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Sample records for nerve sheath decompression

  1. Optic Nerve Decompression

    MedlinePlus

    ... canals). The optic nerve is the “nerve of vision” and extends from the brain, through your skull, and into your eye. A ... limited to, the following: loss of vision, double vision, inadequate ... leakage of brain fluid (CSF), meningitis, nasal bleeding, infection of the ...

  2. Malignant Peripheral Nerve Sheath Tumor.

    PubMed

    James, Aaron W; Shurell, Elizabeth; Singh, Arun; Dry, Sarah M; Eilber, Fritz C

    2016-10-01

    Malignant peripheral nerve sheath tumor (MPNST) is the sixth most common type of soft tissue sarcoma. Most MPNSTs arise in association with a peripheral nerve or preexisting neurofibroma. Neurofibromatosis type is the most important risk factor for MPNST. Tumor size and fludeoxyglucose F 18 avidity are among the most helpful parameters to distinguish MPNST from a benign peripheral nerve sheath tumor. The histopathologic diagnosis is predominantly a diagnosis of light microscopy. Immunohistochemical stains are most helpful to distinguish high-grade MPNST from its histologic mimics. Current surgical management of high-grade MPNST is similar to that of other high-grade soft tissue sarcomas. PMID:27591499

  3. Delayed facial nerve decompression for Bell's palsy.

    PubMed

    Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

    2016-07-01

    Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity. PMID:26319412

  4. Delayed facial nerve decompression for Bell's palsy.

    PubMed

    Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

    2016-07-01

    Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

  5. Malignant Peripheral Nerve Sheath Tumors.

    PubMed

    Durbin, Adam D; Ki, Dong Hyuk; He, Shuning; Look, A Thomas

    2016-01-01

    Malignant peripheral nerve sheath tumors (MPNST) are tumors derived from Schwann cells or Schwann cell precursors. Although rare overall, the incidence of MPNST has increased with improved clinical management of patients with the neurofibromatosis type 1 (NF1) tumor predisposition syndrome. Unfortunately, current treatment modalities for MPNST are limited, with no targeted therapies available and poor efficacy of conventional radiation and chemotherapeutic regimens. Many murine and zebrafish models of MPNST have been developed, which have helped to elucidate the genes and pathways that are dysregulated in MPNST tumorigenesis, including the p53, and the RB1, PI3K-Akt-mTOR, RAS-ERK and Wnt signaling pathways. Preclinical results have suggested that new therapies, including mTOR and ERK inhibitors, may synergize with conventional chemotherapy in human tumors. The discovery of new genome editing technologies, like CRISPR-cas9, and their successful application to the zebrafish model will enable rapid progress in the faithful modeling of MPNST molecular pathogenesis. The zebrafish model is especially suited for high throughput screening of new targeted therapeutics as well as drugs approved for other purposes, which may help to bring enhanced treatment modalities into human clinical trials for this devastating disease. PMID:27165368

  6. Optic Nerve Sheath Mechanics in VIIP Syndrome

    NASA Technical Reports Server (NTRS)

    Raykin, Julia; Feola, Andrew; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian; Ethier, C. Ross

    2015-01-01

    Visual Impairment and Intracranial Pressure (VIIP) syndrome results in a loss of visual function and occurs in astronauts following long-duration spaceflight. Understanding the mechanisms that lead to the ocular changes involved in VIIP is of critical importance for space medicine research. Although the exact mechanisms of VIIP are not yet known, it is hypothesized that microgravity-induced increases in intracranial pressures (ICP) drive the remodeling of the optic nerve sheath, leading to compression of the optic nerve which in turn may reduce visual acuity. Some astronauts present with a kink in the optic nerve after return to earth, suggesting that tissue remodeling in response to ICP increases may be taking place. The goal of this work is to characterize the mechanical properties of the optic nerve sheath (dura mater) to better understand its biomechanical response to increased ICP.

  7. Optic Nerve Sheath Mechanics in VIIP Syndrome

    NASA Technical Reports Server (NTRS)

    Raykin, Julia; Forte, Taylor E.; Wang, Roy; Feola, Andrew; Samuels, Brian; Myers, Jerry; Nelson, Emily; Gleason, Rudy; Ethier, C. Ross

    2016-01-01

    Visual Impairment Intracranial Pressure (VIIP) syndrome is a major concern in current space medicine research. While the exact pathology of VIIP is not yet known, it is hypothesized that the microgravity-induced cephalad fluid shift increases intracranial pressure (ICP) and drives remodeling of the optic nerve sheath. To investigate this possibility, we are culturing optic nerve sheath dura mater samples under different pressures and investigating changes in tissue composition. To interpret results from this work, it is essential to first understand the biomechanical response of the optic nerve sheath dura mater to loading. Here, we investigated the effects of mechanical loading on the porcine optic nerve sheath.Porcine optic nerves (number: 6) were obtained immediately after death from a local abattoir. The optic nerve sheath (dura mater) was isolated from the optic nerve proper, leaving a hollow cylinder of connective tissue that was used for biomechanical characterization. We developed a custom mechanical testing system that allowed for unconfined lengthening, twisting, and circumferential distension of the dura mater during inflation and under fixed axial loading. To determine the effects of variations in ICP, the sample was inflated (0-60 millimeters Hg) and circumferential distension was simultaneously recorded. These tests were performed under variable axial loads (0.6 grams - 5.6 grams at increments of 1 gram) by attaching different weights to one end of the dura mater. Results and Conclusions: The samples demonstrated nonlinear behavior, similar to other soft connective tissue (Figure 1). Large increases in diameter were observed at lower transmural pressures (approximately 0 to 5 millimeters Hg), whereas only small diameter changes were observed at higher pressures. Particularly interesting was the existence of a cross-over point at a pressure of approximately 11 millimeters Hg. At this pressure, the same diameter is obtained for all axial loads applied

  8. Optic Nerve Decompression through a Supraorbital Approach

    PubMed Central

    Rigante, Luigi; Evins, Alexander I.; Berra, Luigi V.; Beer-Furlan, André; Stieg, Philip E.; Bernardo, Antonio

    2015-01-01

    Objective We propose a stepwise decompression of the optic nerve (ON) through a supraorbital minