modifying treatment (DMT). The parameter of interest was change in RNFL thickness assessed at baseline and at weeks 4, 8, and 16. Changes in visual acuity, visual field, and visual evoked potentials (VEPs) served as additional outcome parameters. Results RNFL thinning did not differ between the groups with a mean reduction of 9.80±2.80 µm in IFN-β-treated patients (±SD) vs. 12.44±5.79 µm in patients who did not receive DMT (baseline non-affected eye minus affected eye at week 16; p = 0.67, t-test, 95% confidence interval: −15.77 to 10.48). Parameters of visual function did not show any differences between the groups either. Conclusions In isolated optic neuritis, early IFN-β treatment did not influence RNFL thinning nor had it any effect on recovery of visual functions. PMID:23272128

  6. Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis

    PubMed Central

    Naismith, R T.; Tutlam, N T.; Xu, J; Shepherd, J B.; Klawiter, E C.; Song, S -K.; Cross, A H.

    2009-01-01

    Objectives: Determine the utility of optical coherence tomography (OCT) to detect clinical and subclinical remote optic neuritis (ON), its relationship to clinical characteristics of ON and visual function, and whether the retinal nerve fiber layer (RNFL) thickness functions as a surrogate marker of global disease severity. Methods: Cross-sectional study of 65 subjects with at least 1 clinical ON episode at least 6 months prior. Measures included clinical characteristics, visual acuity (VA), contrast sensitivity (CS), OCT, and visual evoked potentials (VEP). Results: Ninety-six clinically affected optic nerves were studied. The sensitivity of OCT RNFL after ON was 60%, decreasing further with mild onset and good recovery. VEP sensitivity was superior at 81% (p = 0.002). Subclinical ON in the unaffected eye was present in 32%. VEP identified 75% of all subclinically affected eyes, and OCT identified <20%. RNFL thickness demonstrated linear correlations with VA (r = 0.65) and CS (r = 0.72) but was unable to distinguish visual categories <20/50. RNFL was thinner with severe onset and disease recurrence but was unaffected by IV glucocorticoids. OCT measurements were not related to overall disability, ethnicity, sex, or age at onset. The greatest predictor for RNFL in the unaffected eye was the RNFL in the fellow affected eye. Conclusions: Visual evoked potentials (VEP) remains the preferred test for detecting clinical and subclinical optic neuritis. Optical coherence tomography (OCT) measures were unrelated to disability and demographic features predicting a worse prognosis in multiple sclerosis. OCT may provide complementary information to VEP in select cases, and remains a valuable research tool for studying optic nerve disease in populations. GLOSSARY ANOVA = analysis of variance; CIS = clinically isolated syndrome; CS = contrast sensitivity; EDSS = Expanded Disability Status Score; logMAR = logarithm of the minimum angle of resolution; MS = multiple sclerosis; MSSS

  7. RAD001 (everolimus) attenuates experimental autoimmune neuritis by inhibiting the mTOR pathway, elevating Akt activity and polarizing M2 macrophages.

    PubMed

    Han, Ranran; Gao, Juan; Zhai, Hui; Xiao, Jinting; Ding, Ya'nan; Hao, Junwei

    2016-06-01

    Guillain-Barre' syndrome (GBS) is an acute, postinfectious, immune-mediated, demyelinating disease of peripheral nerves and nerve roots. As a classical animal model of GBS, experimental autoimmune neuritis (EAN) has become well-accepted. Additionally, the potent immune modulation exerted by mammalian target of rapamycin (mTOR) inhibitors has been used to treat cancers and showed beneficial effects. Here we demonstrate that the mTOR inhibitor RAD001 (everolimus) protected rats from the symptoms of EAN, as shown by decreased paralysis, diminished inflammatory cell infiltration, reductions in demyelination of peripheral nerves and improved nerve conduction. Furthermore, RAD001 shifted macrophage polarization toward the protective M2 phenotype and modified the inflammatory milieu by downregulating the production of pro-inflammatory cytokines including IFN-γ and IL-17as well as upregulating the release of anti-inflammatory cytokines such as IL-4 and TGF-β. Amounts of the mTOR downstream targets p-P70S6K and p-4E-BP1 in sciatic nerves decreased, whereas the level of its upstream protein p-Akt was elevated. This demonstrated that RAD001 inhibited the mTOR pathway and encouraged the expression of p-Akt, which led to M2 macrophage polarization, thus improved the outcome of EAN in rats. Consequently, RAD001 exhibits strong potential as a therapeutic strategy for ameliorating peripheral poly-neuropathy. PMID:27063582

  8. Isolated new onset 'atypical' optic neuritis in the NMO clinic: serum antibodies, prognoses and diagnoses at follow-up.

    PubMed

    Piccolo, L; Woodhall, M; Tackley, G; Juryńczyk, M; Kong, Y; Domingos, J; Gore, R; Vincent, A; Waters, P; Leite, M I; Palace, J

    2016-02-01

    Severe, recurrent or bilateral optic neuritis (ON) often falls within the neuromyelitis optica spectrum disorders (NMOSD), but the diagnosis can be particularly challenging and has important treatment implications. We report the features, course and outcomes of patients presenting with atypical ON when isolated at onset. We retrospectively analyzed 69 sequential patients referred to a single UK NMO center with isolated ON at onset. Aquaporin-4 antibody (AQP4-Ab) assessment was performed in all patients and IgG1 myelin-oligodenrocyte glycoprotein (MOG-Ab) in AQP4-Ab(neg) patients. 37 AQP4-Ab positive (AQP4-Ab(pos)) and 32 AQP4-Ab negative (AQP4-Ab(neg)) patients (8 with MOG-Ab) were identified. The AQP4-Ab(neg) group included heterogeneous diagnoses: multiple sclerosis (MS), NMO, relapsing isolated ON (RION), monophasic isolated ON and relapsing acute disseminated encephalomyelitis (ADEM)-like syndromes. Compared to AQP4-Ab(neg) patients, AQP4-Ab(pos) patients had a worse residual visual outcome from first attack (median VFSS 4 vs. 0, p = 0.010) and at last assessment (median VFSS 5 versus 2, p = 0.005). However, AQP4-Ab(neg) patients with RION also had poor visual outcome. Up to 35% of AQP4-Ab(neg) patients developed a LETM and two developed low positivity for AQP4-Ab over time. Eight AQP4-Ab(neg) patients (25%) were MOG-Ab positive, covering a range of phenotypes excluding MS; the first ON attack was often bilateral and most had relapsing disease with a poor final visual outcome [VFSS 4, range (0-6)]. In conlcusion, AQP4-Ab positivity is confirmed as a predictor of poor visual outcome but AQP4-Ab(neg) RION also had a poor visual outcome. Of those without AQP4-Ab, 25% had MOG-Ab and another 25% developed MS; thus, MOG-Ab is associated with AQP4-Ab(neg) non-MS ON. PMID:26668077

  9. Purified human C1-esterase inhibitor is safe in acute relapses of neuromyelitis optica

    PubMed Central

    Levy, Michael

    2014-01-01

    Objective: To minimize complement-mediated damage in acute relapses of neuromyelitis optica (NMO) by adding treatment with a complement inhibitor, purified C1-esterase inhibitor, to the current standard of care (high-dose glucocorticoids). Method: We conducted an open-label phase 1b safety and proof-of-concept trial in 10 patients with NMO–immunoglobulin G seropositive NMO or NMO spectrum disease (NMOSD) who presented with acute transverse myelitis and/or optic neuritis. In addition to treating with 1 g of daily IV methylprednisolone, we infused 2,000 units of C1-esterase inhibitor daily for 3 days, beginning on day 1 of hospitalization. The primary outcome measure was safety, and the secondary efficacy measure was change in Expanded Disability Status Scale (EDSS) scores. Results: Ten patients with NMO/NMOSD were enrolled, 7 of whom presented with acute transverse myelitis and 3 with acute optic neuritis. C1-esterase inhibitor proved to be safe in all 10 patients, with no serious adverse events recorded. There were no thromboembolic events or related lab abnormalities in any of the subjects. EDSS scores dropped from a median of 4.5 on admission to 4.0 on discharge and then down to 2.5 on 30-day follow-up. All but 1 patient returned to preattack EDSS or better and only 2 patients required escalation to plasmapheresis. Conclusions: C1-esterase inhibitor is a safe add-on therapy for patients with NMO/NMOSD presenting with acute transverse myelitis and optic neuritis. Preliminary evidence suggests a promising benefit with C1-esterase inhibitor in reducing neurologic damage and improving outcomes. A placebo-controlled trial is necessary to confirm these findings. Classification of evidence: This study provides Class IV evidence that for patients with NMO with acute transverse myelitis or optic neuritis, C1-esterase inhibitor is safe and improves disability. PMID:25340061

  10. Experimental autoimmune neuritis induces differential microglia activation in the rat spinal cord.

    PubMed

    Beiter, Thomas; Artelt, Matthias R; Trautmann, Katrin; Schluesener, Hermann J

    2005-03-01

    The reactive spatial and temporal activation pattern of parenchymal spinal cord microglia was analyzed in rat experimental autoimmune neuritis (EAN). We observed a differential activation of spinal cord microglial cells. A significant increase in ED1(+) microglia predominantly located in the dorsal horn grey matter of lumbar and thoracic spinal cord levels was observed on Day 12. As revealed by morphological criteria and by staining with further activation markers [allograft inflammatory factor 1 (AIF-1), EMAPII, OX6, P2X(4)R], reactive microglia did not reach a macrophage-like state of full activation. On Day 12, a significant proliferative response could be observed, affecting all spinal cord areas and including ED1(+) microglial cells and a wide range of putative progenitor cells. Thus, in rat EAN, a reactive localized and distinct microglial activation correlating with a generalized proliferative response could be observed. PMID:15710454

  11. Recurrent optic neuritis and neuromyelitis optica-IgG following first and second human papillomavirus vaccinations.

    PubMed

    Chang, Hyeyeon; Lee, Hye Lim; Yeo, Minju; Kim, Ji Seon; Shin, Dong-Ick; Lee, Sang-Soo; Lee, Sung-Hyun

    2016-05-01

    Human papillomavirus (HPV) vaccine is widely used to prevent cervical cancer caused by certain types of HPV in girls and young women. Demyelinating disorders within months following HPV innoculation have been reported, but the causal link between HPV vaccination and the onset of demyelinating disorders have not been certain. We report a case of neuromyelitis optica spectrum disorder (NMOSD) that was noteworthy because optic neuritis (ON) occurred in a very close temporal association with both the first and second HPV vaccinations, which might suggest an association between HPV vaccination and the development of NMO-IgG and recurrent ON. This emphasizes the necessity for continuing surveillance for adverse events after HPV vaccination. PMID:27046292

  12. Transplantation of human amniotic epithelial cells repairs brachial plexus injury: pathological and biomechanical analyses

    PubMed Central

    Yang, Qi; Luo, Min; Li, Peng; Jin, Hai

    2014-01-01

    A brachial plexus injury model was established in rabbits by stretching the C6 nerve root. Immediately after the stretching, a suspension of human amniotic epithelial cells was injected into the injured brachial plexus. The results of tensile mechanical testing of the brachial plexus showed that the tensile elastic limit strain, elastic limit stress, maximum stress, and maximum strain of the injured brachial plexuses were significantly increased at 24 weeks after the injection. The treatment clearly improved the pathological morphology of the injured brachial plexus nerve, as seen by hematoxylin eosin staining, and the functions of the rabbit forepaw were restored. These data indicate that the injection of human amniotic epithelial cells contributed to the repair of brachial plexus injury, and that this technique may transform into current clinical treatment strategies. PMID:25657737

  13. Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

    PubMed Central

    Thomas, Jimmy

    2014-01-01

    This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed. PMID:25593443

  14. Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter.

    PubMed

    Reuben, S S; Steinberg, R B

    2000-09-01

    Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. In the first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was advanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative analgesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted. PMID:11090734

  15. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation

    PubMed Central

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-01-01

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved. PMID:24739650

  16. Penile erectile dysfunction after brachial plexus root avulsion injury in rats

    PubMed Central

    Fu, Guo; Qin, Bengang; Jiang, Li; Huang, Xijun; Lu, Qinsen; Zhang, Dechun; Liu, Xiaolin; Zhu, Jiakai; Zheng, Jianwen; Li, Xuejia; Gu, Liqiang

    2014-01-01

    Our previous studies have demonstrated that some male patients suffering from brachial plexus injury, particularly brachial plexus root avulsion, show erectile dysfunction to varying degrees. However, the underlying mechanism remains poorly understood. In this study, we evaluated the erectile function after establishing brachial plexus root avulsion models with or without spinal cord injury in rats. After these models were established, we administered apomorphine (via a subcutaneous injection in the neck) to observe changes in erectile function. Rats subjected to simple brachial plexus root avulsion or those subjected to brachial plexus root avulsion combined with spinal cord injury had significantly fewer erections than those subjected to the sham operation. Expression of neuronal nitric oxide synthase did not change in brachial plexus root avulsion rats. However, neuronal nitric oxide synthase expression was significantly decreased in brachial plexus root avulsion + spinal cord injury rats. These findings suggest that a decrease in neuronal nitric oxide synthase expression in the penis may play a role in erectile dysfunction caused by the combination of brachial plexus root avulsion and spinal cord injury. PMID:25422647

  17. 3T MR tomography of the brachial plexus: structural and microstructural evaluation.

    PubMed

    Mallouhi, Ammar; Marik, Wolfgang; Prayer, Daniela; Kainberger, Franz; Bodner, Gerd; Kasprian, Gregor

    2012-09-01

    Magnetic resonance (MR) neurography comprises an evolving group of techniques with the potential to allow optimal noninvasive evaluation of many abnormalities of the brachial plexus. MR neurography is clinically useful in the evaluation of suspected brachial plexus traumatic injuries, intrinsic and extrinsic tumors, and post-radiogenic inflammation, and can be particularly beneficial in pediatric patients with obstetric trauma to the brachial plexus. The most common MR neurographic techniques for displaying the brachial plexus can be divided into two categories: structural MR neurography; and microstructural MR neurography. Structural MR neurography uses mainly the STIR sequence to image the nerves of the brachial plexus, can be performed in 2D or 3D mode, and the 2D sequence can be repeated in different planes. Microstructural MR neurography depends on the diffusion tensor imaging that provides quantitative information about the degree and direction of water diffusion within the nerves of the brachial plexus, as well as on tractography to visualize the white matter tracts and to characterize their integrity. The successful evaluation of the brachial plexus requires the implementation of appropriate techniques and familiarity with the pathologies that might involve the brachial plexus. PMID:21763092

  18. Bevacizumab is safe in acute relapses of neuromyelitis optica

    PubMed Central

    Mealy, Maureen A.; Shin, Kyong; John, Gareth; Levy, Michael

    2015-01-01

    Objectives Neuromyelitis optica (NMO) is a relapsing autoimmune disease targeting the spinal cord and optic nerve leading to paralysis and blindness. Current treatment for acute NMO attacks is immunosuppression with high-dose corticosteroids and/or plasmapheresis. Preclinical animal studies suggest that bevacizumab might be beneficial in limiting the extent of inflammation during a NMO relapse by reducing the disruption of the blood–brain barrier. Methods We carried out an open-label phase 1b safety and proof-of-concept trial in 10 participants with NMO immunoglobulin G seropositive NMO, NMO spectrum disease and those at high risk for developing NMO/NMO spectrum disease who presented with an acute attack of transverse myelitis, optic neuritis or brainstem inflammation. In addition to treating with 1 g of daily intravenous methylprednisolone, we infused 10 mg/kg of bevacizumab intravenously on day 1 of treatment. The primary outcome measure was safety and the secondary outcome measure was efficacy. Results Of the 10 participants enrolled, five presented with acute transverse myelitis, four with acute optic neuritis and one with a brainstem lesion. Bevacizumab was safe in all 10 participants, with only one serious adverse event within the 90-day follow up that was not attributed to the medication. Three patients recovered to pre-attack neurological function or better, and no patients required escalation to plasmapheresis. Conclusions Bevacizumab is a safe add-on therapy to high-dose corticosteroids for NMO/NMO spectrum disease patients presenting with an acute relapse. PMID:26834844

  19. Brachial Plexus Involvement of Myeloid Sarcoma Detected by Reconstruction Magnetic Resonance Neurography.

    PubMed

    Sugiyama, Atsuhiko; Ito, Shoichi; Sugita, Yasumasa; Shimada, Jun-Ichiro; Takeuchi, Masahiro; Hirano, Shigeki; Kuwabara, Satoshi

    2015-01-01

    Myeloid sarcoma is a rare hematological disorder that presents as an extramedullary mass of immature myeloid precursors. We herein present the case of a 57-year-old man with a seven-month history of progressive weakness in the right upper extremity. Reconstruction magnetic resonance neurography showed a marked enlargement of the right brachial plexus. Fluorodeoxyglucose positron emission tomography revealed a radioactive lesion in the sacrum, in addition to the right brachial plexus, and a biopsy of the sacrum revealed myeloid sarcoma. The brachial plexus lesion was also regarded as myeloid sarcoma because of the treatment response. Isolated myeloid sarcoma involving the brachial plexus is very rare and its diagnosis is difficult as there was neither a history of leukemia nor bone marrow involvement in this patient. In this case, reconstructed magnetic resonance neurography was useful for detecting the brachial plexus mass lesion which led to an early diagnosis and good recovery. PMID:26328656

  20. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging.

    PubMed

    Cejas, C; Rollán, C; Michelin, G; Nogués, M

    2016-01-01

    The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus. PMID:26860655

  1. Management of Shoulder Problems Following Obstetric Brachial Plexus Injury

    PubMed Central

    Nixon, Matthew; Trail, Ian

    2013-01-01

    Obstetric brachial plexus injuries are common, with an incidence of 0.42 per 1000 live births in the UK, and with 25% of patients being left with permanent disability without intervention. The shoulder is the most commonly affected joint and, as a result of the subsequent imbalance of musculature, the abnormal deforming forces cause dysplasia of the glenohumeral joint. In the growing child, this presents with changing pattern of pathology, which requires a multidisciplinary approach and a broad range of treatment modalities to optimize function.

  2. Boston Children's Hospital approach to brachial plexus birth palsy.

    PubMed

    Vuillermin, Carley; Bauer, Andrea S

    2016-07-01

    The treatment of infants with brachial plexus birth palsy (BPBP) continues to be a focus at Boston Children's Hospital. Over the last 15 years, there have been many developments in the treatment of infants with BPBP. Some of the greatest changes have emerged through technical advances such as the advent of distal nerve transfers to allow targeted reinnervation as well as through research to understand the pathoanatomical changes that lead to glenohumeral dysplasia and how this dysplasia can be remodeled. This review will discuss our current practice of evaluation of the infant with BPBP, techniques for microsurgical reconstruction, and prevention and treatment of secondary glenohumeral dysplasia. PMID:27137763

  3. Obesity in children with brachial plexus birth palsy.

    PubMed

    Singh, Avreeta K; Mills, Janith; Bauer, Andrea S; Ezaki, Marybeth

    2015-11-01

    Fetal macrosomia is associated with a 14-fold increased risk of brachial plexus birth palsy (BPBP), and is a predictor of childhood obesity. The purpose of this study was to identify the relationships between BPBP, fetal macrosomia, and childhood obesity. We retrospectively reviewed 214 children with BPBP. The average age was 8 years and 53% had a Narakas 1 grade BPBP. Overall, 49% of children were normal weight, 22% overweight, and 29% obese. Of the children with a history of fetal macrosomia, 41% were obese; a statistically significant difference. Overall quality of life scores, however, were not correlated with obesity. PMID:26163865

  4. Unidentified Bright Objects on Brain Magnetic Resonance Imaging Affect Vestibular Neuritis

    PubMed Central

    Kim, Ji Chan; Chang, Dong Sik; Cho, Chin Saeng

    2015-01-01

    Objectives The aim of this study was to investigate the differences in clinical manifestations of in two groups of vestibular neuritis (VN) patients with or without unidentified bright objects (UBOs). Methods A prospective, observational study with 46 patients diagnosed with VN between May 2013 and November 2013 was executed. A caloric test, a cervical vestibular-evoked myogenic potentials (cVEMPs) test, brain magnetic resonance imaging (MRI), spontaneous nystagmus test, head impulse test, and head-shaking nystagmus test were performed. Results Of the patients, 56.5% (n=26) were classified as UBO-positive by MRI. These showed lower caloric weakness and more prominent cVEMP asymmetry compared with the UBO-negative group (P<0.05). Total VN (TVN) was the most common in the UBO-positive group (45.0%), followed by superior VN (SVN, 30.0%), and inferior VN (IVN, 25.0%). However, in the UBO-negative group, SVN (75.0%) was the most common, followed by TVN and IVN (P<0.05). The recovery rate was not influenced by UBOs (P>0.05). Conclusion UBOs on T2-weighted or fluid attenuated inversion recovery MRI may affect the patterns of the vestibular nerve in patients with VN. PMID:26622955

  5. Analysis of Fundus Photography and Fluorescein Angiography in Nonarteritic Anterior Ischemic Optic Neuropathy and Optic Neuritis

    PubMed Central

    Kim, Min Kyung

    2016-01-01

    Purpose We evaluated fundus and fluorescein angiography (FAG) findings and characteristics that can help distinguish nonarteritic anterior ischemic optic neuropathy (NAION) from optic neuritis (ON). Methods Twenty-three NAION patients and 17 ON with disc swelling patients were enrolled in this study. We performed fundus photography and FAG. The disc-swelling pattern, hyperemia grade, presence of splinter hemorrhages, cotton-wool spots, artery/vein ratio and degree of focal telangiectasia were investigated. The FAG findings for each patient were compared with respect to the following features: the pattern of disc leakage in the early phase, arteriovenous (artery/vein) transit time (second), and the presence and pattern of the filling delay. Results Cotton-wool spots, focal telangiectasia, and venous congestion were more common in the affected eyes of NAION patients. Upon FAG, 76.5% of the patients in the ON group exhibited normal choroidal circulation. However, 56.5% of patients in the NAION group demonstrated abnormal filling defects, such as peripapillary, generalized, or watershed zone filling delays. Conclusions Fundus findings, including cotton-wool spots, focal telangiectasia, and venous congestion in the affected eye, may be clues that can be used to diagnose NAION. In addition, choroidal insufficiencies on FAG could be also helpful in differentiating NAION from ON. PMID:27478356

  6. Transforming growth factor-beta 1 in experimental autoimmune neuritis. Cellular localization and time course.

    PubMed Central

    Kiefer, R.; Funa, K.; Schweitzer, T.; Jung, S.; Bourde, O.; Toyka, K. V.; Hartung, H. P.

    1996-01-01

    Experimental autoimmune neuritis (EAN) is a monophasic inflammatory disorder of the peripheral nervous system that resolves spontaneously by molecular mechanisms as yet unknown. We have investigated whether the immunosuppressive cytokine transforming growth factor-beta 1 (TGF-beta 1) might be endogenously expressed in the peripheral nervous system of Lewis rats with actively induced and adoptive transfer EAN. TGF-beta 1 mRNA was upregulated to high levels in sensory and motor roots, spinal ganglia, and sciatic nerve as revealed by quantitative Northern blot analysis and in situ hybridization histochemistry, with peak levels just preceding the first signs of clinical recovery. TGF-beta 1 mRNA was localized to scattered round cells and dense cellular infiltrates, but only rarely to Schwann cell profiles. Double labeling studies revealed macrophages and subpopulations of T cells as the major cellular source of TGF-beta 1 mRNA. TGF-beta 1 protein was visualized immunocytochemically and localized to infiltrating mononuclear cells with peak expression around the same time as mRNA, in addition to some constitutive expression in axons and Schwann cells. Our studies suggest that the spontaneous recovery observed in Lewis rat EAN might be mediated by the endogenous elaboration of TGF-beta 1 within the peripheral nerve, and that macrophages might control their own cytotoxicity by expressing TGF-beta 1. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 PMID:8546208

  7. Erythropoietin is a hypoxia inducible factor-induced protective molecule in experimental autoimmune neuritis.

    PubMed

    Luo, Bangwei; Jiang, Man; Yang, Xiaofeng; Zhang, Zhiyuan; Xiong, Jian; Schluesener, Hermann J; Zhang, Zhiren; Wu, Yuzhang

    2013-08-01

    Experimental autoimmune neuritis (EAN), an autoantigen-specific T-cell-mediated disease model for human demyelinating inflammatory disease of the peripheral nervous system, is characterized by self-limitation. Here we investigated the regulation and contribution of erythropoietin (EPO) in EAN self-limitation. In EAN sciatic nerves, hypoxia, and protein and mRNA levels of hypoxia-inducible factor 1α (HIF-1α), HIF-2α, EPO and EPO receptor (EPOR) were induced in parallel at disease peak phase but reduced at recovery periods. Further, the deactivation of HIF reduced EAN-induced EPO/EPOR upregulation in EAN, suggesting the central contribution of HIF to EPO/EPOR induction. The deactivation of EPOR signalling exacerbated EAN progression, implying that endogenous EPO contributed to EAN recovery. Exogenous EPO treatment greatly improved EAN recovery. In addition, EPO was shown to promote Schwann cell survival and myelin production. In EAN, EPO treatment inhibited lymphocyte proliferation and altered helper T cell differentiation by inducing increase of Foxp3(+)/CD4(+) regulatory T cells and decrease of IFN-γ(+)/CD4(+) Th1 cells. Furthermore, EPO inhibited inflammatory macrophage activation and promoted its phagocytic activity. In summary, our data demonstrated that EPO was induced in EAN by HIF and contributed to EAN recovery, and endogenous and exogenous EPO could effectively suppress EAN by attenuating inflammation and exerting direct cell protection, indicating that EPO contributes to the self-recovery of EAN and could be a potent candidate for treatment of autoimmune neuropathies. PMID:23603807

  8. Injury mechanisms in supraclavicular stretch injuries of the brachial plexus.

    PubMed

    Soldado, Francisco; Ghizoni, Marcos F; Bertelli, Jayme

    2016-02-01

    The aim of this study was to describe the mechanisms involved in stretch injuries of the brachial plexus. One hundred and fifty consecutive patients with supraclavicular brachial plexus injuries (BPI) were asked about the mechanism of injury during the actual injury event, particularly about the type of trauma to their shoulder, shoulder girdle and head. Fifty-seven of the patients provided enough information about their accident to allow for analysis of the shoulder trauma. The injury mechanism for all patients having upper root or total palsy (n=46) was described as a direct vertical impact to the shoulder. In 44 of these patients, the trauma followed a motorcycle accident and, in most of them, the patient hit a fixed vertical structure before falling to the ground. The injury mechanism for the lower root palsy cases (n=11) was variable. The most frequent mechanism was forceful anterior shoulder compression by a car seat belt. We found that injury mechanisms differed significantly from the ones commonly discussed in published studies. PMID:27117025

  9. The Impact of Pediatric Brachial Plexus Injury on Families

    PubMed Central

    Allgier, Allison; Overton, Myra; Welge, Jeffrey; Mehlman, Charles T.

    2015-01-01

    Purpose To determine the impact on families of children with brachial plexus injuries in order to best meet their clinical and social needs. Methods Our cross-sectional study included families with children between the ages of 1 and 18 with birth or non-neonatal brachial plexus injuries (BPI). The consenting parent or guardian completed a demographic questionnaire and the validated Impact on Family Scale during a single assessment. Total scores can range from 0-100, with the higher the score indicating a higher impact on the family. Factor analysis and item-total correlations were used to examine structure, individual items, and dimensions of family impact. Results One hundred two caregivers participated. Overall, families perceived various dimensions of impact on having a child with a BPI. Total family impact was 43. The 2 individual items correlating most strongly with the overall total score were from the financial dimension of the Impact on Family Scale. The strongest demographic relationship was traveling nationally for care and treatment of the BPI. Severity of injury was marginally correlated with impact on the family. Parent-child agreement about the severity of the illness was relatively high. Conclusion Caretakers of children with a BPI perceived impact on their families in the form of personal strain, family/social factors, financial stress, and mastery. A multidisciplinary clinical care team should address the various realms of impact on family throughout the course of treatment. Level of Evidence II Prognostic PMID:25936738

  10. Acromioclavicular joint dislocation with associated brachial plexus injury

    PubMed Central

    Gallagher, Charles Alexander; Blakeney, William; Zellweger, René

    2014-01-01

    We present the case of a 32-year-old female who sustained a left acromioclavicular (AC) joint type V injury and brachial plexus injury. The patient's AC joint injury was identified 6 days after she was involved in a motorbike accident where she sustained multiple other injuries. She required operative fixation of the AC joint using a locking compression medial proximal tibial plate. At 3 months post operatively, the patient was found to have a subluxed left shoulder as a result of an axonal injury to the upper trunk of the brachial plexus. In addition, the tibial plate had cut out. The plate was subsequently removed. At 8 months the glenohumeral articulation had been restored and the patient had clinically regained significant shoulder function. After 15 months the patient was pain free and could complete all her activities of daily living without impediment. She returned to playing competitive pool after 24 months. PMID:24855076

  11. Traumatic Pseudoaneurysm of Axillary Artery Combined with Brachial Plexus Injury

    PubMed Central

    Chen, Lin; Peng, Feng; Wang, Tao; Chen, Desong; Yang, Jianyun

    2014-01-01

    Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus. PMID:25412426

  12. Complications of Lower-Extremity Outpatient Arteriography via Low Brachial Artery

    SciTech Connect

    Chatziioannou, A.; Ladopoulos, C.; Mourikis, D.; Katsenis, K.; Spanomihos, G.; Vlachos, L.

    2004-01-15

    We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients.The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA - DSA in an outpatient setting.

  13. [Ipsilateral brachial plexus C7 root transfer. Presentation of a case and a literature review].

    PubMed

    Vergara-Amador, Enrique; Ramírez, Alejandro

    2014-01-01

    The C7 root in brachial plexus injuries has been used since 1986, since the first description by Gu at that time. This root can be used completely or partially in ipsilateral or contralateral lesions of the brachial plexus. A review of the literature and the case report of a 21-month-old girl with stab wounds to the neck and section of the C5 root of the right brachial plexus are presented. A transfer of the anterior fibres of the ipsilateral C7 root was performed. At 9 months there was complete recovery of abduction and external rotation of the shoulder. PMID:23474130

  14. Avulsion of the brachial plexus in a great horned owl (Bubo virginaus)

    USGS Publications Warehouse

    Moore, M.P.; Stauber, E.; Thomas, N.J.

    1989-01-01

    Avulsion of the brachial plexus was documented in a Great Horned Owl (Bubo virginianus). A fractured scapula was also present. Cause of these injuries was not known but was thought to be due to trauma. Differentiation of musculoskeletal injury from peripheral nerve damage can be difficult in raptors. Use of electromyography and motor nerve conduction velocity was helpful in demonstrating peripheral nerve involvement. A brachial plexus avulsion was suspected on the basis of clinical signs, presence of electromyographic abnormalities in all muscles supplied by the nerves of the brachial plexus and absence of median-ulnar motor nerve conduction velocities.

  15. MMP-2 -1575G/A polymorphism modifies the onset of optic neuritis as a first presenting symptom in MS?

    PubMed

    Gašparović, Iva; Čizmarević, Nada Starčević; Lovrečić, Luca; Perković, Olivio; Lavtar, Polona; Sepčić, Juraj; Jazbec, Saša Šega; Kapović, Miljenko; Peterlin, Borut; Ristić, Smiljana

    2015-09-15

    Previous studies show altered activities of matrix metalloproteinase (MMP)-2 and MMP-9 in serum and cerebrospinal fluid of multiple sclerosis (MS) and neuromyelitis optica (NMO) patients. Optic neuritis (ON) is a common symptom of both disorders. Here we investigated the impacts of MMP-2 -1575G/A and MMP-9 -1562 C/T gene polymorphisms on disease phenotype in 100 MS patients with ON as a first symptom and 376 MS patients with other initial symptomatology. The MMP-2 -1575G/A polymorphism led to a 5-year-earlier age of disease onset in MS patients with ON as a first symptom (p=0.009). PMID:26298319

  16. Experimental optic neuritis induced by the microinjection of lipopolysaccharide into the optic nerve.

    PubMed

    Aranda, Marcos L; Dorfman, Damián; Sande, Pablo H; Rosenstein, Ruth E

    2015-04-01

    Optic neuritis (ON) is a condition involving primary inflammation, demyelination, and axonal injury in the optic nerve which leads to retinal ganglion cell (RGC) loss, and visual dysfunction. We investigated the ability of a single microinjection of bacterial lipopolysaccharide (LPS) directly into the optic nerve to induce functional and structural alterations compatible with ON. For this purpose, optic nerves from male Wistar rats remained intact or were injected with vehicle or LPS. The effect of LPS was evaluated at several time points post-injection in terms of: i) visual pathway and retinal function (visual evoked potentials (VEPs) and electroretinograms, (ERGs), respectively), ii) anterograde transport from the retina to its projection areas, iii) consensual pupil light reflex (PLR), iv) optic nerve histology, v) microglia/macrophage reactivity (by Iba-1- and ED1-immunostaining), vi) astrocyte reactivity (by glial fibrillary acid protein-immunostaining), vii) axon number (by toluidine blue staining), vii) demyelination (by myelin basic protein immunoreactivity and luxol fast blue staining), viii) optic nerve ultrastructure, and ix) RGC number (by Brn3a immunoreactivity). LPS induced a significant and persistent decrease in VEP amplitude and PLR, without changes in the ERG. In addition, LPS induced a deficit in anterograde transport, and an early inflammatory response consisting in an increased cellularity, and Iba-1 and ED1-immunoreactivity in the optic nerve, which were followed by changes in axonal density, astrocytosis, demyelination, and axon and RGC loss. These results suggest that the microinjection of LPS into the optic nerve may serve as a new experimental model of primary ON. PMID:25687552

  17. Forced Exercise Preconditioning Attenuates Experimental Autoimmune Neuritis by Altering Th1 Lymphocyte Composition and Egress.

    PubMed

    Calik, Michael W; Shankarappa, Sahadev A; Langert, Kelly A; Stubbs, Evan B

    2015-01-01

    A short-term exposure to moderately intense physical exercise affords a novel measure of protection against autoimmune-mediated peripheral nerve injury. Here, we investigated the mechanism by which forced exercise attenuates the development and progression of experimental autoimmune neuritis (EAN), an established animal model of Guillain-Barré syndrome. Adult male Lewis rats remained sedentary (control) or were preconditioned with forced exercise (1.2 km/day × 3 weeks) prior to P2-antigen induction of EAN. Sedentary rats developed a monophasic course of EAN beginning on postimmunization day 12.3 ± 0.2 and reaching peak severity on day 17.0 ± 0.3 (N = 12). By comparison, forced-exercise preconditioned rats exhibited a similar monophasic course but with significant (p < .05) reduction of disease severity. Analysis of popliteal lymph nodes revealed a protective effect of exercise preconditioning on leukocyte composition and egress. Compared with sedentary controls, forced exercise preconditioning promoted a sustained twofold retention of P2-antigen responsive leukocytes. The percentage distribution of pro-inflammatory (Th1) lymphocytes retained in the nodes from sedentary EAN rats (5.1 ± 0.9%) was significantly greater than that present in nodes from forced-exercise preconditioned EAN rats (2.9 ± 0.6%) or from adjuvant controls (2.0 ± 0.3%). In contrast, the percentage of anti-inflammatory (Th2) lymphocytes (7-10%) and that of cytotoxic T lymphocytes (∼20%) remained unaltered by forced exercise preconditioning. These data do not support an exercise-inducible shift in Th1:Th2 cell bias. Rather, preconditioning with forced exercise elicits a sustained attenuation of EAN severity, in part, by altering the composition and egress of autoreactive proinflammatory (Th1) lymphocytes from draining lymph nodes. PMID:26186926

  18. Devic's disease before Devic: Bilateral optic neuritis and simultaneous myelitis in a young woman (1874).

    PubMed

    Jarius, S; Wildemann, B

    2015-11-15

    Neuromyelitis optica (NMO, Devic's disease) is an often severely disabling disorder of the central nervous system (CNS) which mainly affects the optic nerves and spinal cord. NMO was long considered a clinical subform of multiple sclerosis (MS). In 2004, however, Lennon and colleagues described a novel autoantibody in NMO which targets aquaporin-4, the most abundant water channel in the CNS, and which was later shown to be directly pathogenic. This has led to the recognition of NMO as a distinct disease entity in its own right. While the history of 'classical' MS has been extensively studied, only little is known about the early history of NMO. The term neuromyelitis optica was coined in 1894 by Eugène Devic (1858-1930) and Fernand Gault (1873-1936), who were the first to provide a systematic description of that disorder. Here we re-present a very early description of a case of NMO by a Polish physician, Adolf Wurst, which appeared in 1876 in Przegląd Lekarski, one of the oldest Polish medical journals. This report predates Devic and Gault's seminal work on NMO by more than two decades. The patient, a 30-year-old woman, subacutely developed simultaneous bilateral optic neuritis with papilloedema and bilateral blindness and transverse myelitis with severe paraparesis, anaesthesia, and bladder and bowel dysfunction. At last follow-up, one year after onset, she had recovered except for a residual spastic gait and some visual deficit on the right side. Of note, this is the first known case of NMO in a Caucasian patient ever reported outside Western Europe. PMID:26303625

  19. Herpes zoster-associated acute urinary retention in immunocompetent patient.

    PubMed

    Marques, Silvio Alencar; Hortense, Juliana

    2014-01-01

    Herpes zoster-associated urinary retention is an uncommon event related to virus infection of the S2-S4 dermatome. The possible major reasons are ipsilateral hemicystitis, neuritis-induced or myelitis-associated virus infection. We report a case of a 65-year-old immunocompetent female patient who presented an acute urinary retention after four days under treatment with valacyclovir for gluteal herpes zoster. The patient had to use a vesical catheter, was treated with antibiotics and corticosteroids and fully recovered after eight weeks. PMID:25387508

  20. Interscalenic approach to the cervico-brachial plexus.

    PubMed

    Evenepoel, M C; Blomme, A

    1981-12-01

    The concept of a closed peri-neurovascular space surrounding the cervicobrachial plexus, introduced by A. Winnie, allows the blockade of the cervical and brachial plexuses by means of a single puncture technique. The single puncture has positive advantages: 1. The rapidity of the blockade; 2. The simplicity of the blockade; 3. Comfort for the patient. The landmarks are easy to make. As with epidural blockade, the injection level and the volume of local anesthetic determine the quality and extent of the block. The traditional indication is surgery of the shoulder and of the supraclavicular area. A new indication seems to be the implantation of a cardiac pacemaker. Complications often quoted in literature are Horner syndrome-a minor complication-and blockade of the ascending branches of the recurrent laryngeal nerve and of the phrenic nerve. The risk of a pneumothorax is almost nil. PMID:7324853

  1. Supraclavicular Brachial Plexus Block for Arteriovenous Hemodialysis Access Procedures.

    PubMed

    Hull, Jeffrey; Heath, Jean; Bishop, Wendy

    2016-05-01

    Ultrasound-guided supraclavicular brachial plexus block using 1% and 2% lidocaine in 21 procedures is reported. Average procedure time was 5.1 minutes (± 1.2 min; range, 2-8 min). Average time of onset and duration were 4.8 minutes (± 3.7 min; range, 0-10 min) and 77.9 minutes (± 26.7 min; range, 44-133 min), respectively, for sensory block and 8.4 minutes (± 5.7 min; range, 3-23 min) and 99 minutes (± 40.5 min; range, 45-171 min), respectively, for motor block. The pain scale assessment averaged 0.4 (± 1.1; range, 0-4). There were no complications. PMID:27106648

  2. Brachial-Ankle Pulse Wave Velocity: Myths, Misconceptions, and Realities

    PubMed Central

    Sugawara, Jun; Tanaka, Hirofumi

    2015-01-01

    A variety of techniques to evaluate central arterial stiffness have been developed and introduced. None of these techniques, however, have been implemented widely in regular clinical settings, except for brachial-ankle pulse wave velocity (baPWV). The most prominent procedural advantage of baPWV is its ease of use, since it only requires the wrapping of blood pressure cuffs on the 4 extremities. There is mounting evidence indicating the ability of baPWV to predict the risk of future cardiovascular events and total mortality. Additionally, the guidelines for the management of hypertension in Japan recommended the measurement of baPWV be included in the assessment of subclinical target organ damage. However, baPWV has not been fully accepted worldwide due to perceived theoretical and methodological issues. In this review, we address the most frequently mentioned questions and concerns regarding baPWV to shed some light on this simple and easy arterial stiffness measurement. PMID:26587459

  3. Ankle brachial pressure index of normal, healthy, younger adults.

    PubMed

    Niblo, Jane; Coull, Alison

    Doppler ultrasound and ankle brachial pressure index (ABPI) calculations are used in the assessment of lower limb vascularity, specifically to determine arterial deficiency. ABPI is important as it is used as an indicator when deciding management options for the treatment of leg ulceration. This study aimed to investigate the range of ABPI measurement, using Doppler ultrasound and sphygmomanometry in 36 young healthy adults aged 18-55 years. The findings show a mean ABPI in the left leg of 1.19 and a mean ABPI of 1.17 in the right leg which, while within the normal range, are consistently in the upper range and significantly higher than the acknowledged 'normal' midpoint of 1.0. It would appear that younger people will have ABPIs within the upper aspect of the normal range and well above the established norm of 1.0. PMID:24151719

  4. Brachial artery waveforms for automatic blood pressure measurement.

    PubMed

    Al-Jumaily, A M; Lan, H; Stergiopulos, N

    2013-02-01

    Theoretically the auscultatory method using Korotkoff sounds is more related to the maximum artery closure status, while the oscillometric method is more related to the overall artery closure status under the cuff. Therefore, the latter is less accurate than the former. This work introduces a new method, which is more accurate than the oscillometric method and suitable for automatic devices. To monitor the maximum artery closure status, a piezoelectric film sensor is attached to the skin just above the brachial artery and under the central section of the cuff where maximum cuff pressure is transferred to the arm. Using the waveform features obtained by this sensor, measurement errors of 0.7±2.5 and 1.27±4.53 mmHg were obtained for the systolic and diastolic pressure, respectively. These reflect small deviations from auscultatory clinical data. PMID:23149078

  5. Ultrasonography of the brachial plexus, normal appearance and practical applications.

    PubMed

    Lapegue, F; Faruch-Bilfeld, M; Demondion, X; Apredoaei, C; Bayol, M A; Artico, H; Chiavassa-Gandois, H; Railhac, J-J; Sans, N

    2014-03-01

    Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots are accurately identified due to the shape (a single tubercle) of the transverse process of C7 in the paravertebral space, and the superficial position of C5 in the interscalene groove. The téléphérique technique allows the roots, trunks and cords to be followed easily into the supraclavicular fossa. In just a few years, ultrasound imaging of the plexus has become a routine anesthesia examination for guiding nerve blocks. In trained hands, it also provides information in thoracic outlet syndromes, traumatic conditions (particularly for postganglionic lesions) and tumoral diseases. Even if MRI remains the standard examination in these indications, ultrasound, with its higher definition and dynamic character, is an excellent additional method which is still under-exploited. PMID:24603038

  6. Large cervicothoracic myxoinflammatory fibroblastic sarcoma with brachial plexus invasion: A case report and literature review

    PubMed Central

    Jia, Xiaotian; Yang, Jianyun; Chen, Lin; Yu, Cong

    2016-01-01

    Myxoinflammatory fibroblastic sarcoma is a rare sarcoma that develops in patients of all ages, which usually presents as a slow-growing painless mass in the distal extremities. To date, myxoinflammatory fibroblastic sarcoma with invasion of the brachial plexus has rarely been reported in the literature. In this study, a case of large cervicothoracic sarcoma, which invaded the brachial plexus, is presented. The patient reported no sensory disturbance or dyskinesia. The tumor was completely resected without injury of the brachial plexus. The postoperative histological diagnosis was myxoinflammatory fibroblastic sarcoma. Follow-up examination performed 24 months after surgery revealed no tumor recurrence and no sensory disturbance or dyskinesia was reported. This study presents a rare case of large myxoinflammatory fibroblastic sarcoma with brachial plexus invasion that was successfully managed by surgery. PMID:27588121

  7. Brachial Plexus Injury from CT-Guided RF Ablation Under General Anesthesia

    SciTech Connect

    Shankar, Sridhar Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Flanagan, Hugh L.; Whang, Edward E.

    2005-06-15

    Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexus palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication.

  8. Pulsed radiofrequency treatment within brachial plexus for the management of intractable neoplastic plexopathic pain.

    PubMed

    Arai, Young-Chang P; Nishihara, Makoto; Aono, Shuichi; Ikemoto, Tatsunori; Suzuki, Chiharu; Kinoshita, Akiko; Ushida, Takahiro

    2013-04-01

    We report on the use of pulsed radiofrequency (RF) within the plexus for the management of intractable pain in three patients with metastatic or invasive plexopathy. The patients were a 38-year-old woman with a history of breast cancer 6 years earlier whose computed tomography (CT) scans revealed a mass lesion at the infraclavicular part of the right brachial plexus, a 68-year-old man diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the right humerus invading the axillary region of the right brachial plexus, and a 67-year-old woman diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the left humerus invading the axillary region of the left brachial plexus. Ultrasound-guided pulsed RF was performed within the interscalene brachial plexus. During the follow-up period, their intractable pain was moderately controlled. PMID:23070568

  9. OCT/PS-OCT imaging of brachial plexus neurovascular structures

    NASA Astrophysics Data System (ADS)

    Raphael, David T.; Zhang, Jun; Zhang, Yaoping; Chen, Zhongping; Miller, Carol; Zhou, Li

    2004-07-01

    Introduction: Optical coherence tomography (OCT) allows high-resolution imaging (less than 10 microns) of tissue structures. A pilot study with OCT and polarization-sensitive OCT (PS-OCT) was undertaken to image ex-vivo neurovascular structures (vessels, nerves) of the canine brachial plexus. Methods: OCT is an interferometry-based optical analog of B-mode ultrasound, which can image through non-transparent biological tissues. With approval of the USC Animal Care and Use Committee, segments of the supra- and infraclavicular brachial plexus were excised from euthanized adult dogs, and the ex-vivo specimens were placed in cold pH-buffered physiologic solution. An OCT beam, in micrometer translational steps, scanned the fixed-position bisected specimens in transverse and longitudinal views. Two-dimensional images were obtained from identified arteries and nerves, with specific sections of interest stained with hematoxylin-eosin for later imaging through a surgical microscope. Results: with the beam scan direction transverse to arteries, the resulting OCT images showed an identifiable arterial lumen and arterial wall tissue layers. By comparison, transverse beam OCT images of nerves revealed a multitude of smaller nerve bundles contained within larger circular-shaped fascicles. PS-OCT imaging was helpful in showing the characteristic birefringence exhibited by arrayed neural structures. Discussion: High-resolution OCT imaging may be useful in the optical identification of neurovascular structures during attempted regional nerve blockade. If incorporated into a needle-shaped catheter endoscope, such a technology could prevent intraneural and intravascular injections immediately prior to local anesthetic injection. The major limitation of OCT is that it can form a coherent image of tissue structures only to a depth of 1.5 - 2 mm.

  10. Morphometric Atlas Selection for Automatic Brachial Plexus Segmentation

    SciTech Connect

    Van de Velde, Joris; Wouters, Johan; Vercauteren, Tom; De Gersem, Werner; Duprez, Fréderic; De Neve, Wilfried; Van Hoof, Tom

    2015-07-01

    Purpose: The purpose of this study was to determine the effects of atlas selection based on different morphometric parameters, on the accuracy of automatic brachial plexus (BP) segmentation for radiation therapy planning. The segmentation accuracy was measured by comparing all of the generated automatic segmentations with anatomically validated gold standard atlases developed using cadavers. Methods and Materials: Twelve cadaver computed tomography (CT) atlases (3 males, 9 females; mean age: 73 years) were included in the study. One atlas was selected to serve as a patient, and the other 11 atlases were registered separately onto this “patient” using deformable image registration. This procedure was repeated for every atlas as a patient. Next, the Dice and Jaccard similarity indices and inclusion index were calculated for every registered BP with the original gold standard BP. In parallel, differences in several morphometric parameters that may influence the BP segmentation accuracy were measured for the different atlases. Specific brachial plexus-related CT-visible bony points were used to define the morphometric parameters. Subsequently, correlations between the similarity indices and morphometric parameters were calculated. Results: A clear negative correlation between difference in protraction-retraction distance and the similarity indices was observed (mean Pearson correlation coefficient = −0.546). All of the other investigated Pearson correlation coefficients were weak. Conclusions: Differences in the shoulder protraction-retraction position between the atlas and the patient during planning CT influence the BP autosegmentation accuracy. A greater difference in the protraction-retraction distance between the atlas and the patient reduces the accuracy of the BP automatic segmentation result.

  11. Upright MRI of glenohumeral dysplasia following obstetric brachial plexus injury.

    PubMed

    Nath, Rahul K; Paizi, Melia; Melcher, Sonya E; Farina, Kim L

    2007-11-01

    The purpose of this study was to evaluate the role of upright magnetic resonance imaging (MRI) shoulder scanning in the diagnosis of glenohumeral deformity following obstetric brachial plexus injury (OBPI). Eighty-nine children (ages 0.4 to 17.9 years) with OBPI who have medial rotation contracture and reduced passive and active lateral rotation of the shoulder were evaluated via upright MRI of the affected glenohumeral joint. Qualitative impressions of glenoid form were recorded, and quantitative measurements were made of glenoid version and posterior subluxation. Glenoid version of the affected shoulder averaged -16.8 +/- 11.0 degrees (range, -55 degrees to 1 degrees ), and percentage of the humeral head anterior to the glenoid fossa (PHHA) averaged 32.6 +/- 16.5% (range, -17.8% to 52.4%). The glenoid form was normal in 43 children, convex in 19 children and biconcave in 27 children. Standard MRI protocols were used to obtain bilateral images from 14 of these patients. Among the patients with bilateral MR images, glenoid version and PHHA were significantly different between the involved and uninvolved shoulders (P<.000). Glenoid version in the involved shoulder averaged -19.0 +/- 13.1 degrees (range, -52 degrees to -3 degrees ), and PHHA averaged 29.7 +/- 18.4% (range, -16.2% to 48.7%). In the uninvolved shoulder, the average glenoid version and PHHA were -5.2 +/- 3.7 degrees (range, -12 degrees to -1 degrees ) and 47.7 +/- 3.0% (range, 43% to 54%), respectively. The relative beneficial aspects of upright MRI include lack of need for sedation, low claustrophobic potential and, most important, natural, gravity-influenced position, enabling the surgeon to visualize the true preoperative picture of the shoulder. It is an effective tool for demonstrating glenohumeral abnormalities resulting from brachial plexus injury worthy of surgical exploration. PMID:17448618

  12. Brachial plexus injury as an unusual complication of coronary artery bypass graft surgery

    PubMed Central

    Chong, A; Clarke, C; Dimitri, W; Lip, G

    2003-01-01

    Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history. PMID:12612322

  13. Nerve Transfers in Birth Related Brachial Plexus Injuries: Where Do We Stand?

    PubMed

    Davidge, Kristen M; Clarke, Howard M; Borschel, Gregory H

    2016-05-01

    This article reviews the assessment and management of obstetrical brachial plexus palsy. The potential role of distal nerve transfers in the treatment of infants with Erb's palsy is discussed. Current evidence for motor outcomes after traditional reconstruction via interpositional nerve grafting and extraplexal nerve transfers is reviewed and compared with the recent literature on intraplexal distal nerve transfers in obstetrical brachial plexus injury. PMID:27094890

  14. Association of hemoglobin with ankle-brachial index in general population

    PubMed Central

    Chenglong, Zhang; Jing, Lei; Xia, Ke; Yang, Tianlun

    2016-01-01

    OBJECTIVES: Previous studies have demonstrated that both low and high hemoglobin concentrations are predictive of adverse cardiovascular outcomes in various populations. However, an association of hemoglobin with the ankle-brachial index, which is widely used as a screening test for peripheral arterial disease, has not yet been identified. METHODS: We examined 786 subjects (236 women and 550 men) who received routine physical check-ups. The ankle-brachial index and several hematological parameters, including the hemoglobin level, hematocrit and red blood cell count and other demographic and biochemical characteristics were collected. Univariate and multivariate linear regression analyses were performed to assess the relationships between the ankle-brachial index and the independent determinants. Receiver operating characteristic curve analysis was conducted to calculate the cut-off level of hemoglobin for a relatively low ankle-brachial index (less than 20% of all subjects, which was 1.02). RESULTS: The hemoglobin level, hematocrit and red blood cell count were correlated with the ankle-brachial index in the males (r=-0.274, r=-0.224 and r=-0.273, respectively, p<0.001 for all), but these associations were not significant in the females. Multivariate linear regression analysis revealed that the independent determinants of the ankle-brachial index included age, total cholesterol, high-density lipoprotein cholesterol and the white blood cell count for the females and age, hypertension, total cholesterol and hemoglobin (β=-0.001, p<0.001) for the males after adjusting for confounding factors. Receiver operating characteristic curve analysis revealed that the cut-off level of hemoglobin for predicting a low ankle-brachial index was 156.5 g/L in the males. CONCLUSIONS: A high hemoglobin concentration was independently correlated with a low ankle-brachial index in the healthy males, indicating that an elevation in this level may be associated with an increased

  15. Short series of upper limb acute arterial occlusions in 4 different etiologies and review of literature.

    PubMed

    Coskun, Selcuk; Soylu, Lutfi; Coskun, Pınar Koksal; Bayazıt, Murat

    2013-12-01

    Upper limb acute arterial occlusions are uncommon, and when compared with lower limb occlusions, only a few cases have been reported. Although atrial fibrillation is the most common cause, many conditions may lead to ischemia. In this article, 8 cases of upper limb arterial ischemia due to 4 different etiologies were reported (7 brachial, 1 axillary), and the literature was reviewed. PMID:24055482

  16. Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries.

    PubMed

    Jerome, J Terrence Jose; Rajmohan, Bennet

    2012-09-01

    Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5-T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5-T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. PMID:22434572

  17. Optic neuritis and rapidly progressive necrotizing retinitis as the initial signs of subacute sclerosing panencephalitis: a case report with clinical and histopathologic findings.

    PubMed

    Oray, Merih; Tuncer, Samuray; Kir, Nur; Karacorlu, Murat; Tugal-Tutkun, Ilknur

    2014-08-01

    We report a case of subacute sclerosing panencephalitis (SSPE) presenting first with optic neuritis and rapidly progressive necrotizing retinitis at the posterior pole. We reviewed the clinical, laboratory, photographic, angiographic, and histopathologic records of a patient with SSPE. A 15-year-old girl was referred after rapid loss of vision due to optic neuritis and macular necrosis in the right eye. She had a history of cardiac valve surgery, but had no systemic symptoms and extensive work-up was unrewarding. Contralateral involvement with rapidly progressive optic neuritis and macular necrotizing retinitis prompted retinochoroidal biopsy of the right eye, which revealed necrosis of inner retinal layers and perivascular lymphoplasmocytic infiltration with intact choroid and outer retina without any findings of inclusion bodies, microorganisms, or atypical cells. The diagnosis was based on histopathologic findings consistent with SSPE, and detection of elevated measles antibody titers in cerebrospinal fluid and serum. It was further confirmed by development of typical electroencephalography pattern at 6 months and neurological symptoms at 4-year follow-up. Clinicians need to be aware that optic neuritis and necrotizing retinitis at the posterior pole may be the presenting features of SSPE. PMID:24522882

  18. Head impulse gain and saccade analysis in pontine-cerebellar stroke and vestibular neuritis

    PubMed Central

    Todd, Michael; Halmagyi, Gabor M.; Aw, Swee

    2014-01-01

    Objective: We sought to quantify and compare angular vestibulo-ocular reflex (aVOR) gain and compensatory saccade properties elicited by the head impulse test (HIT) in pontine-cerebellar stroke (PCS) and vestibular neuritis (VN). Methods: Horizontal HIT was recorded ≤7 days from vertigo onset with dual-search coils in 33 PCS involving the anterior inferior, posterior inferior, and superior cerebellar arteries (13 AICA, 17 PICA, 3 SCA) confirmed by MRI and 20 VN. We determined the aVOR gain and asymmetry, and compensatory overt saccade properties including amplitude asymmetry and cumulative amplitude (ipsilesional trials [I]; contralesional trials [C]). Results: The aVOR gain (normal: 0.96; asymmetry = 2%) was bilaterally reduced, greater in AICA (I = 0.39, C = 0.57; asymmetry = 20%) than in PICA/SCA strokes (I = 0.75, C = 0.74; asymmetry = 7%), in contrast to the unilateral deficit in VN (I = 0.22, C = 0.76; asymmetry = 54%). Cumulative amplitude (normal: 1.1°) was smaller in AICA (I = 4.2°, C = 3.0°) and PICA/SCA strokes (I = 2.1°, C = 3.0°) compared with VN (I = 8.5°, C = 1.3°). Amplitude asymmetry in AICA and PICA/SCA strokes was comparable, but favored the contralesional side in PICA/SCA strokes and the ipsilesional side in VN. Saccade asymmetry <61% was found in 97% of PCS and none of VN. Gain asymmetry <40% was found in 94% of PCS and 10% of VN. Conclusion: HIT gains and compensatory saccades differ between PCS and VN. VN was characterized by unilateral gain deficits with asymmetric large saccades, AICA stroke by more symmetric bilateral gain reduction with smaller saccades, and PICA stroke by contralesional gain bias with the smallest saccades. Saccade and gain asymmetry should be investigated further in future diagnostic accuracy studies. Classification of evidence: This study provides Class II evidence that aVOR testing accurately distinguishes patients with PCS from VN (sensitivity 94%–97%, specificity 90%–100%). PMID:25253747

  19. Frequency of Autoantibodies and Connective Tissue Diseases in Chinese Patients with Optic Neuritis

    PubMed Central

    Yi, Zuohuizi; Huang, Dehui; Wei, Shihui

    2014-01-01

    Background Optic neuritis (ON) is often associated with other clinical or serological markers of connective tissue diseases (CTDs). To date, the effects of autoantibodies on ON are not clear. Purpose To assess the prevalence, clinical patterns, and short outcomes of autoantibodies and Sjögren’s syndrome (SS) involvement in Chinese ON patients and evaluate the relationship between ON, including their subtypes, and autoantibodies. Methods A total of 190 ON patients were divided into recurrent ON (RON), bilateral ON (BON), and isolated monocular ON (ION). Demographic, clinical, and serum autoantibodies data were compared between them with and without SS involvement. Serum was drawn for antinuclear antibody (ANA), extractable nuclear antigen antibodies (SSA/SSB), rheumatoid factor (RF), anticardiolipin antibodies (ACA), and anti-double-stranded DNA antibody (A-ds DNA), anticardiolipin antibody (ACLs), anti-β2-glycoprotein I (β2-GPI) and Aquaporin-4 antibodies (AQP4-Ab). Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate the atrophy of the optic nerve. Results 68 patients (35.79%) had abnormal autoantibodies, 26(13.68%) patients met diagnostic criteria for CTDs, including 15(7.89%) patients meeting the criteria for SS. Antibodies including SSA/SSB 23 (30.26%) (p1 and p 2<0.001) and AQP4–Ab10 (13.16%) (p1 = 0.044, p2 = 0.01) were significantly different in patients in the RON group when compared with those in the BON (P1 = RON VS ION) and ION (p2 = RON VS ION) groups. SS was more common in RON patients (p1 = 0.04, p2 = 0.028). There was no significant difference between SSA/SSB positive and negative patients in disease characteristics or severity. Similar results were obtained when SS was diagnosed in SSA/SSB positive patients. Conclusion RON and BON were more likely associated with abnormal autoantibodies; furthermore, AQP4 antibody, SSA/SSB and SS were more common in the RON patients. AQP4 antibodydetermination is

  20. Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging.

    PubMed

    Collins, J D; Shaver, M L; Disher, A C; Miller, T Q

    1995-01-01

    Magnetic resonance images (MRI) of brachial plexus anatomy bilaterally, not possible by plain radiographs or CT, were presented to the Vascular Surgery, Neurology, and the Neurosurgery departments. Patients were requested for MRI of their brachial plexus. They were referred for imaging and the imaging results were presented to the faculty and housestaff. Our technique was accepted and adopted to begin referrals for MRI evaluation of brachial plexopathy. Over 175 patients have been studied. Eighty-five patients were imaged with the 1.5 Tesla magnet (Signa; General Electric Medical Systems, Milwaukee, WI) 3-D reconstruction MRI. Coronal, transverse (axial), oblique transverse, and sagittal plane T1-weighted and selected T2-weighted pulse sequences were obtained at 4-5 mm slice thickness, 40-45 full field of view, and a 512 x 256 size matrix. Saline water bags were used to enhance the signal between the neck and the thorax. Sites of brachial plexus compromise were demonstrated. Our technique with 3-D reconstruction increased the definition of brachial plexus pathology. The increased anatomical definition enabled the vascular surgeons and neurosurgeons to improve patient care. Brachial plexus in vivo anatomy as displayed by MRI, magnetic resonance angiography (MRA), and 3-D reconstruction offered an opportunity to augment the teaching of clinical anatomy to medical students and health professionals. Selected case presentations (bodybuilder, anomalous muscle, fractured clavicle, thyroid goiter, silicone breast implant rupture, and cervical rib) demonstrated compromise of the brachial plexus displayed by MRI. The MRI and 3-D reconstruction techniques, demonstrating the bilateral landmark anatomy, increased the definition of the clinical anatomy and resulted in greater knowledge of patient care management. PMID:7697507

  1. Postfixed Brachial Plexus Radiculopathy Due to Thoracic Disc Herniation in a Collegiate Wrestler: A Case Report

    PubMed Central

    Kuzma, Scott A.; Doberstein, Scott T.; Rushlow, David R.

    2013-01-01

    Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1–T2 disc herniation. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Differential Diagnosis: Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. Treatment: The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1–T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Uniqueness: Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. Conclusions: The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1–T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for

  2. Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis.

    PubMed

    Brenton, J Nicholas; Banwell, Brenda L

    2016-01-01

    Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination. PMID:26496907

  3. Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome.

    PubMed

    Wakerley, Benjamin R; Yuki, Nobuhiro

    2014-03-01

    The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome is defined by rapidly progressive oropharyngeal and cervicobrachial weakness associated with areflexia in the upper limbs. Serial nerve conduction studies suggest that PCB represents a localised subtype of Guillain-Barré syndrome characterised by axonal rather than demyelinating neuropathy. Many neurologists are unfamiliar with PCB, which is often misdiagnosed as brainstem stroke, myasthenia gravis or botulism. The presence of additional ophthalmoplegia and ataxia indicates overlap with Fisher syndrome. Half of patients with PCB carry IgG anti-GT1a antibodies which often cross-react with GQ1b, whereas most patients with Fisher syndrome carry IgG anti-GQ1b antibodies which always cross-react with GT1a. Significant overlap between the clinical and serological profiles of these patients supports the view that PCB and Fisher syndrome form a continuous spectrum. In this review, we highlight the clinical features of PCB and outline new diagnostic criteria. PMID:23804237

  4. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    PubMed Central

    Su, Ta-Chen; Torng, Pao-Ling; Jeng, Jiann-Shing; Chen, Ming-Fong; Liau, Chiau-Suong

    2011-01-01

    Background: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited. Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR). Fasting blood levels of glucose, lipids, lipoprotein (a), high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured. Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a) and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity. Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than omnivores. Prevention of vitamin B12 deficiency might be beneficial for cardiovascular health in vegetarians. PMID:21915169

  5. [Differential diagnostic criteria in cervico-brachial psychalgia].

    PubMed

    Tröltzsch, M; Fischer, P

    1979-11-15

    In 100 patients with only for a short time existing pains in the region of neck, shoulder and arm and inconspicuous laboratory and X-ray findings by means of the galvanic test of the muscular function and Janda's test of the muscular function a vastly intact nerve-muscle-apparatus was proved. In the ENR-test after Brengelmann and Brengelmann clear introversion values, significantly high neurodizism values and slightly increased rigidity values were shown. Also the VELA-values were significantly higher than in the normal comparative group. In an additional inquiry predisposing biographical references for the existence of actual conflicts were found. As to the inclusion of further biographical data, 68% of intense affect reactions, 16% of functionally fixed neurotic reactions, 9% of primary and 7% of secondary neurotic maldevelopments are concerned. After a 4-week- hard-and-fast date (15 mg/a day) the complaints improved without a clear retrogression of the neurotic constellations. At the same time a change of the initially slightly increased conducting values of the skin and of the vegetative complaints appeared. A cervico-brachial psychalgia is present, when an organic muscle disease was excluded, when in the ENR-test high values to neuroticism, to introversion and rigidity are found and when a temporary connection to actual conflicts are the result. PMID:549300

  6. Clinical usefulness of ankle brachial index and brachial-ankle pulse wave velocity in patients with ischemic stroke

    PubMed Central

    Lee, Hyung-Suk; Lee, Hye Lim; Han, Ho-seong; Yeo, Minju; Kim, Ji Seon; Lee, Sung-Hyun; Lee, Sang-Soo; Shin, Dong-Ick

    2016-01-01

    Abstract Ankle brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are widely used noninvasive modalities to evaluate atherosclerosis. Recently, evidence has increased supporting the use of ABI and baPWV as markers of cerebrovascular disease. This study sought to examine the relationship between ABI and baPWV with ischemic stroke. This study also aimed to determine which pathogenic mechanism, large artery disease (LAD) or small vessel disease (SVD), is related to ABI or baPWV. Retrospectively, 121 patients with ischemic stroke and 38 subjects with no obvious ischemic stroke history were recruited. First, ABI and baPWV were compared between the groups. Then, within the stroke group, the relevance of ABI and baPWV with regard to SVD and LAD, which were classified by brain magnetic resonance image (MRI) and magnetic resonance angiography (MRA) or computed tomography angiography (CTA) findings, was assessed. The baPWV was higher in the stroke group than non-stroke group (1,944.18±416.6 cm/s vs. 1,749.76±669.6 cm/s, P<0.01). Regarding LAD, we found that mean ABI value was lower in the group with extracranial large artery stenosis (P<0.01), and there was an inverse linear correlation between ABI and the grade of extracranial large artery stenosis (P<0.01). For SVD, there was a significant correlation between SVD and baPWV (2,057.6±456.57 cm/s in the SVD (+) group vs. 1,491±271.62 cm/s in the SVD (-) group; P<0.01). However, the grade of abnormalities detected in SVD did not correlate linearly with baPWV. These findings show that baPWV is a reliable surrogate marker of ischemic stroke. Furthermore, baPWV and ABI can be used to indicate the presence of small vessel disease and large arterial disease, respectively. PMID:27533937

  7. Neuroprotective Effects of Recombinant T-cell Receptor Ligand in Autoimmune Optic Neuritis in HLA-DR2 Mice

    PubMed Central

    Brown, Lori; Andrew, Shayne; Meza-Romero, Roberto; Burrows, Gregory G.; Vandenbark, Arthur A.

    2012-01-01

    Purpose. Optic neuritis (ON) is a condition involving primary inflammation, demyelination, and axonal injury in the optic nerve and leads to apoptotic retinal ganglion cell (RGC) death, which contributes to the persistence of visual loss. Currently, ON has no effective treatment. The goal was to determine the effectiveness of immunotherapy with recombinant T-cell receptor ligand (RTL) in preventing ON in humanized HLA-DR2 transgenic mice. Methods. Experimental autoimmune encephalomyelitis (EAE) was induced with myelin oligodendrocyte glycoprotein in humanized HLA-DR2 (DRβ1*1501) transgenic mice. Five consecutive doses of RTL342M were administrated at the onset of ON. The development of autoimmune ON was assessed by histopathology at different time points. The levels of myelin loss, axonal loss, and RGC damage were examined by immunofluorescence. Results. HLA-DR2 mice developed chronic ON 2 days before EAE characterized by progressive neurodegeneration in both organs. RTL342M significantly suppressed inflammation in the optic nerve and spinal cord and provided protection for at least 30 days. Examination of myelin loss showed a marked suppression of demyelination and an increase in myelin recovery in the optic nerve. Moreover, RTL342M treatment revealed a neuroprotective effect on optic nerve axons and RGCs in retinas at postimmunization (PI) day 62. Conclusions. RTL342M suppressed clinical and histologic signs of EAE/ON by preventing the recruitment of inflammatory cells into the optic nerve and showed neuroprotective effects against ON. However, to achieve full therapeutic benefit, more doses may be needed. These findings suggest a possible clinical application of this novel class of T-cell-tolerizing drugs for patients with optic neuritis. PMID:22167100

  8. Brachial-to-radial systolic blood pressure amplification in patients with type 2 diabetes mellitus.

    PubMed

    Climie, R E D; Picone, D S; Keske, M A; Sharman, J E

    2016-06-01

    Brachial-to-radial-systolic blood pressure amplification (Bra-Rad-SBPAmp) can affect central SBP estimated by radial tonometry. Patients with type 2 diabetes mellitus (T2DM) have vascular irregularities that may alter Bra-Rad-SBPAmp. By comparing T2DM with non-diabetic controls, we aimed to determine the (1) magnitude of Bra-Rad-SBPAmp; (2) haemodynamic factors related to Bra-Rad-SBPAmp; and (3) effect of Bra-Rad-SBPAmp on estimated central SBP. Twenty T2DM (64±8 years) and 20 non-diabetic controls (60±8 years; 50% male both) underwent simultaneous cuff deflation and two-dimensional ultrasound imaging of the brachial and radial arteries. The first Korotkoff sound (denoting SBP) was identified from the first inflection point of Doppler flow during cuff deflation. Bra-Rad-SBPAmp was calculated by radial minus brachial SBP. Upper limb and systemic haemodynamics were recorded by tonometry and ultrasound. Radial SBP was higher than brachial SBP for T2DM (136±19 vs 127±17 mm Hg; P<0.001) and non-diabetic controls (135±12 vs 121±11 mm Hg; P<0.001), but Bra-Rad-SBPAmp was significantly lower in T2DM (9±8 vs 14±7 mm Hg; P=0.042). The product of brachial mean flow velocity × brachial diameter was inversely and independently correlated with Bra-Rad-SBPAmp in T2DM (β=-0.033 95% confidence interval -0.063 to -0.004, P=0.030). When radial waveforms were calibrated using radial, compared with brachial SBP, central SBP was significantly higher in both groups (T2DM, 116±13 vs 125±15 mm Hg; and controls, 112±10 vs 124±11 mm Hg; P<0.001 both) and there was a significant increase in the number of participants classified with 'central hypertension' (SBP⩾130 mm Hg; P=0.004). Compared with non-diabetic controls, Bra-Rad-SBPAmp is significantly lower in T2DM. Regardless of disease status, radial SBP is higher than brachial SBP and this results in underestimation of central SBP using brachial-BP-calibrated radial tonometry. PMID:26446391

  9. The Extent of Blockade Following Axillary and Infraclavicular Approaches of Brachial Plexus Block in Uremic Patients

    PubMed Central

    Sariguney, Damla; Mahli, Ahmet; Coskun, Demet

    2012-01-01

    Introduction This study was aimed to compare the axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method in terms of the sensory and motor block onset, quality, and extent of blocks of brachial plexus in uremic patients who underwent arteriovenous fistula surgery. Methods Forty patients scheduled for creation of arteriovenous fistula with axillary brachial plexus block (group AX, n = 20) or infraclavicular brachial plexus block (IC group, n = 20) were examined. The median, radial, ulnar, and musculocutaneous nerves were selectively localized by nerve stimulation. The volume of the local anesthetics was calculated based on the height of each patient, and the volume determined was prepared by mixing 2% lidocaine and 0.5% bupivacaine in equal proportions. Sensory and motor block were assessed at 3, 6, 9, 12, 15, 18, and 30th min and their durations were measured. Results While the adequate sensory and motor block rate with axillary approach was 100% in musculocutaneous, median, radial, ulnar and medial antebrachial cutaneous nerves, it was 65% in axillary nerve, 80% in intercostobrachial nerve and 95% in medial brachial cutaneous nerve. This rate was found to be 100% for all the nerves with infraclavicular approach. Conclusion For arteriovenous fistula surgeries in uremic patients, both axillary approach performed through multiple injection method and vertical infraclavicular approach performed through single injection method can be used successfully; however, for the short performance of the procedure, infraclavicular block may be preferred. Keywords Brachial plexus block; Axillary; Infraclavicular; Uremic patients PMID:22383924

  10. Use of a Collagen-Based Device for Closure of Low Brachial Artery Punctures

    SciTech Connect

    Belenky, A. Aranovich, D.; Greif, F.; Bachar, G.; Bartal, G.; Atar, E.

    2007-04-15

    Purpose. To report our experience with the Angioseal vascular closure device for hemostasis of distal brachial artery puncture. Methods. Between September 2003 and August 2005, 64 Angioseal vascular closure devices were inserted in 64 patients (40 men, 24 women; mean age 65 years) immediately after diagnostic or therapeutic arterial angiographies performed through a 5 Fr to 7 Fr sheath via the distal brachial artery. Ultrasound examination of the brachial artery preceded the angiography in all cases and only arteries wider than 4 mm were closed by the Angioseal. In cases of a sonographically evident thin subcutaneous space of the cubital fossa, tissue tumescence, using 1% Lidocaine, was performed prior to the arterial closure. Results. The deployment success rate was 100%. No major complications were encountered; only 2 patients developed puncture site hematoma, and these were followed conservatively. Conclusions. Closure of low brachial artery punctures with the Angioseal is simple and safe. No additional manual compression is required. We recommend its use after brachial artery access interventions, through appropriately wide arteries, to improve early patient ambulation and potentially reduce possible puncture site complications.

  11. Early transient radiation-induced brachial plexopathy in locally advanced head and neck cancer

    PubMed Central

    Etiz, Durmus

    2016-01-01

    Aim of the study Early transient brachial plexopathy following radiotherapy (RT) in patients with head and neck cancer may be underreported and associated with a dose-response. Our purpose was to determine the incidence of early transient radiation-ınduced brachial plexopathy (RIBP) in patients receiving primary RT (± chemotherapy) for locally advanced head and neck cancer (HNC). Material and methods Twenty-seven locally advanced HNC patients who have no finding of brachial plexopathy at the diagnosis were evaluated 3 times by a specifically developed 13-item questionnaire for determining early transient RIBP. The 54 brachial plexus in 27 patients were delineated and dose volume histograms were calculated. Results Median follow-up period was 28 (range: 15–40) months. The mean BP volume was 7.9 ±3.6 cm3, and the mean and maximum doses to the BP were 45.3 (range: 32.3–59.3) Gy, and 59.4 (range: 41.4–70.3) Gy, respectively. Maximum dose to the BP was ≥ 70 Gy only in 2 nasopharyngeal cancer patients. Two (7%) early transient RIBP were reported at 7th and 8th month after RT under maximum 67.17 and 55.37 Gy, and mean 52.95 and 38.60 Gy RT doses. Conclusions Two (7%) early RIBP were seen in the patient group, although brachial plexus maximum doses were ≥ 66 Gy in 75% of patients. PMID:27095943

  12. Above Elbow Amputation Under Brachial Plexus Block at Supraclavicular and Interscalene Levels

    PubMed Central

    Ahmad, Hassan; Yadagiri, Manjula; Macrosson, Duncan; Majeed, Amer

    2015-01-01

    Introduction: The brachial plexus block is a commonly performed procedure in the anesthetic practice today. It is performed for analgesia as well as anesthesia for upper limb procedures. It has been used for amputation and replantation surgeries of the upper limb. Case presentation: We present the case of a 68-year-old gentleman who had brachial plexus block at supraclavicular and interscalene levels as the sole anesthetic for undergoing above elbow amputation. He was deemed to be very high risk for a general anesthetic as he suffered from severe chronic obstructive pulmonary disease (COPD) and a very poor exercise tolerance (NYHA Class III). The supraclavicular brachial plexus block was supplemented with an interscalene brachial plexus block due to inadequate surgical anesthesia encountered with the former. The procedure was successfully completed under regional anesthesia. Conclusions: The brachial plexus block can be performed at different levels in the same patient to achieve desired results, while employing sound anatomical knowledge and adhering to the maximum safe dose limit of the local anesthetic. PMID:26705518

  13. Characteristic features of hereditary neuropathy with liability to pressure palsy (HNPP) presenting with brachial plexopathy in soldiers.

    PubMed

    Kim, Kyoung-Eun

    2014-11-15

    A brachial plexus lesion is not common in hereditary neuropathy with liability to pressure palsy (HNPP). We report the clinical and electrodiagnostic features of young soldiers with HNPP presenting with brachial plexopathy. By reviewing 2year medical records from Korean military hospitals, we identified soldiers with brachial plexus lesions. Among them, patients diagnosed with HNPP were determined and clinical and electrophysiological findings were compared between HNPP and non-HNPP patients with a brachial plexus lesion. Thirteen patients (6.8%) were diagnosed with HNPP among 189 patients with a brachial plexus lesion. Push-ups, as either a punishment or an exercise, was the most frequent preceding event in HNPP patients (76.9%), whereas it was rare in non-HNPP patients. The distal motor latency of the median nerve showed the highest sensitivity (90.9%) and specificity (100%) for HNPP in patients with a brachial plexus lesion. In conclusion, HNPP should be suspected in patients with brachial plexopathy if brachial plexopathy develops after push-ups or if the distal motor latency of median nerves is prolonged. PMID:25175852

  14. Constraint-Induced Movement Therapy for Children with Obstetric Brachial Plexus Palsy: Two Single-Case Series

    ERIC Educational Resources Information Center

    Buesch, Francisca Eugster

    2010-01-01

    The objective of this pilot study was to investigate the feasibility of constraint-induced movement therapy (CIMT) in children with obstetric brachial plexus palsy and receive preliminary information about functional improvements. Two patients (age 12 years) with obstetric brachial plexus palsy were included for a 126-h home-based CIMT…

  15. Hand Function in Children with an Upper Brachial Plexus Birth Injury: Results of the Nine-Hole Peg Test

    ERIC Educational Resources Information Center

    Immerman, Igor; Alfonso, Daniel T.; Ramos, Lorna E.; Grossman, Leslie A.; Alfonso, Israel; Ditaranto, Patricia; Grossman, John A. I.

    2012-01-01

    Aim: The aim of this study was to evaluate hand function in children with Erb upper brachial plexus palsy. Method: Hand function was evaluated in 25 children (eight males; 17 females) with a diagnosed upper (C5/C6) brachial plexus birth injury. Of these children, 22 had undergone primary nerve reconstruction and 13 of the 25 had undergone…

  16. Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

    PubMed Central

    Seo, Tae Gyu; Kim, In-Soo; Son, Eun Seok

    2016-01-01

    Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA. PMID:27152289

  17. Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

    PubMed

    Seo, Tae Gyu; Kim, Du Hwan; Kim, In-Soo; Son, Eun Seok

    2016-04-01

    Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA. PMID:27152289

  18. Primary brachial vein transposition for hemodialysis access: report of a case and review of the literature.

    PubMed

    Lambidis, Constantinos; Galanopoulos, Georgios

    2013-07-01

    The superiority of autogenous fistulae in patients with end-stage renal disease, performing hemodialysis, is well established and largely accepted. However, in case that superficial veins in the upper arm are not available for fistula construction, brachial vein transposition may be a viable alternative prior to graft placement. This transposition could be done as a primary or staged procedure, depending on the vein size. We present the case of a 63-year-old male patient with a thrombosed arteriovenous graft in the forearm and a large brachial vein in the ipsilateral upper arm. A one-stage (primary) brachial vein transposition was performed. The fistula, 10 months after its construction, is still patent. No complications have occurred. PMID:23134151

  19. A novel technique of ultrasound-guided brachial plexus block in calves.

    PubMed

    Iwamoto, Jiro; Yamagishi, Norio; Sasaki, Kouya; Kim, Danil; Devkota, Bhuminand; Furuhama, Kazuhisa

    2012-12-01

    An interventional ultrasound technique to increase the safety of surgical treatment of the calf forelimb was tested. First, the brachial plexus was evaluated using ultrasonography and then 2% lidocaine was injected under ultrasound guidance. Ultrasonically, the brachial plexus appeared as multiple hypoechoic areas surrounded by a hyperechoic rim or a hyperechoic structure characterised by multiple discontinuous lines. It was located between the omotransverse muscle and axillary artery and vein. The sensitive effect in the forelimb was seen mainly in the area supplied by the musculocutaneous nerve, indicating successful blockage in the nerve plexus. Out of the eight forelimbs, the motor effect was observed in seven forelimbs. These results suggest the clinical feasibility of ultrasound-guided brachial plexus block in bovine medicine, although further studies are needed to examine various approaches, including the sites of needle insertion and the appropriate volume and dosage of anaesthetic. PMID:22682007

  20. Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience

    PubMed Central

    Elzinga, Kate; Zuo, Kevin J; Olson, Jaret L; Morhart, Michael; Babicki, Sasha; Chan, K Ming

    2014-01-01

    Traumatic brachial plexus root avulsions are devastating injuries, and are complex and challenging to reconstruct. Double free muscle transfer using the gracilis muscles is a potentially effective method of restoring upper extremity function. The authors report on the first two patients treated using this technique in Canada. Both sustained traumatic brachial plexus root avulsion injuries resulting in a flail arm. In the first step of this two-stage procedure, a gracilis muscle was transferred to restore elbow flexion, and wrist and digit extension. Months later, the transfer of the second gracilis muscle was performed to enhance elbow flexion and to enable wrist and digit flexion. Postoperatively, both patients achieved Medical Research Council grade 4 elbow flexion, functional handgrip and were able to return to gainful employment. Patient satisfaction was high and active range of motion improved substantially. The authors’ experience supports the use of this technique following severe brachial plexus injury. PMID:25152644

  1. Brachial Plexopathy/Nerve Root Avulsion in a Football Player: The Role of Electrodiagnostics

    PubMed Central

    Radecki, Jeffrey; Wolfe, Scott W.; Strauss, Helene L.; Mintz, Douglas N.

    2008-01-01

    Electromyography (EMG) studies are a useful tool in anatomical localization of peripheral nerve and brachial plexus injuries. They are especially helpful in distinguishing between brachial plexopathy and nerve root injuries where surgical intervention may be indicated. EMG can also assist in providing prognostic information after nerve injury as well as after nerve repair. In this case report, a football player presented with weakness in his right upper limb after a traction/traumatic injury to the right brachial plexus. EMG studies revealed evidence of both pre- and postganglionic injury to multiple cervical roots. The injury was substantial enough to cause nerve root avulsions involving the C6 and C7 levels. Surgical referral led to nerve grafts targeted at regaining function in shoulder abduction and elbow flexion. After surgery, the patient’s progress was monitored utilizing EMG to assist in identifying true axonal regeneration. PMID:18751870

  2. A cadaveric microanatomical study of the fascicular topography of the brachial plexus.

    PubMed

    Sinha, Sumit; Prasad, G Lakshmi; Lalwani, Sanjeev

    2016-08-01

    OBJECT Mapping of the fascicular anatomy of the brachial plexus could provide the nerve surgeon with knowledge of fascicular orientation in spinal nerves of the brachial plexus. This knowledge might improve the surgical outcome of nerve grafting in brachial plexus injuries by anastomosing related fascicles and avoiding possible axonal misrouting. The objective of this study was to map the fascicular topography in the spinal nerves of the brachial plexus. METHODS The entire right-sided brachial plexus of 25 adult male cadavers was dissected, including all 5 spinal nerves (C5-T1), from approximately 5 mm distal to their exit from the intervertebral foramina, to proximal 1 cm of distal branches. All spinal nerves were tagged on the cranial aspect of their circumference using 10-0 nylon suture for orientation. The fascicular dissection of the C5-T1 spinal nerves was performed under microscopic magnification. The area occupied by different nerve fascicles was then expressed as a percentage of the total cross-sectional area of a spinal nerve. RESULTS The localization of fascicular groups was fairly consistent in all spinal nerves. Overall, 4% of the plexus supplies the suprascapular nerve, 31% supplies the medial cord (comprising the ulnar nerve and medial root of the median nerve [MN]), 27.2% supplies the lateral cord (comprising the musculocutaneous nerve and lateral root of the MN), and 37.8% supplies the posterior cord (comprising the axillary and radial nerves). CONCLUSIONS The fascicular dissection and definitive anatomical localization of fascicular groups is feasible in plexal spinal nerves. The knowledge of exact fascicular location might be translatable to the operating room and can be used to anastomose related fascicles in brachial plexus surgery, thereby avoiding the possibility of axonal misrouting and improving the results of plexal reconstruction. PMID:26654179

  3. Brachial Plexus Tumors in a Consecutive Series of Twenty One Patients

    PubMed Central

    Go, Myeong Hoon; Cho, Ki Hong

    2012-01-01

    Objective This is a retrospective review of 22 surgically treated benign and malignant tumors of brachial plexus region to describe clinical presentation, the characteristics of brachial plexus tumor and clinical outcomes with a literature review. Methods Twenty-one patients with consecutive 22 surgeries for primary brachial plexus tumors were enrolled between February 2002 and November 2011 were included in this study. The medical records of all patients were reviewed. Results Eleven male and 10 female patients were enrolled. Mean age was 39 years. Three patients had brachial plexus tumor associated with neurofibromatosis (13.6%). Presenting signs and symptoms included parenthesis and numbness (54.5%), radiating pain (22.7%), direct tenderness and pain (27.2%), palpable mass (77.3%). Twelve patients presented preoperative sensory deficit (54.5%) and 9 patients presented preoperative motor deficit (40.9%). Twenty tumors (90.9%) were benign and 2 tumors (9.1%) were malignant. Benign tumors included 15 schwannomas (68.2%), 4 neurofibromas (18.2%) and 1 granular cell tumor (4.5%). There were 1 malignant peripheral nerve sheath tumor (MPNST) and 1 malignant granular cell tumor. Gross total resection was achieved in 16 patients (72.7%), including all schwannomas, 1 neurofibroma. Subtotal resection was performed in 6 tumors (27.3%), including 3 neurofibromatosis associated with brachial plexus neurofibromas, 1 MPNST and 2 granular cell tumor in one patient. Conclusion Resection of tumor is the choice of tumor in the most of benign and malignant brachial plexus tumors. Postoperative outcomes are related to grade of resection at surgery and pathological features of tumor. PMID:23091673

  4. Outcome in adolescence of brachial plexus birth palsy

    PubMed Central

    Hulleberg, Gunn; Elvrum, Ann-Kristin G; Brandal, Merethe; Vik, Torstein

    2014-01-01

    Background and purpose — The frequency and severity of a permanent lesion after brachial plexus birth palsy (BPBP) and its impact on activities of daily living are not well documented. We therefore investigated the outcome of BPBP in adolescents, regarding arm function and consequences for activity and participation. Participants and methods — Of 30,574 babies born at St. Olavs University Hospital in 1991–2000, 91 had BPBP (prevalence 3 per 1,000), and 69 of these individuals were examined at a median age of 14 (10–20) years. The examination included the modified Mallet classification, range of motion, shoulder rotation and grip strength, Assisting Hand Assessment, and Canadian Occupational Performance Measure. Of the 22 subjects who were not examined, 3 could not be traced and 19 reported having no problems in the affected arm. Results — At follow-up, 17 adolescents had a permanent lesion (i.e. individual Mallet subscore below 4) with a median Mallet total score of 15 (9–19), while 52 had good or normal shoulder function (median Mallet total score 25 (23–25)). All participants with a permanent lesion had reduced active shoulder rotation (≤ 15°), 16 had elbow extension deficit, and 10 had subnormal grip strength. External rotation was considerably weaker in the affected shoulder. In addition, they had ineffective use of the affected arm in bimanual activities. Even so, all except 1 were independent in activities of daily living, although 15 experienced minor difficulties. Interpretation — Every fourth to fifth child with BPBP had a permanent lesion as an adolescent. External rotation was the most impaired movement. Despite ineffective use of the affected arm in bimanual activities, all of the participants except one were independent in activities of daily living. PMID:25238434

  5. Brachial Artery Aneurysm in a 7-Month-Old Infant: Case Report and Literature Review

    PubMed Central

    Gangopadhyay, Noopur; Chong, Tae; Chhabra, Avneesh

    2016-01-01

    Summary: Congenital upper extremity aneurysms are very rare and can be challenging to diagnose and treat. Although they can present as an isolated finding, they are often associated with other systemic conditions. We present a rare case of brachial artery aneurysm in a 7-month-old boy. The patient was evaluated with ultrasound, magnetic resonance angiography, and vein mapping before surgical reconstruction. After excision of the aneurysm, the brachial artery was reconstructed with an interposition saphenous vein graft. Because of potentially associated diagnoses and the possibility of concurrent aneurysms, this condition requires multidisciplinary management. PMID:27014554

  6. Sup-ER orthosis: an innovative treatment for infants with birth related brachial plexus injury.

    PubMed

    Durlacher, Kim M; Bellows, Doria; Verchere, Cynthia

    2014-01-01

    Impairments in active and passive range of upper extremity supination and shoulder external rotation are common sequelae for children with delayed recovery from birth related brachial plexus injury. Orthotic intervention may complement traditional treatment strategies commonly employed in the newborn period. These authors describe their custom fabricated orthosis designed to balance shoulder growth and muscular function, and improve prognosis of long term functional outcomes for children with birth related brachial plexus injury. - Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor. PMID:25042285

  7. Brachial plexus injury in two red-tailed hawks (Buteo jamaicensis).

    PubMed

    Shell, L; Richards, M; Saunders, G

    1993-01-01

    Two red-tailed hawks (Buteo jamaicensis), found near Deltaville, Virginia (USA), were evaluated because of inability to use a wing. Results of needle electromyographic studies of the affected wing muscles in both hawks were compatible with denervation. On euthanasia, one hawk had extensive axon and myelin loss with multifocal perivascular lymphocytic inflammation of its brachial plexus and radial nerve. Demyelination and axon loss in the dorsal white matter of the spinal cord on the affected side also were found at the origin of the brachial plexus. The other hawk's wing had not returned to functional status > 2 yr after injury. PMID:8383253

  8. Quality of life following traumatic brachial plexus injury: A questionnaire study.

    PubMed

    Gray, Beverley

    2016-08-01

    There is limited qualitative research available that explores the impact of a traumatic brachial plexus injury on patients and their quality of life experiences. This paper builds upon previous work on this subject by this author. Patients were selected from those who were on the database for the Scottish National Brachial Plexus Injury Service between 2011 and 2013. The World Health Organization (WHO) Quality of Life (QoL) - BREF questionnaire was used and 47 questionnaires were distributed with 22 returned. Findings included patients' ratings of their quality of life, physical and psychological health along with their perceived satisfaction with social relationships. PMID:27091305

  9. Imidazol-1-ylethylindazole Voltage-Gated Sodium Channel Ligands Are Neuroprotective during Optic Neuritis in a Mouse Model of Multiple Sclerosis

    PubMed Central

    2014-01-01

    A series of imidazol-1-ylethylindazole sodium channel ligands were developed and optimized for sodium channel inhibition and in vitro neuroprotective activity. The molecules exhibited displacement of a radiolabeled sodium channel ligand and selectivity for blockade of the inactivated state of cloned neuronal Nav channels. Metabolically stable analogue 6 was able to protect retinal ganglion cells during optic neuritis in a mouse model of multiple sclerosis. PMID:24601592

  10. Origin of Medial and Lateral Pectoral Nerves from the Supraclavicular Part of Brachial Plexus and its Clinical Importance – A Case Report

    PubMed Central

    Shetty, Prakashchandra; Nayak, Satheesha B; Kumar, Naveen; Thangarajan, Rajesh; D’Souza, Melanie Rose

    2014-01-01

    Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral nerve arose from the anterior division of the upper trunk of the brachial plexus. The lateral pectoral nerve supplied the pectoralis major and the medial pectoral nerve supplied pectoralis major and pectoralis minor muscles through two separate branches. PMID:24701504

  11. Assessment of variation in depth of brachial plexus using ultrasound for supraclavicular brachial plexus block in patients undergoing elective upper limb surgery

    PubMed Central

    Mistry, Tuhin; Mangal, Vandana; Sharma, Gaurav; Agrawal, Aachu

    2016-01-01

    Background and Aims: Supraclavicular approach to the brachial plexus may be associated with complications such as pneumothorax, inadvertent vascular puncture, inter-scalene block and neurovascular injuries. The present study was conceived to find out the variation in depth of brachial plexus to suggest the minimum length of needle required to effectively perform the block, thus preventing possible complications. Methods: After approval from our Institutional Ethical Committee, informed and written consent was obtained from each of the ninety American Society of Anesthesiologists Physical Status I and II patients recruited, of either sex in the age group of 20–50 years. Supraclavicular fossa was scanned using a high-frequency linear probe, and the distances (shortest distance [SD] from skin to the most superficial neural element and longest distance [LD] from skin to the most deep neural element) were measured using on-screen callipers on optimal frozen image. Pearson correlation was used to find out the relation between these two distances and demographic parameters. Results: Mean SD was 0.60 ± 0.262 cm, and mean LD was found to be 1.34 ± 0.385 cm. We observed significant correlation between these two distances with weight and body mass index (BMI). Conclusion: Significant correlation was observed between SD and LD with weight and BMI. We suggest that a needle with a shaft length of 3 cm will be sufficient to reach the sheath of the brachial plexus during performance of the block. PMID:27330200

  12. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: evaluation of nerve viscoelastic properties

    PubMed Central

    Jin, Hua; Yang, Qi; Ji, Feng; Zhang, Ya-jie; Zhao, Yan; Luo, Min

    2015-01-01

    The transplantation of embryonic stem cells can effectively improve the creeping strength of nerves near an injury site in animals. Amniotic epithelial cells have similar biological properties as embryonic stem cells; therefore, we hypothesized that transplantation of amniotic epithelial cells can repair peripheral nerve injury and recover the creeping strength of the brachial plexus nerve. In the present study, a brachial plexus injury model was established in rabbits using the C6 root avulsion method. A suspension of human amniotic epithelial cells was repeatedly injected over an area 4.0 mm lateral to the cephal and caudal ends of the C6 brachial plexus injury site (1 × 106 cells/mL, 3 μL/injection, 25 injections) immediately after the injury. The results showed that the decrease in stress and increase in strain at 7,200 seconds in the injured rabbit C6 brachial plexus nerve were mitigated by the cell transplantation, restoring the viscoelastic stress relaxation and creep properties of the brachial plexus nerve. The forepaw functions were also significantly improved at 26 weeks after injury. These data indicate that transplantation of human amniotic epithelial cells can effectively restore the mechanical properties of the brachial plexus nerve after injury in rabbits and that viscoelasticity may be an important index for the evaluation of brachial plexus injury in animals. PMID:25883625

  13. Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients

    SciTech Connect

    Olsen, N.K.; Pfeiffer, P.; Johannsen, L.; Schroder, H.; Rose, C. )

    1993-04-30

    The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients, treated according to the Danish Breast Cancer Cooperative Group protocols. One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months (13-99 months). After total mastectomy and axillary node sampling, high-risk patients were randomized to adjuvant therapy. One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks. In addition, 82 of these patients received cytotoxic therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and 46 received tamoxifen. Five percent and 9% of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy, respectively. Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy (p = 0.04) and in younger patients (p = 0.04). The clinical manifestations were paraesthesia (100%), hypaesthesia (74%), weakness (58%), decreased muscle stretch reflexes (47%), and pain (47%). The brachial plexus is more vulnerable to large fraction size. Fractions of 2 Gy or less are advisable. Cytotoxic therapy adds to the damaging effect of radiotherapy. Peripheral nerves in younger patients seems more vulnerable. Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus. 24 refs., 9 tabs.

  14. Intraoperative brachial plexus injury during emergence following movement with arms restrained: a preventable complication?

    PubMed Central

    Chandler, Mark H; DiMatteo, Laura; Hasenboehler, Erik A; Temple, Michael

    2007-01-01

    Background Despite considerable analysis and preventive strategies, brachial plexus injuries remain fairly common in the perioperative setting. These injuries range from brief periods of numbness or discomfort in the immediate postoperative period to, in rare cases, profound, prolonged losses of sensation and function. We present a case of an orthopedic surgery patient who suffered a brachial plexus injury while under anesthesia after trying to sit upright with his arms restrained. Case presentation After the uneventful placement of an intramedullary tibial nail, an 18 year old patient tried to sit upright with his arms restrained while still under the influence of anesthesia. In the immediate postoperative period, the patient complained of a profound loss of sensation in his left arm and an inability to flex his left elbow, suppinate his arm, or abduct and rotate his shoulder. Neurological examination and subsequent studies revealed a C5-6 brachial plexus injury. The patient underwent range of motion physical therapy and, over the next three months, regained the full function and sensation of his left arm. Conclusion Restraining arms during general anesthesia to prevent injury remains a wise practice. However, to avoid injuring the brachial plexus while the arms are restrained, extra caution must be used to prevent unexpected patient movement and to ensure gentle emergence. PMID:18271944

  15. In situ cephalic vein bypasses from axillary to the brachial artery after catheterization injuries.

    PubMed

    Hudorovic, Narcis; Lovricevic, Ivo; Ahel, Zaky

    2010-07-01

    The need to bypass to the brachial artery is rare. Over a five-year period, 16 patients had suffered iatrogenic post-catheterization injuries of the upper extremity. We have performed 16 bypasses, in 16 patients, mean age was 65 years (range 47-75), to the brachial artery originating from an artery proximal to the shoulder joint. In all cases, the axillary artery was the donor artery. All bypasses were created by using the cephalic vein with the in situ technique and distal anastomoses were made to a distance-free section of brachial artery. No operative mortality, neurological complications or major upper-extremity amputation was associated with the procedure. Life-long-conduit analysis showed 75% patency in the five-year period. After iatrogenic post-catheterization trauma of arterial system of upper extremity, bypasses from axillary to brachial artery with the cephalic vein with the in situ technique is a safe operation with satisfactory long-term patency. PMID:20395248

  16. Luxation de l’épaule compliquée de paralysie du plexus brachial

    PubMed Central

    Lukulunga, Loubet Unyendje; Moussa, Abdou Kadri; Mahfoud, Mustapha; EL Bardouni, Ahmed; Berrada, Mohamed Saleh; El Yaacoubi, Moradh

    2014-01-01

    Les auteurs rapportent l'observation d'une paralysie totale du plexus brachial survenue trois mois après un épisode de luxation antéro-interne sous coracoïdienne associée à une fracture du trochiter chez une patiente âgée de 88 ans. PMID:25426187

  17. Ultrasound Guided Low Approach Interscalene Brachial Plexus Block for Upper Limb Surgery

    PubMed Central

    Park, Sun Kyung; Sung, Min Ha; Suh, Hae Jin

    2016-01-01

    Background The interscalene brachial plexus block is widely used for pain control and anesthetic purposes during shoulder arthroscopic surgeries and surgeries of the upper extremities. However, it is known that interscalene brachial plexus block is not appropriate for upper limb surgeries because it does not affect the lower trunk (C8-T1, ulnar nerve) of the brachial plexus. Methods A low approach, ultrasound-guided interscalene brachial plexus block (LISB) was performed on twenty-eight patients undergoing surgery of the upper extremities. The patients were assessed five minutes and fifteen minutes after the block for the degree of block in each nerve and muscle as well as for any complications. Results At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 ± 2.6 and 1.1 ± 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 26 of the 28 patients (92.8%), and in all of the other three nerves in all 28 patients. None of the patients received additional analgesics, and none experienced complications. Conclusions The present study confirmed the achievement of an appropriate sensory and motor block in the upper extremities, including the ulnar nerve, fifteen minutes after LISB, with no complications. PMID:26839666

  18. The Association of Homocysteine and Related Factors to Brachial Artery Diameter and Flow-Mediated Dilation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Brachial artery flow-mediated dilation (BAFMD) has been proposed as a measurement of the degree and severity of cardiovascular disease. The purpose of this study was to (1) evaluate the associations between BAFMD and homocysteine, folate, vitamin B12, vitamin B6, (2) examine the influence of 5,10-me...

  19. Changes in Spinal Cord Architecture after Brachial Plexus Injury in the Newborn

    ERIC Educational Resources Information Center

    Korak, Klaus J.; Tam, Siu Lin; Gordon, Tessa; Frey, Manfred; Aszmann, Oskar C.

    2004-01-01

    Obstetric brachial plexus palsy is a devastating birth injury. While many children recover spontaneously, 20-25% are left with a permanent impairment of the affected limb. So far, concepts of pathology and recovery have focused on the injury of the peripheral nerve. Proximal nerve injury at birth, however, leads to massive injury-induced…

  20. Brachial plexus palsy after a left-side modified radical mastectomy with immediate latissimusdorsi flap reconstruction: report of a case

    PubMed Central

    2013-01-01

    Brachial plexus injury is a rare complication during operation and anesthesia; it can occur as a result of various mechanisms such as inappropriate positioning, over-abduction and stretching the upper limbs. Brachial plexus injury can cause the poor function of the upper limb before recovery, and sometimes serious injury is unable to completely recovered the function permanently. Here, we report a female breast cancer patient who sustained a left brachial plexus palsy after modified radical mastectomy with immediate breast reconstruction with latissimusdorsi flap (LDF). The patient had fully recovered with normal function of her left upper limb six months postoperation after conservative treatment. PMID:24127915

  1. Brachial-Ankle Pulse Wave Velocity: Background, Method, and Clinical Evidence

    PubMed Central

    Munakata, Masanori

    2016-01-01

    Background The populations of many developed countries are becoming progressively older. In aged societies, assessment of total vascular risk is critically important, because old age is usually associated with multiple risks. In this regard, pulse wave velocity (PWV) could be a global cardiovascular marker, since it increases with advancing age, high blood pressure, hyperglycaemia, and other traditional risks, summating cardiovascular risks. Carotid-femoral PWV has been widely applied in Western countries and has been used as a gold-standard PWV measure. However, this measure has never been implemented by general practitioners in Japan, possibly because of methodological difficulties. The life expectancy of Japanese people is now the highest in the world, and the establishment of an adequate total vascular risk measure is an urgent need. Against this background, brachial-ankle PWV was developed at the beginning of this century. Summary Measurement of this parameter is easy, and its reproducibility is good. Moreover, the generality of the methodology is guaranteed. Brachial-ankle PWV has been reported to consistently increase with most traditional cardiovascular risk factors except dyslipidaemia. A meta-analysis of cohort studies including various levels of risk has shown that a 1 m/s increase in brachial-ankle PWV is associated with a 12% increase in the risk of cardiovascular events. Moreover, simultaneous evaluation of the ankle-brachial index could allow further risk stratification of high-risk individuals, who are common in aged societies. This unique feature is indispensable for the management of aged populations, who usually are exposed to multiple risks and have polyvascular diseases. This evidence, however, is chiefly derived from East Asian countries. The collection of data from Caucasian populations, therefore, remains a task for the future. Key Message Brachial-ankle PWV has the potential to become a measure of arterial stiffness worldwide. PMID:27195241

  2. Combined Spinal Cord Stimulation and Peripheral Nerve Stimulation for Brachial Plexopathy: A Case Report.

    PubMed

    Choi, Ji Hye; Choi, Shu Chung; Kim, Dong Kyu; Sung, Choon Ho; Chon, Jin Young; Hong, Sung Jin; Lee, Ji Young; Moon, Ho Sik

    2016-03-01

    Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes cause severe chronic pain and disability. There are a number of possible treatments for this condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been tried for various chronic pain diseases because of their different mechanisms of action.Here, we describe the case of a 54-year-old man who was diagnosed with brachial plexopathy 8 years ago. He underwent video-assisted thoracoscopic surgery to remove a superior mediastinal mass. However, his brachial plexus was damaged during the surgery. Although he had received various treatments, the pain did not improve. For the management of intractable severe pain, he underwent SCS 2 years ago, which initially reduced his pain from numeric rating scale (NRS) 10/10 to NRS 4 - 5/10, but the pain then gradually increased, reaching NRS 8/10, 6 months ago. At that time, he was refractory to other treatments, and we therefore applied PNS in combination with SCS. The PNS electrode was positioned on the radial nerve under ultrasound guidance. After combined PNS and SCS, his background pain disappeared, although a breakthrough pain (NRS 3 - 4/10) was caused intermittently by light touch. Furthermore, the patient's need for analgesics decreased, and he was satisfied with the outcome of this combined treatment. We concluded that combined SCS and PNS is a very useful treatment modality, which can stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial plexopathy. PMID:27008302

  3. Evaluation of the circulating CD34+, CD309+, and endothelial progenitor cells in patients with first attack of optic neuritis

    PubMed Central

    Etemadifar, Masoud; Dehghani, Leila; Ganji, Hamid; Soleimani, Reza; Talebi, Maedeh; Eskandari, Nahid; Samani, Fazel Sahraneshin; Meamar, Rokhsareh

    2015-01-01

    Background: Endothelial progenitor cells (EPCs) are present in circulation and contribute to vasculogenesis in adults. The aim of the present study was to determine the number of circulating EPCs in patients with optic neuritis (ON). Materials and Methods: Fifty patients with ON were diagnosed by expert neurologist and optometrist at the Feiz Hospital, Isfahan, Iran (2012–2013). Blood samples were collected from ON patients in the first attack. The number of EPCs was measured by flow cytometry through the assessment of CD34+ and CD309+ in patients and healthy individuals. Results: With using flow cytometry, CD34+ and CD309+ cells detected in peripheral blood cells of patients (n = 50) with ON, and healthy individuals (n = 30). Patients with ON had (mean = 66.71 ± 17.82) CD34+ and CD309+ cells compared with healthy controls (mean = 28.72 ± 22.46). In addition, there was no significant difference in CD309+ cells in both groups. Conclusion: This study showed elevated CD34+ and CD309+ cells in the early stage of the disease. Regarded to EPC increment in neural repair, it expected the EPC level be increased in these patients, but no detectable differences were observed among both markers in healthy and patient with first attack. PMID:26380236

  4. Optic Neuritis as Isolated Manifestation of Leptomeningeal Carcinomatosis: A Case Report and Systematic Review of Ocular Manifestations of Neoplastic Meningitis

    PubMed Central

    Basilico, Paola; Trezzi, Ilaria; Borellini, Linda; Franco, Giulia; Civelli, Vittorio; Bresolin, Nereo; Baron, Pierluigi

    2013-01-01

    Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique manifestation of meningeal carcinomatosis in 3 patients (7%). Visual loss was the presenting clinical manifestation in 17 patients (50%) and was the most common ocular symptom (70%). Other ocular signs were diplopia, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus. Associated clinical symptoms were headache, altered consciousness, meningism, limb weakness, ataxia, dizziness, seizures, and other cranial nerves involvement. All patients except five underwent CSF examination which was normal in 1 patient, pleocytosis was found in 11 patients, increased protein levels were observed in 16 patients, and decreased glucose levels were found in 8 patients. Cytology was positive in 29 patients (76%). Conclusion. Meningeal carcinomatosis should be considered in patients with ocular symptoms even in the absence of other suggestive clinical symptoms. PMID:24223306

  5. Optic neuritis as isolated manifestation of leptomeningeal carcinomatosis: a case report and systematic review of ocular manifestations of neoplastic meningitis.

    PubMed

    Lanfranconi, Silvia; Basilico, Paola; Trezzi, Ilaria; Borellini, Linda; Franco, Giulia; Civelli, Vittorio; Pallotti, Francesco; Bresolin, Nereo; Baron, Pierluigi

    2013-01-01

    Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique manifestation of meningeal carcinomatosis in 3 patients (7%). Visual loss was the presenting clinical manifestation in 17 patients (50%) and was the most common ocular symptom (70%). Other ocular signs were diplopia, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus. Associated clinical symptoms were headache, altered consciousness, meningism, limb weakness, ataxia, dizziness, seizures, and other cranial nerves involvement. All patients except five underwent CSF examination which was normal in 1 patient, pleocytosis was found in 11 patients, increased protein levels were observed in 16 patients, and decreased glucose levels were found in 8 patients. Cytology was positive in 29 patients (76%). Conclusion. Meningeal carcinomatosis should be considered in patients with ocular symptoms even in the absence of other suggestive clinical symptoms. PMID:24223306

  6. Cervical and ocular vestibular-evoked myogenic potentials in vestibular neuritis: comparison between air- and bone-conducted stimulation.

    PubMed

    Oh, Sun-Young; Kim, Ji-Soo; Yang, Tae-Ho; Shin, Byoung-Soo; Jeong, Seul-Ki

    2013-08-01

    To clarify the changes of cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials induced by air-conducted sound (ACS) and bone-conducted vibration (BCV) in patients with vestibular neuritis (VN), patients with VN (n = 30) and normal controls (n = 45) underwent recording of cVEMP and oVEMP in response to ACS (1,000 Hz, 5 ms, tone bursts) and BCV (500 Hz, short tone burst). Patients with VN showed a high proportion of oVEMP abnormalities in response to both ACS (80.0 %) and BCV at the forehead (Fz, 73.3 %) or the mastoid (76.7 %). In contrast, cVEMPs were mostly normal with both ACS and BCV in the patients. The dissociations in the abnormalities of cVEMP and oVEMP induced by ACS and BCV at the mastoids and at the forehead in patients with VN suggest that oVEMP reflects functions of the superior vestibular nerve and most likely the utricular function. The results of our study suggest that oVEMP induced by either ACS or BCV appears to depend on integrity of the superior vestibular nerve, possibly due to the utricular afferents travelling in it. In contrast, cVEMP elicited by either ACS or BCV may reflect function of the saccular afferents running in the inferior vestibular nerve. PMID:23670310

  7. Isolated CNS Blast Crises in Chronic Myeloid Leukaemia Presenting as Hypertrophic Pachymeningitis and Bilateral Optic Neuritis: A Case Report

    PubMed Central

    Gupta, Naresh

    2016-01-01

    Extramedullary blast crises of Chronic Myeloid Leukaemia (CML) involving CNS is rare and usually accompanies systemic relapse. Isolated CNS blast relapse is an extremely uncommon event. A 35-year-old male was diagnosed with chronic phase (CP) CML two years back at our hospital and was started on imatinib 400 mg daily. Patient achieved haematological and cytogenetic remission at three and 12 months respectively but was non-compliant with medications thereafter. He presented to our emergency with headache and bilateral visual loss. CNS examination revealed neck rigidity and fundoscopy revealed disc edema with retinal vein dilatation and haemorrhages. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis and a positive cytospin for myeloid blasts. MRI brain suggested pachymeningeal enhancement involving falx cerebri and tentorium along with bilateral optic nerve thickening. Patient maintained cytogenetic remission at current presentation. A diagnosis of isolated CNS blast crises with pachymeningitis and bilateral optic nerve involvement was made and two doses of intrathecal chemotherapy were administered. However, patient died due to a rapidly downhill course. A previously unreported finding of pachymeningitis with bilateral optic neuritis has been highlighted in this case, along with a brief review of this rare condition. PMID:26894118

  8. Recurrent brachial artery embolism caused by a crutch-induced axillary artery aneurysm: report of a case.

    PubMed

    Morisaki, Koichi; Kuma, Sosei; Okazaki, Jin

    2014-07-01

    We report a case of axillary artery aneurysm with brachial artery embolism in a 60-year-old man who had walked with the assistance of axillary crutches all of his life since poliomyelitis during infancy had left him with lower limb paralysis. We performed bypass grafting from the axillary to brachial artery with exclusion of the aneurysm. An axillary artery aneurysm is rare, but potentially lethal for the upper extremity; therefore, surgical treatment should be considered. PMID:23807637

  9. Anti-aquaporin-4 IgG in Patients Presenting with Unilateral Optic Neuritis: A Cohort Study

    PubMed Central

    Etemadifar, Masoud; Abtahi, Mohammad-Ali; Razmjoo, Hassan; Abtahi, Seyed-Hossein; Dehghani, Ali-Reza; Abtahi, Zahra-Alsadat; Akbari, Mojtaba; Mazaheri, Shahir; Maghzi, Amir-Hadi

    2012-01-01

    Background: Optic neuritis (ON) can be the first presentation of multiple sclerosis (MS) or neuromyelitis optica (NMO). Anti-aquaporin-4 IgG (AQP4 IgG) is a highly specific and moderately sensitive biomarker for NMO. This study was designed to assess the rate of seropositivity for AQP4 IgG, and the short-term outcome of patients presenting with single isolated ON (SION). Methods: A cohort of 41 consecutive patients experiencing severe (< 20 / 200) SION (not fulfilling the diagnostic criteria for MS or NMO), was prospectively recruited. Blood sampling was carried out immediately after the diagnosis of ON, and AQP4 IgG was tested qualitatively, using an indirect immunofluorescence kit. After clinical and paraclinical investigations, all the patients were followed up for a short-term period of at least 18 months. Results: The seroprevalence among the initial ON patients was 9.7% (4 / 41). The short-term conversion rate to MS and NMO was estimated to be about 7.3 and 4.9%, respectively. The conversion rate to NMO in initially seropositive patients was greater than that for the whole cohort [2 / 4 (50%) vs. 2 / 41 (4.9%); P = 0.035; Odds ratio: 19.5, 95% confidence interval: 1.73 to 219.50]. Conclusion: AQP4 IgG seropositive SION patients were more likely to develop NMO in comparison to the total SION population. Further studies, with a longer follow-up period and larger sample sizes are warranted to assess the clinical and prognostic value of assessing AQP4 IgG in SION. PMID:23024849

  10. Altered intrinsic regional spontaneous brain activity in patients with optic neuritis: a resting-state functional magnetic resonance imaging study

    PubMed Central

    Shao, Yi; Cai, Feng-Qin; Zhong, Yu-Lin; Huang, Xin; Zhang, Ying; Hu, Pei-Hong; Pei, Chong-Gang; Zhou, Fu-Qing; Zeng, Xian-Jun

    2015-01-01

    Objective To investigate the underlying regional homogeneity (ReHo) in brain-activity deficit in patients with optic neuritis (ON) and its relationship with behavioral performance. Materials and methods In total, twelve patients with ON (four males and eight females) and twelve (four males and eight females) age-, sex-, and education-matched healthy controls underwent resting-state functional magnetic resonance imaging scans. The ReHo method was used to assess the local features of spontaneous brain activity. Correlation analysis was used to explore the relationship between the observed mean ReHo values of the different brain areas and the visual evoked potential (VEP) in patients with ON. Results Compared with the healthy controls, patients with ON showed lower ReHo in the left cerebellum, posterior lobe, left middle temporal gyrus, right insula, right superior temporal gyrus, left middle frontal gyrus, bilateral anterior cingulate cortex, left superior frontal gyrus, right superior frontal gyrus, and right precentral gyrus, and higher ReHo in the cluster of the left fusiform gyrus and right inferior parietal lobule. Meanwhile, we found that the VEP amplitude of the right eye in patients with ON showed a positive correlation with the ReHo signal value of the left cerebellum posterior lobe (r=0.701, P=0.011), the right superior frontal gyrus (r=0.731, P=0.007), and the left fusiform gyrus (r=0.644, P=0.024). We also found that the VEP latency of the right eye in ON showed a positive correlation with the ReHo signal value of the right insula (r=0.595, P=0.041). Conclusion ON may involve dysfunction in the default-mode network, which may reflect the underlying pathologic mechanism. PMID:26715848

  11. Prevention and therapy of experimental autoimmune neuritis by an antibody against T cell receptors-alpha/beta.

    PubMed

    Jung, S; Krämer, S; Schluesener, H J; Hünig, T; Toyka, K; Hartung, H P

    1992-06-15

    The mAb R73 directed to the TCR-alpha/beta of rat lymphocytes was tested for its therapeutic potential during the effector phase of experimental autoimmune neuritis (EAN) in Lewis rats. EAN can be actively induced by immunization with bovine peripheral nerve myelin, bovine P2 protein, or a peptide containing its neuritogenic epitope and serves as a model of the human Guilain-Barré syndrome. Adoptive transfer of activated P2-specific T lymphocytes also produces the monophasic disease (AT-EAN) characterized by inflammation and demyelination of peripheral nerves and highlights the central role of T lymphocytes in the pathogenesis of EAN. A single administration of the mAb R73 immediately after injection of activated P2-specific T line cells completely prevented the development of clinical and electrophysiologic signs of EAN in most animals and greatly alleviated the disease in the others. In further experiments mAb R73 was applied after the appearance of first clinical signs of EAN actively induced by immunization with a neuritogenic peptide or bovine peripheral nerve myelin. In both cases the anti-TCR-alpha/beta mAb reversed clinical signs of EAN and prevented the development of peripheral nerve dysfunction. In vivo and in vitro data suggest that impairment of Ag recognition and T cell function by occupancy of the TCR and R73-induced TCR-modulation rather than depletion of TCR-alpha/beta-bearing lymphocytes is the decisive mechanism underlying suppression of EAN that is apparent already within 48 h of the first R73 injection. PMID:1376340

  12. Complete Brachial Artery Transection following closed Posterior Elbow Dislocation: A Rare Case Report

    PubMed Central

    C, JayanthKumar B; Sampath, Deepak; N, Hanumantha Reddy; Motukuru, Vishnu

    2015-01-01

    Introduction: Vascular injury associated withclosed posterior elbow dislocations is rare and it usually occurs along with open dislocation, anterior dislocation, penetrating injuries, dislocations associated with fracture. We report such a case of closed posterior elbow dislocation with complete brachial artery rupture. Case Report: A 58 years old lady sustained posterior dislocation of right elbow following a fall at home. She presented three days later with complaints of severe pain, swelling around the right elbow and numbness of fingers following a closed reduction done elsewhere. Computed graft angiography showed complete transection of brachialartery. Patient was treated with thrombectomy, right great saphenous vein graft interposition repair of brachial artery and forearm fasciotomy. Conclusion: Vascular injuries associated with posterior elbow dislocation are very rare, but high index of suspicion of arterial injury need to be thought off and repeated vascular examination during pre and post reduction stage should be done to prevent complications. PMID:27299092

  13. Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block: A case report.

    PubMed

    Shinn, Helen Ki; Kim, Byung-Gun; Jung, Jong Kwon; Kwon, Hee Uk; Yang, Chunwoo; Won, Jonghun

    2016-06-01

    Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. However, it is generally transient and is resolved over the duration of the local anesthetic's action.We present a case of a patient who experienced prolonged hemidiaphragmatic paresis following a continuous interscalene brachial plexus block for the postoperative pain management of shoulder surgery, and suggest a mechanism that may have led to this adverse effect.Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries. PMID:27310984

  14. Ultrasound-guided central cluster approach for the supraclavicular brachial plexus block: a case series.

    PubMed

    Lee, Mi Geum; Lee, Kyung Cheon; Kim, Hong Soon; Park, Seol Ju; Suh, Young Je; Shin, Hyeon Ju

    2015-12-01

    There are many different approaches to ultrasound-guided supraclavicular brachial plexus block (US-SCBPB), and each has a different success rate and complications. The most commonly performed US-SCBPB is the corner pocket approach in which the needle is advanced very close to the subclavian artery and pleura. Therefore, it may be associated with a risk of subclavian artery puncture or pneumothorax. We advanced the needle into the central part of the neural cluster after penetrating the sheath of the brachial plexus in US-SCBPB. We refer to this new method as the "central cluster approach." In this approach, the needle does not have to advance close to the subclavian artery or pleura. The aim of this study was to evaluate the clinical outcomes of the central cluster approach in US-SCBPB. PMID:26634085

  15. Ultrasound-guided central cluster approach for the supraclavicular brachial plexus block: a case series

    PubMed Central

    Lee, Mi Geum; Lee, Kyung Cheon; Kim, Hong Soon; Park, Seol Ju; Suh, Young Je

    2015-01-01

    There are many different approaches to ultrasound-guided supraclavicular brachial plexus block (US-SCBPB), and each has a different success rate and complications. The most commonly performed US-SCBPB is the corner pocket approach in which the needle is advanced very close to the subclavian artery and pleura. Therefore, it may be associated with a risk of subclavian artery puncture or pneumothorax. We advanced the needle into the central part of the neural cluster after penetrating the sheath of the brachial plexus in US-SCBPB. We refer to this new method as the "central cluster approach." In this approach, the needle does not have to advance close to the subclavian artery or pleura. The aim of this study was to evaluate the clinical outcomes of the central cluster approach in US-SCBPB. PMID:26634085

  16. Iatrogenic brachial artery injury during anterolateral plating of humeral shaft fracture.

    PubMed

    Kumar, Vishal; Behera, Prateek; Aggarwal, Sameer; Meena, Umesh Kumar

    2013-01-01

    There are several well defined indications for surgical management of humeral shaft fractures. Operative procedures on the humerus are associated with their own complications. Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously. We report a case of a 48 years old female, who received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse. CT angiogram showed that there was segmental non-opacification of the brachial artery. There was distal reformation and the thrombosis was decided to be managed conservatively. We believe that the arterial injury was a result of improper surgical technique and the segmental block might be due to improper use of plate holding forceps. This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries. PMID:24295587

  17. Microscopic polyangiitis complicated with bilateral brachial plexopathy: a case report and review of the literature.

    PubMed

    Naseri Alavi, Seyed Ahmad; Meshkini, Mohammad; Pourlak, Tala; Khabbazi, Alireza

    2016-07-01

    Microscopic polyangiitis is a small-vessel necrotizing vasculitis associated with anti-neutrophil cytoplasmic antibodies and presents itself with glomerulonephritis and hemorrhagic pulmonary capillaritis. Peripheral nervous system involvement is common in anti-neutrophil cytoplasmic antibodies-associated vasculitis, but brachial plexopathy is unusual. We present the case of a 22-year-old man with known microscopic polyangiitis who was under maintenance therapy with prednisolone and cyclophosphamide and developed cough, dyspnea, and hemoptysis which increased in 6 days accompanying pain and paresthesia in the upper limbs. His physical examination revealed hypoesthesia, absence of deep tendon reflexes, and decreased muscle strength in the upper limbs. His chest computed tomography scan showed ground glass pattern in the lower and middle lobes. Electromyography and nerve conduction study showed bilateral brachial plexopathy with involvement of all of the cervical roots that were more severe in the lower roots and left side. PMID:26782370

  18. Relation of Ankle Brachial Index to Left Ventricular Ejection Fraction in Non-Diabetic Individuals

    PubMed Central

    Abbasnezhad, Mohsen; Aliasgarzadeh, Akbar; Aslanabadi, Hasan; Habibzadeh, Afshin; Zamani, Bejan

    2011-01-01

    Introduction Peripheral arterial disease is associated with an excessive risk for cardi-ovascular events and mortality. Peripheral arterial disease is usually measured with ankle brachial index (ABI). It is previously shown that the ABI would reflect LV systolic func-tion, as well as atherosclerosis; however, these results are not shown in non-diabetic indi-viduals. In this study, we aim to evaluate this relation in non-diabetic individuals. Methods In a prospective study, 73 non-diabetic individuals (38.4% male with mean age of 59.20±14.42 years) referred for ABI determination who had had the left ventricular ejection fraction determined using trans-thoracic echocardiography were studied. Participants were compared in normal and low ABI groups. Results The mean left ventricular ejection fraction (LVEF) was 52.34±7.69, mean ankle brachial index for the right leg was 1.08±0.13, and the mean ankle brachial index for the left leg was 1.07±0.12. Low ABI incidence was 12.32%. Individuals with low ABI significantly were older (p<0.001) and had lower left ventricular ejection fraction (p<0.001). ABI had significantly inverse corre-lation with LVEF (r=-0.53, p<0.001) and positive correlation with age (r=0.43, p<0.001). The ABI correlated inversely with LVEF in the patients with (r =-0.52, p=0.008) and without (r=-0.55, p<0.001) IHD. Conclusion Results showed that ankle brachial index would be influenced by left ventricular ejection fraction in non-diabetics and to evaluate and monitor cardiovascular risk in patients these should be considered together. PMID:24250966

  19. Perspectives on glenohumeral joint contractures and shoulder dysfunction in children with perinatal brachial plexus palsy.

    PubMed

    Gharbaoui, Idris S; Gogola, Gloria R; Aaron, Dorit H; Kozin, Scott H

    2015-01-01

    Shoulder joint deformities continue to be a challenging aspect of treating upper plexus lesions in children with perinatal brachial plexus palsy (PBPP). It is increasingly recognized that PBPP affects the glenohumeral joint specifically, and that abnormal scapulothoracic movements are a compensatory development. The pathophysiology and assessment of glenohumeral joint contractures, the progression of scapular dyskinesia and skeletal dysplasia, and current shoulder imaging techniques are reviewed. PMID:25835253

  20. Sensory Evaluation of the Hands in Children with Brachial Plexus Birth Injury

    ERIC Educational Resources Information Center

    Palmgren, Tove; Peltonen, Jari; Linder, Tove; Rautakorpi, Sanna; Nietosvaara, Yrjana

    2007-01-01

    The aim of this study was to examine sensory changes of the hand in brachial plexus birth injury (BPBI). Ninety-five patients (43 females, 52 males) comprising two age groups, 6 to 8 years (mean age 7y 6mo) and 12 to 14 years (mean age 13y 2mo), were included. Sixty-four had upper (cervical [C] 5-6), 19 upper and middle (C5-7), and 12 had total…

  1. Watson-Jones Lecture, 1976. Some lesions of the brachial plexus.

    PubMed Central

    Bonney, G.

    1977-01-01

    Three types of lesion of the brachial plexus are discussed: entrapment syndrome; tumours; and traumatic lesions. In the first the importance of the pathological anatomy is stressed; in the second the rewarding results of accurate diagnosis and careful treatment are noted; and in the third the expanding possibilities of neural reconstruction and of specific treatment for pain are described. Images Fig. 1 Fig. 3 Fig. 4 Fig. 5 Fig. 8 Fig. 9 Fig. 10 PMID:879635

  2. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor

    PubMed Central

    Krisht, Khaled M.; Karsy, Michael; Shah, Lubdha M.; Schmidt, Meic H.; Dailey, Andrew T.

    2016-01-01

    Background: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7–T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2–3 months to re-evaluate the size of the mass. PMID:26904368

  3. Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study

    PubMed Central

    Fu, Ruying; Rong, Xiaoming; Wu, Rong; Cheng, Jinping; Huang, Xiaolong; Luo, Jinjun; Tang, Yamei

    2016-01-01

    Radiation-induced brachial plexopathy (RIBP) is one of the late complications in nasopharyngeal carcinoma (NPC) patients who received radiotherapy. We conducted a retrospective study to investigate its clinical characteristics and risk factors. Thirty-onepatients with RIBP after radiotherapy for NPC were enrolled. Clinical manifestations of RIBP, electrophysiologic data, magnetic resonance imaging (MRI), and the correlation between irradiation strategy and incidence of RIBP were evaluated. The mean latency at the onset of RIBP was 4.26 years. Of the symptoms, paraesthesia usually presented first (51.6%), followed by pain (22.6%) and weakness (22.6%). The major symptoms included paraesthesia (90.3%), pain (54.8%), weakness (48.4%), fasciculation (19.3%) and muscle atrophy (9.7%). Nerve conduction velocity (NCV) and electromyography (EMG) disclosed that pathological changes of brachial plexus involved predominantly in the upper and middle trunks in distribution. MRI of the brachial plexus showed hyper-intensity on T1, T2, post-contrast T1 and diffusion weighted whole body imaging with background body signal suppression (DWIBS) images in lower cervical nerves. Radiotherapy with Gross Tumor volume (GTVnd) and therapeutic dose (mean 66.8±2.8Gy) for patients with lower cervical lymph node metastasis was related to a significantly higher incidence of RIBP (P<0.001). Thus, RIBP is a severe and progressive complication of NPC after radiotherapy. The clinical symptoms are predominantly involved in upper and middle trunk of the brachial plexus in distribution. Lower cervical lymph node metastasis and corresponding radiotherapy might cause a significant increase of the RIBP incidence. PMID:26934119

  4. Three dimensionality of gleno-humeral deformities in obstetrical brachial plexus palsy.

    PubMed

    Brochard, Sylvain; Mozingo, Joseph D; Alter, Katharine E; Sheehan, Frances T

    2016-04-01

    The primary objective of this study was to test the hypothesis that gleno-humeral deformity in children and adolescent with obstetrical brachial plexus palsy is three-dimensional (3D). The study also compared the metrological properties of typical two-dimensional gleno-humeral measures to the newly developed 3D measures. Thirteen individuals (age = 11.8 ± 3.3 years) with obstetrical brachial plexus palsy participated in this IRB-approved study. 3D axial magnetic resonance images were acquired for both shoulders. Glenoid and humeral models were created in order to quantify 3D glenoid version, humeral head migration, and glenoid concavity. Two-dimensional (2D) measures were acquired as recommended in the literature. All measures were completed by two observers in this observer-blind study. Compared to the non-involved side, the glenoid was more retroverted (7.91°, p = 0.003) and inferiorly oriented (7.28°, p = 0.009). The humeral head was migrated more posteriorly (5.54 mm, p = 0.007), inferiorly (-3.96 mm, p = 0.013), and medially (-3.63 mm,p = 0.002). Eleven of the 13 glenoids were concave, based on the 3D glenoid models. The concurrent validity between three- and 2D measures were highly dependent of the parameter measured, the slice level used for the 2D analysis, and the presence/absence of pathology (0.63 < r < 0.91). The standard error of measurement for the 2D anterior-posterior version (>3°) was larger than that for the 3D measure of version (<1°) on the involved side. This study clearly demonstrated that the gleno-humeral deformation in obstetrical brachial plexus palsy is 3D, emphasizing the need for 3D subject specific gleno-humeral shape analysis for follow-up and treatment plans in children with obstetrical brachial plexus palsy. PMID:26363273

  5. The combined influence of fat consumption and repeated mental stress on brachial artery flow-mediated dilatation: a preliminary study.

    PubMed

    Poitras, Veronica J; Slattery, David J; Levac, Brendan M; Fergus, Stevenson; Gurd, Brendon J; Pyke, Kyra E

    2014-04-01

    Experienced separately, both acute mental stress and high-fat meal consumption can transiently impair endothelial function, and the purpose of the present study was to investigate their combined impact. On four separate days, 10 healthy men (23 years old) underwent brachial artery flow-mediated dilatation (FMD) tests, before and hourly for 4 h post-consumption of a high-fat (HFM; 54 g fat) or low-fat meal (LFM; 0 g fat; each meal ∼ 1000 calories), with hourly mental stress (mental arithmetic, speech) or control (counting) tasks (conditions HFM+S, LFM+S, HFM and LFM). Data are presented as means ± SD. Plasma triglycerides increased and remained elevated after the high-fat but not the low-fat meal (P = 0.004) and were not affected by mental stress (P = 0.329). Indices of stress reactivity increased during mental stress tasks (mean arterial pressure, ∼ 20 mmHg; heart rate, ∼ 22 beats min(-1); salivary cortisol, ∼ 2.37 nmol l(-1); and plasma noradrenaline, ∼ 0.17 ng ml(-1)) and were not influenced by meal (P > 0.05). There was no effect of the type of meal on FMD (P = 0.562); however, FMD was 4.5 ± 0.5% in the control conditions and 5.8 ± 0.6% in the mental stress conditions (P = 0.087), and this difference was significant when normalized for the shear stress stimulus (FMD/area under the curve of shear stress, P = 0.045). Overall, these preliminary data suggest that postprandial FMD was augmented with mental stress irrespective of meal type. These results are contrary to previous reports of impaired endothelial function after mental stress or fat consumption independently and highlight the need to further investigate the mechanisms underlying the interactions between these factors. PMID:24465021

  6. Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

    PubMed Central

    Healey, Scott; O'Neill, Bridie; Bilal, Haris; Waterworth, Paul

    2013-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘does retraction of the sternum during median sternotomy result in brachial plexus injuries or peripheral neuropathies?’ Altogether 58 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, date, journal and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Caudal placement of the retractor or relieving the pressure superiorly by removing the upper blades of a retractor (P = 0.02) and use of a caudally placed symmetrical retractor has been shown to reduce neuropathy. Positioning of the patient with ‘hands up’ positioning showed significant reduction in the incidence of brachial plexus injuries. Furthermore, how wide the retractor is opened and use of an asymmetrical retractor for internal mammary artery (IMA) harvesting are also important factors in quantifying risk of postoperative neuropathy. Wider sternal retraction and longer bypass time did increase the risk of developing postoperative neuropathy. Three asymmetrical retractors were looked at that demonstrates the Delacroix–Chevalier to be the safest (P < 0.05). We conclude that median sternotomy risks brachial plexus injury and where possible the sternum should be opened as small a distance as possible with symmetrical retractor and using a caudally placed retractor. PMID:23513004

  7. Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults

    PubMed Central

    2009-01-01

    Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients. PMID:19627573

  8. Obstetric brachial plexus palsy: reviewing the literature comparing the results of primary versus secondary surgery.

    PubMed

    Socolovsky, Mariano; Costales, Javier Robla; Paez, Miguel Domínguez; Nizzo, Gustavo; Valbuena, Sebastian; Varone, Ernesto

    2016-03-01

    Obstetric brachial plexus injuries (OBPP) are a relatively common stretch injury of the brachial plexus that occurs during delivery. Roughly 30 % of patients will not recover completely and will need a surgical repair. Two main treatment strategies have been used: primary surgery, consisting in exploring and reconstructing the affected portions of the brachial plexus within the first few months of the patient's life, and secondary procedures that include tendon or muscle transfers, osteotomies, and other orthopedic techniques. Secondary procedures can be done as the only surgical treatment of OBPP or after primary surgery, in order to minimize any residual deficits. Two things are crucial to achieving a good outcome: (1) the appropriate selection of patients, to separate those who will spontaneously recover from those who will recover only partially or not at all; and (2) a good surgical technique. The objective of the present review is to assess the published literature concerning certain controversial issues in OBPP, especially in terms of the true current state of primary and secondary procedures, their results, and the respective roles each plays in modern-day treatment of this complex pathology. Considerable published evidence compiled over decades of surgical experience favors primary nerve surgery as the initial therapeutic step in patients who do not recover spontaneously, followed by secondary surgeries for further functional improvement. As described in this review, the results of such treatment can greatly ameliorate function in affected limbs. For best results, multi-disciplinary teams should treat these patients. PMID:26615411

  9. Gross anatomy of the brachial plexus in the giant Anteater (Myrmecophaga tridactyla).

    PubMed

    Souza, P R; Cardoso, J R; Araujo, L B M; Moreira, P C; Cruz, V S; Araujo, E G

    2014-10-01

    Ten forelimbs of five Myrmecophaga tridactyla were examined to study the anatomy of the brachial plexus. The brachial plexuses of the M. tridactyla observed in the present study were formed by the ventral rami of the last four cervical spinal nerves, C5 through C8, and the first thoracic spinal nerve, T1. These primary roots joined to form two trunks: a cranial trunk comprising ventral rami from C5-C7 and a caudal trunk receiving ventral rami from C8-T1. The nerves originated from these trunks and their most constant arrangement were as follows: suprascapular (C5-C7), subscapular (C5-C7), cranial pectoral (C5-C8), caudal pectoral (C8-T1), axillary (C5-C7), musculocutaneous (C5-C7), radial (C5-T1), median (C5-T1), ulnar (C5-T1), thoracodorsal (C5-C8), lateral thoracic (C7-T1) and long thoracic (C6-C7). In general, the brachial plexus in the M. tridactyla is similar to the plexuses in mammals, but the number of rami contributing to the formation of each nerve in the M. tridactyla was found to be larger than those of most mammals. This feature may be related to the very distinctive anatomical specializations of the forelimb of the anteaters. PMID:23952693

  10. Influence of contralateral homologous cortices on motor cortical reorganization after brachial plexus injuries in rats.

    PubMed

    Zhang, Jie; Chen, Liang; Gu, Yu-dong

    2015-10-01

    Brachial plexus injuries induce corresponding cortical representations to be occupied by adjacent cortices. The purpose of this study was to clarify if contralateral homologous motor regions of adjacent cortices influence occupation of deafferented motor cortex. 36 rats were divided into 3 groups of 12 each. In group 1, total brachial plexus root avulsion (tBPRA) was made on the left side. In group 2, rats underwent left tBPRA combined with corpus callosum transection (CCX). In group 3, only CCX was performed. 6 rats in each group were used for intracortical microstimulation (ICMS) to map representations of motor cortex in the right hemisphere at 7 days and the other 6 rats, at 3 months. 18 more rats without any operation underwent ICMS, with 6 each taken to serve as normal control for motor cortical representations' changes caused by different surgery. Results showed that in groups 1 and 2, sites for motor cortical representations of vibrissae, of neck and of the hindlimb was statistically more than that of control, respectively, and statistically more sites were found at 3 months than at 7 days, respectively. At the two time points, sites for vibrissa cortices and that for the hindlimb were statistically more in group 2 than in group 1, respectively. CCX alone did not induce change of site number for motor cortical representations. We conclude that after tBPRA, contralateral homologous motor cortices may, to some extent, prevent neighboring cortices from encroachment on motor cortical representations of the brachial plexus. PMID:26314511

  11. Central hemodynamics in risk assessment strategies: additive value over and above brachial blood pressure.

    PubMed

    Yannoutsos, Alexandra; Rinaldi, Elisa R; Zhang, Yi; Protogerou, Athanassios D; Safar, Michel E; Blacher, Jacques

    2015-01-01

    Although the clinical relevance of brachial blood pressure (BP) measurement for cardiovascular (CV) risk stratification is nowadays widely accepted, this approach can nevertheless present several limitations. Pulse pressure (PP) amplification accounts for the notable increase in PP from central to peripheral arterial sites. Target organs are more greatly exposed to central hemodynamic changes than peripheral organs. The pathophysiological significance of local BP pulsatility, which has a role in the pathogenesis of target organ damage in both the macro- and the microcirculation, may therefore not be accurately captured by brachial BP as traditionally evaluated with cuff measurements. The predictive value of central systolic BP and PP over brachial BP for major clinical outcomes has been demonstrated in the general population, in elderly adults and in patients at high CV risk, irrespective of the invasive or non-invasive methods used to assess central BP. Aortic stiffness, timing and intensity of wave reflections, and cardiac performance appear as major factors influencing central PP. Great emphasis has been placed on the role of aortic stiffness, disturbed arterial wave reflections and their intercorrelation in the pathophysiological mechanisms of CV diseases as well as on their capacity to predict target organ damage and clinical events. Comorbidities and age-related changes, together with gender-related specificities of arterial and cardiac parameters, are known to affect the predictive ability of central hemodynamics on individual CV risk. PMID:25341861

  12. Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive Study

    PubMed Central

    Emamhadi, Mohammadreza; Chabok, Shahrokh Yousefzadeh; Samini, Fariborz; Alijani, Babak; Behzadnia, Hamid; Firozabadi, Fariborz Ayati; Reihanian, Zoheir

    2016-01-01

    Background: Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers. Methods: Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females) consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated. Results: Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers. Conclusion: The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons. PMID:27517072

  13. Anatomical Advantage to Percutaneous Insertion of the Intra-Aortic Balloon through the Left Brachial Artery over the Right Brachial Artery

    PubMed Central

    Datt, Bharat; Miner, Steve

    2013-01-01

    Abstract: Off-label use of the intra-aortic balloon (IAB) is not recommended in ideal situations and certainly not a Food and Drug Administration-approved activity. The instruction-for-use manual for the IAB recommends percutaneous insertion. However, there are certain extreme situations where “thinking outside the box” appears necessary. We have successfully inserted a transthoracic IAB (TIAB) in the operating room where an open sternum is an option. This has been instituted whenever severe peripheral vascular disease (PVD) precludes a percutaneous attempt or when attempted insertion fails. An open chest is not a choice in the catheterization laboratory or the postoperative setting. We have successfully inserted the IAB through the brachial/axillary artery in a patient with bilateral aortofemoral grafts, with a history of severe PVD, in the cardiac catheterization laboratory. A left-sided approach is advisable for brachial artery insertion and an axillary approach is also possible under sedation. This case report details our experience with transbrachial insertion of the IAB and establishes counterpulsation through this route as a viable option, where an open chest is not available and a percutaneous femoral approach has failed. PMID:23691785

  14. Acute Bronchitis

    MedlinePlus

    ... or though physical contact (for example, on unwashed hands). Being exposed to tobacco smoke, air pollution, dusts, vapors, and fumes can also cause acute bronchitis. Less often, bacteria can also cause acute bronchitis. To diagnose acute ...

  15. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... control. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  16. Central blood pressure estimation by using N-point moving average method in the brachial pulse wave.

    PubMed

    Sugawara, Rie; Horinaka, Shigeo; Yagi, Hiroshi; Ishimura, Kimihiko; Honda, Takeharu

    2015-05-01

    Recently, a method of estimating the central systolic blood pressure (C-SBP) using an N-point moving average method in the radial or brachial artery waveform has been reported. Then, we investigated the relationship between the C-SBP estimated from the brachial artery pressure waveform using the N-point moving average method and the C-SBP measured invasively using a catheter. C-SBP using a N/6 moving average method from the scaled right brachial artery pressure waveforms using VaSera VS-1500 was calculated. This estimated C-SBP was compared with the invasively measured C-SBP within a few minutes. In 41 patients who underwent cardiac catheterization (mean age: 65 years), invasively measured C-SBP was significantly lower than right cuff-based brachial BP (138.2 ± 26.3 vs 141.0 ± 24.9 mm Hg, difference -2.78 ± 1.36 mm Hg, P = 0.048). The cuff-based SBP was significantly higher than invasive measured C-SBP in subjects with younger than 60 years old. However, the estimated C-SBP using a N/6 moving average method from the scaled right brachial artery pressure waveforms and the invasively measured C-SBP did not significantly differ (137.8 ± 24.2 vs 138.2 ± 26.3 mm Hg, difference -0.49 ± 1.39, P = 0.73). N/6-point moving average method using the non-invasively acquired brachial artery waveform calibrated by the cuff-based brachial SBP was an accurate, convenient and useful method for estimating C-SBP. Thus, C-SBP can be estimated simply by applying a regular arm cuff, which is greatly feasible in the practical medicine. PMID:25693855

  17. Quantification of the Interrelationship between Brachial-Ankle and Carotid-Femoral Pulse Wave Velocity in a Workplace Population

    PubMed Central

    Cheng, Yi-Bang; Li, Yan; Sheng, Chang-Sheng; Huang, Qi-Fang; Wang, Ji-Guang

    2016-01-01

    Background Brachial-ankle pulse wave velocity (PWV) is increasingly used for the measurement of arterial stiffness. In the present study, we quantified the interrelationship between brachial-ankle and carotid-femoral PWV in a workplace population, and investigated the associations with cardiovascular risk factors and carotid intima-media thickness (IMT). Methods Brachial-ankle and carotid-femoral PWV were measured using the Omron-Colin VP1000 and SphygmoCor devices, respectively. We investigated the interrelationship by the Pearson's correlation analysis and Bland-Altman plot, and performed sensitivity and specificity analyses. Results The 954 participants (mean ± standard deviation age 42.6 ± 14.2 years) included 630 (66.0%) men and 203 (21.3%) hypertensive patients. Brachial-ankle (13.4 ± 2.7 m/s) and carotid-femoral PWV (7.3 ± 1.6 m/s) were significantly correlated in all subjects (r = 0.75) as well as in men (r = 0.72) and women (r = 0.80) separately. For arterial stiffness defined as a carotid-femoral PWV of 10 m/s or higher, the sensitivity and specificity of brachial-ankle PWV of 16.7 m/s or higher were 72 and 94%, respectively. The area under the receiver operating characteristic curve was 0.953. In multiple stepwise regression, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with age (partial r = 0.33 and 0.34, respectively) and systolic blood pressure (partial r = 0.71 and 0.66, respectively). In addition, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with carotid IMT (r = 0.57 and 0.55, respectively) in unadjusted analysis, but not in analysis adjusted for cardiovascular risk factors (p ≥ 0.08). Conclusions Brachial-ankle and carotid-femoral PWV were closely correlated, and had similar determinants. Brachial-ankle PWV can behave as an ease-of-use alternative measure of arterial stiffness for assessing cardiovascular risk. PMID:27195246

  18. Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages.

    PubMed

    Zhou, Huanfen; Zhao, Shuo; Yin, Dongfang; Chen, Xiaofei; Xu, Quangang; Chen, Tingjun; Li, Xiaoyan; Wang, Junqing; Li, Hongyang; Peng, Chunxia; Lin, Dahe; Wei, Shihui

    2016-07-01

    Little work has been performed on the long-term outcome of optic neuritis (ON) according to the status of aquaporin-4 antibody (AQP4-Ab) and long-term prognosis in older patients in China. This study retrospectively analyzed medical records in a cohort of Chinese patients with 5-year follow-up according to AQP4-Ab status and ages from January 2009 to December 2010. The clinical features, laboratory findings and risk factors for prognosis were analyzed. A total of 128 ON patients were included, 66.4 % of whom were female. The median age at onset was 36.8 years (range 18-73). Serum AQP4-Ab was positive in 45 (35.2 %) patients, with greater frequency in the female, bilateral, and recurrent ON groups (48.2, 42.5 and 53.6 %, respectively). Seropositive AQP4-Ab ON patients had worse visual recovery compared to seronegative patients (p = 0.033). The average and four quadrants of retinal nerve fiber layer (RNFL) thickness were significantly thinner in the seropositive group than in the seronegative group (p < 0.05). At 5-year follow-up, the ON recurrence rate was higher in the seropositive AQP4-Ab patients (37/45, 82.3 %) than in the seronegative patients (35/83, 42.2 %, p < 0.001). Among the seropositive patients, 40 % (18/45) developed neuromyelitis optica (NMO). Only 1.2 % (1/83) of the seronegative patients developed NMO and 4.8 % (4/83) developed to MS. Further, the multivariate analysis in seropositive AQP4-Ab patients showed that two risk factors for transverse myelitis (TM) episode were ocular pain and recurrence within 1 year. The older patients had worse visual outcome after the first episode of ON than the younger patients (p = 0.007). However, the two groups did not differ significantly with regard to prevalence of AQP4-Ab, long-term visual recovery and the risk of developing to NMO/MS. PMID:27159992

  19. Acquired Brachial Cutaneous Dyschromatosis in a 60-Year-Old Male: A Case Report and Review of the Literature

    PubMed Central

    Foering, Kristen

    2014-01-01

    Acquired brachial cutaneous dyschromatosis is an acquired pigmentary disorder that has been described in only 20 patients but likely affects many more. This case of a man with acquired brachial cutaneous dyschromatosis is unique as most reports are in women. We report the case of a 60-year-old male who presents with an asymptomatic eruption characterized by hyperpigmented and telangiectatic macules coalescing into patches on the bilateral extensor aspects of the forearms which is consistent clinically and histopathologically with acquired brachial cutaneous dyschromatosis. Given its presence in patients with clinical evidence of chronic sun exposure and its histopathological finding of solar elastosis, acquired brachial cutaneous dyschromatosis is likely a disorder caused by cumulative UV damage. However, a possible association between angiotensin-converting enzyme inhibitors and acquired brachial cutaneous dyschromatosis exists. Further investigation is needed to elucidate both the pathogenesis of the disorder and forms of effective management. Treatment of the disorder should begin with current established treatments for disorders of dyspigmentation. PMID:25610668

  20. Blockade of the brachial plexus abolishes activation of specific brain regions by electroacupuncture at LI4: a functional MRI study

    PubMed Central

    Gu, Weidong; Jiang, Wei; He, Jingwei; Liu, Songbin; Wang, Zhaoxin

    2015-01-01

    Objective Our aim was to test the hypothesis that electroacupuncture (EA) at acupuncture point LI4 activates specific brain regions by nerve stimulation that is mediatied through a pathway involving the brachial plexus. Methods Twelve acupuncture naive right-handed volunteers were allocated to receive three sessions of EA at LI4 in a random different order (crossover): (1) EA alone (EA); EA after injection of local anaesthetics into the deltoid muscle (EA+LA); and (3) EA after blockade of the brachial plexus (EA+NB). During each session, participants were imaged in a 3 T MRI scanner. Brain regions showing change in blood oxygen level-dependent (BOLD) signal (activation) were identified. Subjective acupuncture sensation was quantified after functional MRI scanning was completed. Results were compared between the three sessions for each individual, and averaged. Results Blockade of the brachial plexus inhibited acupuncture sensation during EA. EA and EA+LA activated the bilateral thalamus, basal ganglia, cerebellum and left putamen, whilst no significant activation was observed during EA+NB. The BOLD signal of the thalamus correlated significantly with acupuncture sensation score during EA. Conclusions Blockade of the brachial plexus completely abolishes patterns of brain activation induced by EA at LI4. The results suggest that EA activates specific brain regions through stimulation of the local nerves supplying the tissues at LI4, which transmit sensory information via the brachial plexus. Trial registration number ChiCTR-OO-13003389. PMID:26464415

  1. Supplementation with omega-3 polyunsaturated fatty acids augments brachial artery dilation and blood flow during forearm contraction.

    PubMed

    Walser, Buddy; Giordano, Rose M; Stebbins, Charles L

    2006-06-01

    Omega-3 polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have beneficial effects on the heart and vasculature. We tested the hypothesis that 6 weeks of dietary supplementation with DHA (2.0 g/day) and EPA (3.0 g/day) enhances exercise-induced increases in brachial artery diameter and blood flow during rhythmic exercise. In seven healthy subjects, blood pressure, heart rate and brachial artery diameter, blood flow, and conductance were assessed before and during the last 30 s of 90 s of rhythmic handgrip exercise (30% of maximal handgrip tension). Blood pressure (MAP), heart rate (HR), and brachial artery vascular conductance were also determined. This paradigm was also performed in six other healthy subjects who received 6 weeks of placebo (safflower oil). Placebo treatment had no effect on any variable. DHA and EPA supplementation enhanced contraction-induced increases in brachial artery diameter (0.28+/-0.04 vs. 0.14+/-0.03 mm), blood flow (367+/-65 vs. 293+/-55 ml min-1) and conductance (3.86+/-0.71 vs. 2.89+/-0.61 ml min-1 mmHg-1) (P<0.05). MAP and HR were unchanged. Results indicate that treatment with DHA and EPA enhances brachial artery blood flow and conductance during exercise. These findings may have implications for individuals with cardiovascular disease and exercise intolerance (e.g., heart failure). PMID:16770472

  2. Accurate quantitative measurements of brachial artery cross-sectional vascular area and vascular volume elastic modulus using automated oscillometric measurements: comparison with brachial artery ultrasound

    PubMed Central

    Tomiyama, Yuuki; Yoshinaga, Keiichiro; Fujii, Satoshi; Ochi, Noriki; Inoue, Mamiko; Nishida, Mutumi; Aziki, Kumi; Horie, Tatsunori; Katoh, Chietsugu; Tamaki, Nagara

    2015-01-01

    Increasing vascular diameter and attenuated vascular elasticity may be reliable markers for atherosclerotic risk assessment. However, previous measurements have been complex, operator-dependent or invasive. Recently, we developed a new automated oscillometric method to measure a brachial artery's estimated area (eA) and volume elastic modulus (VE). The aim of this study was to investigate the reliability of new automated oscillometric measurement of eA and VE. Rest eA and VE were measured using the recently developed automated detector with the oscillometric method. eA was estimated using pressure/volume curves and VE was defined as follows (VE=Δ pressure/ (100 × Δ area/area) mm Hg/%). Sixteen volunteers (age 35.2±13.1 years) underwent the oscillometric measurements and brachial ultrasound at rest and under nitroglycerin (NTG) administration. Oscillometric measurement was performed twice on different days. The rest eA correlated with ultrasound-measured brachial artery area (r=0.77, P<0.001). Rest eA and VE measurement showed good reproducibility (eA: intraclass correlation coefficient (ICC)=0.88, VE: ICC=0.78). Under NTG stress, eA was significantly increased (12.3±3.0 vs. 17.1±4.6 mm2, P<0.001), and this was similar to the case with ultrasound evaluation (4.46±0.72 vs. 4.73±0.75 mm, P<0.001). VE was also decreased (0.81±0.16 vs. 0.65±0.11 mm Hg/%, P<0.001) after NTG. Cross-sectional vascular area calculated using this automated oscillometric measurement correlated with ultrasound measurement and showed good reproducibility. Therefore, this is a reliable approach and this modality may have practical application to automatically assess muscular artery diameter and elasticity in clinical or epidemiological settings. PMID:25693851

  3. Clinical Utility of 18F-FDG PET/CT in brachial plexopathy secondary to metastatic breast cancer

    PubMed Central

    Chandra, Piyush; Purandare, Nilendu; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh

    2016-01-01

    Role of fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in breast cancer is rapidly evolving. Brachial plexopathy is a rare clinical entity in follow-up of operated breast cancer patients, who presents with disease recurrence in the axilla. Conventionally, magnetic resonance imaging is the imaging modality of choice for diagnostic evaluation in these cases and only few case reports/short studies have explored the utility of PET/CT in this clinical indication. We present here a short case series to demonstrate the utility of PET/CT as an important adjunctive imaging modality to magnetic resonance to supplement diagnosis of brachial plexopathy, differentiate radiation-induced brachial plexopathy from neoplastic plexopathy, accurately restage the disease and to monitor response to chemotherapy. PMID:27095861

  4. End-to-side nerve suture in traumatic injuries of brachial plexus: review of the literature and personal case series.

    PubMed

    Battiston, B; Artiaco, S; Conforti, L G; Vasario, G; Tos, P

    2009-10-01

    We used end-to-side nerve coaptation combined with standard end-to-end neurotisations to treat 11 patients who presented with complete (six cases) or incomplete (five cases) traumatic brachial plexus injuries. All patients were available for functional evaluation at a minimum of 2 years postoperatively. In three patients with shoulder abduction recovery, electromyographical studies (EMG) showed a contribution from the end-to-side neurotisation. In the remaining cases end-to-side neurotisations were unsuccessful. Our study did not demonstrate a reliable role for end-to-side nerve suture in brachial plexus surgery. We believe that at present end-to-side suture must not be a substitute for standard reconstructive techniques in brachial plexus surgery. Occasionally termino-lateral nerve sutures may represent a support to standard reconstructive procedures especially in case of severe injuries when few undamaged donor nerves are available. PMID:19587073

  5. Hoxa5 gene regulation: A gradient of binding activity to a brachial spinal cord element.

    PubMed

    Nowling, T; Zhou, W; Krieger, K E; Larochelle, C; Nguyen-Huu, M C; Jeannotte, L; Tuggle, C K

    1999-04-01

    The Hox genes cooperate in providing positional information needed for spatial and temporal patterning of the vertebrate body axis. However, the biological mechanisms behind spatial Hox expression are largely unknown. In transgenic mice, gene fusions between Hoxa5 (previously called Hox-1.3) 5' flanking regions and the lacZ reporter gene show tissue- and time-specific expression in the brachial spinal cord in day 11-13 embryos. A 604-bp regulatory region with enhancer properties directs this spatially specific expression. Fine-detail mapping of the enhancer has identified several elements involved in region-specific expression, including an element required for expression in the brachial spinal cord. Factors in embryonic day 12.5 nuclear extracts bind this element in electrophoretic mobility shift assays (EMSA) and protect three regions from DNase digestion. All three sites contain an AAATAA sequence and mutations at these sites reduce or abolish binding. Furthermore, this element binds specific individual embryonic proteins on a protein blot. The binding activity appears as a gradient along the anterior-posterior axis with two- to threefold higher levels observed in extracts from anterior regions than from posterior regions. In parallel with the EMSA, the proteins on the protein blot also show reduced binding to probes with mutations at the AAATAA sites. Most importantly, transgenic mice carrying Hoxa5/lacZ fusions with the three AAATAA sites mutated either do not express the transgene or have altered transgene expression. The brachial spinal cord element and its binding proteins are likely to be involved in spatial expression of Hoxa5 during development. PMID:10075847

  6. Post-Exercise Ankle-Brachial Pressure Index Demonstrates Altered Endothelial Function in the Elderly

    PubMed Central

    Sato, Shinji; Masami, Kozue; Otsuki, Shingo; Tanaka, Shiro; Nakayama, Noriko; Makita, Shigeru; Koshiyama, Hiroyuki; Nohara, Ryuji

    2011-01-01

    Background: The ankle-brachial pressure index (ABI), the ratio of the systolic blood pressure of the ankle to the systolic brachial pressure, is commonly measured at rest, but ABI values post-exercise enhance the sensitivity of the test and can be used to identify atherosclerotic vascular damage. However, it has not been established whether or not enhanced post-exercise ABI is also associated with endothelial dysfunction. We hypothesized that a decrease in post-exercise ABI is related to impaired endothelial function. Purpose: To investigate alterations in post-exercise ABI values and endothelial dysfunction in the elderly. Methods: The study population comprised 35 men and women aged 51–77 years (mean age: 66 years). Patients with peripheral arterial disease or a history of heart failure were excluded. The ABI was estimated at rest and immediately after exercise. The exercise protocol comprised 2.5 min of active pedal flexion exercises at a speed of 60 times/min. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD) in the brachial artery using ultrasound imaging. Results: No correlation was found between FMD and the ABI at rest. However, a weak correlation was found between FMD and post-exercise ABI (r = 0.46, P = 0.06). A strong correlation was observed between FMD and a decrease in post-exercise ABI compared to baseline readings (r = −0.52, P = 0.01). Multiple linear regression analysis was used to generate a prediction equation for FMD using the percentage decrease in post-exercise ABI. Significant correlations were observed between the ultrasound imaging-measured FMD and the predicted FMD (R2 = 0.27, P = 0.001). Conclusions: Post-exercise ABI appears to be a simple surrogate marker for endothelial function in the elderly, although larger studies are required for validation. PMID:23885186

  7. Difference in carotid artery elasticity in subjects with different brachial artery kinetic of vasodilatation.

    PubMed

    Tripolino, C; Gnasso, A; Carallo, C; Scavelli, F B; Irace, C

    2016-08-01

    Increased carotid stiffness and impaired brachial artery flow-mediated dilatation (FMD) associate with cardiovascular events. We have previously reported three FMD patterns based on the time of maximal dilatation. The aim of the present study was to verify whether different FMD patterns associate with carotid artery stiffness. In all, 133 subjects were enrolled. All participants underwent complete clinical examination, blood sampling and ultrasound study. FMD was used as a measure of endothelial function. Based on the maximal brachial artery FMD, subjects were divided into Early dilators (peak FMD at 50 s), Late dilators (peak FMD over 50 s) and No dilators. Echo-Doppler evaluation of carotid arteries was performed in order to calculate elastic indexes (strain, β-stiffness index and distensibility). In all, 64 subjects were classified as Early FMD, 36 as Late FMD and 33 as No dilators. Age, gender and cardiovascular risk factors were comparable among three groups. Early FMD had higher values of strain compared with both Late and no Dilators (P<0.001). Furthermore, Early dilators showed a significantly lower stiffness and higher distensibility compared with Late and No dilators. No significant differences between Late FMD and No Dilators were detected. Our results demonstrate that common carotid artery elasticity indexes significantly differ among Early, Late and No dilators. Subjects with delayed or absent brachial artery dilatation have stiffer common carotid arteries compared with subjects with early dilatation. In conclusion, our research suggests that the assessment of the kinetics of FMD in a clinical setting might represent a useful screening tool to improve the cardiovascular risk stratification. PMID:26467820

  8. Brachial-ankle pulse wave velocity as a predictor of mortality in elderly Chinese.

    PubMed

    Sheng, Chang-Sheng; Li, Yan; Li, Li-Hua; Huang, Qi-Fang; Zeng, Wei-Fang; Kang, Yuan-Yuan; Zhang, Lu; Liu, Ming; Wei, Fang-Fei; Li, Ge-Le; Song, Jie; Wang, Shuai; Wang, Ji-Guang

    2014-11-01

    Pulse wave velocity (PWV) is a measure of arterial stiffness and predicts cardiovascular events and mortality in the general population and various patient populations. In the present study, we investigated the predictive value of brachial-ankle PWV for mortality in an elderly Chinese population. Our study subjects were older (≥60 years) persons living in a suburban town of Shanghai. We measured brachial-ankle PWV using an automated cuff device at baseline and collected vital information till June 30, 2013, during follow-up. The 3876 participants (1713 [44.2%] men; mean [±SD] age, 68.1±7.3 years) included 2292 (59.1%) hypertensive patients. PWV was on average 17.8 (±4.0) m/s and was significantly (P<0.0001) associated with age (r=0.48) and in unadjusted analysis with all-cause (n=316), cardiovascular (n=148), stroke (n=46), and noncardiovascular mortality (n=168) during a median follow-up of 5.9 years. In further adjusted analysis, we studied the risk of mortality according to the decile distributions of PWV. Only the subjects in the top decile (23.3-39.3 m/s) had a significantly (P≤0.003) higher risk of all-cause mortality (hazard ratio relative to the whole study population, 1.56; 95% confidence interval, 1.16-2.08), especially in hypertensive patients (hazard ratio, 1.86; 95% confidence interval, 1.31-2.64; P=0.02 for the interaction between PWV and hypertension). Similar trends were observed for cardiovascular, stroke, and noncardiovascular mortality, although statistical significance was not reached (P≥0.08). In conclusion, brachial-ankle PWV predicts mortality in elderly Chinese on the conditions of markedly increased PWV and hypertension. PMID:25259749

  9. Range of motion and strength after surgery for brachial plexus birth palsy

    PubMed Central

    2011-01-01

    Background There is little information about the range of motion (ROM) and strength of the affected upper limbs of patients with permanent brachial plexus birth palsy. Patients and methods 107 patients who had brachial plexus surgery in Finland between 1971 and 1998 were investigated in this population-based, cross-sectional, 12-year follow-up study. During the follow-up, 59 patients underwent secondary procedures. ROM and isometric strength of the shoulders, elbows, wrists, and thumbs were measured. Ratios for ROM and strength between the affected and unaffected sides were calculated. Results 61 patients (57%) had no active shoulder external rotation (median 0° (-75–90)). Median active abduction was 90° (1–170). Shoulder external rotation strength of the affected side was diminished (median ratio 28% (0–83)). Active elbow extension deficiency was recorded in 82 patients (median 25° (5–80)). Elbow flexion strength of the affected side was uniformly impaired (median ratio 43% (0–79)). Median active extension of the wrist was 55° (-70–90). The median ratio of grip strength for the affected side vs. the unaffected side was 68% (0–121). Patients with total injury had poorer ROM and strength than those with C5–6 injury. Incongruity of the radiohumeral joint and avulsion were associated with poor strength values. Interpretation ROM and strength of affected upper limbs of patients with surgically treated brachial plexus birth palsy were reduced. Patients with avulsion injuries and/or consequent joint deformities fared worst. PMID:21142823

  10. Décompression chirurgicale du syndrome de défilé thoraco-brachial

    PubMed Central

    Lukulunga, Loubet Unyendje; Moussa, Abdou Kadri; Mahfoud, Mustapha; Ismael, Farid; Berrada, Mohamed Saleh; El Yaacoubi, Moradh

    2014-01-01

    Le syndrome de défilé thoraco-brachial est une pathologie souvent méconnue à cause de diagnostic difficile par manque des signes pathognomoniques conduisant souvent à des errances. Les manifestations cliniques dépendent selon qu'il s'agit d'une compression nerveuse, vasculaire ou vasculo-nerveuse. Le but de cette étude est de décrire certains aspects cliniques particuliers et évaluer le résultat fonctionnel après la décompression chirurgicale du paquet vasculo-nerveux. Notre étude rétrospective a porté sur l'analyse des données cliniques, radiologiques, IRM et EMG sur les patients opérés entre janvier 2010 et juillet 2013 du syndrome de défilé thoraco-brachial dans le service de traumatologie orthopédie de l'hôpital Ibn Sina de Rabat. 15 cas ont été colligés: 12 cas post traumatiques (fracture de la clavicule) et 3 cas d'origines congénitales, dont l’âge moyen était 35 ans (20 à 50 ans) avec 9 femmes et 6 hommes. A la fin du traitement, le score de Dash est passé de 109 (46% Normal=0) à 70 (20%), et le stress test de Roos était de 70/100 à 80/100. Le résultat était excellent dans 12 cas soit (80%) et moins bon dans dans 3 cas (20%). En définitive, la résection de malformations osseuses, l'excision des brides et la neurolyse du plexus brachial suivie de la rééducation a donné une bonne évolution fonctionnelle. PMID:25709735

  11. Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis.

    PubMed

    Kollias, Anastasios; Lagou, Styliani; Zeniodi, Maria Elena; Boubouchairopoulou, Nadia; Stergiou, George S

    2016-01-01

    Accumulating evidence suggests that central blood pressure (BP) may reflect the hemodynamic stress on target organs more accurately than brachial BP. A systematic review assessing the relationship of central versus brachial BP with preclinical target-organ damage was performed. Meta-analysis of cross-sectional data showed that central compared with brachial systolic BP was more closely associated with (1) left ventricular mass index (12 studies, n=6431; weighted age [SD], 49.9 [13.1] years; 51% hypertensives): pooled correlation coefficients r=0.30; 95% confidence interval (CI), 0.23-0.37 versus r=0.26; 95% CI, 0.19-0.33, respectively; P<0.01 for difference; (2) carotid intima-media thickness (7 studies, n=6136; weighted age, 55.6 [13.2] years; 48% hypertensives): r=0.27; 95% CI, 0.19-0.34 versus r=0.23; 95% CI, 0.16-0.30, respectively; P<0.01 for difference; (3) pulse-wave velocity (14 studies, n=3699; weighted age, 53.9 [13.3] years; 53% hypertensives): r=0.42; 95% CI, 0.37-0.47 versus r=0.39; 95% CI, 0.33-0.45, respectively; P<0.01 for difference. Four studies assessing urine albumin excretion (n=3718; weighted age, 56.4 [5] years; 69% hypertensives) reported similar correlations (P=not significant) with central (r=0.22; 95% CI, 0.14-0.29) and brachial systolic BP (r=0.22; 95% CI, 0.12-0.32). Similar findings were observed for central compared with brachial pulse pressure in terms of relationship with target-organ damage. Metaregression analyses did not reveal any significant effect of age. In conclusion, central compared with brachial BP seems to be more strongly associated with most of the investigated indices of preclinical organ damage. PMID:26597821

  12. Brachial Plexopathy in Apical Non-Small Cell Lung Cancer Treated With Definitive Radiation: Dosimetric Analysis and Clinical Implications

    SciTech Connect

    Eblan, Michael J.; Corradetti, Michael N.; Lukens, J. Nicholas; Xanthopoulos, Eric; Mitra, Nandita; Christodouleas, John P.; Grover, Surbhi; Fernandes, Annemarie T.; Langer, Corey J.; Evans, Tracey L.; Stevenson, James; Rengan, Ramesh; Apisarnthanarax, Smith

    2013-01-01

    Purpose: Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients. Methods and Materials: Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received {>=}50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines. Results: Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received {<=}78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving {>=}1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively. Conclusions: RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of

  13. Effect of dexamethasone in low volume supraclavicular brachial plexus block: A double-blinded randomized clinical study

    PubMed Central

    Alarasan, Arun Kumar; Agrawal, Jitendre; Choudhary, Bhanu; Melhotra, Amrita; Uike, Satyendre; Mukherji, Arghya

    2016-01-01

    Background and Aims: With the use of ultrasound, a minimal effective volume of 20 ml has been described for supraclavicular brachial plexus block. However achieving a long duration of analgesia with this minimal volume remains a challenge. We aimed to determine the effect of dexamethasone on onset and duration of analgesia in low volume supraclavicular brachial plexus block. Material and Methods: Sixty patients were randomly divided into two groups of 30 each. Group C received saline (2 ml) + 20 ml of 0.5% bupivacaine and Group D received dexamethasone (8 mg) + 20 ml of 0.5% bupivacaine in supraclavicular brachial plexus block. Hemodynamic variables and visual analog scale (VAS) score were noted at regular intervals until 450 min. The onset and duration of sensory and motor block were measured. The incidence of “Halo” around brachial plexus was observed. Student's t-test and Chi-square test were used for statistical analysis. Results: The onset of sensory and motor block was significantly earlier in dexamethasone group (10.36 ± 1.99 and 12 ± 1.64) minutes compared to control group (12.9 ± 2.23 and 18.03 ± 2.41) minutes. The duration of sensory and motor block was significantly prolonged in dexamethasone group (366 ± 28.11 and 337.33 ± 28.75) minutes compared to control group (242.66 ± 26.38 and 213 ± 26.80) minutes. The VAS score was significantly lower in dexamethasone group after 210 min. “Halo” was present around the brachial plexus in all patients in both the groups. Conclusion: Dexamethasone addition significantly increases the duration of analgesia in patients receiving low volume supraclavicular brachial plexus block. No significant side-effects were seen in patients receiving dexamethasone as an adjunct. PMID:27275056

  14. Successful management of complex regional pain syndrome type 1 using single injection interscalene brachial plexus block

    PubMed Central

    Fallatah, Summayah M.A.

    2014-01-01

    Complex regional pain syndrome (CRPS) type 1 of the upper limb is a painful and debilitating condition. Interscalene brachial plexus block (ISB) in conjugation with other modalities was shown to be a feasible therapy with variable success. We reported a case of CRPS type 1 as diagnosed by International Association for the Study of Pain criteria in which pharmacological approaches failed to achieve adequate pain relief and even were associated with progressive dysfunction of the upper extremity. Single injection ISB, in combination with physical therapy and botulinum toxin injection, was successful to alleviate pain with functional restoration. PMID:25422619

  15. Reactivity to low-flow as a potential determinant for brachial artery flow-mediated vasodilatation.

    PubMed

    Aizawa, Kunihiko; Elyas, Salim; Adingupu, Damilola D; Casanova, Francesco; Gooding, Kim M; Strain, W David; Shore, Angela C; Gates, Phillip E

    2016-06-01

    Previous studies have reported a vasoconstrictor response in the radial artery during a cuff-induced low-flow condition, but a similar low-flow condition in the brachial artery results in nonuniform reactivity. This variable reactivity to low-flow influences the subsequent flow-mediated dilatation (FMD) response following cuff-release. However, it is uncertain whether reactivity to low-flow is important in data interpretation in clinical populations and older adults. This study aimed to determine the influence of reactivity to low-flow on the magnitude of brachial artery FMD response in middle-aged and older individuals with diverse cardiovascular risk profiles. Data were analyzed from 165 individuals, divided into increased cardiovascular risk (CVR: n = 115, 85M, 67.0 ± 8.8 years) and healthy control (CTRL: n = 50, 30M, 63.2 ± 7.2 years) groups. Brachial artery diameter and blood velocity data obtained from Doppler ultrasound were used to calculate FMD, reactivity to low-flow and estimated shear rate (SR) using semiautomated edge-detection software. There was a significant association between reactivity to low-flow and FMD in overall (r = 0.261), CTRL (r = 0.410) and CVR (r = 0.189, all P < 0.05) groups. Multivariate regression analysis found that reactivity to low-flow, peak SR, and baseline diameter independently contributed to FMD along with sex, the presence of diabetes, and smoking (total R(2) = 0.450). There was a significant association between reactivity to low-flow and the subsequent FMD response in the overall dataset, and reactivity to low-flow independently contributed to FMD These findings suggest that reactivity to low-flow plays a key role in the subsequent brachial artery FMD response and is important in the interpretation of FMD data. PMID:27335431

  16. MR Imaging of Brachial Plexus and Limb-Girdle Muscles in Patients with Amyotrophic Lateral Sclerosis.

    PubMed

    Gerevini, Simonetta; Agosta, Federica; Riva, Nilo; Spinelli, Edoardo G; Pagani, Elisabetta; Caliendo, Giandomenico; Chaabane, Linda; Copetti, Massimiliano; Quattrini, Angelo; Comi, Giancarlo; Falini, Andrea; Filippi, Massimo

    2016-05-01

    Purpose To assess brachial plexus magnetic resonance (MR) imaging features and limb-girdle muscle abnormalities as signs of muscle denervation in patients with amyotrophic lateral sclerosis (ALS). Materials and Methods This study was approved by the local ethical committees on human studies, and written informed consent was obtained from all subjects before enrollment. By using an optimized protocol of brachial plexus MR imaging, brachial plexus and limb-girdle muscle abnormalities were evaluated in 23 patients with ALS and clinical and neurophysiologically active involvement of the upper limbs and were compared with MR images in 12 age-matched healthy individuals. Nerve root and limb-girdle muscle abnormalities were visually evaluated by two experienced observers. A region of interest-based analysis was performed to measure nerve root volume and T2 signal intensity. Measures obtained at visual inspection were analyzed by using the Wald χ(2) test. Mean T2 signal intensity and volume values of the regions of interest were compared between groups by using a hierarchical linear model, accounting for the repeated measurement design. Results The level of interrater agreement was very strong (κ = 0.77-1). T2 hyperintensity and volume alterations of C5, C6, and C7 nerve roots were observed in patients with ALS (P < .001 to .03). Increased T2 signal intensity of nerve roots was associated with faster disease progression (upper-limb Medical Research Council scale progression rate, r = 0.40; 95% confidence interval: 0.001, 0.73). Limb-girdle muscle alterations (ie, T2 signal intensity alteration, edema, atrophy) and fat infiltration also were found, in particular, in the supraspinatus muscle, showing more frequent T2 signal intensity alterations and edema (P = .01) relative to the subscapularis and infraspinatus muscles. Conclusion Increased T2 signal intensity and volume of brachial nerve roots do not exclude a diagnosis of ALS and suggest involvement of the peripheral

  17. Brachial artery injury due to closed posterior elbow dislocation: case report☆

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; do Val Sella, Guilherme; Checchia, Caio Santos; Checchia, Sergio Luiz

    2016-01-01

    An association between closed posterior elbow dislocation and traumatic brachial artery injury is rare. Absence of radial pulse on palpation is an important warning sign and arteriography is the gold-standard diagnostic test. Early diagnosis is essential for appropriate treatment to be provided. This consists of joint reduction and immobilization, along with urgent surgical restoration of arterial flow. Here, a case (novel to the Brazilian literature) of an association between these injuries (and the treatment implemented) in a 27-year-old male patient is reported. These injuries were sustained through physical assault. PMID:27069896

  18. Brachial artery retrograde flow increases with age: relationship to physical function

    PubMed Central

    Credeur, Daniel P.; Dobrosielski, Devon A.; Arce-Esquivel, Arturo A.; Welsch, Michael A.

    2010-01-01

    The purpose of this study was to examine the flow velocity pattern of the brachial artery and to determine its relationship to measures of physical function. Subjects from the Louisiana Healthy Aging Study (n = 95; age = 84 ± 10 years) were evaluated. Brachial artery flow velocities and dimensions were measured using high-resolution ultrasonography. The continuous scale of physical function and performance test (CS-PFP10) was used to assess physical function. This test is based on the performance of 11 activities of daily living. Total CS-PFP10 score was 39.51 ± 21.21 U. Mean antegrade and retrograde velocities at rest were 14.2 ± 4.7 and 3.6 ± 2.2 cm/s, respectively. Ante-/retrograde ratio was 5.5 ± 4.6. Brachial artery diameter was 4.3 ± 0.7 mm. Pulse pressure and vascular conductance were 66 ± 18 mmHg, and 0.9 ± 0.5 ml/min/mmHg, respectively. Vascular conductance (r = −0.34), ante-/retrograde ratio (r = −0.42) and CS-PFP10 (r = −0.65) were inversely and retrograde velocity (r = 0.40) and pulse pressure (r = 0.36), were directly associated with age. Retrograde velocity was inversely related to vascular conductance (r = −0.27) and CS-PFP10 total score (r = −0.45). A MANOVA revealed that those with the higher CS-PFP10 scores had a lower retrograde velocity (P = 0.0001), but this association was, in part, age-dependent. Among nonagenarians (n = 52), those in the lower tertiles of the CS-PFP10 scores had significantly higher retrograde velocities compared to those in the higher tertiles (P = 0.035). These data indicate an increase in brachial retrograde velocity with age. These hemodynamic changes are related to a decline in physical function. PMID:19565260

  19. Severe Outcome of Pharyngeal-Cervical-Brachial Pure Motor Axonal Neuropathy

    PubMed Central

    Bonanni, L.; Onofrj, V.; Scorrano, V.; Onofrj, M.; Thomas, A.

    2010-01-01

    We present two further cases of the pharyngeal-cervical-brachial (PCB) form of GBS, with unfavourable outcome, showing dramatic dissociation between upper and lower body Symptoms. Both patients showed rapidly progressive motor denervation with disappearance of Compound Muscle Action Potentials (CMAPs) in upper limbs muscles. Sensory Nerve Action Potentials (SNAPs) were instead normal. Normal reflexes, F waves and action potentials were elicited in lower limbs. Despite i.v. Immunoglobulin treatment no recovery was observed and both patients died within a year from onset of symptoms. PMID:20309392

  20. Safety of brachial arteriogram using a 3-French dilator to evaluate nonmaturing arteriovenous fistulae.

    PubMed

    Vachharajani, Tushar J; Asif, Arif

    2014-01-01

    Nonmaturing arteriovenous fistula remains a hurdle in improving the fistula rate in the hemodialysis population. Timely referral can assist in salvaging fistula with endovascular interventions. Pathology at the inflow segment is frequently encountered as a primary reason for maturation failure. Conventional retrograde angiography can result in poor delineation of the inflow segment and may not be an ideal method for evaluating nonmaturing fistulae. Moreover, the risk of vascular rupture and overzealous diagnosis of accessory veins often result in additional unnecessary therapeutic interventions. Alternatively, a direct brachial arteriogram can provide complete anatomic delineation to perform appropriate endovascular interventions. PMID:24118439

  1. Brachial blood pressure-independent relations between radial late systolic shoulder-derived aortic pressures and target organ changes.

    PubMed

    Norton, Gavin R; Majane, Olebogeng H I; Maseko, Muzi J; Libhaber, Carlos; Redelinghuys, Michelle; Kruger, Deirdre; Veller, Martin; Sareli, Pinhas; Woodiwiss, Angela J

    2012-04-01

    Central aortic blood pressure (BP; BPc) predicts outcomes beyond brachial BP. In this regard, the application of a generalized transfer function (GTF) to radial pulse waves for the derivation of BPc is an easy and reproducible measurement technique. However, the use of the GTF may not be appropriate in all circumstances. Although the peak of the second shoulder of the radial waveform (P2) is closely associated with BPc, and, hence, BPc may be assessed without the need for a GTF, whether P2-derived BPc is associated with adverse cardiovascular changes independent of brachial BP is uncertain. Thus, P2- and GTF-derived aortic BPs were assessed using applanation tonometry and SphygmoCor software. Left ventricular mass was indexed for height(1.7) (n=678) and carotid intima-media thickness (IMT; n=462) was determined using echocardiography and vascular ultrasound. With adjustments for nurse-derived brachial pulse pressure (PP), P2-derived central PP was independently associated with left ventricular mass indexed for height(1.7) (partial r=0.18; P<0.0001) and IMT (partial r=0.40; P<0.0001). These relations were similar to nurse-derived brachial PP-independent relations between GTF-derived central PP and target organ changes (left ventricular mass indexed for height(1.7): partial r=0.17, P<0.0001; IMT: partial r=0.37, P<0.0001). In contrast, with adjustments for central PP, nurse-derived brachial PP-target organ relations were eliminated (partial r=-0.21 to 0.05). Twenty-four-hour, day, and night PP-target organ relations did not survive adjustments for nurse-derived brachial BP. In conclusion, central PP derived from P2, which does not require a GTF, is associated with cardiovascular target organ changes independent of brachial BP. Thus, when assessing adverse cardiovascular effects of aortic BP independent of brachial BP, P2-derived measures may complement GTF-derived measures of aortic BP. PMID:22331378

  2. Thrombin Injection for Treatment of Brachial Artery Pseudoaneurysm at the Site of a Hemodialysis Fistula: Report of Two Patients

    SciTech Connect

    Clark, Timothy W.I.; Abraham, Robert J.

    2000-09-15

    We report two patients with arteriovenous hemodialysis fistulas that were complicated by brachial artery pseudoaneurysms. Each pseudoanerysm was percutaneously thrombosed with an injection of thrombin, using techniques to prevent escape of thrombin into the native brachial artery. In one patient, an angioplasty balloon was inflated across the neck of the aneurysm during thrombin injection. In the second patient, thrombin was injected during ultrasound-guided compression of the neck of the pseudoaneurysm. Complete thrombosis of each pseudoaneurysm was achieved within 30 sec. No ischemic or embolic events occurred. This technique may be useful in treating pseudoaneurysms of smaller peripheral arteries.

  3. An Adult Case of Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibody-associated Multiphasic Acute Disseminated Encephalomyelitis at 33-year Intervals.

    PubMed

    Numa, Soichiro; Kasai, Takashi; Kondo, Takayuki; Kushimura, Yukie; Kimura, Ayaka; Takahashi, Hisashi; Morita, Kanako; Tanaka, Akihiro; Noto, Yu-Ichi; Ohara, Tomoyuki; Nakagawa, Masanori; Mizuno, Toshiki

    2016-01-01

    Acute disseminated encephalomyelitis (ADEM) followed by optic neuritis (ON) has been reported as a distinct phenotype associated with anti-myelin oligodendrocyte protein (MOG) antibody. We herein report the case of a 37-year-old woman who was diagnosed with ADEM at 4 years old of age and who subsequently developed ON followed by recurrent ADEM 33 years after the initial onset. A serum analysis showed anti-MOG antibody positivity. This phenotype has only previously been reported in pediatric cases. Neurologists thus need to be aware that the phenotype may occur in adult patients, in whom it may be assumed to be atypical multiple sclerosis. PMID:26984094

  4. Activation of the adenosine A2A receptor exacerbates experimental autoimmune neuritis in Lewis rats in association with enhanced humoral immunity.

    PubMed

    Zhang, Min; Li, Xiao-Li; Li, Heng; Wang, Shan; Wang, Cong-Cong; Yue, Long-Tao; Xu, Hua; Zhang, Peng; Chen, Hui; Yang, Bing; Duan, Rui-Sheng

    2016-04-15

    Accumulated evidence demonstrated that Adenosine A2A receptor (A2AR) is involved in the inflammatory diseases. In the present study, we showed that a selective A2AR agonist, CGS21680, exacerbated experimental autoimmune neuritis in Lewis rats induced with bovine peripheral myelin. The exacerbation was accompanied with reduced CD4(+)Foxp3(+) T cells, increased CD4(+)CXCR5(+) T cells, B cells, dendritic cells and antigen-specific autoantibodies, which is possibly due to the inhibition of IL-2 induced by CGS21680. Combined with previous studies, our data indicate that the effects of A2AR stimulation in vivo are variable in different diseases. Caution should be taken in the use of A2AR agonists. PMID:27049573

  5. Structural Alterations of Segmented Macular Inner Layers in Aquaporin4-Antibody-Positive Optic Neuritis Patients in a Chinese Population

    PubMed Central

    Peng, Chunxia; Wang, Wei; Xu, Quangang; Zhao, Shuo; Li, Hongyang; Yang, Mo; Cao, Shanshan; Zhou, Huanfen; Wei, Shihui

    2016-01-01

    Objectives This study aimed to analyse the structural injury of the peripapillary retinal nerve fibre layer (pRNFL) and segmented macular layers in optic neuritis (ON) in aquaporin4-antibody (AQP4-Ab) seropositivity(AQP4-Ab-positiveON) patients and in AQP4-Ab seronegativity (AQP4-Ab-negative ON) patients in order to evaluate their correlations with the best-corrected visual acuity (BCVA) and the value of the early diagnosis of neuromyelitis optica (NMO). Design This is a retrospective, cross-sectional and control observational study. Methods In total, 213 ON patients (291 eyes) and 50 healthy controls (HC) (100 eyes) were recruited in this study. According to a serum AQP4-Ab assay, 98 ON patients (132 eyes) were grouped as AQP4-Ab-positive ON and 115 ON patients (159 eyes) were grouped as AQP4-Ab-negative ON cohorts. All subjects underwent scanning with spectralis optical coherence tomography (OCT) and BCVA tests. pRNFL and segmented macular layer measurements were analysed. Results The pRNFL thickness in AQP4-Ab-positive ON eyes showed a more serious loss during 0–2 months (-27.61μm versus -14.47 μm) and ≥6 months (-57.91μm versus -47.19μm) when compared with AQP4-Ab-negative ON eyes. AQP4-Ab-positive ON preferentially damaged the nasal lateral pRNFL. The alterations in the macular ganglion cell layer plus the inner plexiform layer (GCIP) in AQP4-Ab-positive ON eyes were similar to those in AQP4-Ab-negative ON eyes. AQP4-Ab-positive ON eyes had entirely different injury patterns in the inner nuclear layer (INL) compared with AQP4-Ab-negative ON eyes during the first 6 months after the initial ON attack. These differences were as follows: the INL volume of AQP4-Ab-positive ON eyes had a gradual growing trend compared with AQP4-Ab-negative ON eyes, and it increased rapidly during 0–2 months, reached its peak during 2–4 months, and then decreased gradually. The pRNFL and GCIP in AQP4-Ab-positive ON eyes had positive correlations with BCVA. When the p

  6. Labyrinthitis and Vestibular Neuritis

    MedlinePlus

    ... any further problems. A key component of successful adaptation is a dedicated effort to keep moving, despite ... can prolong or even prevent the process of adaptation. Authors: Charlotte L. Shupert, PhD with contributions from ...

  7. Acute dietary nitrate supplementation does not augment submaximal forearm exercise hyperemia in healthy young men

    PubMed Central

    Kim, Jin-Kwang; Moore, David J.; Maurer, David G.; Kim-Shapiro, Daniel B.; Basu, Swati; Flanagan, Michael P.; Skulas-Ray, Ann C.; Kris-Etherton, Penny; Proctor, David N.

    2014-01-01

    Despite the popularity of dietary nitrate supplementation and the growing evidence base of its potential ergogenic and vascular health benefits, there is no direct information about its effects on exercising limb blood flow in humans. We hypothesized that acute dietary nitrate supplementation from beetroot juice would augment the increases in forearm blood flow, as well as the progressive dilation of the brachial artery, during graded handgrip exercise in healthy young men. In a randomized, double-blind, placebo-controlled crossover study, 12 young (22 ± 2 years) healthy men consumed a beetroot juice (140 mL Beet-It Sport, James White Juice Company) that provided 12.9 mmol (0.8 g) of nitrate or placebo (nitrate-depleted Beet-It Sport) on 2 study visits. At 3 h postconsumption, brachial artery diameter, flow, and blood velocity were measured (Doppler ultrasound) at rest and during 6 exercise intensities. Nitrate supplementation raised plasma nitrate (19.5-fold) and nitrite (1.6-fold) concentrations, and lowered resting arterial pulse wave velocity (PWV) versus placebo (all p < 0.05) indicating absorption, conversion, and a biological effect of this supplement. The supplement-associated lowering of PWV was also negatively correlated with plasma nitrite (r = -0.72, p = 0.0127). Despite these systemic effects, nitrate supplementation had no effect on brachial artery diameter, flow, or shear rates at rest (all p ≥ 0.28) or during any exercise workload (all p ≥ 0.18). These findings suggest that acute dietary nitrate supplementation favorably modifies arterial PWV, but does not augment blood flow or brachial artery vasodilation during non-fatiguing forearm exercise in healthy young men. PMID:25536008

  8. Acute dietary nitrate supplementation does not augment submaximal forearm exercise hyperemia in healthy young men.

    PubMed

    Kim, Jin-Kwang; Moore, David J; Maurer, David G; Kim-Shapiro, Daniel B; Basu, Swati; Flanagan, Michael P; Skulas-Ray, Ann C; Kris-Etherton, Penny; Proctor, David N

    2015-02-01

    Despite the popularity of dietary nitrate supplementation and the growing evidence base of its potential ergogenic and vascular health benefits, there is no direct information about its effects on exercising limb blood flow in humans. We hypothesized that acute dietary nitrate supplementation from beetroot juice would augment the increases in forearm blood flow, as well as the progressive dilation of the brachial artery, during graded handgrip exercise in healthy young men. In a randomized, double-blind, placebo-controlled crossover study, 12 young (22 ± 2 years) healthy men consumed a beetroot juice (140 mL Beet-It Sport, James White Juice Company) that provided 12.9 mmol (0.8 g) of nitrate or placebo (nitrate-depleted Beet-It Sport) on 2 study visits. At 3 h postconsumption, brachial artery diameter, flow, and blood velocity were measured (Doppler ultrasound) at rest and during 6 exercise intensities. Nitrate supplementation raised plasma nitrate (19.5-fold) and nitrite (1.6-fold) concentrations, and lowered resting arterial pulse wave velocity (PWV) versus placebo (all p < 0.05), indicating absorption, conversion, and a biological effect of this supplement. The supplement-associated lowering of PWV was also negatively correlated with plasma nitrite (r = -0.72, p = 0.0127). Despite these systemic effects, nitrate supplementation had no effect on brachial artery diameter, flow, or shear rates at rest (all p ≥ 0.28) or during any exercise workload (all p ≥ 0.18). These findings suggest that acute dietary nitrate supplementation favorably modifies arterial PWV, but does not augment blood flow or brachial artery vasodilation during nonfatiguing forearm exercise in healthy young men. PMID:25536008

  9. Acute Bronchitis

    MedlinePlus

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis ...

  10. Non-invasive model-based estimation of aortic pulse pressure using suprasystolic brachial pressure waveforms.

    PubMed

    Lowe, A; Harrison, W; El-Aklouk, E; Ruygrok, P; Al-Jumaily, A M

    2009-09-18

    Elevated central arterial (aortic) blood pressure is related to increased risk of cardiovascular disease. Methods of non-invasively estimating this pressure would therefore be helpful in clinical practice. To achieve this goal, a physics-based model is derived to correlate the arterial pressure under a suprasystolic upper-arm cuff to the aortic pressure. The model assumptions are particularly applicable to the measurement method and result in a time-domain relation with two parameters, namely, the wave propagation transit time and the reflection coefficient at the cuff. Central pressures estimated by the model were derived from completely automatic, non-invasive measurement of brachial blood pressure and suprasystolic waveform and were compared to simultaneous invasive catheter measurements in 16 subjects. Systolic blood pressure agreement, mean (standard deviation) of difference was -1 (7)mmHg. Diastolic blood pressure agreement was 4 (4)mmHg. Correlation between estimated and actual central waveforms was greater than 90%. Individualization of model parameters did not significantly improve systolic and diastolic pressure agreement, but increased waveform correlation. Further research is necessary to confirm that more accurate brachial pressure measurement improves central pressure estimation. PMID:19665136

  11. Ankle Brachial Index: simple non-invasive estimation of peripheral artery disease

    NASA Astrophysics Data System (ADS)

    Pieniak, Marcin; Cieślicki, Krzysztof; Żyliński, Marek; Górski, Piotr; Murgrabia, Agnieszka; Cybulski, Gerard

    2014-11-01

    According to international guidelines, patients with Peripheral Artery Disease (PAD) are burdened with high cardiovascular risk. One of the simplest, non-invasive methods for PAD detection is the ankle-brachial index (ABI) measurement. The ABI is calculated as the ratio of systolic blood pressure at the ankle (pressure in the posterior tibial artery or the dorsal artery) to the systolic pressure in the arm (in the brachial artery) when the body is in a horizontal position. The physiological value of the ABI is assumed to be between 1 and 1.3; however, these limits vary from study to study. A value less than 0.9 indicates PAD. Some authors propose also measuring the ABI on both sides of the body to highlight possible differences in blood pressure between the opposite arterial segments. The aim of this study was to perform a meta-analysis of the ABI diagnostic criteria used in different publications. Additionally, ABI measurements were performed on 19 healthy patients in age ranged from 20 to 63 years. The results showed a slight dependence between age and the differences between the values obtained from left and right sides of the body.

  12. Exercise intensity modulates brachial artery retrograde blood flow and shear rate during leg cycling in hypoxia.

    PubMed

    Iwamoto, Erika; Katayama, Keisho; Ishida, Koji

    2015-06-01

    The purpose of this study was to elucidate the effect of exercise intensity on retrograde blood flow and shear rate (SR) in an inactive limb during exercise under normoxic and hypoxic conditions. The subjects performed two maximal exercise tests on a semi-recumbent cycle ergometer to estimate peak oxygen uptake (V˙O2peak) while breathing normoxic (inspired oxygen fraction [FIO2 = 0.21]) and hypoxic (FIO2 = 0.12 or 0.13) gas mixtures. Subjects then performed four exercise bouts at the same relative intensities (30 and 60% V˙O2peak) for 30 min under normoxic or hypoxic conditions. Brachial artery diameter and blood velocity were simultaneously recorded, using Doppler ultrasonography. Retrograde SR was enhanced with increasing exercise intensity under both conditions at 10 min of exercise. Thereafter, retrograde blood flow and SR in normoxia returned to pre-exercise levels, with no significant differences between the two exercise intensities. In contrast, retrograde blood flow and SR in hypoxia remained significantly elevated above baseline and was significantly greater at 60% than at 30% V˙O2peak. We conclude that differences in exercise intensity affect brachial artery retrograde blood flow and SR during prolonged exercise under hypoxic conditions. PMID:26038470

  13. Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

    PubMed

    Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

    2016-06-01

    The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV. PMID:26835823

  14. The minimum effective concentration (MEC90 ) of ropivacaine for ultrasound-guided supraclavicular brachial plexus block.

    PubMed

    Fang, G; Wan, L; Mei, W; Yu, H H; Luo, A L

    2016-06-01

    The aim of this study was to determine the minimum effective concentration of ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Fifty-one patients undergoing arm surgery received double-injection ultrasound-guided supraclavicular block using ropivacaine 40 ml. The concentration of ropivacaine administered to each patient started at 0.225% and then depended on the response of the previous one, based on a biased coin design up-and-down sequential method. In case of failure, the ropivacaine concentration was increased by 0.025% w/v in the next subject. In the case of a successful block, the next patient was randomised to the same concentration or a concentration 0.025% w/v less. Success was defined as complete sensory blockade of the brachial plexus 30 min after the block together with pain-free surgery. The minimum effective ropivacaine concentration in 90% of subjects was 0.257% w/v (95% CI 0.241-0.280%). PMID:26945818

  15. Brachial artery Doppler flux parameters before and after hot flush in Mexican postmenopausal women: preliminary report

    PubMed Central

    Rodríguez, Karina Vázquez; Ortiz, Sergio Rosales

    2016-01-01

    Objective To analyse brachial artery flux parameters in postmenopausal women before and after hot flush. Material and methods Two groups of postmenopausal women were studied: Group I, without vasomotor symptoms (n = 10) and Group II, with vasomotor symptoms (n = 10). In all them a brachial artery Doppler ultrasound was done, measuring before and after hyperaemic stimulus of the arterial diameter (AD), the pulsatility index (PI), and the resistive index (RI). In Group I, measurements were done at baseline and five minutes after. In Group II, measurements were at baseline, and one and five minutes after the hot-flush. Comparison between the groups was done with Mann-Whitney U test, and within the groups with Wilcoxon test. Results No differences were found among the groups in Doppler parameters. When comparing each group separately, in Group I, at baseline and at five minutes measurements, the AD was greater after the hyperaemic stimulus than before it. In group II at baseline, the PI was significantly greater after the hyperaemic stimulus than before to it. At the first and fifth minute, the AD was significantly greater after the hyperaemic stimulus than before to it. Conclusions No differences were found between those who did not have and those who had hot flushes. PMID:27095957

  16. Is Brachial Artery Flow-Mediated Dilation Associated with Negative Affect?

    PubMed Central

    Kamarck, Thomas W.; Matthews, Karen A.; Brockwell, Sarah E.; Sutton-Tyrrell, Kim

    2010-01-01

    Background Trait negative affect has been implicated as a risk marker for cardiovascular disease, but the mechanisms underlying this association are uncertain. Purpose Our aim was to examine associations between trait measures of anger, hostility, depression, and anxiety with endothelial dysfunction via brachial artery flow-mediated dilation (FMD), an early indicator of cardiovascular disease. Method FMD was examined in 332 healthy older adults. Measures included Beck Anxiety and Depression Inventories, Cook–Medley Hostility Scale, and Spielberger State-Trait Anger Expression Inventory (Anger In, Anger Out, and Trait Anger). Results Mean age was 60.5±4.8 years; 83% of participants were Caucasian and 49% were female. FMD was greater in women compared to men (6.17% vs. 4.07%, p<0.001). Women reported significantly greater Anxiety (p<0.001), and men reported greater Hostility (p=0.004). In separate multivariable linear regression models controlling for cardiovascular risk factors, plus current hormone therapy for women, smaller FMD was associated with higher Anger In for women (β=− 0.222, p=0.04) and showed a trend with higher Hostility for men (β= −0.082, p=0.09). Conclusion Endothelial dysfunction, as indicated by less vasodilatation of the brachial artery, is positively associated with measures of hostility and anger suppression in healthy older adults. Thus, associations between negative affect and cardiovascular health may be apparent early in the disease process. PMID:19306064

  17. Brachial plexus birth palsy: Management during the first year of life.

    PubMed

    Abid, A

    2016-02-01

    Brachial plexus birth palsy (BPBP) is defined as an injury to any nerve root of the brachial plexus during difficult delivery. BPBP is relatively rare; its incidence has remained constant over the last few decades, mostly due to unpredictable risk factors, such as shoulder dystocia. Both diagnosis and assessment of spontaneous recovery is based on clinical examination. Electromyography is difficult to interpret in the newborn and is therefore not meaningful. MRI of the cervical spine requires sedation or general anesthesia. Searching for a pre-ganglion tear prior to surgery is indicted. Prognosis depends on the level of the injury (pre- or post-ganglion), size and severity of the post-ganglion tears, speed of recovery, and quality of initial management. Although spontaneous recovery is frequent, some children suffer various degrees of sequelae, up to complete loss of function of the affected upper limb. Recent publications have improved general knowledge and indications for surgery. However, some aspects, such as indication and timing of nerve repair continue to be debated. PMID:26774906

  18. Exercise intensity modulates brachial artery retrograde blood flow and shear rate during leg cycling in hypoxia

    PubMed Central

    Iwamoto, Erika; Katayama, Keisho; Ishida, Koji

    2015-01-01

    The purpose of this study was to elucidate the effect of exercise intensity on retrograde blood flow and shear rate (SR) in an inactive limb during exercise under normoxic and hypoxic conditions. The subjects performed two maximal exercise tests on a semi-recumbent cycle ergometer to estimate peak oxygen uptake (O2peak) while breathing normoxic (inspired oxygen fraction [FIO2 = 0.21]) and hypoxic (FIO2 = 0.12 or 0.13) gas mixtures. Subjects then performed four exercise bouts at the same relative intensities (30 and 60% O2peak) for 30 min under normoxic or hypoxic conditions. Brachial artery diameter and blood velocity were simultaneously recorded, using Doppler ultrasonography. Retrograde SR was enhanced with increasing exercise intensity under both conditions at 10 min of exercise. Thereafter, retrograde blood flow and SR in normoxia returned to pre-exercise levels, with no significant differences between the two exercise intensities. In contrast, retrograde blood flow and SR in hypoxia remained significantly elevated above baseline and was significantly greater at 60% than at 30% O2peak. We conclude that differences in exercise intensity affect brachial artery retrograde blood flow and SR during prolonged exercise under hypoxic conditions. PMID:26038470

  19. Retrieval of a subintimal fractured guide wire from the brachial artery following saphenous vein graft stenting.

    PubMed

    Danson, Edward J; Ward, Michael

    2015-06-01

    We present a case of a 58-year-old woman with diabetes mellitus with a history of angina, coronary artery bypass 24 years previously and who underwent retrieval of a fractured coronary buddy wire from the right brachial artery following attempted coronary intervention to a saphenous vein graft via the right radial route. Attempted removal of the guide wire had caused guide catheter-induced dissection of the vein graft in addition to a distal stent edge dissection before fracture in the brachial artery. The fractured end of the buddy wire was found to be in the subintimal space and could only be retrieved by advancing the wire into the subclavian artery by means of wrapping its free portion around the guiding catheter. Its fractured end could then be snared into the guiding catheter but could only be withdrawn from behind the stented segment in the vein graft by means of a trap balloon in the guiding catheter. Successful stenting of a guide catheter-induced dissection and distal stent edge dissection within the vein graft was then performed. This case highlights the hazards of deploying stents over buddy wires and of fractured guide wires in coronary intervention. © 2015 Wiley Periodicals, Inc. PMID:25345676

  20. Recovery of brachial plexus lesions resulting from heavy backpack use: A follow-up case series

    PubMed Central

    2011-01-01

    Background Brachial plexus lesions as a consequence of carrying a heavy backpack have been reported, but the typical clinical course and long-term consequences are not clear. Here we evaluated the clinical course and pattern of recovery of backpack palsy (BPP) in a large series of patients. Methods Thirty-eight consecutive patients with idiopathic BPP were identified from our population of 193,450 Finnish conscripts by means of computerised register. A physiotherapist provided instructions for proper hand use and rehabilitative exercises at disease onset. The patients were followed up for 2 to 8 years from the diagnosis. We also searched for genetic markers of hereditary neuropathy with pressure palsies. Mann-Whitney U-test was used to analyze continuous data. The Fischer's exact test was used to assess two-way tables. Results Eighty percent of the patients recovered totally within 9 months after the onset of weakness. Prolonged symptoms occurred in 15% of the patients, but daily activities were not affected. The weight of the carried load at the symptom onset significantly affected the severity of the muscle strength loss in the physiotherapeutic testing at the follow-up. The initial electromyography did not predict recovery. Genetic testing did not reveal de novo hereditary neuropathy with pressure palsies. Conclusions The prognosis of BPP is favorable in the vast majority of cases. Electromyography is useful for diagnosis. To prevent brachial plexus lesions, backpack loads greater than 40 kg should be avoided. PMID:21429232

  1. Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

    PubMed Central

    Wan, Yuzhu; Shi, Guanggang; Wang, Haibo

    2016-01-01

    Background: The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. Aims: To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Study Design: Retrospective cross-sectional study. Methods: The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Results: Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conclusion: Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS. PMID:27606135

  2. Meningoencephalitis-like onset of post-infectious AQP4-IgG-positive optic neuritis complicated by GM1-IgG-positive acute polyneuropathy.

    PubMed

    Benedetti, Luana; Franciotta, Diego; Beronio, Alessandro; Delucchi, Stefano; Capellini, Cesare; Del Sette, Massimo

    2015-02-01

    Fifteen days after a respiratory infection, a 45-year-old woman presented with paresthesias in the hands and feet, bilateral loss of vision, fever, headache, and impairment of consciousness. Magnetic resonance imaging (MRI) showed predominant lesions in the optic tracts, optic chiasm, and hypothalamus. Cerebrospinal fluid analysis revealed elevated protein level, and lymphocytic pleocytosis. Neurophysiological studies disclosed a demyelinating sensorimotor polyneuropathy. Serum anti-Mycoplasma pneumoniae immunoglobulin (Ig)M, anti-GM1 IgG, and anti-AQP4 IgG were positive. This case, which is remarkable for post-infectious meningoencephalitis-like onset, MRI picture, and dysimmunity to central and peripheral nervous system autoantigens, underpins the pivotal diagnostic role of anti-AQP4-IgG, and expands the list of clinico-pathological findings that can associate with neuromyelitis optica spectrum disorders. PMID:24557856

  3. Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia

    PubMed Central

    Stav, Anatoli; Reytman, Leonid; Stav, Michael-Yohay; Portnoy, Isaak; Kantarovsky, Alexander; Galili, Offer; Luboshitz, Shmuel; Sevi, Roger; Sternberg, Ahud

    2016-01-01

    Objective We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods This is a prospective randomized observer-blinded study. The three approaches of the US-guided BPB without neurostimulation were compared for quality, performance time, and correlation between performance time and BMI. Intercostobrachial and medial brachial cutaneous nerve blocks were used in all patients. Results A total of 101 patients were randomized into three groups: SCL (supraclavicular), ICL (infraclavicular), and AX (axillary). Seven patients were excluded due to various factors. All three groups were similar in demographic data, M:F proportion, preoperative diagnosis and type of surgery, anesthesiologists who performed the block, and surgical staff that performed the surgical intervention. The time between the end of the block performance and the start of the operation was also similar. The quality of the surgical anesthesia and discomfort during the operation were identical following comparison between groups. No direct positive correlation was observed between BMI and the block performance time. The time for the axillary block was slightly longer than the time for the supra- and infraclavicular approaches, but it had no practical clinical significance. Transient Horner syndrome was observed in three patients in the SCL group. No other adverse effects or complications were observed. Conclusions All three approaches can be used for US-guided BPB with similar quality of surgical anesthesia for operations of below the shoulder. A block of the intercostobrachial and medial brachial cutaneous nerves is recommended. Obesity is not

  4. Different associations between beta-blockers and other antihypertensive medication combinations with brachial blood pressure and aortic waveform parameters

    PubMed Central

    Sluyter, John D.; Hughes, Alun D.; Lowe, Andrew; Parker, Kim H.; Camargo, Carlos A.; Hametner, Bernhard; Wassertheurer, Siegfried; Scragg, Robert K.R.

    2016-01-01

    Background Comparing the relationships of antihypertensive medications with brachial blood pressure (BP) and aortic waveform parameters may help clinicians to predict the effect on the latter in brachial BP-based antihypertensive therapy. We aimed to make such comparisons with new waveform measures and a wider range of antihypertensive regimens than examined previously. Methods Cross-sectional analysis of 2933 adults (61% male; aged 50–84 years): 1637 on antihypertensive treatment and 1296 untreated hypertensives. Sixteen medicine regimens of up to 4 combinations of drugs from 6 antihypertensive classes were analysed. Aortic systolic BP, augmentation index (AIx), excess pressure integral (EPI), backward pressure amplitude (Pb), reflection index (RI) and pulse wave velocity (PWV) were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. Results Forest plots of single-drug class comparisons across regimens with the same number of drugs (for between 1- and 3-drug regimens) revealed that AIx, Pb, RI and/or loge(EPI) were higher (maximum difference = 5.6%, 2.2 mm Hg, 0.0192 and 0.13 loge(mm Hg · s), respectively) with the use of a beta-blocker compared with vasodilators and diuretics, despite no brachial systolic and diastolic BP differences. These differences were reduced (by 34–57%) or eliminated after adjustment for heart rate, and similar effects occurred when controlling for systolic ejection period or diastolic duration. Conclusions Beta-blocker effects on brachial BP may overestimate effects on aortic waveform parameters. Compared to other antihypertensives, beta-blockers have weaker associations with wave reflection measures and EPI; this is predominantly due to influences on heart rate. PMID:27340919

  5. Brachial Plexus-Associated Neuropathy After High-Dose Radiation Therapy for Head-and-Neck Cancer

    SciTech Connect

    Chen, Allen M.; Hall, William H.; Li, Judy; Beckett, Laurel; Farwell, D. Gregory; Lau, Derick H.; Purdy, James A.

    2012-09-01

    Purpose: To identify clinical and treatment-related predictors of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer. Methods and Materials: Three hundred thirty patients who had previously completed radiation therapy for head-and-neck cancer were prospectively screened using a standardized instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from completion of radiation therapy was 56 months (range, 6-135 months). One-hundred fifty-five patients (47%) were treated by definitive radiation therapy, and 175 (53%) were treated postoperatively. Radiation doses ranged from 50 to 74 Gy (median, 66 Gy). Intensity-modulated radiation therapy was used in 62% of cases, and 133 patients (40%) received concurrent chemotherapy. Results: Forty patients (12%) reported neuropathic symptoms, with the most common being ipsilateral pain (50%), numbness/tingling (40%), motor weakness, and/or muscle atrophy (25%). When patients with <5 years of follow-up were excluded, the rate of positive symptoms increased to 22%. On univariate analysis, the following factors were significantly associated with brachial plexus symptoms: prior neck dissection (p = 0.01), concurrent chemotherapy (p = 0.01), and radiation maximum dose (p < 0.001). Cox regression analysis confirmed that both neck dissection (p < 0.001) and radiation maximum dose (p < 0.001) were independently predictive of symptoms. Conclusion: The incidence of brachial plexus-associated neuropathies after radiation therapy for head-and-neck cancer may be underreported. In view of the dose-response relationship identified, limiting radiation dose to the brachial plexus should be considered when possible.

  6. Acute Effect of High-Intensity Eccentric Exercise on Vascular Endothelial Function in Young Men.

    PubMed

    Choi, Youngju; Akazawa, Nobuhiko; Zempo-Miyaki, Asako; Ra, Song-Gyu; Shiraki, Hitoshi; Ajisaka, Ryuichi; Maeda, Seiji

    2016-08-01

    Choi, Y, Akazawa, N, Zempo-Miyaki, A, Ra, S-G, Shiraki, H, Ajisaka, R, and Maeda, S. Acute effect of high-intensity eccentric exercise on vascular endothelial function in young men. J Strength Cond Res 30(8): 2279-2285, 2016-Increased central arterial stiffness is as an independent risk factor for cardiovascular disease. Evidence regarding the effects of high-intensity resistance exercise on vascular endothelial function and central arterial stiffness is conflicting. The purpose of this study was to examine the effects of acute high-intensity eccentric exercise on vascular endothelial function and central arterial stiffness. We evaluated the acute changes in endothelium-dependent flow-mediated dilation (FMD), low-flow-mediated constriction (L-FMC), and arterial stiffness after high-intensity eccentric exercise. Seven healthy, sedentary men (age, 24 ± 1 year) performed maximal eccentric elbow flexor exercise using their nondominant arm. Before and 45 minutes after eccentric exercise, carotid arterial compliance and brachial artery FMD and L-FMC in the nonexercised arm were measured. Carotid arterial compliance was significantly decreased, and β-stiffness index significantly increased after eccentric exercise. Brachial FMD was significantly reduced after eccentric exercise, whereas there was no significant difference in brachial L-FMC before and after eccentric exercise. A positive correlation was detected between change in arterial compliance and change in FMD (r = 0.779; p ≤ 0.05), and a negative correlation was detected between change in β-stiffness index and change in FMD (r = -0.891; p < 0.01) with eccentric exercise. In this study, acute high-intensity eccentric exercise increased central arterial stiffness; this increase was accompanied by a decrease in endothelial function caused by reduced endothelium-dependent vasodilation but not by a change in endothelium-dependent vasoconstriction. PMID:24832967

  7. Autogenous side-to-side brachial-basilic fistulas without vein transposition: a valuable option?

    PubMed

    Lomonte, Carlo; Casucci, Francesco; Antonelli, Maurizio; Losurdo, Nicola; Marchio, Giovanni; Teutonico, Annalisa; Libutti, Pasquale; Basile, Carlo

    2009-01-01

    An autogenous brachial-basilic arteriovenous fistula (BBAVF) in the upper arm must be considered before placing prosthetic grafts in hemodialysis patients with multiple failures of forearm AVFs. The aim of this observational study was to compare technical and clinical outcomes of a new construction technique for BBAVF (n-BBAVF) with that of the standard one-stage side-artery to end-vein transposed BBAVF (t-BBAVF). A n-BBAVF is constructed in the following way: basilic vein and brachial artery are isolated. Patency of the proximal and distal vein is verified by injecting warmed (37 degrees C) saline solution. A venotomy and an arterotomy of 4-5 mm are performed. The two vessels are prepared for a side-to-side anastomosis without transposition of the vein. The latter allows both an antegrade and retrograde flow along the basilic vein, both proximally and distally to the anastomosis with more sites available for the venipunctures of the dialysis. Thirty BBAVFs were constructed as the secondary or tertiary vascular access in 30 patients over a 4-year period: 17 patients with adequate forearm basilic vein underwent the construction of a n-BBAVF; 13 underwent the construction of a t-BBAVF. The construction of a n-BBAVF requires a significantly lesser surgical time (55.0 +/- 9.0 minutes vs. 115.0 +/- 18.0, p < 0.0001), has fewer surgical complications (5.9% vs. 46.2%, p < 0.0001), and a reduced time to first use (24.5 +/- 6.3 vs. 37.7 +/- 9.1 days, p < 0.0001) than that of a t-BBAVF. n-BBAVFs showed a relatively low rate of thrombosis per patient-year at risk (0.067 at 1 year and 0.099 at 2 years). The latter was significantly lower at 1 year when compared with t-BBAVFs (0.067 vs. 0.285; p < 0.004). Our policy of "all AVFs should be autogenous" led us to the construction of a vascular access which is based on a side-to-side anastomosis between the brachial artery and the basilic vein without transposition of the vein allowing both antegrade and retrograde flow into the

  8. Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction.

    PubMed

    Chen, Shyh-Ming; Tsai, Tzu-Hsien; Hang, Chi-Ling; Yip, Hon-Kan; Fang, Chi-Yuan; Wu, Chiung-Jen; Guo, Gary Bih-Fang

    2011-01-01

    Endothelial dysfunction may be particularly important in the pathogenesis of young patients with acute myocardial infarction (AMI), because they have different clinical characteristics compared with older patients. We investigated endothelial function in relation to AMI in this young age group. From January 2005 to March 2008, 29 of 31 consecutive patients with acute ST-elevation myocardial infarction (STEMI) who were <40 years old and received direct percutaneous coronary intervention (PCI) were enrolled in the study. We compared the coronary risk factors and flow-mediated vasodilation (FMD) in the brachial artery between the acute STEMI patients and 29 age- and gender-matched controls that did not have AMI. Baseline brachial artery diameter and responses to glyceryl trinitrate were similar between the two groups. In contrast, FMD was significantly lower in the young acute STEMI group than in the control (3.47 ± 4.08 vs. 7.45 ± 4.67%, p = 0.001) and correlated with the Thrombolysis in Myocardial Infarction (TIMI) risk score. The impaired FMD in the acute STEMI group was independent of smoking, hyperlipidemia, hypertension, nitrate use, or body mass index. In multiple logistic regression analysis, only FMD and age, not traditional cardiovascular risk factors, were found to be significantly associated with acute STEMI (odds ratio = 0.75, 95% CI 0.63-0.90, p < 0.01). In conclusion, independent of conventional risk factors, severe endothelial dysfunction occurs in young acute STEMI patients and correlates with TIMI score. In addition to age, impaired FMD is the only significant factor associated with acute STEMI in this young population. PMID:20949355

  9. [Brachial plexus compression from supraclavicular encapsulated fat necrosis. A case report].

    PubMed

    Domínguez-Páez, Miguel; de Miguel-Pueyo, Luis; Marín-Salido, Esteban José; Carrasco-Brenes, Antonio; Martín-Gallego, Alvaro; Arráez-Sánchez, Miguel Ángel

    2014-01-01

    We report the case of a 44-year-old male, lacking clinical history of previous illness, who had surgery at our hospital to treat a mass in the supraclavicular space. The patient presented with a 1-month progressive distal paresis of the left arm. The histo-pathological examination of the mass revealed an encapsulated fat necrosis. Fat necrosis is characterised by cystic architecture, encapsulation with fat necrosis within, and inflammatory infiltration of its walls. Neural structure compression secondary to this tumour mass is very rare. Fat necrosis is more frequent in the lower limbs, in areas exposed to trauma. This article is the first report of brachial plexus compression due to supraclavicular fat necrosis. PMID:24837841

  10. Brachial plexus neuropathy secondary to septic arthritis and osteomyelitis: report of two cases.

    PubMed

    Wang, Y C; Lin, F K; Hung, K L; Wu, D Y

    1994-01-01

    Two infants, delivered uneventfully, later developed right brachial plexus palsy secondary to pyogenic osteomyelitis and arthritis of the right shoulder joint. Weakness of right arms occurred at the sixth and tenth days of age respectively. Both had right arm tenderness on palpation and passive movement. Roentgenograms of their right shoulder joints showed irregular radiolucency of the proximal margin of right humerus head. In both cases, electromyography revealed various degrees of significant denervation pattern for the C5-C7 innervated muscles. Pus culture from right shoulder joints grew Streptococcus viridans and Staphylococcus aureus, respectively. After antibiotic therapy and arthrotomy with drainage, weakness improved gradually following continuous rehabilitation. Follow-up at six months of age showed almost complete recovery of right upper extremity function in one patient, but mild residual weakness in the other. Follow-up electromyography studies showed continued improvement. The possible mechanism of this rare occurrence is discussed. PMID:7942033

  11. Missile Injury by A Weed Wacker Resulting in a False Aneurysm of the Brachial Artery

    PubMed Central

    Naraynsingh, Vijay; Ramdass, Michael J

    2011-01-01

    A novel now commonly used device in many countries called a “weed-wacker” is a mechanical rotating device with a cord used to trim lawns and grass. A case of a 14-year old boy with a false aneurysm of the brachial artery is presented; he sustained a missile injury by a piece of rusty steel projected by use of a weed wacker. Missile injuries by nail guns and bullets have been documented in the literature; however, this mechanism of injury by a weed-wacker has never been previously described and is presented as a unique mechanism of injury and brings attention the issue of safety with the use of the weed-wacker. PMID:22114655

  12. Brachial artery perforator-based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis.

    PubMed

    Sekiguchi, Hirotake; Motomiya, Makoto; Sakurai, Keisuke; Matsumoto, Dai; Funakoshi, Tadanao; Iwasaki, Norimasa

    2015-02-01

    It is difficult for most plastic and orthopaedic surgeons to treat nerve dysfunction related to neural adhesion because the pathophysiology and suitable treatment have not been clarified. In the current report, we describe our experience of surgical treatment for adhesive ulnar neuropathy. A 58-year-old male complained of pain radiating to the ulnar nerve-innervated area during elbow and wrist motion caused by adhesive ulnar neuropathy after complex open trauma of the elbow joint. The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve. This flap may be a useful option for ulnar nerve coverage after neurolysis without microvascular anastomosis in specific cases. PMID:25088214

  13. [Ankle-brachial pressure index as a predictor of future cardiovascular outcomes].

    PubMed

    Topalusić, Iva; Valpotić, Ina; Marković, Asja Stipić

    2012-10-01

    Peripheral arterial occlusive disease is very common in the general population and it is mostly of atherosclerotic origin. About 50%-75% of patients are asymptomatic. Many studies have shown the ankle-brachial pressure index (ABPI) to be a simple and reliable test with high sensitivity (90%) and specificity (98%) in the diagnosis of hemodynamically relevant stenosis of an arterial segment and also in detection of asymptomatic patients. The values of ABPI < 0.90 suggest widespread atherosclerosis, while the ABPI > 1.40 is associated with arterial calcification and wall stiffening. This test is highly specific (92.7%) in predicting future cardiovascular and cerebrovascular risk and could provide a tool for more focused prevention strategies. PMID:23814974

  14. A correlation study between ankle brachial pressure index and the severity of coronary artery disease.

    PubMed

    Benyakorn, Thoetphum; Kuanprasert, Sarun; Rerkasem, Kittipan

    2012-06-01

    Previous studies have shown that there was a correlation between low ankle brachial pressure index (ABPI) and the presence of the coronary artery disease (CAD). However, few studies have investigated the correlation between ABPI and the severity of CAD by using a scoring system. The authors aimed to investigate this correlation by using ABPI and CAD diagnosed by coronary angiography (CAG). A total of 213 consecutive patients awaiting CAG in Maharaj Nakorn Chiang Mai Hospital from July 2009 to November 2009 were enrolled in this study. The ABPI was measured before CAG. The severity of CAD was graded on CAG by using SYNTAX scores. The authors found a significantly negative correlation between ABPI and SYNTAX scores (correlation coefficient = -.172, P = .01). The authors concluded that ABPI appeared to correlate negatively with the severity of CAD in the Thai population. PMID:22561522

  15. Clinical Assessment of the Infant and Child Following Perinatal Brachial Plexus Injury

    PubMed Central

    Duff, Susan V.; DeMatteo, Carol

    2015-01-01

    STUDY DESIGN Literature review INTRODUCTION After perinatal brachial plexus injury (PBPI), clinicians play an important role in injury classification as well as the assessment of recovery and secondary conditions. Early assessment guides the initial plan of care and influences follow-up and long-term outcome. PURPOSE To review methods used to assess, classify and monitor the extent and influence of PBPI with an emphasis on guidelines for clinicians. METHODS We use The International Classification of Functioning, Disability, and Health (ICF) model to provide a guide to assessment after PBPI for rehabilitation clinicians. DISCUSSION With information gained from targeted assessments, clinicians can design interventions to increase the opportunities infants and children have for optimal recovery and to attain skills that allow participation in areas of interest. PMID:25840493

  16. Axillary artery pseudoaneurysm resulting in brachial plexus injury in a patient taking new oral anticoagulants.

    PubMed

    Monem, Mohammed; Iskandarani, Mohamad Khalid; Gokaraju, Kishan

    2016-01-01

    We discuss the case of an independent 80-year-old Caucasian woman, being treated with new oral anticoagulants for a previous deep vein thrombosis, who had fallen on her right shoulder. She made a delayed presentation to the emergency department with a wrist drop in her right dominant hand. She had right arm bruising with good distal pulses but had a global neurological deficit in the hand. Plain radiographs of the shoulder, humerus, elbow, forearm and wrist demonstrated no fractures. MRI showed a significant right axillary lesion distorting the surrounding soft tissues, including the brachial plexus, and CT with contrast confirmed this to be a large axillary pseudoaneurysm. This was treated with an endovascular stent resulting in slightly improved motor function, but the significant residual deficit required subsequent rehabilitation to improve right upper limb function. PMID:27535738

  17. Acute nephritic syndrome

    MedlinePlus

    Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute ... Acute nephritic syndrome is often caused by an immune response triggered by an infection or other disease. Common causes ...

  18. Brachial artery vasomotion and transducer pressure effect on measurements by active contour segmentation on ultrasound

    SciTech Connect

    Cary, Theodore W.; Sultan, Laith R.; Sehgal, Chandra M.; Reamer, Courtney B.; Mohler, Emile R.

    2014-02-15

    Purpose: To use feed-forward active contours (snakes) to track and measure brachial artery vasomotion on ultrasound images recorded in both transverse and longitudinal views; and to compare the algorithm's performance in each view. Methods: Longitudinal and transverse view ultrasound image sequences of 45 brachial arteries were segmented by feed-forward active contour (FFAC). The segmented regions were used to measure vasomotion artery diameter, cross-sectional area, and distention both as peak-to-peak diameter and as area. ECG waveforms were also simultaneously extracted frame-by-frame by thresholding a running finite-difference image between consecutive images. The arterial and ECG waveforms were compared as they traced each phase of the cardiac cycle. Results: FFAC successfully segmented arteries in longitudinal and transverse views in all 45 cases. The automated analysis took significantly less time than manual tracing, but produced superior, well-behaved arterial waveforms. Automated arterial measurements also had lower interobserver variability as measured by correlation, difference in mean values, and coefficient of variation. Although FFAC successfully segmented both the longitudinal and transverse images, transverse measurements were less variable. The cross-sectional area computed from the longitudinal images was 27% lower than the area measured from transverse images, possibly due to the compression of the artery along the image depth by transducer pressure. Conclusions: FFAC is a robust and sensitive vasomotion segmentation algorithm in both transverse and longitudinal views. Transverse imaging may offer advantages over longitudinal imaging: transverse measurements are more consistent, possibly because the method is less sensitive to variations in transducer pressure during imaging.

  19. Characterizing Methods of Measuring Flow-Mediated Dilation in the Brachial Artery

    NASA Technical Reports Server (NTRS)

    Callender, Ariane R.

    2010-01-01

    Regulation of vascular tone is one of the many important functions of the vascular endothelium. Endothelial dysfunction is a critical early event in the pathogenesis of atherosclerosis and occurs in the absence of angiographic disease. Flow-Mediated Dilation (FMD) is a noninvasive technique commonly used to evaluate endothelium-dependent vasodilation in humans and gauge the health of the cardiovascular system. Reductions in brachial artery FMD have been strongly correlated with disease progression and are predictive of future cardiac events. The flow stimulus for brachial artery FMD occurs as a result of the increased shear stress following deflation of an occlusion cuff around the upper arm. Using 2-dimensional ultrasound, changes in arterial diameter up to 5-minutes following cuff deflation are calculated from baseline image measurements. Along with pulsed Doppler measures of flow velocity through the artery, flow-mediated, endothelium-dependent vasodilation can be assessed. There is debate among investigators, however, about the proper positioning of the occlusion cuff during FMD testing. It is thought that placement of the cuff around the upper arm may not accurately reflect the impact of nitric oxide, a critically important molecule released as a result of the increased shear stress created by the FMD technique. Data suggest that the production of other endogenous metabolites may also contribute to FMD-related changes when positioning the cuff around the upper arm. To overcome the potential influence of such molecules, researchers now suggest that the occlusion cuff be placed below the elbow allowing a more precise estimate of nitric oxide mediated dilation. The purpose of this study is to compare the differences in FMD between the two methodologies of occlusion cuff placement. In addition, this study will determine the method that is easier for ultrasound technicians to perform and will produce a low coefficient of variance between technicians. Ultimately

  20. Reproducibility of Brachial Vascular Changes with Alterations in End-Tidal Carbon Dioxide.

    PubMed

    Geijer, Justin R; Evanoff, Nicholas G; Kelly, Aaron S; Chernin, Michael A; Stoltman, Matthew G; Dengel, Donald R

    2016-07-01

    The purpose of this study was to examine the reproducibility of the peripheral vascular response to hypercapnia. Healthy college-aged men (n = 7) and women (n = 10) underwent an iso-oxic 10-mm Hg increase in PetCO2 for 12 min. Brachial artery diameter changes were measured using ultrasound imaging. Two tests were completed on day 1 with 15 min of rest between tests. Tests were repeated on day 2. Paired t-tests, Bland-Altman plots and intra-class correlations (ICCs) determined reproducibility. There were no significant differences in peak dilation within day (5.33 ± 3.73% vs. 4.52 ± 2.49%, p = 0.378). The within-day ICC was poor (0.213). Within-day time-to-peak dilation did not significantly differ (660.0 ± 231.8 s vs. 602.7 ± 259.9 s, p = 0.379), and the ICC was fair (0.416, p = 0.113). Between-day peak dilation did not significantly differ (5.24 ± 3.84% vs. 4.71 ± 3.17%, p = 0.123), and the ICC was fair (0.419). Hypercapnia-induced brachial artery dilation is similar within day and between days. The ICC for peak dilation suggests the methodology is not reproducible. PMID:27061149

  1. Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

    PubMed Central

    Rosati, Marco; Andreani, Lorenzo; Poggetti, Andrea; Zampa, Virna; Parchi, Paolo; Lisanti, Michele

    2013-01-01

    Introduction: The thoracic outlet syndrome (TOS) is a rare complication of clavicular fracture, occurring in 0.5-9% of cases. In the literature from 1965 – 2010, 425 cases of TOS complicating a claviclular fracture were described. However, only 5 were observed after a surgical procedure of reduction and fixation. The causes of this complication were due to the presence of an exuberant callus, to technical surgery errors or to vascular lesions. In this paper we describe a case of brachial plexus plasy after osteosynthesis of clavicle fracture Case Report: A 48 year old female, presented to us with inveterate middle third clavicle fracture of 2 months duration. She was an alcoholic, smoker with an history of opiate abuse and was HCV positive. At two month the fracture was displaced with no signs of union and open rigid fixation with plate was done. The immediate postoperative patient had signs of neurologic injury. Five days after surgery showed paralysis of the ulnar nerve, at 10 days paralysis of the median nerve, radial and ulnar paresthesias in the territory of the C5-C6-C7-C8 roots. She was treated with rest, steroids and neurotrophic drugs. One month after surgery the patient had signs of complete denervation around the brachial plexus. Implant removal was done and in a month ulnar and median nerve functions recovered. At three months post implant removal the neurological picture returned to normal. Conclusion: We can say that TOS can be seen as arising secondary to an “iatrogenic compartment syndrome” justified by the particular anatomy of the space cost joint. The appropriateness of the intervention for removal of fixation devices is demonstrated by the fact that the patient has returned to her daily activities in the absence of symptoms and good functional recovery in about three months, despite fracture nonunion. PMID:27298912

  2. Clonidine as an adjuvant to ropivacaine-induced supraclavicular brachial plexus block for upper limb surgeries

    PubMed Central

    Patil, Kalyani Nilesh; Singh, Noopur Dasmit

    2015-01-01

    Background and Aims: Ropivacaine is a new amide, long acting, pure S-enantiomer, local anesthetic, with differential blocking effect. The addition of clonidine to local anesthetic improves the quality of peripheral nerve blocks. This study was conducted to evaluate the effect of clonidine on characteristics of ropivacaine-induced supraclavicular brachial plexus block. Material and Methods: A total of 60 adult patients were randomly recruited to two groups of 30 each: Group I: 30 ml 0.75% ropivacaine + 1 ml normal saline. Group II: 30 ml 0.75% ropivacaine + 1 mcg/kg clonidine diluted to 1 ml with normal saline. Results: The onset of sensorimotor block was earlier in Group II (4.36 ± 0.81 min for sensory block and 9.83 ± 1.12 min for motor block) than in Group I (4.84 ± 0.65 min for sensory block and 10.85 ± 0.79 min for motor block). The duration of both sensory and motor block were significantly prolonged by clonidine (P < 0.001). The duration of analgesia was also prolonged in patients receiving clonidine (613.10 ± 51.797 min vs. 878.33 ± 89.955 min). Although incidence of hypotension and bradycardia was higher in Group II when compared to Group I, it was not clinically significant. Conclusions: Ropivacaine 0.75% is well-tolerated and provides effective surgical anesthesia as well as relief of postoperative pain. Clonidine as an adjuvant to ropivacaine significantly enhances the quality of supraclavicular brachial plexus block by faster onset, prolonged duration of sensory and motor block and improved postoperative analgesia, without associated adverse effects at the dose used. PMID:26330717

  3. Association of brachial-ankle pulse wave velocity with cardiovascular risk factors in systemic lupus erythematosus.

    PubMed

    Tso, T K; Huang, W N; Huang, H Y; Chang, C K

    2005-01-01

    Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis. Increasing arterial stiffness is closely associated with atherosclerotic cardiovascular diseases, and pulse wave velocity (PWV) is considered to be an indicator of arterial stiffness. The objective of this study was to identify the relationship between brachial-ankle pulse wave velocity (baPWV) and cardiovascular risk factors in patients with SLE. Age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBS), plasma lipid profile, plasma homocysteine, thiobarbituric acid reactive substances (TBARS), baPWV, ankle-brachial index (ABI), and SLE-related factors were determined in a total of 83 SLE patients (12 males and 71 females). All SLE patients were further classified into two subgroups according to baPWV value (baPWV < 1400 cm/s, n=37 versus baPWV > 1400 cm/s, n=46). The mean baPWV value of studied SLE patients was 1520 +/- 381 cm/s. Age, BMI, SBP, DBP, FBS, TBARS and homocysteine levels were significantly higher in SLE patients with baPWV value > 1400cm/s than in SLE patients with baPWV value < 1400cm/s. In addition, baPWV correlated significantly with age, SBP, DBP, FBS and homocysteine. Moreover, stepwise multiple regression analysis showed that age and SBP were independently associated with baPWV. The results of this study indicate a possible link between vascular stiffness measured by baPWV and cardiovascular risk factors in patients with SLE. PMID:16335579

  4. Effects of Handgrip Training With Venous Restriction on Brachial Artery Vasodilation

    PubMed Central

    Credeur, Daniel P.; Hollis, Brandon C.; Welsch, Michael A.

    2010-01-01

    Previous studies have shown that resistance training with restricted venous blood flow (Kaatsu) results in significant strength gains and muscle hypertrophy. However, few studies have examined the concurrent vascular responses following restrictive venous blood flow training protocols. Purpose To examine the effects of 4 weeks of handgrip exercise training, with and without venous restriction, on handgrip strength and brachial artery flow mediated dilation (BAFMD). Methods Twelve participants (age=22±1yr; male = 5, female = 7), completed 4 weeks of bilateral handgrip exercise training (Duration: 20 min; Intensity: 60% of the MVC; Cadence: 15 grips*min−1; Frequency: 3 sessions*week−1). During each session venous blood flow was restricted in one arm (Experimental arm = EXP) using a pneumatic cuff placed 4 cm proximal to the antecubital fossa, and inflated to 80 mmHg for the duration of each exercise session. The EXP and control (CON) arm were randomly selected. Handgrip strength was measured using a hydraulic hand dynamometer. Brachial diameters and blood velocity profiles were assessed, using Doppler ultrasonography, before and after 5 min of forearm occlusion (200 mmHg), prior to and at the end of 4 weeks exercise. Results Following exercise training, handgrip strength increased 8.32% (p=0.05) in the CON arm and 16.17% (p=0.05) in the EXP arm. BAFMD increased 24.19% (p=0.0001) in the CON arm, and decreased 30.36% (p=0.0001) in the EXP arm. Conclusion The data indicate handgrip training combined with venous restriction results in superior strength gains, but reduced BAFMD compared to the non-restricted arm. PMID:20019641

  5. Platelet to Lymphocyte Percentage Ratio Is Associated With Brachial-Ankle Pulse Wave Velocity in Hemodialysis.

    PubMed

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Mai, Hsiu-Chin; Su, Ho-Ming; Chang, Jer-Ming; Chen, Hung-Chun

    2016-02-01

    Increased arterial stiffness in patients receiving hemodialysis (HD) is highly prevalent and is associated with cardiovascular morbidity and mortality. In HD, inflammation is one of the major causes of increased arterial stiffness. Activation of platelets and decreased lymphocyte percentage (LYMPH%) may exhibit inflammation. The aim of this study is to examine the relationship between platelet to LYMPH% ratio and arterial stiffness in HD patients.A total of 220 patients receiving HD were enrolled in this study. The brachial-ankle pulse wave velocity (baPWV) was measured using an ankle-brachial index form device. Multivariate linear regression analysis was performed to investigate the relations of the platelet to LYMPH% ratio and baPWV. The value of the platelet to LYMPH% ratio was 59.2 ± 33.3 (10 cells/L/%). After multivariate stepwise analysis, diabetes (β: 163.973, P = 0.02), high systolic blood pressure (per 1 mm Hg, β: 9.010, P < 0.001), high platelet to LYMPH% ratio (per 10 cells/L/%, β: 3.334, P < 0.01), and low albumin (per 0.1 mg/dL, β: -55.912, P < 0.001) were independently associated with an increased baPWV. Furthermore, high white blood cells (per 10 cells/L, β: 3.941, P < 0.001), high neutrophil percentage (per 1%, β: 1.144, P < 0.001), and high CRP (per 1 mg/L, β: 9.161, P = 0.03) were independently associated with an increased platelet to LYMPH% ratio.An increased platelet to LYMPH% ratio is associated with an increased baPWV in HD patients. An easy and inexpensive laboratory measure of platelet to LYMPH% ratio may provide an important information regarding arterial stiffness in patients with HD. PMID:26871812

  6. Extended Long-Term (5 Years) Outcomes of Triangle Tilt Surgery in Obstetric Brachial Plexus Injury

    PubMed Central

    Nath, Rahul K; Somasundaram, Chandra

    2013-01-01

    Objective: We evaluated the "extended" long-term (5 years) functional outcomes in obstetric brachial plexus injury (OBPI) patients, who underwent triangle tilt surgery between February 2005 and January 2008. Methods: Twenty two children (9 girls and 13 boys, mean age at surgery was 5.8 years; ranging 2.1-11.8 years old), who initially presented with medial rotation contracture and scapula deformity secondary to obstetric brachial plexus injury were included in this study. Functional movements were evaluated pre-operatively, and 5 years following triangle tilt surgery by modified Mallet scale. Results: Here, we report long-term (5 years) follow-up of triangle tilt surgery for 22 OBPI patients. Upper extremity functional movements such as, external rotation (2.5±0.6 to 4.1±0.8, p<0.0001), hand-to-spine (2.6±0.6 to 3.4±1.1, p<0.005), hand-to-neck (2.7±0.7 to 4.3±0.7, p<0.0001), hand-to-mouth (2.3±0.9 (92º±33) to 4.2±0.5 (21º±16), p<0.0001), and supination (2.6±1.1 (-8.2º ±51) to 4.1±0.7 (61±32)) were significantly improved (p<0.0001), and maintained over the extended long-term (5 years). Total modified Mallet functional score was also shown to improve from 14.1±2.7 to 20.3±2.5. Conclusions: The triangle tilt surgery improved all shoulder functions significantly, and maintained over the extended long-term (5 years) in these patients. PMID:23730369

  7. Anatomical variations in the brachial plexus roots: implications for diagnosis of neurogenic thoracic outlet syndrome.

    PubMed

    Leonhard, Vanessa; Smith, Riley; Caldwell, Gregory; Smith, Heather F

    2016-07-01

    Neurogenic thoracic outlet syndrome (NTOS) is the most common type of TOS. Typically it results from impingement of the neurovasculature as it passes between the anterior and middle scalene muscles; this classic anatomical relationship being the foundation of clinical diagnosis. Positional testing relies on vascular compromise occurring when the subclavian artery is compressed in this space. This study describes several anatomical variations observed in this relationship. Sixty-five cadavers (35m/30f) were assessed to determine the frequency and extent of brachial plexus branching variants. A total of thirty-one variations from "classic" anatomy were observed (47.7%). In two specimens (3.1%), the entire superior trunk coursed completely anterior to the anterior scalene in a position of relative vulnerability. In 27 instances, a portion of or the entire superior trunk pierced the anterior scalene muscle, and in two, the middle trunk also pierced the muscle belly. Interestingly, while two bilateral branching variations were observed, the majority occurred unilaterally, and almost exclusively on the left side. There were no sex differences in frequency. The high frequency of these variations and their potential to predispose patients to neurogenic TOS suggest that current diagnostic methods may be insufficient in clinical diagnosis. Due to lack of vascular compromise, patients with the piercing variant would not display positive signs on the traditional positional tests. The use of ultrasound to determine the route of the brachial plexus could determine whether this variation is present in patients who suffer from TOS symptoms but lack a diagnosis based on traditional positional testing. PMID:27133185

  8. Morphological Assessment of Cadaveric Radial, Brachial and Subclavian Arteries: A Neurointerventional Approach

    PubMed Central

    Yilmaz, Ali; Ozkul, Ayca; Shin, Dong Seong; Im, Soo-Bin; Yoon, Seok-Mann

    2015-01-01

    Objective The transradial catheterization (TRC) is becoming widespread, primarily for neurointerventions. Therefore, the evaluation of radial artery puncture in clinical practice and a better understanding of the anatomy are important to improve the safety of neuroendovascular surgery. Methods Ten formalin-fixed adult Korean cadavers were dissected to expose radial artery (RA), brachial artery (BrA) and subclvian artery (ScA), bilaterally. Vessel lengths and diameters were meaured using a caliper and distance between the specific point of vessels and the anatomical landmarks including the radial styloid process, the medial epicondyle of the humerus, the sternoclavicular joint, and the vertebral artery orifice were also measured. Results The average length between the radial (RAPS) and the BrA puncture sites (BrAPS) and between the vertebral artery orifice (VAO) and the BrA bifurcation (BrAB) did not differ between sides (p>0.05). The average length between the radial styloid process (RSP) and the RAPS was 13.41±2.19 mm, and the RSP was 26.85±2.47 mm from the median nerve (MN). The mean length between the medial epicondyle (ME) and the BrAPS as 44.23±5.47 mm, whereas the distance between the ME and the MN was 42.23±4.77 mm. The average VAO-ScA angle was 70.94±6.12°, and the length between the ScA junction (SCJ) and the VAO was 60.30±8.48 mm. Conclusion This study provides basic anatomical information about the radial artery and the brachial route and can help improving new techniques, selection of size and shape of catheters for TRC. This can help neurointerventionists who adopt a transradial neuroendovascular approach and offers comprehensive and safe care to their patients. PMID:26819682

  9. Dose–Volume Modeling of Brachial Plexus-Associated Neuropathy After Radiation Therapy for Head-and-Neck Cancer: Findings From a Prospective Screening Protocol

    SciTech Connect

    Chen, Allen M.; Wang, Pin-Chieh; Daly, Megan E.; Cui, Jing; Hall, William H.; Vijayakumar, Srinivasan; Phillips, Theodore L.; Farwell, D. Gregory; Purdy, James A.

    2014-03-15

    Purpose: Data from a prospective screening protocol administered for patients previously irradiated for head-and-neck cancer was analyzed to identify dosimetric predictors of brachial plexus-associated neuropathy. Methods and Materials: Three hundred fifty-two patients who had previously completed radiation therapy for squamous cell carcinoma of the head and neck were prospectively screened from August 2007 to April 2013 using a standardized self-administered instrument for symptoms of neuropathy thought to be related to brachial plexus injury. All patients were disease-free at the time of screening. The median time from radiation therapy was 40 months (range, 6-111 months). A total of 177 patients (50%) underwent neck dissection. Two hundred twenty-one patients (63%) received concurrent chemotherapy. Results: Fifty-one patients (14%) reported brachial plexus-related neuropathic symptoms with the most common being ipsilateral pain (50%), numbness/tingling (40%), and motor weakness and/or muscle atrophy (25%). The 3- and 5-year estimates of freedom from brachial plexus-associated neuropathy were 86% and 81%, respectively. Clinical/pathological N3 disease (P<.001) and maximum radiation dose to the ipsilateral brachial plexus (P=.01) were significantly associated with neuropathic symptoms. Cox regression analysis revealed significant dose–volume effects for brachial plexus-associated neuropathy. The volume of the ipsilateral brachial plexus receiving >70 Gy (V70) predicted for symptoms, with the incidence increasing with V70 >10% (P<.001). A correlation was also observed for the volume receiving >74 Gy (V74) among patients treated without neck dissection, with a cutoff of 4% predictive of symptoms (P=.038). Conclusions: Dose–volume guidelines were developed for radiation planning that may limit brachial plexus-related neuropathies.

  10. Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan

    PubMed Central

    Lewis, Jane EA; Williams, Paul; Davies, Jane H

    2016-01-01

    Objectives: This cross-sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (1) ankle brachial index and (2) pulse volume waveform analysis recorded by the same automated device, with the presence or absence of peripheral arterial disease being verified by ultrasound duplex scan. Methods: Patients (n=205) referred for lower limb arterial assessment underwent ankle brachial index measurement and pulse volume waveform recording using volume plethysmography, followed by ultrasound duplex scan. The presence of peripheral arterial disease was recorded if ankle brachial index <0.9; pulse volume waveform was graded as 2, 3 or 4; or if haemodynamically significant stenosis >50% was evident with ultrasound duplex scan. Outcome measure was agreement between the measured ankle brachial index and interpretation of pulse volume waveform for peripheral arterial disease diagnosis, using ultrasound duplex scan as the reference standard. Results: Sensitivity of ankle brachial index was 79%, specificity 91% and overall accuracy 88%. Pulse volume waveform sensitivity was 97%, specificity 81% and overall accuracy 85%. The combined sensitivity of ankle brachial index and pulse volume waveform was 100%, specificity 76% and overall accuracy 85%. Conclusion: Combining these two diagnostic modalities within one device provided a highly accurate method of ruling out peripheral arterial disease, which could be utilised in primary care to safely reduce unnecessary secondary care referrals. PMID:27493755

  11. Acute sacroiliitis.

    PubMed

    Slobodin, Gleb; Rimar, Doron; Boulman, Nina; Kaly, Lisa; Rozenbaum, Michael; Rosner, Itzhak; Odeh, Majed

    2016-04-01

    The purpose of this study was to review the data on the etiology, risk factors, clinical presentations, and diagnosis of acute sacroiliitis. A Pubmed search utilizing the indexing term "acute sacroiliitis" was conducted and the data pertinent to the aim of the review was extracted and organized in accordance with the preplanned structure of the manuscript. The diagnosis of acute sacroiliitis is often challenging because of both the relative rarity of this presentation and diverse character of acute sacroiliac pain, frequently mimicking other, more prevalent disorders. Technetium bone scintigraphy can localize the disease process to the sacroiliac joint, while computed tomography or magnetic resonance imaging can be used for the detailed characterization and the extent of the disease as well as the diagnosis of complications. Pyogenic sacroiliitis is by far the most common cause of acute sacroiliitis. Brucellosis, acute sacroiliitis in the course of reactive arthritis, and crystalline-induced sacroiliitis frequently imitate pyogenic sacroiliitis. Acute sacroiliitis can rarely be also related to hematological malignancies or treatment with isotretinoin. Awareness to the possibility of acute sacroiliitis and a thorough physical examination are the necessary prerequisites to its timely diagnosis, while the appropriate laboratory and imaging studies should confirm the precise diagnosis and direct the appropriate treatment strategy. PMID:26847855

  12. Late onset brachial artery thrombosis and total temporary peripheral neuropathy in a child with humerus supracondylar fracture: a case report.

    PubMed

    Ege, Tolga; Türkkan, Selim; Günay, Celalettin; Külahçı, Yalçın; Kürklü, Mustafa

    2015-01-01

    Pediatric supracondylar fractures of the humerus are generally associated with neurovascular complications due to the deformity and sharp nature of bone fragments. When treated inadequately, these injuries may result in catastrophic complications, such as Volkmann's contracture and amputation. To our knowledge, late onset brachial arterial thrombosis and total temporary peripheral neuropathy after surgery of pediatric supracondylar fracture in the setting of normal preoperative vascular examination has not been reported yet. In this study, a 2-year and 6- month-old girl, who had delayed brachial arterial thrombosis after a displaced humerus supracondylar fracture surgery treated with embolectomy, was reported. Total lesion of median, ulnar and radial nerves completely resolved four months after surgery. Close neurovascular monitoring on the postoperative phase especially in severely displaced supracondylar fractures is strongly emphasized even in the setting of well-perfused hand. PMID:25779718

  13. Supraclavicular Brachial Plexus Block With or Without Dexamethasone as an Adjuvant to 0.5% Levobupivacaine: A Comparative Study

    PubMed Central

    Bhupal, Jatinder Paul Singh; Kumar, Parmod; Gandhi, Gurjit Singh

    2016-01-01

    Introduction Brachial plexus block is an excellent method for attaining optimal operating conditions by producing complete muscular relaxation, maintaining stable intraoperative haemodynamics and the associated sympathetic block. In addition, they provide extended postoperative analgesia with minimal side effects. Different adjuvants have been described in literature to hasten the onset and prolong the duration of block. The present study was conducted to study the effect of adding dexamethasone to levobupivacaine in supraclavicular brachial plexus block. Aim To observe the effect of dexamethasone on onset and duration of anaesthesia, when used as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. Materials and Methods A total of 60 patients in the age group of 18-65 years belonging to ASA physical status I or II were included in the study. They are randomly allocated in two groups and each group included 30 patients. In group 1, patients received 30ml of 0.5% isobaric levobupivacaine with 2ml of isotonic sodium chloride. In group 2 patients received 8mg (2ml) dexamethasone in addition to 30ml of 0.5% isobaric levobupivacaine. Results The results showed that the onset of sensory and motor block were faster in group 2(p<0.05). The duration of sensory and motor block were significantly longer in group 2 (p<0.05). VAS score at 12 hours were significantly lower in group 2 (p<0.05). None of the patients had bradycardia, hypotension or any other side effects. Conclusion Dexamethasone added to levobupivacaine for supraclavicular brachial plexus block reduces the time to onset of sensory and motor blockage and prolongs the duration of analgesia. PMID:27504384

  14. Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study

    PubMed Central

    Padur, Ashwini Aithal; Shanthakumar, Swamy Ravindra; Shetty, Surekha Devadas; Prabhu, Gayathri Sharath; Patil, Jyothsna

    2016-01-01

    Introduction Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. Aim Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. Materials and Methods Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. Results In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. Conclusion Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb. PMID:27190783

  15. Magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma: a report of 53 cases.

    PubMed

    Van Soens, Iris; Struys, Michel M; Polis, Ingeborgh E; Bhatti, Sofie F; Van Meervenne, Sofie A; Martlé, Valentine A; Nollet, Heidi; Tshamala, Mulenda; Vanhaesebrouck, An E; Van Ham, Luc M

    2009-10-01

    Brachial plexus trauma is a common clinical entity in small animal practice and prognostic indicators are essential early in the course of the disease. Magnetic stimulation of the radial nerve and consequent recording of the magnetic motor evoked potential (MMEP) was examined in 36 dogs and 17 cats with unilateral brachial plexus trauma. Absence of deep pain perception (DPP), ipsilateral loss of panniculus reflex, partial Horner's syndrome and a poor response to MMEP were related to the clinical outcome in 29 of the dogs and 13 of the cats. For all animals, a significant difference was found in MMEP between the normal and the affected limb. Absence of DPP and unilateral loss of the panniculus reflex were indicative of an unsuccessful outcome in dogs. Additionally, the inability to evoke a MMEP was associated with an unsuccessful outcome in all animals. It was concluded that magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma may provide an additional diagnostic and prognostic tool. PMID:18602850

  16. Evaluating the acromion marker cluster as a method for measuring scapular orientation in children with brachial plexus birth palsy.

    PubMed

    Nicholson, Kristen F; Russo, Stephanie A; Kozin, Scott H; Zlotolow, Dan A; Hulbert, Robert L; Rowley, K Michael; Richards, James G

    2014-02-01

    Several studies have described using an acromion marker cluster for measuring scapular orientation in healthy adults performing planar motions. It is unknown whether the acromion marker cluster method will provide the same level of accuracy in children with brachial plexus birth palsy. This study compared this method to palpation for calculating scapular orientation in children with brachial plexus birth palsy performing clinically relevant movements. Scapular orientation in ten patients was determined by palpation and an acromion marker cluster in neutral and six Modified Mallet positions. RMSEs and mean relative errors were calculated. Resultant RMSEs ranged from 5.2 degrees to 21.4 degrees. The averages of the mean relative errors across all positions for each axis were 177.4% for upward/downward rotation, 865.0% for internal/external rotation, and 166.2% for anterior/posterior tilt. The acromion marker cluster method did not accurately measure scapular rotation relative to the total movement on an individual or group basis in the population. With most relative errors over 100%, the acromion marker cluster method often produced errors larger than the actual measured motion. The accuracy of the acromion marker cluster method limits its use as a clinical tool for measuring scapular kinematics on children with brachial plexus birth palsy. PMID:24676519

  17. Acute malocclusion.

    PubMed

    Dupont, John S

    2006-01-01

    Acute malocclusion can result from disturbances in the maxillary/mandibular tooth relationship. These alterations in the occlusal position can result from high fillings, sinus problems, abscesses, periodontal disease, and moving or erupting teeth. Conditions seen less frequently include acute malocclusions secondary to an event (such as trauma) that make a stable dental relationship an unstable one. Patients can demonstrate any of a number of clinical conditions that interfere with their comfort and ability to function. This article provides information on some of the less familiar causes of acute malocclusion. PMID:16689064

  18. Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment☆

    PubMed Central

    de Moraes, Frederico Barra; Kwae, Mário Yoshihide; da Silva, Ricardo Pereira; Porto, Celmo Celeno; Magalhães, Daniel de Paiva; Paulino, Matheus Veloso

    2015-01-01

    Objective To evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus. Method This was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: (1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; (2) grade of strength of the shoulder, elbow and wrist/hand; (3) sensitivity; and (4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi-square, Friedman, Wilcoxon and Kruskal–Wallis tests were used (p < 0.05). Results The patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2–48). Thirty-one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery in 39 cases (81.3%). The ROM achieved was ≥30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p = 0.001). Thirteen (27.1%) already had shoulder strength ≥M3 (p = 0.001). Twenty-seven patients (56.2%) had elbow flexion ≥80°, with a range from 30° to 160° and mean of 80.6° (p < 0.001). Twenty-two had strength ≥M3 (p < 0.001). Twenty-two patients (45.8%) had wrist extension ≥30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p = 0.003). Twenty-seven (56.3%) presented wrist/hand extension strength ≥M3 (p = 0.002). Forty-five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p = 0.006). The initial VAS was 4.5 (range: 1.0–9.0) and the final VAS was 3.0 (range: 1.0–7.0) (p < 0.001). Conclusion Traumatic lesions of the brachial plexus were more prevalent among young adults (21–40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second

  19. The effect of exercise training on ankle-brachial index in type 2 diabetes

    PubMed Central

    Barone Gibbs, Bethany; Dobrosielski, Devon A.; Althouse, Andrew D.; Stewart, Kerry J.

    2013-01-01

    Introduction Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM). Methods Participants (n=140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40–65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention. Results Baseline ABI was 1.02±0.02 in exercisers and 1.03±0.01 in controls (p=0.57). At 6 months, exercisers vs. controls improved ABI by 0.04±0.02 vs. −0.03±0.02 (p=0.001). This change was driven by an increase in ankle pressures (p<0.01) with no change in brachial pressures (p=0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI<1.0 (0.14±0.03 vs. 0.02±0.02, p=0.004), but not in those with a baseline ABI≥1.0 (p=0.085). The prevalence of ABI between 1.0–1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β=0.061, p=0.004). Conclusion These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0. PMID:23958264

  20. Acute Bronchitis

    MedlinePlus

    ... bronchitis? Acute bronchitis is almost always caused by viruses that attack the lining of the bronchial tree ... infection. As your body fights back against these viruses, more swelling occurs and more mucus is produced. ...

  1. Acute Pericarditis

    MedlinePlus

    ... large pericardial effusions). Acute pericarditis usually responds to colchicine or NSAIDs (such as aspirin and ibuprofen ) taken ... reduce pain but relieves it by reducing inflammation. Colchicine also decreases the chance of pericarditis returning later. ...

  2. Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation

    PubMed Central

    Souza, Lidiane; Lemos, Thiago; Silva, Débora C.; de Oliveira, José M.; Guedes Corrêa, José F.; Tavares, Paulo L.; Oliveira, Laura A.; Rodrigues, Erika C.; Vargas, Claudia D.

    2016-01-01

    Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions. Results: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818). Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition. PMID:26834610

  3. Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury.

    PubMed

    Fraiman, D; Miranda, M F; Erthal, F; Buur, P F; Elschot, M; Souza, L; Rombouts, S A R B; Schimmelpenninck, C A; Norris, D G; Malessy, M J A; Galves, A; Vargas, C D

    2016-01-01

    This study aims at the effects of traumatic brachial plexus lesion with root avulsions (BPA) upon the organization of the primary motor cortex (M1). Nine right-handed patients with a right BPA in whom an intercostal to musculocutaneous (ICN-MC) nerve transfer was performed had post-operative resting state fMRI scanning. The analysis of empirical functional correlations between neighboring voxels revealed faster correlation decay as a function of distance in the M1 region corresponding to the arm in BPA patients as compared to the control group. No differences between the two groups were found in the face area. We also investigated whether such larger decay in patients could be attributed to a gray matter diminution in M1. Structural imaging analysis showed no difference in gray matter density between groups. Our findings suggest that the faster decay in neighboring functional correlations without significant gray matter diminution in BPA patients could be related to a reduced activity in intrinsic horizontal connections in M1 responsible for upper limb motor synergies. PMID:27547727

  4. Simple fast noninvasive technique for measuring brachial wall mechanics during flow mediated vasodilatation analysis

    NASA Astrophysics Data System (ADS)

    Mahmoud, Ahmed M.; Stapleton, Phoebe A.; Frisbee, Jefferson C.; D'Audiffret, Alexandre; Mukdadi, Osama M.

    2009-02-01

    Measurement of flow-mediated vasodilatation (FMD) in brachial and other conduit arteries has become a common method to asses the status of endothelial function in vivo. In spite of the direct relationship between the arterial wall multi-component strains and FMD responses, direct measurement of wall strain tensor due to FMD has not yet been reported in the literature. In this work, a noninvasive direct ultrasound-based strain tensor measuring (STM) technique is presented to assess changes in the mechanical parameters of the vascular wall during FMD. The STM technique utilizes only sequences of B-mode ultrasound images, and starts with segmenting a region of interest within the artery and providing the acquisition parameters. Then a block matching technique is employed to measure the frame to frame local velocities. Displacements, diameter change, multi-component strain tensor and strain rates are then calculated by integrating or differentiating velocity components. The accuracy of the STM algorithm was assessed using a phantom study, and was further validated using in vivo data from human subjects. Results indicate the validity and versatility of the STM algorithm, and describe how parameters other than the diameter change are sensitive to pre- and post-occlusion, which can then be used for accurate assessment of atherosclerosis.

  5. High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy

    PubMed Central

    Chang, Kate Wan-Chu; Yang, Lynda J-S.; Driver, Lynn; Nelson, Virginia S.

    2016-01-01

    AIM Association of language impairment with neonatal brachial plexus palsy (NBPP) has not been reported in the literature. The current treatment paradigm for NBPP focuses on upper extremity motor recovery with little formal assessment of other aspects of development, such as language. We performed a cross-sectional pilot study to investigate early language delay prevalence in toddlers with NBPP and potential NBPP-related factors involved. METHOD Twenty toddlers with NBPP were consecutively recruited (12 males, 8 females; mean age 30 mos). Preschool Language Scale Score (4th edition), demographics, and socioeconomic status were collected. NBPP-related factors such as palsy side, treatment type, Narakas grade, muscle MRC score, and Raimondi hand score were reported. Student t test, chi-square, or Fisher exact test were applied. Statistical significance level was established at p<0.05. RESULTS Of study participants, 30% were diagnosed with language delay, while the prevalence of language delay in the population with normal development in this age range was approximately 5-15%. INTERPRETATION We observed high language delay prevalence among toddlers with NBPP. Although our subject sample is small, our findings warrant further study of this phenomenon. Early identification and timely intervention based on type of language impairment may be critical for improving communication outcome in this population. PMID:25160543

  6. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery

    PubMed Central

    Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K.

    2016-01-01

    The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery. PMID:27073779

  7. Ankle-Brachial Index and Bone Turnover in Patients on Dialysis

    PubMed Central

    Marchais, Sylvain J.; Guérin, Alain P.; de Vernejoul, Marie-Christine

    2015-01-01

    An association between atherosclerosis and osteoporosis has been reported in several studies. This association could result from local intraosseous atherosclerosis and ischemia, which is shown by limb osteoporosis in patients with peripheral artery disease (PAD), but also could result from bidirectional communication between the skeleton and blood vessels. Systemic bone disorders and PAD are frequent in ESRD. Here, we investigated the possible interaction of these disorders. For 65 prevalent nondiabetic patients on hemodialysis, we measured ankle-brachial pressure index (ABix) and evaluated mineral and bone disorders with bone histomorphometry. In prevalent patients on hemodialysis, PAD (ABix<0.9 or >1.4/incompressible) was associated with low bone turnover and pronounced osteoblast resistance to parathyroid hormone (PTH), which is indicated by decreased double-labeled surface and osteoblast surface (P<0.001). Higher osteoblast resistance to PTH in patients with PAD was characterized by weaker correlation coefficients (slopes) between serum PTH and double-labeled surface (P=0.02) or osteoblast surface (P=0.03). The correlations between osteoclast number or eroded surface and serum mineral parameters, including PTH, did not differ for subjects with normal ABix and PAD. Common vascular risk factors (dyslipidemia, smoking, and sex) were similar for normal, low, and incompressible ABix. Patients with PAD were older and had high C-reactive protein levels and longer hemodialysis vintage. These results indicate that, in prevalent nondiabetic patients with ESRD, PAD associates with low bone turnover and pronounced osteoblast resistance to PTH. PMID:25231881

  8. Ankle-brachial index and bone turnover in patients on dialysis.

    PubMed

    London, Gérard M; Marchais, Sylvain J; Guérin, Alain P; de Vernejoul, Marie-Christine

    2015-02-01

    An association between atherosclerosis and osteoporosis has been reported in several studies. This association could result from local intraosseous atherosclerosis and ischemia, which is shown by limb osteoporosis in patients with peripheral artery disease (PAD), but also could result from bidirectional communication between the skeleton and blood vessels. Systemic bone disorders and PAD are frequent in ESRD. Here, we investigated the possible interaction of these disorders. For 65 prevalent nondiabetic patients on hemodialysis, we measured ankle-brachial pressure index (ABix) and evaluated mineral and bone disorders with bone histomorphometry. In prevalent patients on hemodialysis, PAD (ABix<0.9 or >1.4/incompressible) was associated with low bone turnover and pronounced osteoblast resistance to parathyroid hormone (PTH), which is indicated by decreased double-labeled surface and osteoblast surface (P<0.001). Higher osteoblast resistance to PTH in patients with PAD was characterized by weaker correlation coefficients (slopes) between serum PTH and double-labeled surface (P=0.02) or osteoblast surface (P=0.03). The correlations between osteoclast number or eroded surface and serum mineral parameters, including PTH, did not differ for subjects with normal ABix and PAD. Common vascular risk factors (dyslipidemia, smoking, and sex) were similar for normal, low, and incompressible ABix. Patients with PAD were older and had high C-reactive protein levels and longer hemodialysis vintage. These results indicate that, in prevalent nondiabetic patients with ESRD, PAD associates with low bone turnover and pronounced osteoblast resistance to PTH. PMID:25231881

  9. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy*

    PubMed Central

    Chagas-Neto, Francisco Abaete; Dalto, Vitor Faeda; Crema, Michel Daoud; Waters, Peter M.; Gregio-Junior, Everaldo; Mazzer, Nilton; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    Objective To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head. PMID:27403013

  10. Pulsed Doppler: determination of diameter, blood flow velocity, and volumic flow of brachial artery in man.

    PubMed

    Levenson, J A; Peronneau, P A; Simon, A; Safar, M E

    1981-03-01

    A pulsed Doppler velocimeter suitable for the determination of blood flow velocity and volumic flow in peripheral arteries is described. The apparatus has two main characteristics: an adjustable range-gated time system and a double transducer probe. The error in the determination of the angle between the ultrasound beam and flow of blood with this apparatus was less than 2%, and overestimation of the arterial diameter due to the sample volume size did not exceed 0.035 +/- 0.015 cm. The apparatus was used to determine diameter, blood flow velocity and volumic flow of the brachial artery of 22 healthy men. The values were respectively 0.440 +/- 0.010 cm, 9.15 +/- 1.01 cm.s-1 and 85 +/- 10 cm3.min-1. Administration of intravenous nitroglycerin significantly increased the arterial diameter (p less than 0.001) without any significant change in volumic flow. The described pulsed Doppler velocimeter provides an accurate noninvasive method for determining volumic flow in peripheral arteries in clinical investigation and cardiovascular pharmacology. PMID:6455197

  11. Relationship between brachial-ankle pulse wave velocity and metabolic syndrome components in a Chinese population

    PubMed Central

    Zhou, Fang; Zhang, Haifeng; Yao, Wenming; Mei, Hongbin; Xu, Dongjie; Sheng, Yanhui; Yang, Rong; Kong, Xiangqing; Wang, Liansheng; Zou, Jiangang; Yang, Zhijian; Li, Xinli

    2014-01-01

    Abstract The purpose of this study was to assess the relationship between arterial stiffness, as measured by brachial-ankle pulse wave velocity (baPWV), and the presence of the metabolic syndrome (MS) in a Chinese population. A total of 4,445 subjects were enrolled. The prevalence of MS in our study population was 21.7%, 17.2% and 25.6% for the general population, males and females, respectively. With adjustments for age, gender, cigarette smoking, heart rate, total cholesterol, low-density lipoprotein (LDL) cholesterol, and the use of anti-hypertensive drug, the stepwise regression analysis showed that baPWV had a significant relationship with components of MS, including systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), glucose (P < 0.001), high-density lipoprotein (HDL) cholesterol (P  =  0.04), and triglycerides (P < 0.001), but no relationship with waist circumference (P  =  0.25). With an increase in the number of the MS components, baPWV increased significantly both in women and men. This study indicated that the MS is indeed a risk factor for arterial stiffness. Monitoring of baPWV in patients with MS may help in identifying persons at high risk for cardiovascular disease. PMID:25050109

  12. Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery.

    PubMed

    Salem, Mohamed H; Winckelmann, Jörg; Geiger, Peter; Mehrkens, Hans-Hinrich; Salem, Khaled H

    2012-08-01

    In a prospective controlled trial to compare conventional interscalene brachial plexus block (ISBPB) using anatomic landmarks and electro-stimulation with a combined technique of ultrasound guidance followed by nerve stimulation, 60 patients were randomized into 2 matched equal groups: Group A using nerve stimulation (NS) alone and Group B using the combination of ultrasound and NS. The time to detect the plexus (3.9 ± 4 min in Group A and 3.3 ± 1.4 min in Group B) was not significantly different. We needed to reposition the needle once (n = 13) or twice (n = 4) in Group B. First-shot motor response was achieved in all but one patient in Group A; here we were only able to locate the plexus by use of ultrasound. None of the patients needed general anaesthesia. There were no significant differences between postoperative pain, motor power, or patient's satisfaction. ISBPB seems similarly effective using electro-stimulation and ultrasound if performed by experienced anesthesiologists. PMID:22391670

  13. Hands-up positioning during asymmetric sternal retraction for internal mammary artery harvest: a possible method to reduce brachial plexus injury.

    PubMed

    Jellish, W S; Blakeman, B; Warf, P; Slogoff, S

    1997-02-01

    This study compares the hands-up (HU) with the arms at side (AAS) position to determine whether one is beneficial in reducing brachial plexus stress during asymmetric sternal retraction. Eighty patients undergoing cardiac surgery were assigned to either Group 1 (AAS) or Group 2 (HU). Perioperative neurologic evaluations of the brachial plexus were performed and somatosensory evoked potentials (SSEPs) were collected during internal mammary artery harvest using asymmetric sternal retraction. Demographic data, SSEP changes, and postoperative brachial plexus symptoms were compared between groups. SSEP amplitude decreased in 95% of all patients during retractor placement with substantial decreases (> 50%) observed on the left side in 50% of the AAS and 35% of the HU patients. Amplitude recovery was normally seen in both groups after asymmetric retractor removal. Similar changes were noted, to a lesser degree, on the right side. During asymmetric sternal retraction, HU positioning offered minimal benefit in reducing brachial plexus stress as measured by SSEP. Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury. However, none of the four patients with plexus symptoms in the HU group had ulnar nerve problems, suggesting that the higher incidence of postoperative symptoms observed with AAS positioning may occur from ulnar nerve compression. PMID:9024012

  14. Acute myelogenous leukemia (AML) - children

    MedlinePlus

    Acute myelogenous leukemia - children; AML; Acute myeloid leukemia - children; Acute granulocytic leukemia - children; Acute myeloblastic leukemia - children; Acute non-lymphocytic leukemia (ANLL) - children

  15. Adding Papillomacular Bundle Measurements to Standard Optical Coherence Tomography Does Not Increase Sensitivity to Detect Prior Optic Neuritis in Patients with Multiple Sclerosis

    PubMed Central

    Laible, Mona; Jarius, Sven; Schmidt-Bacher, Annette; Platten, Michael; Haas, Jürgen

    2016-01-01

    Purpose To improve the detection of retinal nerve fiber layer (RNFL) thinning in multiple sclerosis (MS), a special peripapillary ring scanning algorithm (N-site RNFL, N-RNFL) was developed for spectral domain optical coherence tomography (SD-OCT). In contrast to the standard protocol (ST-RNFL) scanning starts nasally, not temporally, and provides an additional sector of analysis, the papillomacular bundle (PMB). We aimed to ascertain whether the temporal RNFL differs between the two techniques, whether N-RNFL is more sensitive than ST-RNFL to detect previous optic neuritis (ON), and whether analyzing the PMB adds additional sensitivity. Furthermore, we investigated whether RNFL is associated with disease severity and/or disease duration. Methods We conducted a cross-sectional case-control study of 38 patients with MS, of whom 24 had a history of ON, and 40 healthy controls (HC). Subjects with ON within the previous 6 months were excluded. Records included clinical characteristics, visual evoked potentials (VEP), and SD-OCT in both techniques. Results In a total of 73 evaluable MS eyes, temporal N-RNFL was abnormal in 17.8%, temporal ST-RNFL in 19.2%, and the PMB-RNFL in 21.9%. In ON eyes, the sensitivity of temporal N-RNFL and ST-RNFL did not differ significantly (37.0%/33.3%, p = 0.556). The sensitivity of VEP was 85.2%. RNFL thickness was associated with disease severity in all eyes, with and without a history of ON, and with disease duration. Conclusion The two OCT techniques detected previous ON with similar sensitivity, but the sensitivity of VEPs was superior to that of both N-RNFL and ST-RNFL. Our results indicate that the widely used ST-RNFL technique is appropriate for peripapillary RNFL measurements in MS patients. PMID:27171375

  16. Preventive effect of vitamin D3 supplementation on conversion of optic neuritis to clinically definite multiple sclerosis: a double blind, randomized, placebo-controlled pilot clinical trial.

    PubMed

    Derakhshandi, Hajar; Etemadifar, Masoud; Feizi, Awat; Abtahi, Seyed-Hossein; Minagar, Alireza; Abtahi, Mohammad-Ali; Abtahi, Zahra-Alsadat; Dehghani, Alireza; Sajjadi, Sepideh; Tabrizi, Nasim

    2013-09-01

    Multiple sclerosis (MS) presents with optic neuritis (ON) in 20 % of cases and 50 % of ON patients develop MS within 15 years. In this study, we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS (primary outcome) and on the MRI lesions (secondary outcome) of ON patients with low serum 25 (OH) D levels. Thirty ON patients (15 in each of 2 groups, aged 20-40 years) with serum 25 (OH) D levels of less than 30 ng/ml were enrolled in a double blind, randomized, parallel-group trial. The treatment group (cases) received 50,000 IU of vitamin D3 weekly for 12 months and the control group (controls) received a placebo weekly for 12 months. Finally, the subsequent relapse rate and changes in MRI plaques were compared between the two groups. Risk reduction was 68.4 % for the primary outcome in the treatment group (relative risk = 0.316, p = 0.007). After 12 months, patients in the treatment group had a significantly lower incidence rate of cortical, juxtacortical, corpus callosal, new T2, new gadolinium-enhancing lesions and black holes. The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group (p = 0.092). Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 (OH) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS. PMID:23250818

  17. White and Gray Matter Volume Changes and Correlation with Visual Evoked Potential in Patients with Optic Neuritis: A Voxel-Based Morphometry Study.

    PubMed

    Huang, Xin; Zhang, Qiang; Hu, Pei-Hong; Zhong, Yu-Lin; Zhang, Ying; Wei, Rong; Xu, Ting-Ting; Shao, Yi; fMRI Study Group, And Oculopathy

    2016-01-01

    BACKGROUND The aim of this study was to investigate potential morphological alterations of gray and white matter in patients with optic neuritis (ON) and their relationship with behavioral performance, using voxel-based morphometry (VBM). MATERIAL AND METHODS Twelve (4 males, 8 females) patients with ON and 12 (4 males, 8 females) age-, sex-, and education-matched healthy controls (HCs) underwent magnetic resonance imaging (MRI). Imaging data were analyzed using two-sample t tests to identify group differences in gray and white matter volume (GMV, WMV). Correlation analysis was used to explore relationships between observed GMV and WMV of different areas and visual evoked potential (VEP) in ON. RESULTS Compared with HCs, ON patients had: significantly decreased GMV in the left postcentral gyrus, left inferior frontal gyrus, left anterior cingulate, left and right middle frontal gyrus, and right inferior parietal lobule; decreased WMV in the left middle frontal gyrus, right superior frontal gyrus, left precentral gyrus and right inferior parietal lobule; and increased WMV in the left fusiform gyrus and left inferior parietal lobule. VEP latency of the right eye in ON correlated positively with WMV signal value of the left fusiform gyrus (r=0.726, p=0.008), and negatively with GMV signal value of the right inferior parietal lobule (r=-0.611, p=0.035). Duration of ON correlated negatively with WMV signal value of the right superior frontal gyrus (r=-0.662, p=0.019), while best-corrected visual acuity (VA) of the right eye correlated negatively with WMV signal value of the left middle frontal gyrus (r=-0.704, p=0.011). CONCLUSIONS These results suggest significant brain involvement in ON, which may reflect the underlying pathologic mechanism. Correlational results demonstrate that VEP in ON is closely associated with WMV and GMV atrophy in many brain regions. PMID:27045330

  18. Disturbed spontaneous brain-activity pattern in patients with optic neuritis using amplitude of low-frequency fluctuation: a functional magnetic resonance imaging study

    PubMed Central

    Huang, Xin; Cai, Feng-Qin; Hu, Pei-Hong; Zhong, Yu-Lin; Zhang, Ying; Wei, Rong; Pei, Chong-Gang; Zhou, Fu-Qing; Shao, Yi

    2015-01-01

    Objective To use the amplitude of low-frequency fluctuation (ALFF) technique to investigate the local features of spontaneous brain activity in optic neuritis (ON) and their relationship with behavioral performance. Materials and methods Twelve patients with ON (four male, eight female) and twelve age-, sex-, and education status-matched healthy controls (HCs) (four male, eight female) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. The ALFF technique was used to assess local features of spontaneous brain activity. Correlation analysis was used to explore the relationship between the observed mean ALFF values of the different areas and visual evoked potentials (VEPs) in patients with ON. Results Compared with HCs, patients with ON had significantly decreased ALFF values in the posterior and anterior lobes of the right cerebellum, right putamen, right inferior frontal gyrus, right insula, right supramarginal gyrus, right inferior parietal lobule, left medial frontal gyrus, left superior temporal gyrus, bilateral anterior cingulate/medial frontal gyrus, and bilateral precuneus, and significantly increased ALFF values in the posterior lobes of the left and right cerebellum, right inferior temporal gyrus, right inferior temporal/fusiform gyrus, left parahippocampal gyrus, left fusiform gyrus, left calcarine fissure, left inferior parietal lobule, and left cuneus. We found negative correlations between the mean ALFF signal value of the left parahippocampal gyrus and the VEP amplitude of the right eye in ON (r=−0.584, P=0.046), and a positive correlation between the mean ALFF signal value of the bilateral precuneus and the best-corrected visual acuity of the left eye (r=0.579, P=0.048) in patients with ON. Conclusion ON mainly seems to involve dysfunction in the default-mode network, cerebellum, and limbic system, which may reflect the underlying pathologic mechanism of ON. PMID:26719692

  19. White and Gray Matter Volume Changes and Correlation with Visual Evoked Potential in Patients with Optic Neuritis: A Voxel-Based Morphometry Study

    PubMed Central

    Huang, Xin; Zhang, Qiang; Hu, Pei-Hong; Zhong, Yu-Lin; Zhang, Ying; Wei, Rong; Xu, Ting-Ting; Shao, Yi

    2016-01-01

    Background The aim of this study was to investigate potential morphological alterations of gray and white matter in patients with optic neuritis (ON) and their relationship with behavioral performance, using voxel-based morphometry (VBM). Material/Methods Twelve (4 males, 8 females) patients with ON and 12 (4 males, 8 females) age-, sex-, and education-matched healthy controls (HCs) underwent magnetic resonance imaging (MRI). Imaging data were analyzed using two-sample t tests to identify group differences in gray and white matter volume (GMV, WMV). Correlation analysis was used to explore relationships between observed GMV and WMV of different areas and visual evoked potential (VEP) in ON. Results Compared with HCs, ON patients had: significantly decreased GMV in the left postcentral gyrus, left inferior frontal gyrus, left anterior cingulate, left and right middle frontal gyrus, and right inferior parietal lobule; decreased WMV in the left middle frontal gyrus, right superior frontal gyrus, left precentral gyrus and right inferior parietal lobule; and increased WMV in the left fusiform gyrus and left inferior parietal lobule. VEP latency of the right eye in ON correlated positively with WMV signal value of the left fusiform gyrus (r=0.726, p=0.008), and negatively with GMV signal value of the right inferior parietal lobule (r=−0.611, p=0.035). Duration of ON correlated negatively with WMV signal value of the right superior frontal gyrus (r=−0.662, p=0.019), while best-corrected visual acuity (VA) of the right eye correlated negatively with WMV signal value of the left middle frontal gyrus (r=−0.704, p=0.011). Conclusions These results suggest significant brain involvement in ON, which may reflect the underlying pathologic mechanism. Correlational results demonstrate that VEP in ON is closely associated with WMV and GMV atrophy in many brain regions. PMID:27045330

  20. Impact of acute caffeine ingestion on endothelial function in subjects with and without coronary artery disease.

    PubMed

    Shechter, Michael; Shalmon, Guy; Scheinowitz, Mickey; Koren-Morag, Nira; Feinberg, Micha S; Harats, Dror; Sela, Ben Ami; Sharabi, Yehonatan; Chouraqui, Pierre

    2011-05-01

    Although coffee is a widely used, pharmacologically active beverage, its impact on the cardiovascular system is controversial. To explore the effect of acute caffeine ingestion on brachial artery flow-mediated dilation (FMD) in subjects without coronary artery disease (CAD; controls) and patients with CAD, we prospectively assessed brachial artery FMD in 40 controls and 40 age- and gender-matched patients with documented stable CAD on 2 separate mornings 1 week to 2 weeks apart. After overnight fasting, discontinuation of all medications for ≥12 hours, and absence of caffeine for >48 hours, participants received capsules with caffeine 200 mg or placebo. One hour after drug ingestion, participants underwent brachial artery FMD and nitroglycerin-mediated dilation (NTG) using high-resolution ultrasound. As expected, patients with CAD were more often diabetic, hypertensive, obese, dyslipidemic, and smoked more than controls (p <0.01 for all comparisons). Aspirin, Clopidogrel, angiotensin-converting enzyme inhibitors, β blockers, and statins were significantly more common in patients with CAD than in controls (p <0.01 for all comparisons). At baseline, FMD, but not NTG, was significantly lower in patients with CAD compared to controls. Acute caffeine ingestion significantly increased FMD (patients with CAD 5.6 ± 5.0% vs 14.6 ± 5.0%, controls 8.4 ± 2.9% vs 18.6 ± 6.8%, p <0.001 for all comparisons) but not NTG (patients with CAD 13.0 ± 5.2% vs 13.8 ± 6.1%, controls 12.9 ± 3.9% vs 13.9 ± 5.8%, p = NS for all comparisons) and significantly decreased high-sensitivity C-reactive protein (patients with CAD 2.6 ± 1.4 vs 1.4 ± 1.2 mg/L, controls 3.4 ± 3.0 vs 1.2 ± 1.0 mg/L, p <0.001 for all comparisons) in the 2 groups compared to placebo. In conclusion, acute caffeine ingestion significantly improved endothelial function assessed by brachial artery FMD in subjects with and without CAD and was associated with lower plasma markers of inflammation. PMID:21349479

  1. Features of anti-aquaporin 4 antibody-seropositive Chinese patients with neuromyelitis optica spectrum optic neuritis.

    PubMed

    Li, Hongyang; Wang, Yanling; Xu, Quangang; Zhang, Aidi; Zhou, Huanfen; Zhao, Shuo; Kang, Hao; Peng, Chunxia; Cao, Shanshan; Wei, Shihui

    2015-10-01

    The detection of anti-aquaporin-4 autoantibody (AQP-4 Ab) is crucial to detect patients who will develop neuromyelitis optica (NMO); however, there are few studies on the AQP-4 Ab serostatus of patients with neuromyelitis optica spectrum ON. We analyzed the clinical and paraclinical features of neuromyelitis optica spectrum ON patients in China according to the patients' AQP4-Ab serostatus. 125 patients with recurrent and bilateral ON with simultaneous attacks were divided into AQP-4 Ab-seropositive and -seronegative groups. Demographic, clinical, serum autoantibody data, connective tissue disorders (CTDs), visual performance were compared. A Visual Acuity (VA) of less than 0.1 during acute ON attacks occurred more frequently in the seropositive group (p = 0.023); however, there was not a significant difference between groups on VA recovery after the first attack. The seropositive group experienced the worst outcome during the last attack (p = 0.017). Other co-existing autoimmunity antibodies (p < 0.001) and CTDs (p < 0.001) were more prevalent in seropositive patients. There were no significant differences on VA recovery and RNFLT combined with other autoantibodies or CTDs. The two groups did not differ significantly with regard to time to relapse, annualized relapse rates, time of diagnosis NMO, or RNFL. There were no significant differences on VA recovery and RNFLT combined with other autoantibodies or CTDs. RNFLT was thinner in NMO seropositive patients. Although AQP-4 Ab expression predicted poor visual outcome, positive patients were usually associated with mild symptoms at first onset. Anti-SSA/SSB antibody or Sjögren syndrome may be associated with AQP-4 Ab in neuromyelitis optica spectrum ON. PMID:26162715

  2. Recurrent vocal fold paralysis and parsonage-turner syndrome.

    PubMed

    Pinto, Marcus Vinicius; Joffily, Lucia; Vincent, Maurice Borges

    2013-01-01

    Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP. PMID:24288639

  3. Acute Pneumonia.

    PubMed

    Arshad, Hammad; Fasanya, Adebayo; Cheema, Tariq; Singh, Anil C

    2016-01-01

    Acute pneumonia is an active infection of the lungs that results when an individual at risk gets exposed to a particular microbiological pathogen. Acute pneumonia is the leading cause of death in the United States that is attributable to an infection. The risk factors, pathogenesis, and microbiological organisms involved differ if the pneumonia develops in the community versus health care-associated environment. The development of concise and comprehensive guidelines has led to an improvement in the management of the problem. However, the emergence of multidrug-resistant organisms and the increase in the percentage of elderly population keep mortality risk very substantial. PMID:26919676

  4. The investigation of traumatic lesions of the brachial plexus by electromyography and short latency somatosensory potentials evoked by stimulation of multiple peripheral nerves.

    PubMed Central

    Yiannikas, C; Shahani, B T; Young, R R

    1983-01-01

    A study of 10 patients with brachial plexus trauma was performed to determine whether the diagnostic accuracy of sensory evoked potentials (SEPs) may be improved by using stimulation of multiple peripheral nerves (median, radial, musculocutaneous and ulnar). In addition, the relative advantages of SEPs and peripheral electrophysiological studies were considered. SEP patterns following most common brachial plexus lesions were predictable. Injuries to the upper trunk affected the musculocutaneous and radial SEPs predominantly. Lower trunk or medial cord lesions primarily affected ulnar SEPs. Diffuse brachial plexus lesions affected SEPs from all stimulation sites. In the majority of cases, the necessary information was obtainable from conventional EMG: however, for lesions involving the upper segments only, SEP techniques were more useful. It is suggested that selective SEPs from appropriate peripheral nerves when interpreted in combination with conventional EMG may add useful additional information. PMID:6317804

  5. The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome

    PubMed Central

    Carmona, Sergio; Martínez, Carlos; Zalazar, Guillermo; Moro, Marcela; Batuecas-Caletrio, Angel; Luis, Leonel; Gordon, Carlos

    2016-01-01

    The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient’s age. Grade 2–3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2–3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate. PMID:27551274

  6. The Diagnostic Accuracy of Truncal Ataxia and HINTS as Cardinal Signs for Acute Vestibular Syndrome.

    PubMed

    Carmona, Sergio; Martínez, Carlos; Zalazar, Guillermo; Moro, Marcela; Batuecas-Caletrio, Angel; Luis, Leonel; Gordon, Carlos

    2016-01-01

    The head impulse, nystagmus type, test of skew (HINTS) protocol set a new paradigm to differentiate peripheral vestibular disease from stroke in patients with acute vestibular syndrome (AVS). The relationship between degree of truncal ataxia and stroke has not been systematically studied in patients with AVS. We studied a group of 114 patients who were admitted to a General Hospital due to AVS, 72 of them with vestibular neuritis (based on positive head impulse, abnormal caloric tests, and negative MRI) and the rest with stroke: 32 in the posterior inferior cerebellar artery (PICA) territory (positive HINTS findings, positive MRI) and 10 in the anterior inferior cerebellar artery (AICA) territory (variable findings and grade 3 ataxia, positive MRI). Truncal ataxia was measured by independent observers as grade 1, mild to moderate imbalance with walking independently; grade 2, severe imbalance with standing, but cannot walk without support; and grade 3, falling at upright posture. When we applied the HINTS protocol to our sample, we obtained 100% sensitivity and 94.4% specificity, similar to previously published findings. Only those patients with stroke presented with grade 3 ataxia. Of those with grade 2 ataxia (n = 38), 11 had cerebellar stroke and 28 had vestibular neuritis, not related to the patient's age. Grade 2-3 ataxia was 92.9% sensitive and 61.1% specific to detect AICA/PICA stroke in patients with AVS, with 100% sensitivity to detect AICA stroke. In turn, two signs (nystagmus of central origin and grade 2-3 Ataxia) had 100% sensitivity and 61.1% specificity. Ataxia is less sensitive than HINTS but much easier to evaluate. PMID:27551274

  7. A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block

    PubMed Central

    Tripathi, Archana; Sharma, Khushboo; Somvanshi, Mukesh; Samal, Rajib Lochan

    2016-01-01

    Background and Aims: Various additives are mixed with local anesthetic agents to increase the quality of block in regional anesthesia. We compared clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block with respect to the onset and duration of sensory and motor block and duration of analgesia. Material and Methods: Sixty American Society of Anesthesiologists Grades I and II patients scheduled for various orthopedic surgeries of the upper limb under supraclavicular brachial plexus block were divided into two equal groups in a randomized, double-blind manner. Patients were assigned randomly to one of the two groups. In Group C (n = 30), 39 ml of 0.25% bupivacaine plus 1 ml (1 μg/kg) clonidine and in Group D (n = 30), 39 ml of 0.25% bupivacaine plus 1 ml (1 μg/kg) dexmedetomidine were given. The onset and duration of sensory and motor block, duration of analgesia, and quality of anesthesia were studied in both the groups. Results: There was no statistically significant difference in the onset of sensory and motor block in both the groups. The durations of sensory and motor block were 316.67 ± 45.21 and 372.67 ± 44.48 min, respectively, in Group C, whereas they were 502.67 ± 43.78 and 557.67 ± 38.83 min, respectively, in Group D. The duration of analgesia was 349.33 ± 42.91 min, significantly less in Group C compared to 525.33 ± 42.89 min in Group D (P < 0.001). The quality of anesthesia was significantly better in dexmedetomidine group compared to clonidine group (P < 0.001). Conclusion: The addition of dexmedetomidine prolongs the durations of sensory and motor block and duration of analgesia and improves the quality of anesthesia as compared with clonidine when injected with bupivacaine in supraclavicular brachial plexus block. PMID:27625483

  8. Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients

    PubMed Central

    Gerage, Aline M.; Benedetti, Tania R. B.; Farah, Breno Q.; Santana, Fábio da S.; Ohara, David; Andersen, Lars B.; Ritti-Dias, Raphael M.

    2015-01-01

    Background Physical activity is recommended as a part of a comprehensive lifestyle approach in the treatment of hypertension, but there is a lack of data about the relationship between different intensities of physical activity and cardiovascular parameters in hypertensive patients. The purpose of this study was to investigate the association between the time spent in physical activities of different intensities and blood pressure levels, arterial stiffness and autonomic modulation in hypertensive patients. Methods In this cross-sectional study, 87 hypertensive patients (57.5 ± 9.9 years of age) had their physical activity assessed over a 7 day period using an accelerometer and the time spent in sedentary activities, light physical activities, moderate physical activities and moderate-to-vigorous physical activities was obtained. The primary outcomes were brachial and central blood pressure. Arterial stiffness parameters (augmentation index and pulse wave velocity) and cardiac autonomic modulation (sympathetic and parasympathetic modulation in the heart) were also obtained as secondary outcomes. Results Sedentary activities and light physical activities were positively and inversely associated, respectively, with brachial systolic (r = 0.56; P < 0.01), central systolic (r = 0.51; P < 0.05), brachial diastolic (r = 0.45; P < 0.01) and central diastolic (r = 0.42; P < 0.05) blood pressures, after adjustment for sex, age, trunk fat, number of antihypertensive drugs, accelerometer wear time and moderate-to-vigorous physical activities. Arterial stiffness parameters and cardiac autonomic modulation were not associated with the time spent in sedentary activities and in light physical activities (P > 0.05). Conclusion Lower time spent in sedentary activities and higher time spent in light physical activities are associated with lower blood pressure, without affecting arterial stiffness and cardiac autonomic modulation in hypertensive patients. PMID:26717310

  9. Effects of age, sex and smoking on ankle-brachial index in a Finnish population at risk for cardiovascular disease

    PubMed Central

    Syvänen, Kari; Aarnio, Pertti; Jaatinen, Pekka; Korhonen, Päivi

    2007-01-01

    BACKGROUND Smoking is a well-known risk factor for peripheral arterial disease (PAD). Data regarding differences in the prevalence of PAD between sexes are somewhat controversial. In addition, most studies indicate that the prevalence of PAD increases with age in both sexes. In the present study, the effects of sex, age and smoking on the ankle-brachial index (ABI) in a Finnish cardiovascular risk population were investigated. OBJECTIVES To investigate the relationship between the ankle-brachial index, and age, sex and smoking in a Finnish population at risk for cardiovascular disease. METHODS All men and women between 45 and 70 years of age living in a rural town (Harjavalta, Finland; total population 7700) were invited to participate in a population survey (Harmonica study). Patients with previously diagnosed diabetes or vascular disease were excluded. In total, 2856 patients were invited to participate in the study. From these subjects, a cardiovascular risk population was screened. Complete data were available from 1028 persons. ABI (the ratio between the posterior tibial or dorsalis pedis artery and brachial artery pressures) was measured, and questionnaires were used to detect smoking status and relevant medical history. Only current smoking status was taken into account. RESULTS The mean ABI for the entire study population was 1.10 (range 0.56 to 1.64). Current smokers had a lower mean ABI (1.06; P<0.001). There was no statistically significant difference in ABI values among age groups, although the majority of patients with ABI values below 0.9 were older than 60 years of age. There was no statistically significant difference in ABI between sexes. CONCLUSION As previously reported, the present study shows the significant effect of smoking in the development of PAD. No statistically significant difference was found among age groups, but the tendency was toward lower ABIs in the oldest age groups. Sex had a minimal effect on the ABI. PMID:22477327

  10. Clonidine as an adjuvant for ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet: A clinical study

    PubMed Central

    Gupta, Kumkum; Tiwari, Vaibhav; Gupta, Prashant K; Pandey, Mahesh Narayan; Singhal, Apoorva B; Shubham, Garg

    2014-01-01

    Background and Aims: Clonidine has been used as an adjuvant to local anesthetic to extend the duration of block. The present study was aimed to compare the onset and duration of sensory and motor blockade of 0.75% ropivacaine alone or in combination with clonidine during ultrasound guided supraclavicular brachial plexus block for upper extremity surgeries under tourniquet. Materials and Methods: Sixty four adult American Society of Anesthesiologist grade 1 and 2 patients, scheduled for upper extremity surgeries were randomized to receive either 19.8 mL of 0.75% ropivacaine with 0.2 mL of normal saline (Group R) or 0.2 mL (30 μg) of clonidine (Group RC) in supraclavicular block. Onset and duration of sensory and motor blockade was compared. The hemodynamic variability, sedation, respiratory adequacy and any other adverse effects were also recorded. Result: Ultrasound helped to visualize the nerves, needle and spread of local anesthetic at the brachial plexus block site. There was no statistically significant difference in the onset of sensory and motor blockade between the groups. Surgical anesthesia was achieved at the mean time of 20 min in all patients. Prolonged post-operative analgesia (mean duration 956 min) was observed in RC group as compared with R group (736 min). No complication of technique or adverse effect of ropivacaine and clonidine was reported. Conclusion: Clonidine as an adjuvant to ropivacaine for ultrasound guided supraclavicular brachial plexus enhanced duration of post-operative analgesia. There was no incidence of vessel puncture or pneumothorax. PMID:25425780

  11. Local injection of autologous bone marrow cells to regenerate muscle in patients with traumatic brachial plexus injury

    PubMed Central

    Hogendoorn, S.; Duijnisveld, B. J.; van Duinen, S. G.; Stoel, B. C.; van Dijk, J. G.; Fibbe, W. E.; Nelissen, R. G. H. H.

    2014-01-01

    Objectives Traumatic brachial plexus injury causes severe functional impairment of the arm. Elbow flexion is often affected. Nerve surgery or tendon transfers provide the only means to obtain improved elbow flexion. Unfortunately, the functionality of the arm often remains insufficient. Stem cell therapy could potentially improve muscle strength and avoid muscle-tendon transfer. This pilot study assesses the safety and regenerative potential of autologous bone marrow-derived mononuclear cell injection in partially denervated biceps. Methods Nine brachial plexus patients with insufficient elbow flexion (i.e., partial denervation) received intramuscular escalating doses of autologous bone marrow-derived mononuclear cells, combined with tendon transfers. Effect parameters included biceps biopsies, motor unit analysis on needle electromyography and computerised muscle tomography, before and after cell therapy. Results No adverse effects in vital signs, bone marrow aspiration sites, injection sites, or surgical wound were seen. After cell therapy there was a 52% decrease in muscle fibrosis (p = 0.01), an 80% increase in myofibre diameter (p = 0.007), a 50% increase in satellite cells (p = 0.045) and an 83% increase in capillary-to-myofibre ratio (p < 0.001) was shown. CT analysis demonstrated a 48% decrease in mean muscle density (p = 0.009). Motor unit analysis showed a mean increase of 36% in motor unit amplitude (p = 0.045), 22% increase in duration (p = 0.005) and 29% increase in number of phases (p = 0.002). Conclusions Mononuclear cell injection in partly denervated muscle of brachial plexus patients is safe. The results suggest enhanced muscle reinnervation and regeneration. Cite this article: Bone Joint Res 2014;3:38–47. PMID:24565688

  12. Validating the RTOG-Endorsed Brachial Plexus Contouring Atlas: An Evaluation of Reproducibility Among Patients Treated by Intensity-Modulated Radiotherapy for Head-and-Neck Cancer

    SciTech Connect

    Yi, Sun K.; Hall, William H.; Mathai, Mathew; Dublin, Arthur B.; Gupta, Vishal; Purdy, James A.; Chen, Allen M.

    2012-03-01

    Purpose: To evaluate interobserver variability for contouring the brachial plexus as an organ-at-risk (OAR) and to analyze its potential dosimetric consequences in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Methods and Materials: Using the Radiation Therapy Oncology Group (RTOG)-endorsed brachial plexus contouring atlas, three radiation oncologists independently delineated the OAR on treatment planning computed-tomography (CT) axial scans from 5 representative patients undergoing IMRT to a prescribed dose of 70 Gy for head-and-neck cancer. Dose-volume histograms for the brachial plexus were calculated, and interobserver differences were quantified by comparing various dosimetric statistics. Qualitative analysis was performed by visually assessing the overlapping contours on a single beam's eye view. Results: Brachial plexus volumes for the 5 patients across observers were 26 cc (18-35 cc), 25 cc (21-30 cc), 29 cc (28-32 cc), 29 cc (23-38 cc), and 29 cc (23-34 cc). On qualitative analysis, minimal variability existed except at the inferolateral portion of the OAR, where slight discrepancies were noted among the physicians. Maximum doses to the brachial plexus ranged from 71.6 to 72.6 Gy, 75.2 to 75.8 Gy, 69.1 to 71.0 Gy, 76.4 to 76.9 Gy, and 70.6 to 71.4 Gy. Respective volumes receiving doses greater than 60 Gy (V60) were 8.6 to 10.9 cc, 6.2 to 8.1 cc, 8.2 to 11.6 cc, 8.3 to 10.5 cc, and 5.6 to 9.8 cc. Conclusion: The RTOG-endorsed brachial plexus atlas provides a consistent set of guidelines for contouring this OAR with essentially no learning curve. Adoption of these contouring guidelines in the clinical setting is encouraged.

  13. Acute Pancreatitis

    PubMed Central

    Geokas, Michael C.

    1972-01-01

    For many decades two types of acute pancreatitis have been recognized: the edematous or interstitial and the hemorrhagic or necrotic. In most cases acute pancreatitis is associated with alcoholism or biliary tract disease. Elevated serum or urinary α-amylase is the most important finding in diagnosis. The presence of methemalbumin in serum and in peritoneal or pleural fluid supports the diagnosis of the hemorrhagic form of the disease in patients with a history and enzyme studies suggestive of pancreatitis. There is no characteristic clinical picture in acute pancreatitis, and its complications are legion. Pancreatic pseudocyst is probably the most common and pancreatic abscess is the most serious complication. The pathogenetic principle is autodigestion, but the precise sequence of biochemical events is unclear, especially the mode of trypsinogen activation and the role of lysosomal hydrolases. A host of metabolic derangements have been identified in acute pancreatitis, involving lipid, glucose, calcium and magnesium metabolism and changes of the blood clotting mechanism, to name but a few. Medical treatment includes intestinal decompression, analgesics, correction of hypovolemia and other supportive and protective measures. Surgical exploration is advisable in selected cases, when the diagnosis is in doubt, and is considered imperative in the presence of certain complications, especially pancreatic abscess. PMID:4559467

  14. Neurological complications of acute multifocal placoid pigment epitheliopathy.

    PubMed

    Brownlee, W J; Anderson, N E; Sims, J; Pereira, J A

    2016-09-01

    Acute multifocal placoid pigment epitheliopathy (AMPPE) is an autoimmune chorioretinal disease that can be complicated by neurological involvement. There is limited information on this potentially treatable condition in the neurological literature. The objective of this patient series is to describe the neurological complications of AMPPE. We retrospectively identified patients with neurological complications of AMPPE seen at Auckland Hospital between 2008 and 2013 and summarised cases in the literature between 1976 and 2013. We identified five patients with neurological complications of AMPPE at Auckland Hospital and 47 reported patients. These patients demonstrated a spectrum of neurological involvement including isolated headache, stroke or transient ischaemic attack, seizures, venous sinus thrombosis, optic neuritis, sensorineural hearing loss and peripheral vestibular disorder. We propose criteria to define AMPPE with neurological complications. A cerebrospinal fluid (CSF) lymphocytosis in a patient with isolated headache may predict the development of cerebrovascular complications of AMPPE. Patients with cerebrovascular complications of AMPPE have a poor prognosis with high rates of death and neurological disability among survivors. Predictors of poor outcome in those who develop neurological complications of AMPPE are a relapsing course, generalised seizures and multifocal infarction on MRI. All patients with neurological complications of AMPPE, including headache alone, should be investigated with an MRI brain and CSF examination. Patients with focal neurological symptoms should receive intravenous (IV) methylprednisolone followed by a tapering course of oral steroids for at least 3months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids. PMID:27183958

  15. Brachial artery reactivity and vascular reactive hyperemia for preoperative anaesthesia risk assessment – an observational study

    PubMed Central

    2014-01-01

    Background Non-invasive measures of vascular reactivity have emerged to refine cardiovascular risk. However, limited data exists investigating vascular reactivity as a preoperative diagnostic tool for anesthesiologists. In this study, we compare the utility of two non-invasive techniques, Brachial Artery Reactivity Testing (BART) and Digital Thermal Monitoring (DTM), as surrogates for measuring vascular reactivity. Methods Following IRB approval, 26 patients scheduled for major thoracic surgery (e.g. esophagectomy and pneumonectomy) were studied prospectively. BART [Flow mediated dilation (FMD) and Peak flow velocity (PFV)] and DTM [Temperature rebound (TR%)] were performed preoperatively at baseline using 5 minute blood pressure cuff occlusion of the upper arm. Statistical summaries were provided for the comparison of BART and DTM with select patient characteristics, and correlations were used to investigate the strength of the relationship between BART and DTM measurements. Results Patients preoperatively diagnosed with hyperlipidemia were associated with lower FMD% values {Median (Range): 14.8 (2.3, 38.1) vs. 6.2 (0.0, 14.3); p = 0.006}. There were no significant associations between BART and DTM techniques in relation to cardiovascular risk factors or postoperative complications. Conclusion Our study suggests that impaired vascular reactivity as measured by BART is associated with the incidence of hyperlipidemia. Also, using a novel technique such as DTM may provide a simpler and more accessible point of care testing for vascular reactivity in a perioperative setting. Both non-invasive techniques assessing vascular function warrant further refinement to better assist preoperative optimization strategies aimed at improving perioperative vascular function. PMID:24971042

  16. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block

    PubMed Central

    Ghodki, Poonam Sachin; Singh, Noopur Dasmit

    2016-01-01

    Background and Aims: We compared interscalene brachial plexus block (ISBPB) using peripheral nerve stimulation (PNS) and ultrasound (US) techniques. The primary outcomes were the incidence of hemidiaphragmatic paresis (HDP) and the duration of the block. Secondary outcomes were the block success rate, time to conduct the block, onset of sensory block, and dermatomal spread, postoperative pain by Numeric Rating Scale (NRS), duration of postoperative analgesia and incidence of complications. Material and Methods: We conducted a prospective, randomized, and observer-blinded study in 60 patients undergoing shoulder arthroscopy under block plus general anesthesia. ISBPB was performed with 10 ml of 0.5% bupivacaine using either PNS (Group PNS, n = 30) or US (Group US, n = 30). Hemidiaphragmatic function, the primary outcome, was assessed by ultrasonographic evaluation of diaphragmatic movement and pulmonary function tests using a bedside spirometer (forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate). General anesthesia was administered to all the patients for surgery. P < 0.05 test was considered to be statistically significant. Results: Twelve patients in Group PNS had HDP and none in Group US (P < 0.0001). PFTs were also significantly reduced in Group PNS (P < 0.0001). The time to conduct the block and sensory onset time both were less in Group US (P < 0.05). The groups did not differ in block success rate, duration of analgesia, and NRS. Other complications like incidence of Horner's syndrome and vascular puncture were comparable in both the groups. Conclusions: PNS guided ISBPB with 10 ml of 0.5% bupivacaine is associated with a higher incidence of HDP as compared to US guided ISBPB. There is no significant difference in quality or duration of analgesia in the two groups.

  17. Coordination and Balance in Children with Birth-Related Brachial Plexus Injury: A Preliminary Study

    PubMed Central

    Bucevska, Marija; Verchere, Cynthia

    2015-01-01

    ABSTRACT Purpose: Most children with severe birth-related brachial plexus injury (BRBPI) have some functional impairment, but information on the impact of BRBPI on coordination and balance is limited. The study's purpose was to determine whether children with BRBPI exhibit deficits in body coordination and balance. Method: A prospective cohort study involving 39 children with BRBPI aged 5–15 years was conducted. Range of motion, strength, active movement, and balance and coordination motor skills were assessed using the Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), and the Movement Assessment Battery for Children—Second Edition (MABC-2). A self-report measure of physical disability, the Activities Scale for Kids—Performance Version (ASKp), was also administered. Results: Participants scored a mean of 44.72 on the BOT-2 Body Coordination composite subtest; scores can range from 20 to 80. Eleven participants (28.2%) scored below average on this test. Participants scored a mean of 7.3 on the Balance subtest of the MABC-2; scores can range from 1 to 19. Twenty-six participants (66.7%) scored below average on this test. Of 38 participants, 25 (65.8%) had an ASKp score indicating some level of disability (<95/100); we found a statistically significant difference in balance (p=0.007) between these 25 participants and those without disability (ASKp score 95–100). Conclusions: The majority of our study population scored in the categories of at risk or significant difficulty for balance on the MABC-2. Balance rehabilitation may be a valuable treatment adjunct for children with BRBPI. PMID:25931660

  18. Comparison of the Vertical and the Highest Point of Shoulder Methods in Brachial Plexus Block

    PubMed Central

    S, Kiritoglu; G, Basaranoglu; M, Comlekci; M, Suren; K, Erkalp; G, Teker; L, Saidoglu

    2009-01-01

    Background and Aim: Brachial plexus block by the highest point of the shoulder method may decrease the rate of complication in comparing with the vertical method because the needle is more lateral in the former. We aimed to investigate the highest point of the shoulder block technique against the vertical infraclavicular plexus method regarding the success rates and complications. Patients and Methods: Thirty patients with ASA I-III undergoing elective surgery were included in this study. Patients were divided into two groups, randomly. Group 1 was the highest point of the shoulder method (n of 15), and goup 2 was the vertical approach technique (n of 15). The extensor motor response of hand, wrist and elbow (The target nerves in the operation area: n. medianus, n. ulnaris, n. radialis and n. musculocutanaeus) was obtained by neurostimulation technique. Then, 30 ml bupivacaine (0.5%) was used for the initial block. Spread of analgesia and sensory and motor blocks were evaluated every 5 minutes by an anesthesiologist who was blind to the block techniques. Statistical Analysis: T-test and Mann-Whitney U test were used. Results: Successful block was achieved in all patients in both groups. There was no difference among the groups for the onset of block and the duration of block (both sensory and motor), the number of attempt, and the depth of the neddle. One patient developed pneumothorax in group 2. Procedure time of the block was longer in group 2 than in group 1 (p<0.05). Conclusions: The highest point of shoulder method with a less complication rate and shorter procedure time has a comparable success rate to vertical approach technique. PMID:23675114

  19. Contribution of nitric oxide to brachial artery vasodilation during progressive handgrip exercise in the elderly

    PubMed Central

    Wray, D. Walter; Witman, Melissa A. H.; Layec, Gwenael; Barrett-O'Keefe, Zachary; Ives, Stephen J.; Conklin, Jamie D.; Reese, Van; Richardson, Russell S.

    2013-01-01

    The reduction in nitric oxide (NO)-mediated vascular function with age has largely been determined by flow-mediated dilation (FMD). However, in light of recent uncertainty surrounding the NO dependency of FMD and the recognition that brachial artery (BA) vasodilation during handgrip exercise is predominantly NO-mediated in the young, we sought to determine the contribution of NO to BA vasodilation in the elderly using the handgrip paradigm. BA vasodilation during progressive dynamic (1 Hz) handgrip exercise performed at 3, 6, 9, and 12 kg was assessed with and without NO synthase (NOS) inhibition [intra-arterial NG-monomethyl-l-arginine (l-NMMA)] in seven healthy older subjects (69 ± 2 yr). Handgrip exercise in the control condition evoked significant BA vasodilation at 6 (4.7 ± 1.4%), 9 (6.5 ± 2.2%), and 12 kg (9.5 ± 2.7%). NOS inhibition attenuated BA vasodilation, as the first measurable increase in BA diameter did not occur until 9 kg (4.0 ± 1.8%), and the change in BA diameter at 12 kg was reduced by ∼30% (5.1 ± 2.2%), with unaltered shear rate (Control: 407 ± 57, l-NMMA: 427 ± 67 s−1). Although shifted downward, the slope of the relationship between BA diameter and shear rate during handgrip exercise was unchanged (Control: 0.0013 ± 0.0004, l-NMMA: 0.0011 ± 0.007, P = 0.6) as a consequence of NOS inhibition. Thus, progressive handgrip exercise in the elderly evokes a robust BA vasodilation, the magnitude of which was only minimally attenuated following NOS inhibition. This modest contribution of NO to BA vasodilation in the elderly supports the use of the handgrip exercise paradigm to assess NO-dependent vasodilation across the life span. PMID:23948773

  20. Inter-Arm Difference in Brachial Blood Pressure in the General Population of Koreans

    PubMed Central

    Song, Bo Mi; Shim, Jee-Seon; Lee, Myung Ha; Choi, Dong Phil

    2016-01-01

    Background and Objectives We investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors. Subjects and Methods A total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure. Results The mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure. Conclusion Large inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure. PMID:27275174

  1. Surrogates of Large Artery versus Small Artery Stiffness and Ankle-Brachial Index

    PubMed Central

    Korhonen, Päivi; Syvänen, Kari; Aarnio, Pertti

    2011-01-01

    Peripheral artery tonometry (PAT) is a novel method for assessing arterial stiffness of small digital arteries. Pulse pressure can be regarded as a surrogate of large artery stiffness. When ankle-brachial index (ABI) is calculated using the higher of the two ankle systolic pressures as denominator (ABI-higher), leg perfusion can be reliably estimated. However, using the lower of the ankle pressures to calculate ABI (ABI-lower) identifies more patients with isolated peripheral arterial disease (PAD) in ankle arteries. We aimed to compare the ability of PAT, pulse pressure, and different calculations of ABI to detect atherosclerotic disease in lower extremities. We examined PAT, pulse pressure, and ABI in 66 cardiovascular risk subjects in whom borderline PAD (ABI 0.91 to 1.00) was diagnosed 4 years earlier. Using ABI-lower to diagnose PAD yielded 2-fold higher prevalence of PAD than using ABI-higher. Endothelial dysfunction was diagnosed in 15/66 subjects (23%). In a bivariate correlation analysis, pulse pressure was negatively correlated with ABI-higher (r = −0.347, p = 0.004) and with ABI-lower (r = −0.424, p < 0.001). PAT hyperemic response was not significantly correlated with either ABI-higher (r = −0.148, p = 0.24) or with ABI-lower (r = −0.208, p = 0.095). Measurement of ABI using the lower of the two ankle pressures is an efficient method to identify patients with clinical or subclinical atherosclerosis and worth performing on subjects with pulse pressure above 65 mm Hg. The usefulness of PAT measurement in detecting PAD is vague. PMID:22942632

  2. Endothelial function in a cardiovascular risk population with borderline ankle–brachial index

    PubMed Central

    Syvänen, Kari; Korhonen, Päivi; Partanen, Auli; Aarnio, Pertti

    2011-01-01

    Introduction: The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle–brachial index (ABI). Traditionally ABI values > 1.00–1.40 have been considered normal and ABI ≤ 0.90 defines PAD. Recent studies, however, have shown that individuals with ABI values between 0.90–1.00 are also at risk of cardiovascular events. We studied this cardiovascular risk population subgroup in order to determine their endothelial function using peripheral arterial tonometry (PAT). Methods: We selected 66 individuals with cardiovascular risk and borderline ABI. They all had hypertension, newly diagnosed glucose disorder, metabolic syndrome, obesity, or a ten year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System (SCORE). Subjects with previously diagnosed diabetes or cardiovascular disease were excluded. Endothelial function was assessed by measuring the reactive hyperemia index (RHI) from fingertips using an Endo-PAT device. Results: The mean ABI was 0.95 and mean RHI 2.11. Endothelial dysfunction, defined as RHI < 1.67, was detected in 15/66 (23%) of the subjects. There were no statistically significant differences in RHI values between subjects with different cardiovascular risk factors. The only exception was that subjects with impaired fasting glucose (IFG) had slightly lower RHI values (mean RHI 1.91) than subjects without IFG (mean RHI 2.24) (P = 0.02). Conclusions: In a cardiovascular risk population with borderline ABI nearly every fourth subject had endothelial dysfunction, indicating an elevated risk of cardiovascular events. This might point out a subgroup of individuals in need of more aggressive treatment for their risk factors. PMID:21415923

  3. Arterial pressure: agreement between a brachial cuff-based device and radial tonometry

    PubMed Central

    Park, Chloe M.; Korolkova, Olga; Davies, Justin E.; Parker, Kim H.; Siggers, Jennifer H.; March, Katherine; Tillin, Therese; Chaturvedi, Nish; Hughes, Alun D.

    2014-01-01

    Objectives: Aortic (central) blood pressure (BP) differs from brachial BP and may be a superior predictor of cardiovascular events. However, its measurement is currently restricted to research settings, owing to a moderate level of operator dependency. We tested a new noninvasive device in a large UK cohort. The device estimates central BP using measurements obtained with an upper arm cuff inflated to suprasystolic pressure. We compared these estimates with those obtained using radial tonometry as well as with invasively acquired measurements of aortic BP in a limited number of individuals. Methods: Consecutive cuff-based and tonometry-based estimates of the pressure waveform and the central BP were obtained from 1107 individuals (70 ± 6 years). Short-term and long-term reproducibility studies were performed on 28 individuals. Simultaneous cuff-based and invasively measured pressure traces were acquired and compared in an additional six individuals (65 ± 20 years). Results: Central systolic BP, as estimated by the cuff-based device, was found to be highly reproducible (coefficient of variation 4 and 8% for short and long-term reproducibility, respectively) and was comparable to that estimated by tonometry (average difference 3 ± 6 mmHg, intraclass correlation coefficient = 0.91). The cuff-based pressure waveforms were similar to those acquired invasively (cross-correlation coefficient 0.93), and the difference in the estimated central systolic BP was −5 ± 8 mmHg (P = 0.2). Conclusion: Cuff-based devices show promise to simplify the measurement of central BP, whilst maintaining a similar fidelity to tonometry. This could lead to improved adoption of estimates of central BP in clinical practice. PMID:24379000

  4. Aging Index using Photoplethysmography for a Healthcare Device: Comparison with Brachial-Ankle Pulse Wave Velocity

    PubMed Central

    Hong, Kyung Soon; Park, Kyu Tae

    2015-01-01

    Objectives Recent studies have emphasized the potential information embedded in peripheral fingertip photoplethysmogram (PPG) signals for the assessment of arterial wall stiffening during aging. For the discrimination of arterial stiffness with age, the brachial-ankle pulse wave velocity (baPWV) has been widely used in clinical applications. The second derivative of the PPG (acceleration photoplethysmogram [APG]) has been reported to correlate with the presence of atherosclerotic disorders. In this study, we investigated the association among age, the baPWV, and the APG and found a new aging index reflecting arterial stiffness for a healthcare device. Methods The APG and the baPWV were simultaneously applied to assess the accuracy of the APG in measuring arterial stiffness in association with age. A preamplifier and motion artifact removal algorithm were newly developed to obtain a high quality PPG signal. In total, 168 subjects with a mean ± SD age of 58.1 ± 12.6 years were followed for two months to obtain a set of complete data using baPWV and APG analysis. Results The baPWV and the B ratio of the APG indices were correlated significantly with age (r = 0.6685, p < 0.0001 and r = -0.4025, p < 0.0001, respectively). A regression analysis revealed that the c and d peaks were independent of age (r = -0.3553, p < 0.0001 and r = -0.3191, p < 0.0001, respectively). Conclusions We determined the B ratio, which represents an improved aging index and suggest that the APG may provide qualitatively similar information for arterial stiffness. PMID:25705555

  5. Three-dimensional Humeral Morphological Alterations and Atrophy Associated with Obstetrical Brachial Plexus Palsy

    PubMed Central

    Sheehan, Frances T.; Brochard, Sylvain; Behnam, Abrahm J.; Alter, Katharine E.

    2014-01-01

    Background Obstetrical Brachial Plexus Palsy (OBPP) is a common birth injury, resulting in severe functional losses. Yet, little is known about how OBPP affects the 3D humeral morphology. Thus, the purpose of this study was to measure the 3D humeral architecture in children with unilateral OBPP. Methods Thirteen individuals (4F/9M, age=11.8±3.3 years, Mallet score=15.1±3.0) participated in this IRB-approved study. A three-dimensional T1-weighted gradient-recalled-echo magnet resonance image set was acquired for both upper limbs (involved/non-involved). Humeral size, version, and inclination were quantified from 3D humeral models derived from these images. Results The involved humeral head was significantly less retroverted and in declination (medial humeral head pointed anteriorly and inferiorly), relative to the non-involved side. Osseous atrophy was present in all three dimensions and affected the entire humerus. The inter-rater reliability was excellent (ICC = 0.96–1.00). Discussion This study demonstrated that both humeral atrophy and bone shape deformities associated with OBPP are not limited to the axial plane, but are three-dimensional phenomena. Incorporating information related to these multiplanar, 3D, humeral deformities into surgical planning could potentially improve functional outcomes following surgery. The documented reduction in retroversion is an osseous adaptation, which may help maintain glenohumeral congruency by partially compensating for the internal rotation of the arm. The humeral head declination is a novel finding and may be an important factor to consider when developing OBPP management strategies, as it has been shown to lead to significant supraspinatus inefficiencies and increased required elevation forces. Level of evidence Anatomic Study, Imaging PMID:24291045

  6. Comparison of two techniques for ultrasound-guided axillary brachial plexus blockade in cats.

    PubMed

    Ansón, Agustina; Laredo, Francisco G; Gil, Francisco; Soler, Marta; Belda, Eliseo; Ayala, Maria D; Agut, Amalia

    2015-06-01

    Axillary blockade of the brachial plexus (BP) is advocated in humans and dogs for surgical procedures carried out on the foot, carpus and elbow as it provides complete analgesia distally from above the elbow joint. The aim of this study was to develop an ultrasound (US)-guided approach to block the BP in cats. Two groups of 12 feline cadavers each were used to compare two different techniques to block the BP at the axillary level. The reliability of the techniques was assessed by anatomical and computed tomography (CT) studies. Cadavers of the first group were positioned in dorsal recumbency with the forelimb to be blocked adducted (thoracic limbs flexed and orientated caudally) (FAD technique). The second group was positioned in dorsal recumbency with the forelimb abducted 90° (FAB technique). The accuracy of the techniques was determined by US after injecting 1 ml blue ink along the BP nerves, and by CT after injecting 1 ml of an iodinated contrast medium. The anatomical and CT studies confirmed the accuracy of the US location of the BP nerves. Staining of the axillaris, musculocutaneous, radialis, medianus and ulnaris nerves was observed in 100% of cats using the FAB technique and in 66% of the cats using the FAD technique. Rate of complications was higher in the FAD technique. In conclusion, a US-guided axillary approach to the BP by the use of a FAB technique is a safe and feasible procedure to block the BP in the cat. Further studies are needed to ascertain whether the technique can be applied in a clinical setting. PMID:25193280

  7. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery

    PubMed Central

    Lim, Se Hun; Lee, Wonjin; Park, JaeGwan; Kim, Myoung-hun; Cho, Kwangrae; Lee, Jeong Han; Cheong, Soon Ho

    2016-01-01

    Background Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. Methods Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. Results The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. Conclusions The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery. PMID:27482313

  8. An Anatomically Validated Brachial Plexus Contouring Method for Intensity Modulated Radiation Therapy Planning

    SciTech Connect

    Van de Velde, Joris; Audenaert, Emmanuel; Speleers, Bruno; Vercauteren, Tom; Mulliez, Thomas; Vandemaele, Pieter; Achten, Eric; Kerckaert, Ingrid; D'Herde, Katharina; De Neve, Wilfried; Van Hoof, Tom

    2013-11-15

    Purpose: To develop contouring guidelines for the brachial plexus (BP) using anatomically validated cadaver datasets. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to obtain detailed visualizations of the BP region, with the goal of achieving maximal inclusion of the actual BP in a small contoured volume while also accommodating for anatomic variations. Methods and Materials: CT and MRI were obtained for 8 cadavers positioned for intensity modulated radiation therapy. 3-dimensional reconstructions of soft tissue (from MRI) and bone (from CT) were combined to create 8 separate enhanced CT project files. Dissection of the corresponding cadavers anatomically validated the reconstructions created. Seven enhanced CT project files were then automatically fitted, separately in different regions, to obtain a single dataset of superimposed BP regions that incorporated anatomic variations. From this dataset, improved BP contouring guidelines were developed. These guidelines were then applied to the 7 original CT project files and also to 1 additional file, left out from the superimposing procedure. The percentage of BP inclusion was compared with the published guidelines. Results: The anatomic validation procedure showed a high level of conformity for the BP regions examined between the 3-dimensional reconstructions generated and the dissected counterparts. Accurate and detailed BP contouring guidelines were developed, which provided corresponding guidance for each level in a clinical dataset. An average margin of 4.7 mm around the anatomically validated BP contour is sufficient to accommodate for anatomic variations. Using the new guidelines, 100% inclusion of the BP was achieved, compared with a mean inclusion of 37.75% when published guidelines were applied. Conclusion: Improved guidelines for BP delineation were developed using combined MRI and CT imaging with validation by anatomic dissection.

  9. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

    PubMed Central

    Shahien, Radi; Bowirrat, Abdalla

    2011-01-01

    We report a complication related to epidural analgesia for delivery in a 24- year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy. PMID:21386953

  10. A report of hereditary neuropathy with liability to pressure palsy (HNPP) presenting with brachial plexopathy: the value of complete electrodiagnostic testing.

    PubMed

    Bulusu, Srinivas; McMillan, Hugh J

    2011-09-01

    Patients with hereditary neuropathy with liability to pressure palsy (HNPP) typically present with a mononeuropathy (particularly peroneal or ulnar palsy) or a brachial plexopathy. Careful electrodiagnostic testing has an important role in establishing the diagnosis of HNPP differentiating this condition from other inherited or acquired neuropathies as well as obviating the need for unnecessary surgeries. We present a case of a patient who presented with a painless brachial plexopathy who was found to have multiple sites of segmental demyelination on nerve conduction studies, consistent with HNPP. We review the clinical and electrodiagnostic features of HNPP including the key electrodiagnostic findings to screen for this disorder. PMID:21988036

  11. On the effect of thermal agents in the response of the brachial biceps at different contraction levels.

    PubMed

    Garcia, Larissa Martins; Soares, Alcimar Barbosa; Simieli, Camila; Boratino, Alessandra Vairo Peres; Guirro, Rinaldo Roberto de Jesus

    2014-12-01

    The objective of this study was to assess electromyographic features of the brachial biceps muscle after the application of cryotherapy and short-wave diathermy. Sixty healthy volunteers participated in the study and were equally divided into three groups: cryotherapy - application of ice packs for 30 min; short-wave diathermy for 20 min; and control. The thermal agents were applied to the anterior and posterior regions of the non-dominant arm. The electromyographic (EMG) signal from the brachial biceps was recorded before and after the application of thermal agents during flexion of the elbow joint at 25%, 50%, 75% of a maximum voluntary isometric contraction defined at least two days before the actual experiments (MVICbl). The volunteers also were asked to execute a free MVIC before and after the application of the thermal agents (MVIC free). A linear regression model with mixed effects (random and fixed) was used. Intra-group analysis showed a reduction in root mean square (RMS) at MVIC free, with no change in the median frequency of the EMG signal at any contraction level for the short-wave diathermy group. An increase on RMS values and a decrease on median frequencies were found after the application of cryotherapy for all contraction levels. The results imply that cryotherapy plays an important role on changing neuromuscular responses at various levels of muscle contraction. Therapists should be aware of that and carefully consider its use prior to activities in which neuromuscular precision is required. PMID:25148950

  12. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients

    PubMed Central

    Yang, Yi; Yang, Jian-Tao; Fu, Guo; Li, Xiang-Ming; Qin, Ben-Gang; Hou, Yi; Qi, Jian; Li, Ping; Liu, Xiao-Lin; Gu, Li-Qiang

    2016-01-01

    In the study, the functional recovery and relative comprehensive quality of life of cases of global brachial plexus treated with free functioning muscle transfers were investigated. Patients who received functioning gracilis muscle transfer between August 1999 and October 2014 to reconstruct elbow flexion, wrist and fingers extension were recruited. The mean age of the patients was 26.36 (range, 16–42) years. The mean period of time from gracilis transfer to the last follow-up was 54.5 months (range, 12–185 months). Muscle power, active range of motion of the elbow flexion, wrist extension, and total active fingers extension were recorded. SDS, SAS and DASH questionnaires were given to estimate patients’ quality of life. 35.71% reported good elbow flexion and 50.00% reported excellent elbow flexion. The average ROM of the elbow flexion was 106.5° (range, 0–142°) and was 17.00° (range, 0–72°) for wrist extension. The average DASH score was 51.14 (range, 17.5–90.8). The prevalence of anxiety and depression were 42.86% and 45.24%. Thrombosis and bowstringing were the most common short and long-term complications. Based on these findings, free gracilis transfer using accessory nerve as donor nerve is a satisfactory treatment to reconstruct the elbow flexion and wrist extension in global-brachial-plexus-injured patients. PMID:26935173

  13. MICROSURGICAL TRANSFER OF THE GRACILIS MUSCLE FOR ELBOW FLEXION IN BRACHIAL PLEXUS INJURY IN ADULTS: RETROSPECTIVE STUDY OF EIGHT CASES

    PubMed Central

    Kimura, Luiz Koiti; do Nascimento, Alexandre Tadeu; Capócio, Roberto; Mattar, Rames; Rezende, Marcelo Rosa; Wei, Teng Hsiang; Torres, Luciano Ruiz; Moya, Fernando Munhoz

    2015-01-01

    Objective: Treating brachial plexus injuries is a major challenge, especially lesions that are presented late, with more than 12 months of evolution. We retrospectively analyzed patients who underwent one of the possibilities for attempting to restore the function of upper limbs affected under such conditions: microsurgical transfer of the gracilis muscle for elbow flexion. Methods: Eight patients were included, divided into two groups: one in which the procedure consisted of neurorrhaphy of the muscle flap with sural nerve grafting and anastomosis more distally; and the other, in which the neurorrhaphy was performed directly on the spinal accessory nerve, with anastomosis in thoracoacromial vessels. Results: We found a significant difference between the groups. A greater number of satisfactory results (75% M4) were found among patients who underwent direct neurorrhaphy, whereas the procedure using grafts for neurorrhaphy was less successful (25% M4). Conclusion: Patients who underwent microsurgical functional transfer of the gracilis muscle in which vascular anastomoses were performed in thoracoacromial vessels presented better functional outcomes than shown by those whose anastomoses were in the brachial artery with subsequent use of a nerve graft. PMID:27027050

  14. Dexamethasone or Dexmedetomidine as Local Anesthetic Adjuvants for Ultrasound-guided Axillary Brachial Plexus Blocks with Nerve Stimulation

    PubMed Central

    Lee, Myeong Jong; Koo, Dae Jeong; Choi, Yu Sun; Lee, Kyu Chang

    2016-01-01

    Background The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine added to ropivacaine on the onset and duration of ultrasound-guided axillary brachial plexus blocks (BPB). Methods Fifty-one ASA physical status I-II patients with elective forearm and hand surgery under axillary brachial plexus blocks were randomly allocated to receive 20 ml of 0.5% ropivacaine with 2 ml of isotonic saline (C group, n = 17), 20 ml of 0.5% ropivacaine with 2 ml (10 mg) of dexamethasone (D group, n = 17) or 20 ml of 0.5% ropivacaine with 2 ml (100 µg) of dexmedetomidine (DM group, n = 17). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. Results The duration of the sensory block was extended in group D and group DX compared with group C (P < 0.05), but there was no significant difference between group D and group DX. However, there were no significant differences in onset time in all three groups. Conclusions Dexamethasone 10 mg and dexmedetomidine 100 µg were equally effective in extending the duration of ropivacaine in ultrasound-guided axillary BPB with nerve stimulation. However, neither drug has significantly effects the onset time. PMID:26839668

  15. Persistence of Neonatal Brachial Plexus Palsy Associated with Maternally Reported Route of Delivery: Review of 387 Cases.

    PubMed

    Chang, Kate W-C; Ankumah, Nana-Ama E; Wilson, Thomas J; Yang, Lynda J-S; Chauhan, Suneet P

    2016-07-01

    Objective The factors associated with persistent neonatal brachial plexus palsy (PNBPP) are unknown. Our objectives are to compare PNBPP at 1 and 2 years in children delivered via vaginal delivery (VD) versus cesarean delivery (CD) and in children delivered via VD with or without reported shoulder dystocia (SD). Study Design Retrospective cohort of children diagnosed with neonatal brachial plexus palsy (NBPP). Maternally reported delivery history and presence of SD were recorded with Student t-test, chi-square test, and odds ratio (OR) with 95% confidence intervals (CI) calculated for comparisons. Results Of 387 cases of NBPP, 8% (30) delivered via CD. Rates of PNBPP were higher in the VD group at 1 and 2 years (60% of CD and 85% of VD; OR, 0.26; 95% CI, 0.11-0.62 at 1 year; 33% of CD and 73% of VD; OR, 0.15; 95% CI, 0.05-0.39 at 2 years). There was no difference in PNBPP in women with VD with or without maternally reported SD (87 vs. 85%, p = 0.68 at 1 year; 64 vs. 61%, p = 0.61 at 2 years). Conclusion PNBPP is possible with CD, and there is no difference in PNBPP in VD with or without maternally reported SD. A prospective study is warranted to ascertain associative factors. PMID:26890435

  16. Vascularized Thoracodorsal to Suprascapular Nerve Transfer, a Novel Technique to Restore Shoulder Function in Partial Brachial Plexopathy

    PubMed Central

    Potter, Shirley M.; Ferris, Scott I.

    2016-01-01

    We describe the clinical outcome of a novel nerve transfer to restore active shoulder motion in upper brachial plexus injury. The thoracodorsal nerve (TDN) was successfully used as a vascularized donor nerve to neurotize to the suprascapular nerve (SSN) in a patient with limited donor nerve availability. At 4 years follow-up, he had regained useful external rotation of the injured limb, with no significant donor site morbidity. Shoulder abduction return was less impressive, however, and reasons for this are discussed. We provide a comprehensive review of the literature on this topic and a subsequent discussion on the details of this novel technique. This is the first reported case of TDN to SSN transfer, and also the first reported case of a vascularized TDN transfer in the English language literature. We advocate direct thoracodorsal to SSN transfer as a valid surgical option for the restoration of shoulder function in patients with partial brachial plexus avulsion, when conventional nerve donors are unavailable. PMID:27014699

  17. Acute diarrhea.

    PubMed

    Barr, Wendy; Smith, Andrew

    2014-02-01

    Acute diarrhea in adults is a common problem encountered by family physicians. The most common etiology is viral gastroenteritis, a self-limited disease. Increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea. A history and physical examination evaluating for risk factors and signs of inflammatory diarrhea and/or severe dehydration can direct any needed testing and treatment. Most patients do not require laboratory workup, and routine stool cultures are not recommended. Treatment focuses on preventing and treating dehydration. Diagnostic investigation should be reserved for patients with severe dehydration or illness, persistent fever, bloody stool, or immunosuppression, and for cases of suspected nosocomial infection or outbreak. Oral rehydration therapy with early refeeding is the preferred treatment for dehydration. Antimotility agents should be avoided in patients with bloody diarrhea, but loperamide/simethicone may improve symptoms in patients with watery diarrhea. Probiotic use may shorten the duration of illness. When used appropriately, antibiotics are effective in the treatment of shigellosis, campylobacteriosis, Clostridium difficile, traveler's diarrhea, and protozoal infections. Prevention of acute diarrhea is promoted through adequate hand washing, safe food preparation, access to clean water, and vaccinations. PMID:24506120

  18. Sinusitis (acute)

    PubMed Central

    2008-01-01

    Introduction Acute sinusitis is defined pathologically, by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1−5% of the adult population each year in Europe. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with clinically diagnosed acute sinusitis, and with radiologically or bacteriologically confirmed acute sinusitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides, different doses [amoxicillin, co-amoxiclav, doxycycline, cephalosporins, macrolides], long-course regimens), antihistamines, cephalosporins or macrolides, decongestants (xylometazoline, phenylephrine, pseudoephedrine), doxycycline, saline nasal washes, steam inhalation, and topical corticosteroids (intra-nasal). PMID:19450327

  19. Sinusitis (acute)

    PubMed Central

    2011-01-01

    Introduction Acute sinusitis is defined pathologically, by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks. Clinically, it is characterised by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever. It affects 1% to 5% of the adult population each year in Europe. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with clinically diagnosed acute sinusitis, and in people with radiologically or bacteriologically confirmed acute sinusitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (amoxicillin, amoxicillin–clavulanic acid [co-amoxiclav], doxycycline, cephalosporins, macrolides; different doses, long-course regimens), antihistamines, decongestants (xylometazoline, phenylephrine, pseudoephedrine), saline nasal washes, steam inhalation, and topical corticosteroids (intranasal). PMID:22189346

  20. Acute glomerulonephritis.

    PubMed

    Yoshizawa, N

    2000-09-01

    Acute glomerulonephritis (AGN) is a representative disease of acute nephritic syndrome characterized by the sudden appearance of edema, hematuria, proteinuria, and hypertension. The prototype of AGN is acute poststreptococcal glomerulonephritis (APSGN). "Nephritogenic streptococci" are defined as organisms that are cultured from a patient who develops AGN. Although only a limited number of M-types of streptococci have been recognized as "nephritogenic streptococci", all M-types of streptococci may have nephritogenic potential because the genes for major putative nephritogenic antigens such as SPEB and NAPIr are found to be present in all group A streptococci thus far examined. Pathogenic mechanisms for APSGN involving both humoral and cell-mediated immunity have been recently proposed. The role of humoral immunity is presumed to be mediated by the in situ formation of nephritogenic streptococcal antigen-antibody complexes and circulating immune complexes. While in the cellular immune component a role for delayed-type hypersensitivity has been suggested to contribute to the pathogenesis of APSGN. PMID:10969898

  1. Feed-forward active contour analysis for improved brachial artery reactivity testing.

    PubMed

    Pugliese, Daniel N; Sehgal, Chandra M; Sultan, Laith R; Reamer, Courtney B; Mohler, Emile R

    2016-08-01

    The object of this study was to utilize a novel feed-forward active contour (FFAC) algorithm to find a reproducible technique for analysis of brachial artery reactivity. Flow-mediated dilation (FMD) is an important marker of vascular endothelial function but has not been adopted for widespread clinical use given its technical limitations, including inter-observer variability and differences in technique across clinical sites. We developed a novel FFAC algorithm with the goal of validating a more reliable standard. Forty-six healthy volunteers underwent FMD measurement according to the standard technique. Ultrasound videos lasting 5-10 seconds each were obtained pre-cuff inflation and at minutes 1 through 5 post-cuff deflation in longitudinal and transverse views. Automated segmentation using the FFAC algorithm with initial boundary definition from three different observers was used to analyze the images to measure diameter/cross-sectional area over the cardiac cycle. The %FMD was calculated for average, minimum, and maximum diameters/areas. Using the FFAC algorithm, the population-specific coefficient of variation (CV) at end-diastole was 3.24% for transverse compared to 9.96% for longitudinal measurements; the subject-specific CV was 15.03% compared to 57.41%, respectively. For longitudinal measurements made via the conventional method, the population-specific CV was 4.77% and subject-specific CV was 117.79%. The intraclass correlation coefficient (ICC) for transverse measurements was 0.97 (95% CI: 0.95-0.98) compared to 0.90 (95% CI: 0.84-0.94) for longitudinal measurements with FFAC and 0.72 (95% CI: 0.51-0.84) for conventional measurements. In conclusion, transverse views using the novel FFAC method provide less inter-observer variability than traditional longitudinal views. Improved reproducibility may allow adoption of FMD testing in a clinical setting. The FFAC algorithm is a robust technique that should be evaluated further for its ability to replace the

  2. Ankle-Brachial Index and cardiovascular events in atrial fibrillation. The ARAPACIS Study.

    PubMed

    Violi, Francesco; Davì, Giovanni; Proietti, Marco; Pastori, Daniele; Hiatt, William R; Corazza, Gino Roberto; Perticone, Francesco; Pignatelli, Pasquale; Farcomeni, Alessio; Vestri, Anna Rita; Lip, Gregory Y H; Basili, Stefania

    2016-04-01

    Atrial fibrillation (AF) patients are at high risk for thrombotic and vascular events related to their cardiac arrhythmia and underlying systemic atherosclerosis. Ankle-Brachial Index (ABI) is a non-invasive tool in evaluating systemic atherosclerosis, useful in predicting cardiovascular events in general population; no data are available in AF patients. ARAPACIS is a prospective multicentre observational study performed by the Italian Society of Internal Medicine, analysing association between low ABI (≤ 0.90) and vascular events in NVAF out- or in-patients, enrolled in 136 Italian centres. A total of 2,027 non-valvular AF (NVAF) patients aged > 18 years from both sexes followed for a median time of 34.7 (interquartile range: 22.0-36.0) months, yielding a total of 4,614 patient-years of observation. Mean age was 73 ± 10 years old with 55 % male patients. A total of 176 patients (8.7 %) experienced a vascular event, with a cumulative incidence of 3.81 %/patient-year. ABI≤ 0.90 was more prevalent in patients with a vascular event compared with patients free of vascular events (32.2 vs 20.2 %, p< 0.05). On Cox proportional hazard analysis, ABI≤ 0.90 was an independent predictor of vascular events (hazard ratio (HR): 1.394, 95 % confidence interval (CI): 1.042-1.866; p=0.02), vascular death (HR: 2.047, 95 % CI: 1.255-3.338; p=0.004) and MI (HR: 2.709, 95 % CI: 1.485-5.083; p=0.001). This latter association was also confirmed after excluding patients with previous MI (HR: 2.901, 95 % CI: 1.408-5.990, p=0.004). No association was observed between low ABI and stroke/transient ischaemic attack (p=0.91). In conclusion, low ABI is useful to predict MI and vascular death in NVAF patients and may independently facilitate cardiovascular risk assessment in NVAF patients. PMID:26740316

  3. Ankle brachial index values, leg symptoms, and functional performance among community-dwelling older men and women in the lifestyle interventions and independence for elders study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The prevalence and significance of low normal and abnormal ankle brachial index (ABI) values in a community dwelling population of sedentary, older individuals is unknown. We describe the prevalence of categories of definite peripheral artery disease (PAD), borderline ABI, low-normal ABI and no PAD...

  4. Multiple sclerosis as a cause of the acute vestibular syndrome.

    PubMed

    Pula, J H; Newman-Toker, D E; Kattah, J C

    2013-06-01

    Multiple sclerosis (MS) causes dizziness and vertigo. Reports suggest responsible lesions are often in the intra-pontine 8th nerve fascicle. We sought to determine frequency and clinical features of demyelinating acute vestibular syndrome (AVS). This is a prospective observational study (1999-2011). Consecutive AVS patients (vertigo, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) with a risk for central localization underwent structured bedside examination and neuroimaging. When applicable, we identified MS based on clinical, imaging, and laboratory features. Of 170 AVS presentations, 4% (n = 7) were due to demyelinating disease. Five had an acute MS plaque likely responsible for the clinical syndrome. Lesion location varied-1 medulla; 1 inferior cerebellar peduncle; 1 middle cerebellar peduncle; 1 posterior pontine tegmentum; 1 in the intrapontine 8th nerve fascicle; 1 superior cerebellar peduncle; 1 midbrain. Only two had a lesion in or near the intra-pontine 8th nerve fascicle. Three were first presentations (i.e., clinically isolated demyelinating syndrome), while the others were known MS. All had central oculomotor signs. In two patients, the only central sign was a normal horizontal head impulse test (h-HIT) of vestibular function. All patients improved with steroid therapy. Demyelinating disease was an uncommon cause of AVS in our series. Symptomatic lesions were not restricted to the 8th nerve fascicle. Five patients had relatively obvious oculomotor signs, making differentiation from vestibular neuritis straightforward. Two patients had unidirectional, horizontal nystagmus that followed Alexander's law and was suppressed with fixation (true pseudoneuritis). The presence of a normal h-HIT in these suggested central localization. PMID:23392781

  5. Somatosensory evoked potential monitoring of the brachial plexus to predict nerve injury during internal mammary artery harvest: intraoperative comparisons of the Rultract and Pittman sternal retractors.

    PubMed

    Jellish, W S; Martucci, J; Blakeman, B; Hudson, E

    1994-08-01

    Brachial plexus injury after coronary artery bypass grafting (CABG) continues to be a common problem postoperatively. With the use of somatosensory evoked potential monitoring (SSEP), neurologic integrity of the brachial plexus during internal mammary artery (IMA) harvest was assessed and the Rultract and Pittman sternal retractors were compared to determine what effect they had on SSEP characteristics. Results showed that the Rultract and Pittman retractors caused large decreases in SSEP amplitudes after insertion, (1.25 +/- 0.14 versus 0.72 +/- 0.09, P < 0.05; and 1.64 +/- 0.27 versus 0.91 +/- 0.14, P < 0.05) respectively. This decrease was noted in 85% of Rultract and 68.75% of Pittman patients, respectively. Amplitudes increased after retractor removal but never returned to baseline values. Cooley retractor placement in the patients not undergoing IMA harvest (control) produced only mild decreases in amplitude. Waveform latency increased in all groups after retractor placement, but these increases were thought to be clinically insignificant. Postoperatively, three patients in each of the IMA retractor groups had brachial plexus symptoms (18%), whereas only one patient in the control group had symptoms. Somatosensory evoked potential monitoring seems to be a sensitive intraoperative monitor for assessing brachial plexus injury during CABG. The nerve plexus seems to be most at risk for pathologic injury during retraction of the sternum for IMA harvest. Though the Rultract retractor caused greater changes in SSEP characteristics than the Pittman, no clinical outcome differences between the two could be ascertained. Using SSEP monitoring may reduce brachial plexus injury during IMA harvest by allowing early detection of nerve compromise and therapeutic interventions to alleviate the insult while under general anesthesia. PMID:7948794

  6. Application of the N-point moving average method for brachial pressure waveform-derived estimation of central aortic systolic pressure.

    PubMed

    Shih, Yuan-Ta; Cheng, Hao-Min; Sung, Shih-Hsien; Hu, Wei-Chih; Chen, Chen-Huan

    2014-04-01

    The N-point moving average (NPMA) is a mathematical low-pass filter that can smooth peaked noninvasively acquired radial pressure waveforms to estimate central aortic systolic pressure using a common denominator of N/4 (where N=the acquisition sampling frequency). The present study investigated whether the NPMA method can be applied to brachial pressure waveforms. In the derivation group, simultaneously recorded invasive high-fidelity brachial and central aortic pressure waveforms from 40 subjects were analyzed to identify the best common denominator. In the validation group, the NPMA method with the obtained common denominator was applied on noninvasive brachial pressure waveforms of 100 subjects. Validity was tested by comparing the noninvasive with the simultaneously recorded invasive central aortic systolic pressure. Noninvasive brachial pressure waveforms were calibrated to the cuff systolic and diastolic blood pressures. In the derivation study, an optimal denominator of N/6 was identified for NPMA to derive central aortic systolic pressure. The mean difference between the invasively/noninvasively estimated (N/6) and invasively measured central aortic systolic pressure was 0.1±3.5 and -0.6±7.6 mm Hg in the derivation and validation study, respectively. It satisfied the Association for the Advancement of Medical Instrumentation standard of 5±8 mm Hg. In conclusion, this method for estimating central aortic systolic pressure using either invasive or noninvasive brachial pressure waves requires a common denominator of N/6. By integrating the NPMA method into the ordinary oscillometric blood pressure determining process, convenient noninvasive central aortic systolic pressure values could be obtained with acceptable accuracy. PMID:24420554

  7. User-guided automated segmentation of time-series ultrasound images for measuring vasoreactivity of the brachial artery induced by flow mediation

    NASA Astrophysics Data System (ADS)

    Sehgal, Chandra M.; Kao, Yen H.; Cary, Ted W.; Arger, Peter H.; Mohler, Emile R.

    2005-04-01

    Endothelial dysfunction in response to vasoactive stimuli is closely associated with diseases such as atherosclerosis, hypertension and congestive heart failure. The current method of using ultrasound to image the brachial artery along the longitudinal axis is insensitive for measuring the small vasodilatation that occurs in response to flow mediation. The goal of this study is to overcome this limitation by using cross-sectional imaging of the brachial artery in conjunction with the User-Guided Automated Boundary Detection (UGABD) algorithm for extracting arterial boundaries. High-resolution ultrasound imaging was performed on rigid plastic tubing, on elastic rubber tubing phantoms with steady and pulsatile flow, and on the brachial artery of a healthy volunteer undergoing reactive hyperemia. The area of cross section of time-series images was analyzed by UGABD by propagating the boundary from one frame to the next. The UGABD results were compared by linear correlation with those obtained by manual tracing. UGABD measured the cross-sectional area of the phantom tubing to within 5% of the true area. The algorithm correctly detected pulsatile vasomotion in phantoms and in the brachial artery. A comparison of area measurements made using UGABD with those made by manual tracings yielded a correlation of 0.9 and 0.8 for phantoms and arteries, respectively. The peak vasodilatation due to reactive hyperemia was two orders of magnitude greater in pixel count than that measured by longitudinal imaging. Cross-sectional imaging is more sensitive than longitudinal imaging for measuring flow-mediated dilatation of brachial artery, and thus may be more suitable for evaluating endothelial dysfunction.

  8. [Acute myocarditis].

    PubMed

    Combes, Alain

    2012-06-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent-onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:22515999

  9. [Acute myocarditis].

    PubMed

    Combes, Alain

    2013-05-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:23789482

  10. Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation

    PubMed Central

    Schultz, Martin G.; Hughes, Alun D.; Davies, Justin E.; Sharman, James E.

    2015-01-01

    Central augmentation pressure (AP) and index (AIx) predict cardiovascular events and mortality, but underlying physiological mechanisms remain disputed. While traditionally believed to relate to wave reflections arising from proximal arterial impedance (and stiffness) mismatching, recent evidence suggests aortic reservoir function may be a more dominant contributor to AP and AIx. Our aim was therefore to determine relationships among aortic-brachial stiffness mismatching, AP, AIx, aortic reservoir function, and end-organ disease. Aortic (aPWV) and brachial (bPWV) pulse wave velocity were measured in 359 individuals (aged 61 ± 9, 49% male). Central AP, AIx, and aortic reservoir indexes were derived from radial tonometry. Participants were stratified by positive (bPWV > aPWV), negligible (bPWV ≈ aPWV), or negative stiffness mismatch (bPWV < aPWV). Left-ventricular mass index (LVMI) was measured by two-dimensional-echocardiography. Central AP and AIx were higher with negative stiffness mismatch vs. negligible or positive stiffness mismatch (11 ± 6 vs. 10 ± 6 vs. 8 ± 6 mmHg, P < 0.001 and 24 ± 10 vs. 24 ± 11 vs. 21 ± 13%, P = 0.042). Stiffness mismatch (bPWV -aPWV) was negatively associated with AP (r = −0.18, P = 0.001) but not AIx (r = −0.06, P = 0.27). Aortic reservoir pressure strongly correlated to AP (r = 0.81, P < 0.001) and AIx (r = 0.62, P < 0.001) independent of age, sex, heart rate, mean arterial pressure, and height (standardized β = 0.61 and 0.12, P ≤ 0.001). Aortic reservoir pressure independently predicted abnormal LVMI (β = 0.13, P = 0.024). Positive aortic-brachial stiffness mismatch does not result in higher AP or AIx. Aortic reservoir function, rather than discrete wave reflection from proximal arterial stiffness mismatching, provides a better model description of AP and AIx and also has clinical relevance as evidenced by an independent association of aortic reservoir pressure with LVMI. PMID:26276816

  11. Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation.

    PubMed

    Schultz, Martin G; Hughes, Alun D; Davies, Justin E; Sharman, James E

    2015-10-01

    Central augmentation pressure (AP) and index (AIx) predict cardiovascular events and mortality, but underlying physiological mechanisms remain disputed. While traditionally believed to relate to wave reflections arising from proximal arterial impedance (and stiffness) mismatching, recent evidence suggests aortic reservoir function may be a more dominant contributor to AP and AIx. Our aim was therefore to determine relationships among aortic-brachial stiffness mismatching, AP, AIx, aortic reservoir function, and end-organ disease. Aortic (aPWV) and brachial (bPWV) pulse wave velocity were measured in 359 individuals (aged 61 ± 9, 49% male). Central AP, AIx, and aortic reservoir indexes were derived from radial tonometry. Participants were stratified by positive (bPWV > aPWV), negligible (bPWV ≈ aPWV), or negative stiffness mismatch (bPWV < aPWV). Left-ventricular mass index (LVMI) was measured by two-dimensional-echocardiography. Central AP and AIx were higher with negative stiffness mismatch vs. negligible or positive stiffness mismatch (11 ± 6 vs. 10 ± 6 vs. 8 ± 6 mmHg, P < 0.001 and 24 ± 10 vs. 24 ± 11 vs. 21 ± 13%, P = 0.042). Stiffness mismatch (bPWV-aPWV) was negatively associated with AP (r = -0.18, P = 0.001) but not AIx (r = -0.06, P = 0.27). Aortic reservoir pressure strongly correlated to AP (r = 0.81, P < 0.001) and AIx (r = 0.62, P < 0.001) independent of age, sex, heart rate, mean arterial pressure, and height (standardized β = 0.61 and 0.12, P ≤ 0.001). Aortic reservoir pressure independently predicted abnormal LVMI (β = 0.13, P = 0.024). Positive aortic-brachial stiffness mismatch does not result in higher AP or AIx. Aortic reservoir function, rather than discrete wave reflection from proximal arterial stiffness mismatching, provides a better model description of AP and AIx and also has clinical relevance as evidenced by an independent association of aortic reservoir pressure with LVMI. PMID:26276816

  12. Acute cerebellar ataxia

    MedlinePlus

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, especially younger than age 3, may occur several weeks after an illness caused by a virus. ...

  13. Ear infection - acute

    MedlinePlus

    Otitis media - acute; Infection - inner ear; Middle ear infection - acute ... Casselbrandt ML, Mandel EM. Acute otitis media and otitis media with effusion. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. ...

  14. Antibodies to Aquaporin 4, Myelin-Oligodendrocyte Glycoprotein, and the Glycine Receptor α1 Subunit in Patients With Isolated Optic Neuritis

    PubMed Central

    Martinez-Hernandez, Eugenia; Sepulveda, Maria; Rostásy, Kevin; Höftberger, Romana; Graus, Francesc; Harvey, Robert J.; Saiz, Albert; Dalmau, Josep

    2016-01-01

    IMPORTANCE In patients with isolated optic neuritis (ON), the presence of antibodies to aquaporin 4 (AQP4) has diagnostic and prognostic value. In the same clinical setting, the significance of antibodies to myelin-oligodendrocyte glycoprotein (MOG) or the glycine receptor α1 subunit (GlyR) is unclear. OBJECTIVES To investigate the frequency of antibodies to AQP4, MOG, and GlyR in patients with unilateral or bilateral, severe, or recurrent isolated ON and to determine their clinical and prognostic correlates. DESIGN, SETTING, AND PARTICIPANTS Retrospective case-control study from November 1, 2005, through May 30, 2014 with the detection of autoantibodies in a neuroimmunology referral center. We included 51 patients with ON but without clinical and magnetic resonance imaging findings outside the optic nerves and 142 controls (30 healthy individuals, 48 patients with neuromyelitis optica, and 64 patients with multiple sclerosis). MAIN OUTCOMES AND MEASURES Clinicoimmunologic analysis. We determined the presence of antibodies to AQP4, MOG, and GlyR using cell-based assays. RESULTS The median age of the patients at the onset of ON symptoms was 28 (range, 5–65) years; 36 patients (71%) were female. Antibodies were identified in 23 patients (45%), including MOG in 10 patients, AQP4 in 6 patients, and GlyR in 7 patients (concurrent with MOG in 3 and concurrent with AQP4 in 1). Patients with AQP4 antibodies (median visual score, 3.5 [range, 1–9]) had a worse visual outcome than patients with MOG antibodies alone (median visual score, 0 [range, 0–5]; P = .007), patients with seronegative findings (n = 28) (median visual score, 1.0 [range, 0–14]; P = .08), and patients with GlyR antibodies alone (n = 3) (median visual score, 0 [range, 0–2]; P = .10). The median age of the 7 patients with GlyR antibodies was 27 (range, 11–38) years; 5 (71%) of these were female. Among the 3 patients with GlyR antibodies alone, 1 patient had monophasic ON, 1 had recurrent isolated

  15. Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus.

    PubMed

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

    2016-06-01

    OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002-2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study. Their average age was 26 years (SD 8.4 years), and the mean interval between their injury and surgery was 5.2 months (SD 2.4 months). Prior to 2005, the suprascapular and spinal accessory nerves were dissected through a classic supraclavicular L-shape incision (n = 29). Afterward (n = 81), the spinal accessory and suprascapular nerves were dissected via an oblique incision, extending from the point at which the plexus crossed the clavicle to the anterior border of the trapezius muscle. In 17 of these patients, because of clavicle fractures or dislocation, scapular fractures or retroclavicular scarring, the incision was extended by detaching the trapezius from the clavicle to expose the suprascapular nerve at the suprascapular fossa. In all patients, the brachial plexus was explored and elbow flexion reconstructed by root grafting (n = 95), root grafting and phrenic nerve transfer (n = 6), phrenic nerve transfer (n = 1), or third, fourth, and fifth intercostal nerve transfer. Postoperatively, patients were followed for an average of 40 months (SD 13.7 months). RESULTS Failed recovery, meaning less than 30° abduction, was observed in 10 (9%) of the 110 patients. The failure rate was 25% between 2002 and 2004, but dropped to 5% after the staged/extended approach was introduced. The mean overall range of abduction recovery was 58.5° (SD 26°). Comparing before and after distal suprascapular nerve exploration (2005-2012), the

  16. Sudden severe postoperative dyspnea following shoulder surgery: Remember inadvertent phrenic nerve block due to interscalene brachial plexus block.

    PubMed

    Jariwala, Arpit; Kumar, B C Raju Pavan; Coventry, David M

    2014-04-01

    Advanced imaging techniques, improved operative techniques, and instrumentation combined with better patient awareness and expectations have resulted in an exponential increase in upper limb surgical procedures during recent times. Surgical teams expect superior analgesia and regional blocks have matched these expectations quite often resulting in improved patient satisfaction and early rehabilitation to achieve best results. Ultrasound-guided interscalene brachial plexus block (ISB) is commonly used to provide analgesia for procedures involving shoulder girdle. We report a case of symptomatic hemi-diaphragmatic paresis (HDP) due to the phrenic nerve block following ISB for arthroscopic sub-acromial decompression of the shoulder presenting as severe postoperative dyspnea. There is strong evidence of HDP following ISB in anesthetic literature, but not reported in related surgical specialties such as orthopedics. We wish to inform upper-limb surgeons and educate junior doctors and other ancillary staff working in upper-limb units to be aware of this serious but reversible complication. PMID:25114416

  17. [Acute and chronic limb ischemia in endurance athletes - a serious diagnosis of exercise-induced lower limb pain].

    PubMed

    Regus, Susanne; Lang, Werner

    2016-07-01

    Lower extremity pain due to acute or chronic ischemia in high performance endurance athletes is an often forgotten differential diagnosis. A variety of symptoms constitues a multi-disciplinary challenge. Intermittent claudication or acute ischemia are clinical symptoms indicative of this vascular disease. The most important basic methods of investigation are anamnesis and clinical examination. Furthermore, the determination of the ankle-brachial index (ABI) and duplexsonography should be considered. In addition, modern cross-sectional imaging techniques such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are recommended. In case of suspect findings, the digital substraction angiography (DSA) represents a high resolution image technique for illustration of the vessel lumen. If necessary, interventional therapy (balloon angioplasty or clot lysing) can be performed simultaneously. Surgical revision remains the gold-standard of therapy and the fastest way in which athletes regain maximum performance abilities. Correct diagnosis of lower limb ischemia affecting endurance athletes should be performed without delays. Determining the ankle-brachial index following maximal exertion represents the most important diagnostic tool. Surgical treatment techniques as decompression and revascularisation provide the best long-term results. PMID:27464284

  18. Acute pain.

    PubMed

    Good, M

    1999-01-01

    The review of acute pain describes the problem of unresolved pain and its effects on the neural, autonomic, and immune systems. Conceptualizations and mechanisms of pain are reviewed as well as theories of pain management. Descriptive studies of patient and nurse factors that inhibit effective pain management are discussed, followed by studies of pharmacological and nonpharmacological interventions. Critical analysis reveals that most studies were atheoretical, and therefore, this proliferation of information lacked conceptual coherence and organization. Furthermore, the nature and extent of barriers to pain management were described, but few intervention studies have been devised, as yet, to modify the knowledge, beliefs, and attitudes of nurses and patients that are barriers to pain management. Although some of the complementary therapies have sufficient research support to be used in clinical pain management, the physiological mechanisms and outcomes need to be studied. It is critical at this time to design studies of interventions to improve assessment, decision making, attentive care, and patient teaching. PMID:10418655

  19. Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research

    PubMed Central

    Alley, Hugh; Owens, Christopher D.; Gasper, Warren J.; Grenon, S. Marlene

    2014-01-01

    The vascular endothelium is a monolayer of cells that cover the interior of blood vessels and provide both structural and functional roles. The endothelium acts as a barrier, preventing leukocyte adhesion and aggregation, as well as controlling permeability to plasma components. Functionally, the endothelium affects vessel tone. Endothelial dysfunction is an imbalance between the chemical species which regulate vessel tone, thombroresistance, cellular proliferation and mitosis. It is the first step in atherosclerosis and is associated with coronary artery disease, peripheral artery disease, heart failure, hypertension, and hyperlipidemia. The first demonstration of endothelial dysfunction involved direct infusion of acetylcholine and quantitative coronary angiography. Acetylcholine binds to muscarinic receptors on the endothelial cell surface, leading to an increase of intracellular calcium and increased nitric oxide (NO) production. In subjects with an intact endothelium, vasodilation was observed while subjects with endothelial damage experienced paradoxical vasoconstriction. There exists a non-invasive, in vivo method for measuring endothelial function in peripheral arteries using high-resolution B-mode ultrasound. The endothelial function of peripheral arteries is closely related to coronary artery function. This technique measures the percent diameter change in the brachial artery during a period of reactive hyperemia following limb ischemia. This technique, known as endothelium-dependent, flow-mediated vasodilation (FMD) has value in clinical research settings. However, a number of physiological and technical issues can affect the accuracy of the results and appropriate guidelines for the technique have been published. Despite the guidelines, FMD remains heavily operator dependent and presents a steep learning curve. This article presents a standardized method for measuring FMD in the brachial artery on the upper arm and offers suggestions to reduce intra

  20. Effect of Collateral Sprouting on Donor Nerve Function After Nerve Coaptation: A Study of the Brachial Plexus

    PubMed Central

    Reichert, Paweł; Kiełbowicz, Zdzisław; Dzięgiel, Piotr; Puła, Bartosz; Wrzosek, Marcin; Bocheńska, Aneta; Gosk, Jerzy

    2016-01-01

    Background The aim of the present study was to evaluate the donor nerve from the C7 spinal nerve of the rabbit brachial plexus after a coaptation procedure. Assessment was performed of avulsion of the C5 and C6 spinal nerves treated by coaptation of these nerves to the C7 spinal nerve. Material/Methods After nerve injury, fourteen rabbits were treated by end-to-side coaptation (ETS), and fourteen animals were treated by side-to-side coaptation (STS) on the right brachial plexus. Electrophysiological and histomorphometric analyses and the skin pinch test were used to evaluate the outcomes. Results There was no statistically significant difference in the G-ratio proximal and distal to the coaptation in the ETS group, but the differences in the axon, myelin sheath and fiber diameters were statistically significant. The comparison of the ETS and STS groups distal to the coaptation with the controls demonstrated statistically significant differences in the fiber, axon, and myelin sheath diameters. With respect to the G-ratio, the ETS group exhibited no significant differences relative to the control, whereas the G-ratio in the STS group and the controls differed significantly. In the electrophysiological study, the ETS and STS groups exhibited major changes in the biceps and subscapularis muscles. Conclusions The coaptation procedure affects the histological structure of the nerve donor, but it does not translate into changes in nerve conduction or the sensory function of the limb. The donor nerve lesion in the ETS group is transient and has minimal clinical relevance. PMID:26848925

  1. Effect of Collateral Sprouting on Donor Nerve Function After Nerve Coaptation: A Study of the Brachial Plexus.

    PubMed

    Reichert, Pawel; Kiełbowicz, Zdzisław; Dzięgiel, Piotr; Puła, Bartosz; Wrzosek, Marcin; Bocheńska, Aneta; Gosk, Jerzy

    2016-01-01

    BACKGROUND The aim of the present study was to evaluate the donor nerve from the C7 spinal nerve of the rabbit brachial plexus after a coaptation procedure. Assessment was performed of avulsion of the C5 and C6 spinal nerves treated by coaptation of these nerves to the C7 spinal nerve. MATERIAL AND METHODS After nerve injury, fourteen rabbits were treated by end-to-side coaptation (ETS), and fourteen animals were treated by side-to-side coaptation (STS) on the right brachial plexus. Electrophysiological and histomorphometric analyses and the skin pinch test were used to evaluate the outcomes. RESULTS There was no statistically significant difference in the G-ratio proximal and distal to the coaptation in the ETS group, but the differences in the axon, myelin sheath and fiber diameters were statistically significant. The comparison of the ETS and STS groups distal to the coaptation with the controls demonstrated statistically significant differences in the fiber, axon, and myelin sheath diameters. With respect to the G-ratio, the ETS group exhibited no significant differences relative to the control, whereas the G-ratio in the STS group and the controls differed significantly. In the electrophysiological study, the ETS and STS groups exhibited major changes in the biceps and subscapularis muscles. CONCLUSIONS The coaptation procedure affects the histological structure of the nerve donor, but it does not translate into changes in nerve conduction or the sensory function of the limb. The donor nerve lesion in the ETS group is transient and has minimal clinical relevance. PMID:26848925

  2. Relations of Arterial Stiffness and Brachial Flow-Mediated Dilation With New-Onset Atrial Fibrillation: The Framingham Heart Study.

    PubMed

    Shaikh, Amir Y; Wang, Na; Yin, Xiaoyan; Larson, Martin G; Vasan, Ramachandran S; Hamburg, Naomi M; Magnani, Jared W; Ellinor, Patrick T; Lubitz, Steven A; Mitchell, Gary F; Benjamin, Emelia J; McManus, David D

    2016-09-01

    The relations of measures of arterial stiffness, pulsatile hemodynamic load, and endothelial dysfunction to atrial fibrillation (AF) remain poorly understood. To better understand the pathophysiology of AF, we examined associations between noninvasive measures of vascular function and new-onset AF. The study sample included participants aged ≥45 years from the Framingham Heart Study offspring and third-generation cohorts. Using Cox proportional hazards regression models, we examined relations between incident AF and tonometry measures of arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (augmentation index), pressure pulsatility (central pulse pressure), endothelial function (flow-mediated dilation), resting brachial arterial diameter, and hyperemic flow. AF developed in 407/5797 participants in the tonometry sample and 270/3921 participants in the endothelial function sample during follow-up (median 7.1 years, maximum 10 years). Higher augmentation index (hazard ratio, 1.16; 95% confidence interval, 1.02-1.32; P=0.02), baseline brachial artery diameter (hazard ratio, 1.20; 95% confidence interval, 1.01-1.43; P=0.04), and lower flow-mediated dilation (hazard ratio, 0.79; 95% confidence interval, 0.63-0.99; P=0.04) were associated with increased risk of incident AF. Central pulse pressure, when adjusted for age, sex, and hypertension (hazard ratio, 1.14; 95% confidence interval, 1.02-1.28; P=0.02) was associated with incident AF. Higher pulsatile load assessed by central pulse pressure and greater apparent wave reflection measured by augmentation index were associated with increased risk of incident AF. Vascular endothelial dysfunction may precede development of AF. These measures may be additional risk factors or markers of subclinical cardiovascular disease associated with increased risk of incident AF. PMID:27456517

  3. Computerized tomography myelography with coronal and oblique coronal view for diagnosis of nerve root avulsion in brachial plexus injury

    PubMed Central

    2007-01-01

    Background The authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view. Methods CT myelography was performed with penetration of the cervical subarachnoid space by the contrast medium. Then the coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyl transferase activity measurement in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy was compared with that of CT myelography with axial view, correlated with surgical findings or a natural course in 57 cervical roots in 28 patients. Results Coronal and oblique coronal views were superior to axial views in visualization of the rootlets and orientation of the exact level of the root. Sensitivity and specificity for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were 100% and 96%, respectively. There was no statistically significant difference between coronal and oblique coronal views and axial views. Conclusion The information by the coronal and oblique coronal slice CT myelography enabled the authors to assess the rootlets of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction. PMID:17651476

  4. Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy

    PubMed Central

    Nath, Rahul K.; Somasundaram, Chandra

    2012-01-01

    Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5–9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1–17.9 years). Results: The mean preoperative total Mallet score was 14.8 (range, 10–20), and active abduction was 84° (range, 20°–140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13–25, P < .0001), and the mean active abduction improved to 132° (range, 40°–180°, P < .0003). Conclusion: The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder. PMID:23308301

  5. Association of Brachial-Ankle Pulse Wave Velocity and Cardiomegaly With Aortic Arch Calcification in Patients on Hemodialysis

    PubMed Central

    Shin, Ming-Chen Paul; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Chen, Jui-Hsin; Chen, Szu-Chia; Chang, Jer-Ming; Chen, Hung-Chun

    2016-01-01

    Abstract Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD). We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4. Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003–1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046–1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4. Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients. PMID:27175684

  6. Association of Brachial-Ankle Pulse Wave Velocity and Cardiomegaly With Aortic Arch Calcification in Patients on Hemodialysis.

    PubMed

    Shin, Ming-Chen Paul; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Chen, Jui-Hsin; Chen, Szu-Chia; Chang, Jer-Ming; Chen, Hung-Chun

    2016-05-01

    Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD).We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4.Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003-1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046-1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4.Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients. PMID:27175684

  7. Effect of adding tetracaine to bupivacaine on duration of analgesia in supraclavicular brachial plexus nerve blocks for ambulatory shoulder surgery

    PubMed Central

    Pearson, Linda T.; Lowry, Benjamin P.; Culp, William C.; Kitchings, Olen E.; Meyer, Tricia A.; McAllister, Russell K.; Roberson, Charles R.

    2015-01-01

    The objective of this study was to determine if the addition of 1% tetracaine to 0.25% bupivacaine prolonged the duration of postoperative analgesia of supraclavicular brachial plexus nerve blockade for patients undergoing ambulatory shoulder surgery. We conducted a prospective, double-blinded, randomized controlled clinical study at an ambulatory surgery center utilizing ultrasound- and nerve stimulation-guided supraclavicular nerve blockade for postoperative analgesia. The control group received 30 mL of 0.25% bupivacaine plus 4 mL preservative-free saline. The study group received 30 mL of 0.25% bupivacaine plus 4 mL of 1% tetracaine. Patients documented their visual analog scale scores and intake of pain medications for 3 days. Primary outcomes included time of first postoperative pain, time of first postoperative pain pill, and time of return of motor and sensory function. Secondary outcomes included pain score and pain medication intake trends and adverse events secondary to the nerve block. A total of 84 patients completed the study, 42 patients in each group. The study group was statistically significantly older than the control group (mean age, 54 vs 48 years; P = 0.04). The mean duration of analgesia was 16.6 ± 8.3 h for the control group and 17.1 ± 7.3 h for the study group (P = 0.69). No outcomes were statistically different. In conclusion, there was no significant difference in duration of postoperative analgesia with the addition of 1% tetracaine to 0.25% bupivacaine in supraclavicular brachial plexus nerve blockade. No differences were identified in postoperative pain medications, pain scores, or complications. PMID:26130874

  8. Acute neck cellulitis and mediastinitis complicating a continuous interscalene block.

    PubMed

    Capdevila, Xavier; Jaber, Samir; Pesonen, Pertti; Borgeat, Alain; Eledjam, Jean-Jacques

    2008-10-01

    We report a case of acute neck cellulitis and mediastinitis complicating a continuous interscalene brachial plexus block. A 61-yr-old man was scheduled for an elective arthroscopic right shoulder rotator cuff repair. A continuous interscalene block was done preoperatively and 20 mL of 0.5% bupivacaine and 20 mL of 2% mepivacaine were injected through the catheter. Postoperative analgesia was provided by a continuous infusion of bupivacaine, 0.25% at 5 mL/h for 39 h using a 240-mL elastomeric disposable pump. The day after surgery, the patient complained of neck pain. The analgesic block was not fully effective. He was discharged home. Three days later, the patient was readmitted with neck edema and erythema, fever and fatigue. Neck ultrasonography and computed tomographic scan revealed an abscess of the interscalene and sternocleidomastiod muscles and cellulitis, as well as acute mediastinitis. Two blood cultures and surgical samples were positive for Staphylococcus aureus. The infection was treated with surgery, the site was surgically debrided, and a 2-mo course of vancomycin, imipenem, and oxacilline. The technique of drawing local anesthetic from the bottle and filling the elastomeric pump was the most likely cause of infection. This case emphasizes the importance of strict aseptic conditions during puncture, catheter insertion, and management of the local anesthetic infusate. PMID:18806062

  9. Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

    SciTech Connect

    Acosta, S. Sonesson, B.; Resch, T.

    2009-09-15

    The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

  10. A Rare Form of Guillan Barre Syndrome: A Child Diagnosed with Anti-GD1a and Anti-GD1b Positive Pharyngeal-Cervical-Brachial Variant

    PubMed Central

    Uysalol, Metin; Tatlı, Burak; Uzel, Nedret; Çıtak, Agop; Aygün, Erhan; Kayaoğlu, Semra

    2013-01-01

    Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Case Report: Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. Conclusion: In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes. PMID:25207134

  11. Percutaneous T2 and T3 Radiofrequency Sympathectomy for Complex Regional Pain Syndrome Secondary to Brachial Plexus Injury: A Case Series

    PubMed Central

    Phui, Vui Eng; Nizar, Abd Jalil; Yeo, Sow Nam

    2013-01-01

    Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management. PMID:24156009

  12. Use of chemical shift encoded magnetic resonance imaging (CSE-MRI) for high resolution fat-suppressed imaging of the brachial and lumbosacral plexuses

    PubMed Central

    Grayev, Allison; Reeder, Scott; Hanna, Amgad

    2016-01-01

    Purpose In the era of increasingly complex surgical techniques for peripheral nerve repair, there is a need for high spatial resolution imaging of the neural plexuses in the body. We describe our experience with chemical shift encoded MRI and its implications for patient management. Materials and methods IDEAL water-fat separation is a chemical shift based method of homogeneously suppressing signal from fat, while maintaining adequate signal. This technique was used in clinical practice and the patient images reviewed. Results IDEAL water-fat separation was shown to improve visualization of the brachial and lumbosacral plexuses with good fat suppression and high signal to noise ratio. Conclusion IDEAL water − fat separation is an excellent technique to use in the imaging of the brachial and lumbosacral plexuses as it balances the need for homogeneous fat suppression with maintenance of excellent signal to noise ratio. PMID:27161071

  13. High dietary sodium reduces brachial artery flow-mediated dilation in humans with salt-sensitive and salt-resistant blood pressure.

    PubMed

    Matthews, Evan L; Brian, Michael S; Ramick, Meghan G; Lennon-Edwards, Shannon; Edwards, David G; Farquhar, William B

    2015-06-15

    Recent studies demonstrate that high dietary sodium (HS) impairs endothelial function in those with salt-resistant (SR) blood pressure (BP). The effect of HS on endothelial function in those with salt-sensitive (SS) BP is not currently known. We hypothesized that HS would impair brachial artery flow-mediated dilation (FMD) to a greater extent in SS compared with SR adults. Ten SR (age 42 ± 5 yr, 5 men, 5 women) and 10 SS (age 39 ± 5 yr, 5 men, 5 women) healthy, normotensive participants were enrolled in a controlled feeding study consisting of a run-in diet followed by a 7-day low dietary sodium (LS) (20 mmol/day) and a 7-day HS (300 mmol/day) diet in random order. Brachial artery FMD and 24-h BP were assessed on the last day of each diet. SS BP was individually assessed and defined as a change in 24-h mean arterial pressure (MAP) of >5 mmHg between the LS and HS diets (ΔMAP: SR -0.6 ± 1.2, SS 7.7 ± 0.4 mmHg). Brachial artery FMD was lower in both SS and SR individuals during the HS diet (P < 0.001), and did not differ between groups (P > 0.05) (FMD: SR LS 10.6 ± 1.3%, SR HS 7.2 ± 1.5%, SS LS 12.5 ± 1.7%, SS HS 7.8 ± 1.4%). These data indicate that an HS diet impairs brachial artery FMD to a similar extent in adults with SS BP and SR BP. PMID:26078434

  14. Fluid overload, pulse wave velocity, and ratio of brachial pre-ejection period to ejection time in diabetic and non-diabetic chronic kidney disease.

    PubMed

    Tsai, Yi-Chun; Chiu, Yi-Wen; Kuo, Hung-Tien; Chen, Szu-Chia; Hwang, Shang-Jyh; Chen, Tzu-Hui; Kuo, Mei-Chuan; Chen, Hung-Chun

    2014-01-01

    Fluid overload is one of the characteristics in chronic kidney disease (CKD). Changes in extracellular fluid volume are associated with progression of diabetic nephropathy. Not only diabetes but also fluid overload is associated with cardiovascular risk factors The aim of the study was to assess the interaction between fluid overload, diabetes, and cardiovascular risk factors, including arterial stiffness and left ventricular function in 480 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. Brachial-ankle pulse wave velocity (baPWV), as a good parameter of arterial stiffness, and brachial pre-ejection period (bPEP)/brachial ejection time (bET), correlated with impaired left ventricular function were measured by ankle-brachial index (ABI)-form device. Of all patients, 207 (43.9%) were diabetic and 240 (50%) had fluid overload. For non-diabetic CKD, fluid overload was associated with being female (β = -2.87, P = 0.003), heart disease (β = 2.69, P = 0.04), high baPWV (β = 0.27, P = 0.04), low hemoglobin (β = -1.10, P < 0.001), and low serum albumin (β = -5.21, P < 0.001) in multivariate analysis. For diabetic CKD, fluid overload was associated with diuretics use (β = 3.69, P = 0.003), high mean arterial pressure (β = 0.14, P = 0.01), low bPEP/ET (β = -0.19, P = 0.03), low hemoglobin (β = -1.55, P = 0.001), and low serum albumin (β = -9.46, P < 0.001). In conclusion, baPWV is associated with fluid overload in non-diabetic CKD and bPEP/bET is associated with fluid overload in diabetic CKD. Early and accurate assessment of these associated cardiovascular risk factors may improve the effects of entire care in late CKD. PMID:25386836

  15. Effect of ketamine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: A double-blind randomized clinical trial study

    PubMed Central

    Lashgarinia, Mohammadreza; Naghibi, Khosro; Honarmand, Azim; Safavi, Mohammadreza; Khazaei, Mehdi

    2014-01-01

    Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. Ketamine has been reported to enhance the analgesic effects of local anesthetics. We have conducted this study to assess whether coadministration of ketamine can prolong the local analgesic effect of lidocaine in the supraclavicular brachial plexus block for patients undergoing elective upper extremity surgery. Materials and Methods: Sixty adult patients undergoing elective surgery of the elbow, forearm, wrist or hand were randomly allocated in two groups of 30 patients each. Group 1 (ketamine group) received 5 mg/kg lidocaine 1.5% plus 2 mg/kg ketamine, Group 2 (control group) received 5 mg/kg lidocaine 1.5% and saline. The outcome measures included severity of pain by using visual analog scale (VAS, 0 = no pain 10 cm = the most severe pain), time of first request for analgesia, and total dose of postoperative opioid administration. The data was analyzed using the χ2 test, student's t-test, Kaplan-Meier survival analysis, and Multivariate analysis tests. Results: Patients in the control group had a higher VAS than patients who received ketamine, at all time points during the first 24 hours after surgery (all P < 0.05). The time of first request for analgesia in the ketamine group was significantly more than in the control group (8.93 ± 1.0 vs. 7.30 ± 1.9, respectively, P < 0.001). Conclusion: The addition of ketamine to lidocaine in the ultrasound-guided brachial plexus block could decrease the postoperative pain and need for analgesic. Therefore, it could be considered as an option in the brachial plexus block to enhance the analgesic action of lidocaine. PMID:25538918

  16. Flow-mediated dilatation, using time course data, shows maturation of the brachial artery from young children to mid-adolescents.

    PubMed

    Kontos, Anna; Pamula, Yvonne; Martin, James; Gent, Roger; Lushington, Kurt; Baumert, Mathias; Willoughby, Scott; Richardson, Malcolm; Couper, Jennifer; Kennedy, Declan

    2015-03-01

    Flow-mediated dilatation (FMD) is a tool widely used to measure arterial responsiveness to sheer stress. However, there is scant literature to show how the peripheral arterial response changes as the vascular system matures. One reason for this is that the feasibility of measuring FMD in younger children has not been established. The aim of the present study was to assess brachial artery function at rest and during the FMD response after 4 min ischaemia of the forearm in children aged 6-15 years. Time to reach maximum FMD (FMDmax ) was found to be correlated with age (r = 0.4, P < 0.05), resting brachial artery diameter (r = 0.4, P < 0.05), height (r = 0.4, P < 0.05), body mass index (BMI; r = 0.45, P < 0.05), body surface area (r = 0.44, P < 0.05) and resting blood flow (r = 0.37, P < 0.05). However, there was no correlation between the traditional FMD response at 60 s or FMD maximal dilation and age, resting brachial artery diameter, height, weight, BMI, body surface area and resting blood flow. In conclusion, the time taken to reach the maximal dilation response is related to age, brachial artery luminal diameter and body habitus, but not the traditional measure of FMD response at 60 s or the maximal dilatation percentage. PMID:25491271

  17. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index

    PubMed Central

    Manisty, Charlotte H; Hughes, Alun D

    2013-01-01

    AIMS Brachial systolic blood pressure (bSBP) exceeds aortic pressure by a variable amount, and estimated central systolic blood pressure (cSBP) may be a better indicator of cardiovascular risk than bSBP. We undertook a systematic review and meta-analysis to compare the effect of single and multiple antihypertensive agents on bSBP, cSBP and augmentation index (AIx). Methods A random effects meta-analysis was performed on 24 randomized controlled trials of antihypertensives with measurements of bSBP, cSBP and/or AIx. Separate analyses were performed for drug comparisons with or without placebo, and drug combinations. Results In the placebo vs. drug meta-analysis, antihypertensive therapy reduced bSBP more than cSBP and there was no statistically significant evidence of heterogeneity by drug class, although the number of individual studies was small. In placebo-adjusted drug vs. drug comparison, treatment with β-blockers, omapatrilat and thiazide diuretics lowered cSBP significantly less than bSBP (i.e. central to brachial amplification decreased), whereas other monotherapies lowered cSBP and bSBP to similar extents. Sample sizes were too small and effect estimates insufficiently precise to allow firm conclusions to be made regarding comparisons between individual drug classes. Antihypertensive combinations that included β-blockers decreased central to brachial amplification. β-Blockers increased AIx, whereas all other antihypertensive agents reduced AIx to similar extents. CONCLUSIONS A reduction in central to brachial amplification by some classes of antihypertensive drug will result in lesser reductions in cSBP despite achievement of target bSBP. This effect could contribute to differences in outcomes in randomized clinical trials when β-blocker- and/or diuretic-based antihypertensive therapy are compared with other regimens. PMID:22625662

  18. A randomised placebo-controlled trial examining the effect on hand supination after the addition of a suprascapular nerve block to infraclavicular brachial plexus blockade.

    PubMed

    Flohr-Madsen, S; Ytrebø, L M; Valen, K; Wilsgaard, T; Klaastad, Ø

    2016-08-01

    Some surgeons believe that infraclavicular brachial plexus blocks tends to result in supination of the hand/forearm, which may make surgical access to the dorsum of the hand more difficult. We hypothesised that this supination may be reduced by the addition of a suprascapular nerve block. In a double-blind, randomised, placebo-controlled study, our primary outcome measure was the amount of supination (as assessed by wrist angulation) 30 min after infraclavicular brachial plexus block, with (suprascapular group) or without (control group) a supplementary suprascapular block. All blocks were ultrasound-guided. The secondary outcome measure was an assessment by the surgeon of the intra-operative position of the hand. Considering only patients with successful nerve blocks, mean (SD) wrist angulation was lower (33 (27) vs. 61 (44) degrees; p = 0.018) and assessment of the hand position was better (11/11 vs. 6/11 rated as 'good'; p = 0.04) in the suprascapular group. The addition of a suprascapular nerve block to an infraclavicular brachial plexus block can provide a better hand/forearm position for dorsal hand surgery. PMID:27396247

  19. Brachial branches of the medial antebrachial cutaneous nerve: A case report with its clinical significance and a short review of the literature.

    PubMed

    Stylianos, Kapetanakis; Konstantinos, Giatroudakis; Pavlos, Pavlidis; Aliki, Fiska

    2016-01-01

    The medial antebrachial cutaneous nerve (MACN) is a branch of the brachial plexus with a great variation within its branches. Knowledge of these variations is critical to neurologists, hand surgeons, plastic surgeons, and vascular surgeons. The aim of this study was to search for variations of the MACN and to discuss their clinical significance. For this study, six arm cadavers from three fresh cadavers were dissected and examined to find and study possible anatomical variations of the MACN. The authors report a rare case of a variation of the MACN, in which there are four brachial cutaneous branches, before the separation to anterior (volar) and posterior (ulnar) branch, that provide sensory innervation to the medial, inferior half of the arm, in the area that is commonly innervated from the medial brachial cutaneous nerve. To our knowledge, this is the first documented case of this nerve variation. This variation should be taken into serious consideration for the differential diagnosis of patients with complaints of hypoesthesia, pain, and paresthesia and for the surgical operations in the medial part of the arm. PMID:27365965

  20. Obstetrical brachial plexus palsy: Can excision of upper trunk neuroma and nerve grafting improve function in babies with adequate elbow flexion at nine months of age?

    PubMed

    Argenta, Anne E; Brooker, Jack; MacIssac, Zoe; Natali, Megan; Greene, Stephanie; Stanger, Meg; Grunwaldt, Lorelei

    2016-05-01

    Accepted indications for exploration in obstetrical brachial plexus palsy (OBPP) vary by center. Most agree that full elbow flexion against gravity at nine months of age implies high chance of spontaneous recovery and thus excludes a baby from surgical intervention. However, there are certain movements of the shoulder and forearm that may not be used frequently by the infant, but are extremely important functionally as they grow. These movements are difficult to assess in a baby and may lead to some clinicians to recommend conservative treatment, when this cohort of infants may in fact benefit substantially from surgery. A retrospective review was conducted on all infants managed surgically at the Brachial Plexus Center of a major children's hospital from 2009 to 2014. Further analysis identified five patients who had near-normal AMS scores for elbow flexion but who had weakness of shoulder abduction, flexion, external rotation, and/or forearm supination. In contrast to standard conservative management, this cohort underwent exploration, C5-6 neuroma excision, and sural nerve grafting. Data analysis was performed on this group to look for overall improvement in function. During an average follow-up period of 29 months, all patients made substantial gains in motor function of the shoulder and forearm, without loss of elbow flexion or extension, or worsening of overall outcome. In select infants with brachial plexus injuries but near-normal AMS scores for elbow flexion, surgical intervention may be indicated to achieve the best functional outcome. PMID:26806089

  1. Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report

    PubMed Central

    Koutsouflianiotis, Konstantinos; Iliou, Kalliopi; Bitsis, Theodosios; Kitsoulis, Panagiotis

    2016-01-01

    A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus’ repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus. PMID:27504272

  2. Brachial branches of the medial antebrachial cutaneous nerve: A case report with its clinical significance and a short review of the literature

    PubMed Central

    Stylianos, Kapetanakis; Konstantinos, Giatroudakis; Pavlos, Pavlidis; Aliki, Fiska

    2016-01-01

    The medial antebrachial cutaneous nerve (MACN) is a branch of the brachial plexus with a great variation within its branches. Knowledge of these variations is critical to neurologists, hand surgeons, plastic surgeons, and vascular surgeons. The aim of this study was to search for variations of the MACN and to discuss their clinical significance. For this study, six arm cadavers from three fresh cadavers were dissected and examined to find and study possible anatomical variations of the MACN. The authors report a rare case of a variation of the MACN, in which there are four brachial cutaneous branches, before the separation to anterior (volar) and posterior (ulnar) branch, that provide sensory innervation to the medial, inferior half of the arm, in the area that is commonly innervated from the medial brachial cutaneous nerve. To our knowledge, this is the first documented case of this nerve variation. This variation should be taken into serious consideration for the differential diagnosis of patients with complaints of hypoesthesia, pain, and paresthesia and for the surgical operations in the medial part of the arm. PMID:27365965

  3. Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report.

    PubMed

    Paraskevas, George; Koutsouflianiotis, Konstantinos; Iliou, Kalliopi; Bitsis, Theodosios; Kitsoulis, Panagiotis

    2016-06-01

    A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus' repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus. PMID:27504272

  4. Arterial damages in acute elbow dislocations: which diagnostic tests are required?

    PubMed

    Lutter, Christoph; Pfefferkorn, Ronny; Schoeffl, Volker

    2016-01-01

    Blunt vessel injuries of peripheral arteries caused by a direct trauma are rare. Studies have described the frequency of arterial ruptures following closed elbow dislocations in 0.3-1.7% of all cases. However, arterial damage does not always necessarily appear as a complete rupture of the vessel with a loss of peripheral circulation and ischaemic symptoms; a relatively strong periarticular system of collaterals can maintain circulation. Furthermore, the traumatic dislocation can also cause intimal tears, arterial dissections and aneurysms or thrombosis. In all cases of vessel injury, including total disruption, a peripheral pulse might still be palpable. 3 weeks after an acute elbow dislocation, we have diagnosed a patient with a long-segment stenosis of the brachial artery and a thrombosis of the radial artery. Therefore, the close anatomic proximity to the neurovascular structures should always be considered in cases of elbow dislocations, even if peripheral pulses are traceable. PMID:27436035

  5. Infusion Methods for Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Byeon, Gyeong Jo; Yoon, Ji Uk; Kim, Eun Jung; Baek, Seung Hoon; Ri, Hyun Su

    2015-01-01

    Background Infusion methods during regional analgesia using perineural catheters may influence the quality of postoperative analgesia. This study was conducted to compare the effects of combined or bolus-only infusion of 0.2% ropivacaine on the postoperative analgesia in interscalene brachial plexus block (ISBPB) with perineural catheterization. Methods Patients scheduled for arthroscopic rotator cuff repair were divided into two groups, one that would receive a combined infusion (group C, n = 32), and one that would receive intermittent infusion (group I, n = 32). A perineural catheter was inserted into the interscalene brachial plexus (ISBP) using ultrasound (US) and nerve stimulation, and 10 ml of 0.2% ropivacaine was administered. After the operation, group C received a continuous infusion of 4 ml/h, and a 4 ml bolus with a lockout interval of 60 min. Group I received only a 4 ml bolus, and the lockout interval was 30 min. Postoperative pain by the numeric rating scale (NRS) and the forearm muscle tone by the manual muscle test (MMT) were checked and evaluated at the following timepoints: preoperative, and postoperative 1, 4, 12, 24, 36, and 48 h. Supplemental opioid requirements, total consumed dose of local anesthetic, and adverse effects were compared between the two groups. Results Sixty-four patients completed the study and the postoperative values such as operation time, time to discharge, and operation site were comparable. There were no differences in NRS scores and supplemental opioid requirements between the two groups. The MMT scores of group I at 4 and 12 h after surgery were significantly higher than those of group C (P < 0.05). The total consumed dose of local anesthetic was significantly lower in group I than in group C (P < 0.05). The adverse effects were not different between the groups. Conclusions The bolus-only administration of 0.2% ropivacaine provided a similar analgesic effect with a lower total volume of local anesthetic and decreased

  6. The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block

    PubMed Central

    El-Baradey, Ghada F.; Elshmaa, Nagat S.

    2014-01-01

    Aims: The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block. Settings and Design: This is a prospective randomized controlled observer-blinded study. Subjects and Methods: This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 μg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 μg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request. Statistical Analysis Used: The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant. Results: Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E. Conclusions: In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects. PMID:25538528

  7. Novel description of the 24-hour circadian rhythms of brachial versus central aortic blood pressure and the impact of blood pressure treatment in a randomized controlled clinical trial: The Ambulatory Central Aortic Pressure (AmCAP) Study.

    PubMed

    Williams, Bryan; Lacy, Peter S; Baschiera, Fabio; Brunel, Patrick; Düsing, Rainer

    2013-06-01

    Elevated brachial blood pressure (BP) is associated with increased cardiovascular risk and predicts morbidity and mortality in humans. Recently, 24-hour ambulatory BP monitoring and assessment of central aortic BP have been introduced to improve BP phenotyping. The Ambulatory Central Aortic Pressure (AmCAP) study combines these approaches and describes, for the first time, the diurnal patterns of simultaneously measured 24-hour ambulatory brachial and central pressures in a prespecified substudy embedded within a clinical trial of BP lowering in patients with hypertension. Twenty-four-hour ambulatory brachial and central pressure measurements were acquired using a tonometer mounted into the articulating strap of a wristwatch-like device (BPro) in 171 participants with hypertension recruited into the ASSERTIVE (AliSkiren Study of profound antihypERtensive efficacy in hyperTensIVE patients) trial. Participants were randomly assigned to BP lowering with either aliskiren 300 mg QD or telmisartan 80 mg QD for 12 weeks. Ambulatory brachial and central BP was measured in all participants both at baseline and at study end. Brachial and central BP both demonstrated typical diurnal patterns with lower pressures at night. However, night time was associated with smaller reductions in central relative to brachial pressure and decreased pulse pressure amplification (P<0.0001 for both). These effects were not modulated after BP lowering and were maintained after adjustment for day and night-time BP and heart rate (P=0.02). This study demonstrates that brachial and central pressure show different diurnal patterns, which are not modulated by BP-lowering therapy, with relatively higher night-time central pressures. These novel data indicate that night-time central BP may provide prognostic importance and warrants further investigation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00865020. PMID:23630950

  8. Flow-mediated dilation in the inactive limb following acute hypoxic exercise.

    PubMed

    Katayama, Keisho; Yamashita, Shin; Iwamoto, Erika; Ishida, Koji

    2016-01-01

    The purpose of this study was to elucidate the effect of acute aerobic exercise performed under hypoxic conditions on flow-mediated dilation (FMD) in the inactive limb. Seven males participated in the study. The subjects performed two submaximal leg cycling on a semirecumbent ergometer at the same relative intensity (60% peak oxygen uptake) in normoxia [inspired oxygen fraction (FIO2) = 0·21] and hypoxia (FIO2 = 0·12-0·13) for 30 min. The brachial artery diameter and blood velocity during exercise were measured via ultrasound, and the antegrade and retrograde shear rates were calculated. Before and 5, 30 and 60 min after exercise, brachial artery FMD was measured in normoxia. FMD was estimated as the percentage increase in peak diameter from the baseline diameter at prior occlusion (%FMD) and as the controlling changes in baseline diameter (the corrected-%FMD). No difference in antegrade shear rate during exercise was detected between the normoxic and hypoxic conditions, whereas the retrograde shear rate was larger during hypoxic exercise. The %FMD decreased significantly at 5 min after exercise in both normoxia and hypoxia, and it returned to pre-exercise levels within 60 min of recovery. Significant decreases in FMD at 5 min after exercise had disappeared when the baseline diameter was controlled using an analysis of covariance (the corrected-%FMD). No significant differences were observed between the normoxic and hypoxic trials in the %FMD and corrected-%FMD following exercise. These results suggest that hypoxia has no impact on endothelial function in the inactive limb following acute aerobic exercise. PMID:25257848

  9. Acute Inactivity Impairs Glycemic Control but Not Blood Flow to Glucose Ingestion

    PubMed Central

    Reynolds, Leryn J; Credeur, Daniel P; Holwerda, Seth W; Leidy, Heather J; Fadel, Paul J; Thyfault, John P

    2014-01-01

    Purpose Insulin-stimulated increases in skeletal muscle blood flow play a role in glucose disposal. Indeed, 7 days of aerobic exercise in type 2 diabetes patients increased blood flow responses to an oral glucose tolerance test (OGTT) and improved glucose tolerance. More recent work suggests that reduced daily physical activity impairs glycemic control (GC) in healthy individuals. Herein, we sought to determine if an acute reduction in daily activity (from >10,000 to <5,000 steps/day) for 5 days (RA5) in healthy individuals reduced insulin-stimulated blood flow and GC in parallel and if a 1 day return to activity (RTA1) improved these outcomes. Methods OGTTs were performed as a stimulus to increase insulin in 14 healthy, recreationally active men (24±1.1 yrs) at baseline, RA5, and RTA1. Measures of insulin sensitivity (Matsuda index) and femoral and brachial artery blood flow were made during the OGTT. Free living measures of GC including peak postprandial glucose (peak PPG) were also made via continuous glucose monitoring. Results Femoral and brachial artery blood flow increased during the OGTT but neither was significantly impacted by changes in physical activity (p>0.05). However, insulin sensitivity was decreased by RA5 (11.3±1.5 to 8.0±1.0; p<0.05). Likewise, free living GC measures of peak post prandial blood glucose (113±3 to 123±5 mg/dL; p<0.05) was significantly increased at RA5. Interestingly, insulin sensitivity and GC as assessed by peak PPG were not restored after RTA1 (p>0.05). Conclusions Thus, acute reductions in physical activity impaired GC and insulin sensitivity; however blood flow responses to an OGTT were not affected. Further, a 1 day return to activity was not sufficient to normalize GC following 5 days of reduced daily physical activity. PMID:25207931

  10. Diagnostic accuracy of acute vestibular syndrome at the bedside in a stroke unit.

    PubMed

    Chen, L; Lee, W; Chambers, B R; Dewey, H M

    2011-05-01

    Acute vestibular syndrome may be due to vestibular neuritis (VN) or posterior circulation strokes. Bedside ocular motor testing performed by experts is superior to early MRI in excluding strokes. We sought to demonstrate that differentiation of strokes from VN in our stroke unit is reliable. During a prospective study at a tertiary hospital over 1 year, patients with AVS were evaluated in the emergency department (ED) and underwent admission with targeted examination: gait, gaze-holding, horizontal head impulse test (hHIT), testing for skew deviation (SD) and vertical smooth pursuit (vSP). Neuroimaging included CT, transcranial Doppler (TCD) and MRI with MR angiogram (MRA). VN was diagnosed with normal diffusion-weighted images (DWI) and absence of neurological deficits on follow-up. Acute strokes were confirmed with DWI. A total of 24 patients with AVS were enrolled and divided in two groups. In the pure vestibular group (n = 20), all VN (n = 10/10) had positive hHIT and unidirectional nystagmus, but 1 patient had SD and abnormal vertical smooth pursuit (SP). In all the strokes (n = 10/10), one of the following signs suggestive of central lesion was present: negative hHIT, central-type nystagmus, SD or abnormal vSP. Finding one of these was 100% sensitive and 90% specific for stroke. In the cochleovestibular group (n = 4) all had normal DWI, but 3 patients had central ocular motor signs (abnormal vertical SP and SD). Whilst the study is small, classification of AVS in our stroke unit is reliable. The sensitivity and specificity of bedside ocular motor testing are comparable to those previously reported by expert neuro-otologists. Acute cochleovestibular loss and normal DWI may signify a labyrinthine infarct but differentiating between different causes of inner ear dysfunction is not possible with bedside testing. PMID:21153732

  11. Acute kidney failure

    MedlinePlus

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... There are many possible causes of kidney damage. They include: ... cholesterol (cholesterol emboli) Decreased blood flow due to very ...

  12. Acute arterial occlusion - kidney

    MedlinePlus

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  13. Acute arterial occlusion - kidney

    MedlinePlus

    ... arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury ...

  14. Acute Lymphocytic Leukemia

    MedlinePlus

    ... hard for blood to do its work. In acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, there are too ... of white blood cells called lymphocytes or lymphoblasts. ALL is the most common type of cancer in ...

  15. Association of Diabetes and Hemodialysis With Ankle Pressure and Ankle-Brachial Index in Japanese Patients With Critical Limb Ischemia

    PubMed Central

    Takahara, Mitsuyoshi; Kaneto, Hideaki; Iida, Osamu; Katakami, Naoto; Matsuoka, Taka-aki; Ikeda, Masahiko; Shimomura, Iichiro

    2012-01-01

    OBJECTIVE To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI). RESEARCH DESIGN AND METHODS We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI. RESULTS Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level. CONCLUSIONS Diabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients. PMID:22723344

  16. Anatomical and Functional Estimations of Brachial Artery Diameter and Elasticity Using Oscillometric Measurements with a Quantitative Approach

    PubMed Central

    Yoshinaga, Keiichiro; Fujii, Satoshi; Tomiyama, Yuuki; Takeuchi, Keisuke; Tamaki, Nagara

    2016-01-01

    Noninvasive vascular function measurement plays an important role in detecting early stages of atherosclerosis and in evaluating therapeutic responses. In this regard, recently, new vascular function measurements have been developed. These new measurements have been used to evaluate vascular function in coronary arteries, large aortic arteries, or peripheral arteries. Increasing vascular diameter represents vascular remodeling related to atherosclerosis. Attenuated vascular elasticity may be a reliable marker for atherosclerotic risk assessment. However, previous measurements for vascular diameter and vascular elasticity have been complex, operator-dependent, or invasive. Therefore, simple and reliable approaches have been sought. We recently developed a new automated oscillometric method to measure the estimated area (eA) of a brachial artery and its volume elastic modulus (VE). In this review, we further report on this new measurement and other vascular measurements. We report on the reliability of the new automated oscillometric measurement of eA and VE. Based on our findings, this measurement technique should be a reliable approach, and this modality may have practical application to automatically assess muscular artery diameter and elasticity in clinical or epidemiological settings. In this review, we report the characteristics of our new oscillometric measurements and other related vascular function measurements. PMID:27493898

  17. To determine block establishment time of supraclavicular brachial plexus block using blunt versus short bevel needle: A prospective randomized trial

    PubMed Central

    Ahuja, V; Thapa, D; Gombar, S; Dhiman, D

    2016-01-01

    Background: Unintentional intraneural injection under ultrasound guidance (USG) with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB) have been reported. Materials and Methods: We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30): SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30): SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects. Results: The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects. Conclusion: The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events. PMID:27375378

  18. Mobile technology: Creation and use of an iBook to teach the anatomy of the brachial plexus.

    PubMed

    Stewart, Stuart; Choudhury, Bipasha

    2015-01-01

    In an era of digitally connected students, there is a demand for academic material to be delivered through electronic mobile devices and not just through traditional methods such as lectures and tutorials. A digital interactive book-iBook (for use on the Apple iPad)-was created to teach undergraduate anatomical science students (n = 26) four key areas of the brachial plexus: definitions, gross anatomy, relative anatomy, and functions of terminal branches. Students were asked to complete preresource and postresource questionnaires, which were used to calculate the mean improvement score and ultimately the efficacy of the resource. Free text comments were gathered to evaluate student opinions on this mode of learning. The mean score on the preresource and postresource questionnaires was 4.07 of 8 and 5.69 of 8, respectively. The overall mean improvement score was 1.62, determined statistically significant by a dependent t-test (P = 0.0004). Findings demonstrate that digital books on the iPad provide a uniquely interactive way of delivering information and engaging students. Furthermore, digital books can be used alongside traditional methods of teaching anatomy to enhance and promote deep learning in students. PMID:25351850

  19. Change in Elasticity Caused by Flow-Mediated Dilation Measured Only for Intima-Media Region of Brachial Artery

    NASA Astrophysics Data System (ADS)

    Sugimoto, Masataka; Hasegawa, Hideyuki; Kanai, Hiroshi

    2005-08-01

    Endothelial dysfunction is considered to be an initial step of arteriosclerosis [R. Ross: N. Engl. J. Med. 340 (2004) 115]. For the assessment of the endothelium function, brachial artery flow-mediated dilation (FMD) caused by increased blood flow has been evaluated with ultrasonic diagnostic equipment. In the case of conventional methods, the change in artery diameter caused by FMD is measured [M. Hashimoto et al.: Circulation 92 (1995) 3431]. Although the arterial wall has a layered structure (intima, media, and adventitia), such a structure is not taken into account in conventional methods because the change in diameter depends on the characteristic of the entire wall. However, smooth muscle present only in the media contributes to FMD, whereas the collagen-rich hard adventitia does not contribute. In this study, we measure the change in elasticity of only the intima-media region including smooth muscle using the phased tracking method [H. Kanai et al.: IEEE Trans. Ultrason. Ferroelectr. Freq. Control 43 (1996) 791]. From the change in elasticity, FMD measured only for the intima-media region by our proposed method was found to be more sensitive than that measured for the entire wall by the conventional method.

  20. The asymmetric scent: ringtailed lemurs ( Lemur catta) have distinct chemical signatures in left and right brachial glands

    NASA Astrophysics Data System (ADS)

    Dapporto, Leonardo

    2008-10-01

    Distinctive cues are predicted to evolve when the benefits obtained by the recognition process overcome its costs. When individual recognition is particularly beneficial for both senders and receivers, the expression of strongly distinctive signals is predicted to evolve. On the other hand, it could be predicted that each individual should show a very stable individual signature. In the same perspective, a great stability of the individual signatures could be expected. Lemur catta is the first non-human primate in which olfactory individual recognition has been demonstrated on the basis of the specialized brachial gland secretions. In this paper, I performed gas chromatograph analyses of right and left gland samples collected in two different periods (breeding and non-breeding seasons) from seven males. The aim was to verify if a diversification in such cues, already demonstrated at the inter-individual level, also occurs at the intra-individual level between left and right glands. I verified, by discriminant analysis and chemical distance comparisons, that each gland of each lemur has its particular signature that is maintained through time. Moreover, such diversification resulted so marked to make the overall intra-individual chemical differences similar to/as strong as the inter-individual ones. Since in rodents several odors from different glands may be integrated in individual recognition, I suggest that bilateral diversification in L. catta scents may offer an enhanced distinctiveness that could provide benefits in mate choice and social relationships.

  1. Genome-Wide Association Study to Identify Common Variants Associated with Brachial Circumference: A Meta-Analysis of 14 Cohorts

    PubMed Central

    Boraska, Vesna; Day-Williams, Aaron; Franklin, Christopher S.; Elliott, Katherine S.; Panoutsopoulou, Kalliope; Tachmazidou, Ioanna; Albrecht, Eva; Bandinelli, Stefania; Beilin, Lawrence J.; Bochud, Murielle; Cadby, Gemma; Ernst, Florian; Evans, David M.; Hayward, Caroline; Hicks, Andrew A.; Huffman, Jennifer; Huth, Cornelia; James, Alan L.; Klopp, Norman; Kolcic, Ivana; Kutalik, Zoltán; Lawlor, Debbie A.; Musk, Arthur W.; Pehlic, Marina; Pennell, Craig E.; Perry, John R. B.; Peters, Annette; Polasek, Ozren; Pourcain, Beate St; Ring, Susan M.; Salvi, Erika; Schipf, Sabine; Staessen, Jan A.; Teumer, Alexander; Timpson, Nicholas; Vitart, Veronique; Warrington, Nicole M.; Yaghootkar, Hanieh; Zemunik, Tatijana; Zgaga, Lina; An, Ping; Anttila, Verneri; Borecki, Ingrid B.; Holmen, Jostein; Ntalla, Ioanna; Palotie, Aarno; Pietiläinen, Kirsi H.; Wedenoja, Juho; Winsvold, Bendik S.; Dedoussis, George V.; Kaprio, Jaakko; Province, Michael A.; Zwart, John-Anker; Burnier, Michel; Campbell, Harry; Cusi, Daniele; Davey Smith, George; Frayling, Timothy M.; Gieger, Christian; Palmer, Lyle J.; Pramstaller, Peter P.; Rudan, Igor; Völzke, Henry; Wichmann, H. -Erich; Wright, Alan F.; Zeggini, Eleftheria

    2012-01-01

    Brachial circumference (BC), also known as upper arm or mid arm circumference, can be used as an indicator of muscle mass and fat tissue, which are distributed differently in men and women. Analysis of anthropometric measures of peripheral fat distribution such as BC could help in understanding the complex pathophysiology behind overweight and obesity. The purpose of this study is to identify genetic variants associated with BC through a large-scale genome-wide association scan (GWAS) meta-analysis. We used fixed-effects meta-analysis to synthesise summary results across 14 GWAS discovery and 4 replication cohorts comprising overall 22,376 individuals (12,031 women and 10,345 men) of European ancestry. Individual analyses were carried out for men, women, and combined across sexes using linear regression and an additive genetic model: adjusted for age and adjusted for age and BMI. We prioritised signals for follow-up in two-stages. We did not detect any signals reaching genome-wide significance. The FTO rs9939609 SNP showed nominal evidence for association (p<0.05) in the age-adjusted strata for men and across both sexes. In this first GWAS meta-analysis for BC to date, we have not identified any genome-wide significant signals and do not observe robust association of previously established obesity loci with BC. Large-scale collaborations will be necessary to achieve higher power to detect loci underlying BC. PMID:22479309

  2. Subclinical Atherosclerosis in Patients with Cushing Syndrome: Evaluation with Carotid Intima-Media Thickness and Ankle-Brachial Index

    PubMed Central

    Petramala, Luigi; Lorenzo, D'Elia; Iannucci, Gino; Concistré, Antonio; Zinnamosca, Laura; Marinelli, Cristiano; De Vincentis, Giuseppe; Ciardi, Antonio; De Toma, Giorgio

    2015-01-01

    Background Cushing syndrome (CS) has been described as a killing disease due its cardiovascular complications. In fact, chronic cortisol excess leads to a constellation of complications, including hypertension, hyperglycemia, adiposity, and thromboembolism. The main vascular alteration associated with CS is atherosclerosis. Methods Aim of this study was to analyze carotid intima-media thickness (cIMT) and ankle-brachial index (ABI), two surrogate markers of subclinical atherosclerosis in a consecutive series of CS patients, compared to patients with essential hypertension (EH) and health subjects (HS). Results Patients with CS showed a significant increase (P<0.05) of cIMT (0.89±0.17 mm) compared to EH (0.81±0.16 mm) and HS (0.75±0.4 mm), with a high prevalence of plaque (23%; P<0.03). Moreover, CS patients showed a mean ABI values (1.07±0.02) significantly lower respect to HS (1.12±0.11; P<0.05), and a higher percentage (20%) of pathological values of ABI (≤0.9; P<0.03). Conclusion In conclusion, we confirmed and extended the data of cIMT in CS, and showed that the ABI represent another surrogate marker of subclinical atherosclerosis in this disease. PMID:26354490

  3. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis

    PubMed Central

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Shih, Ming-Chen Paul; Chang, Jer-Ming; Chen, Hung-Chun

    2016-01-01

    Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI < 0.95 or ≥0.95 and an AoAC score of >4 or ≤4 according to receiver operating characteristic curve. Those with an ABI < 0.95 and AoAC > 4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD. PMID:27608939

  4. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease.

    PubMed

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-01-01

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p < 0.001). PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p's < 0.001). As expected the ABI of treated limbs showed significant improvement post-revascularization (p < 0.001). ABI after revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI < 0.15). Interestingly, poor responders reported improvement in symptoms on the PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization. PMID:25993299

  5. Developing core sets for patients with obstetric brachial plexus injury based on the International Classification of Functioning, Disability and Health

    PubMed Central

    Duijnisveld, B. J.; Saraç, Ç.; Malessy, M. J. A.; Vliet Vlieland, T. P. M.; Nelissen, R. G. H. H.; Brachial Plexus Advisory Board, The ICF

    2013-01-01

    Background Symptoms of obstetric brachial plexus injury (OBPI) vary widely over the course of time and from individual to individual and can include various degrees of denervation, muscle weakness, contractures, bone deformities and functional limitations. To date, no universally accepted overall framework is available to assess the outcome of patients with OBPI. The objective of this paper is to outline the proposed process for the development of International Classification of Functioning, Disability and Health (ICF) Core Sets for patients with an OBPI. Methods The first step is to conduct four preparatory studies to identify ICF categories important for OBPI: a) a systematic literature review to identify outcome measures, b) a qualitative study using focus groups, c) an expert survey and d) a cross-sectional, multicentre study. A first version of ICF Core Sets will be defined at a consensus conference, which will integrate the evidence from the preparatory studies. In a second step, field-testing among patients will validate this first version of Core Sets for OBPI. Discussion The proposed method to develop ICF Core Sets for OBPI yields a practical tool for multiple purposes: for clinicians to systematically assess and evaluate the individual’s functioning, for researchers to design and compare studies, and for patients to get more insight into their health problems and their management. PMID:23836476

  6. Surgical correction of ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy sequelae.

    PubMed

    Bhardwaj, Praveen; Parekh, Harshil; Venkatramani, Hari; Raja Sabapathy, S

    2015-01-01

    Ulnar deviation deformity of the wrist in patients with birth brachial plexus palsy is an important cosmetic concern among the patients and their relatives; especially in the patients who have recovered the basic limb functions. Though there is ample literature available regarding the management of the shoulder deformity there is paucity of literature regarding management of wrist ulnar deviation deformity. We report our experience with correction of this deformity in five cases with isolated ulnar deviation deformity without forearm rotational deformity or weakness of the wrist muscles. All the patients underwent extensor carpi ulnaris (ECU) to extensor carpi radialis longus (ECRL) tendon transfer. At a minimum of 18 months follow-up all the patients and their families were satisfied with the cosmetic appearance of the limb. Correction of the deformity improves the appearance of the limb, improves self-confidence of the child, and allows them to integrate well into the society. Interestingly, the patients expressed improvement in their grip strength and overall hand function after this surgery. The notable functions which improved were easy reach of the hand-to-mouth for feeding and easy handling of the things requiring bimanual activities. Although the main aim of this operation was to correct the appearance of the hand it was found to be also functionally useful by the patients and hence we are encouraged to report it for wider use. The results were maintained during the follow-up period of as long as 47 months. PMID:25609294

  7. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

    PubMed Central

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-01-01

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p < 0.001). PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p’s < 0.001). As expected the ABI of treated limbs showed significant improvement post-revascularization (p < 0.001). ABI after revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI < 0.15). Interestingly, poor responders reported improvement in symptoms on the PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization. PMID:25993299

  8. MUSCLE TRANSFER FROM TRICEPS TO BICEPS IN PATIENTS WITH CHRONIC INJURY OF THE UPPER TRUNK OF THE BRACHIAL PLEXUS

    PubMed Central

    Souza, Fabiano Inúcio de; Saito, Mateus; Kimura, Luiz Koiti; Júnior, Rames Mattar; Zumiotti, Arnaldo Valdir

    2015-01-01

    Objective: To evaluate the results from transposition of the triceps for elbow flexion in patients with chronic and complete injury to the upper trunk of the brachial plexus. Methods: This was a retrospective study, including only patients who had biceps grade 0 and triceps grade 5, who underwent anterior transfer of the triceps muscle, performed between 1998 and 2005. The affected side, sex, type of accident, strength of elbow flexion, complications and patient satisfaction were investigated in 11 cases. Results: 10 patients were male; the age range was from 24 to 49 years, with a mean of 33.7 years. The minimum time between injury and surgery was 21 months (range 21-74 months). The left side was affected in eight cases, and the right only in three. Good results were obtained in 10 patients, who acquired elbow flexion strength of grade 3 (two cases) and grade 4 (eight cases), while one evolved unfavorably with grade 2 strength. Two cases had complications (initial compartment syndrome and insufficient tensioning). All the patients said that they were satisfied with the procedure. Conclusion: Anterior transposition of the triceps muscle provided patient satisfaction in all cases except one, attaining strength grade 4 in eight cases, grade 3 in two cases and grade 2 in one case. PMID:27022572

  9. The anesthetic considerations while performing supraclavicular brachial plexus block in emergency surgical patients using a nerve stimulator

    PubMed Central

    Tantry, Thrivikrama Padur; Shetty, Pramal; Shetty, Rithesh; Shenoy, Sunil P.

    2015-01-01

    Regional anesthesia is favored in patients who undergo emergency extremity (limb) surgery, and specifically so in the absence of fasting status. In the absence of ultrasonic guidance, the nerve stimulator still remains a valuable tool in performing a brachial block, but its use is difficult in an emergency surgical patient and greater cautious approach is essential. We identified the supraclavicular plexus by the nerve stimulation-motor response technique as follows. Anterior chest muscles contractions, diaphragmatic contraction, deltoid contractions, and posterior shoulder girdle muscle contractions when identified were taken as “negative response” with decreasing stimulating current. A forearm muscle contraction, especially “wrist flexion” and “finger flexion” at 0.5 mA of current was taken as “positive response.” If no positive response was identified, the “elbow flexion” was considered as the final positive response for successful drug placement. The series of patients had difficulty for administering both general and regional anesthesia and we considered them as complex scenarios. The risk of the block failure was weighed heavily against the benefits of its success. The described series includes patients who had successful outcomes in the end and the techniques, merits, and risks are highlighted. PMID:26417145

  10. Measurement characteristics of the ankle–brachial index: results from the Action for Health in Diabetes study

    PubMed Central

    Espeland, Mark A; Regensteiner, Judith G; Jaramillo, Sarah A; Gregg, Edward; Knowler, William C; Wagenknecht, Lynne E; Bahnson, Judy; Haffner, Steven; Hill, James; Hiatt, William R

    2009-01-01

    Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle–brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2–3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30–40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk. PMID:18687759

  11. Associations Between Ankle-Brachial Index and Cognitive Function: Results from the Lifestyle Interventions and Independence for Elders Trial

    PubMed Central

    Espeland, Mark A.; Newman, Anne B.; Sink, Kaycee; Gill, Thomas M.; King, Abby C.; Miller, Michael E.; Guralnik, Jack; Katula, Jeff; Church, Timothy; Manini, Todd; Reid, Kieran F.; McDermott, Mary M.

    2015-01-01

    OBJECTIVE To evaluate cross-sectional and longitudinal associations between ankle-brachial index (ABI) and indicators of cognitive function DESIGN Randomized clinical trial (Lifestyle Interventions and Independence for Elders Trial) SETTING Eight US academic centers PARTICIPANTS 1,601 adults (ages 70–89 years, sedentary, non-demented, and with functional limitations MEASUREMENTS Baseline ABI and interviewer- and computer-administered cognitive function assessments were obtained from which compared a physical activity intervention with a health education control. Cognitive function was re-assessed 24 months later (interviewer-administered) and 18 or 30 months later (computer-administered) and central adjudication was used to classify individuals as having mild cognitive impairment, probable dementia, or neither. RESULTS Lower ABI had a modest independent association poorer cognitive functioning at baseline (partial r=0.09; p<0.001). While, lower baseline ABI was not associated with overall changes in cognitive function test scores, it was associated with higher odds for two-year progression to a composite of either mild cognitive impairment or probable dementia (OR=2.60 per unit lower ABI; 95% confidence interval [1.06,6.37]). Across two years, changes in ABI were not associated with changes in cognitive function. CONCLUSION In an older cohort of non-demented sedentary individuals with functional limitations, lower baseline ABI was independently correlated with cognitive function and associated with greater 2-year risk for progression to mild cognitive impairment or probable dementia. PMID:25869993

  12. Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation

    PubMed Central

    Olcaysu, Osman Okan; Cadirci, Kenan; Durur Karakaya, Afak; Bayramlar, Huseyin

    2015-01-01

    Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation. Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE). The patient's best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared. Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves. PMID:25705536

  13. Imaging of Acute Pancreatitis.

    PubMed

    Thoeni, Ruedi F

    2015-11-01

    Acute pancreatitis is an acute inflammation of the pancreas. Several classification systems have been used in the past but were considered unsatisfactory. A revised Atlanta classification of acute pancreatitis was published that assessed the clinical course and severity of disease; divided acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis; discerned an early phase (first week) from a late phase (after the first week); and focused on systemic inflammatory response syndrome and organ failure. This article focuses on the revised classification of acute pancreatitis, with emphasis on imaging features, particularly on newly-termed fluid collections and implications for the radiologist. PMID:26526433

  14. Measurement of brachial artery endothelial function using a standard blood pressure cuff.

    PubMed

    Maltz, Jonathan S; Tison, Geoffrey H; Alley, Hugh F; Budinger, Thomas F; Owens, Christopher D; Olgin, Jeffrey

    2015-11-01

    The integrity of endothelial function in major arteries (EFMA) is a powerful independent predictor of heart attack and stroke. Existing ultrasound-based non-invasive assessment methods are technically challenging and suitable only for laboratory settings. EFMA, like blood pressure (BP), is both acutely and chronically affected by factors such as lifestyle and medication. Consequently, laboratory-based measurements cannot fully gauge the effects of medical interventions on EFMA. EFMA and BP have, arguably, comparable (but complementary) value in the assessment of cardiovascular health. Widespread deployment of EFMA assessment is thus a desirable clinical goal. To this end, we propose a device based on modifying the measurement protocol of a standard electronic sphygmomanometer. The protocol involves inflating the cuff to sub-diastolic levels to enable recording of the pulse waveform before and after vasodilatory stimulus. The mechanical unloading of the arterial wall provided by the cuff amplifies the distension that occurs with each pulse, which is measured as a pressure variation in the cuff. We show that the height of the rising edge of each pulse is proportional to the change in lumen area between diastole and systole. This allows the effect of vasodilatory stimuli on the artery to be measured with high sensitivity. We compare the proposed cuff flow-mediated dilation (cFMD) method to ultrasound flow-mediated dilation (uFMD). We find significant correlation (r = 0.55, p = 0.003, N = 27) between cFMD- and uFMD-based metrics obtained when the release of a 5 min cuff occlusion is employed to induce endothelial stimulus via reactive hyperemia. cFMD is approximately proportional to the square of uFMD, representing a typical increase in sensitivity to vasodilation of 300-600%. This study illustrates the potential for an individual to conveniently measure his/her EFMA by using a low-cost reprogrammed home sphygmomanometer. PMID:26393958

  15. Measurement of brachial artery endothelial function using a standard blood pressure cuff

    PubMed Central

    Maltz, Jonathan S; Tison, Geoffrey H; Alley, Hugh F; Budinger, Thomas F; Owens, Christopher D; Olgin, Jeffrey

    2016-01-01

    The integrity of endothelial function in major arteries (EFMA) is a powerful independent predictor of heart attack and stroke. Existing ultrasound-based non-invasive assessment methods are technically challenging and suitable only for laboratory settings. EFMA, like blood pressure (BP), is both acutely and chronically affected by factors such as lifestyle and medication. Consequently, lab-based measurements cannot fully gauge the effects of medical interventions on EFMA. EFMA and BP have, arguably, comparable (but complementary) value in the assessment of cardiovascular health. Widespread deployment of EFMA assessment is thus a desirable clinical goal. To this end, we propose a device based on modifying the measurement protocol of a standard electronic sphygmomanometer. Methods The protocol involves inflating the cuff to sub-diastolic levels to enable recording of the pulse waveform before and after vasodilatory stimulus. The mechanical unloading of the arterial wall provided by the cuff amplifies the distension that occurs with each pulse, which is measured as a pressure variation in the cuff. We show that the height of the rising edge of each pulse is proportional to the change in lumen area between diastole and systole. This allows the effect of vasodilatory stimuli on the artery to be measured with high sensitivity. We compare the proposed cuff flow-mediated dilation (cFMD) method to ultrasound FMD (uFMD). Results We find significant correlation (r=0.55, p = 0.003, N=27) between cFMD- and uFMD-based metrics obtained when the release of a 5-minute cuff occlusion is employed to induce endothelial stimulus via reactive hyperemia. cFMD is approximately proportional to the square of uFMD, representing a typical increase in sensitivity to vasodilation of 300–600%. Conclusion This study illustrates the potential for an individual to conveniently measure his/her EFMA by using a low-cost reprogrammed home sphygmomanometer. PMID:26393958

  16. Acute loss of consciousness.

    PubMed

    Tristán, Bekinschtein; Gleichgerrcht, Ezequiel; Manes, Facundo

    2015-01-01

    Acute loss of consciousness poses a fascinating scenario for theoretical and clinical research. This chapter introduces a simple yet powerful framework to investigate altered states of consciousness. We then explore the different disorders of consciousness that result from acute brain injury, and techniques used in the acute phase to predict clinical outcome in different patient populations in light of models of acute loss of consciousness. We further delve into post-traumatic amnesia as a model for predicting cognitive sequels following acute loss of consciousness. We approach the study of acute loss of consciousness from a theoretical and clinical perspective to conclude that clinicians in acute care centers must incorporate new measurements and techniques besides the classic coma scales in order to assess their patients with loss of consciousness. PMID:25702218

  17. Decitabine in Treating Children With Relapsed or Refractory Acute Myeloid Leukemia or Acute Lymphoblastic Leukemia

    ClinicalTrials.gov

    2013-01-22

    Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Promyelocytic Leukemia (M3); Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia

  18. Pain relief after ambulatory hand surgery: A comparison between dexmedetomidine and clonidine as adjuvant in axillary brachial plexus block: A prospective, double-blinded, randomized controlled study

    PubMed Central

    Das, A; Dutta, S; Chattopadhyay, S; Chhaule, S; Mitra, T; Banu, R; Mandal, P; Chandra, M

    2016-01-01

    Background: For ages various adjuvants have been tried to prolong axillary brachial plexus block. We compared the effect of adding dexmedetomidine versus clonidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. Materials and Methods: A total of 90 patients (20-40 years) posted for ambulatory elective hand surgery under axillary brachial plexus block were divided into two equal groups (groups ropivacaine dexmedetomidine [RD] and ropivacaine clonidine [RC]) in a randomized, double-blind fashion. In group RD (n = 45) 30 ml 0.5% ropivacaine + 100 μg of dexmedetomidine and group RC (n = 45) 30 ml 0.5% ropivacaine + 75 μg clonidine were administered in axillary plexus block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics and side-effects were recorded for each patient. Results: Though with similar demographic profile in both groups, sensory and motor block in group RD (P < 0.05) was earlier than group RC. Sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RD (P < 0.05) than group RC. Postoperative VAS value at 18 h were significantly lower in group RD (P < 0.05). Intraoperative hemodynamics were insignificantly lower in group RD (P < 0.05) without any appreciable side-effects. Conclusion: It can be concluded that adding dexmedetomidine to axillary plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side-effects. PMID:26955303

  19. Association of Aortic Compliance and Brachial Endothelial Function with Cerebral Small Vessel Disease in Type 2 Diabetes Mellitus Patients: Assessment with High-Resolution MRI.

    PubMed

    Shan, Yan; Lin, Jiang; Xu, Pengju; Zeng, Mengsu; Lin, Huandong; Yan, Hongmei

    2016-01-01

    Objective. To assess the possible association of aortic compliance and brachial endothelial function with cerebral small vessel disease in type 2 diabetes mellitus (DM2) patients by using 3.0 T high-resolution magnetic resonance imaging. Methods. Sixty-two clinically confirmed DM2 patients (25 women and 37 men; mean age: 56.8 ± 7.5 years) were prospectively enrolled for noninvasive MR examinations of the aorta, brachial artery, and brain. Aortic arch pulse wave velocity (PWV), flow-mediated dilation (FMD) of brachial artery, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Pearson and Spearman correlation analysis were performed to analyze the association between PWV and FMD with clinical data and biochemical test results. Univariable logistic regression analyses were used to analyze the association between PWV and FMD with cerebral small vessel disease. Multiple logistic regression analyses were used to find out the independent predictive factors of cerebral small vessel disease. Results. Mean PWV was 6.73 ± 2.00 m/s and FMD was 16.67 ± 9.11%. After adjustment for compounding factors, PWV was found significantly associated with lacunar brain infarcts (OR = 2.00; 95% CI: 1.14-3.2; P < 0.05) and FMD was significantly associated with periventricular WMHs (OR = 0.82; 95% CI: 0.71-0.95; P < 0.05). Conclusions. Quantitative evaluation of aortic compliance and endothelial function by using high-resolution MRI may be potentially useful to stratify DM2 patients with risk of cerebral small vessel disease. PMID:27525261

  20. Association of Aortic Compliance and Brachial Endothelial Function with Cerebral Small Vessel Disease in Type 2 Diabetes Mellitus Patients: Assessment with High-Resolution MRI

    PubMed Central

    Shan, Yan; Zeng, Mengsu; Lin, Huandong; Yan, Hongmei

    2016-01-01

    Objective. To assess the possible association of aortic compliance and brachial endothelial function with cerebral small vessel disease in type 2 diabetes mellitus (DM2) patients by using 3.0 T high-resolution magnetic resonance imaging. Methods. Sixty-two clinically confirmed DM2 patients (25 women and 37 men; mean age: 56.8 ± 7.5 years) were prospectively enrolled for noninvasive MR examinations of the aorta, brachial artery, and brain. Aortic arch pulse wave velocity (PWV), flow-mediated dilation (FMD) of brachial artery, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Pearson and Spearman correlation analysis were performed to analyze the association between PWV and FMD with clinical data and biochemical test results. Univariable logistic regression analyses were used to analyze the association between PWV and FMD with cerebral small vessel disease. Multiple logistic regression analyses were used to find out the independent predictive factors of cerebral small vessel disease. Results. Mean PWV was 6.73 ± 2.00 m/s and FMD was 16.67 ± 9.11%. After adjustment for compounding factors, PWV was found significantly associated with lacunar brain infarcts (OR = 2.00; 95% CI: 1.14–3.2; P < 0.05) and FMD was significantly associated with periventricular WMHs (OR = 0.82; 95% CI: 0.71–0.95; P < 0.05). Conclusions. Quantitative evaluation of aortic compliance and endothelial function by using high-resolution MRI may be potentially useful to stratify DM2 patients with risk of cerebral small vessel disease. PMID:27525261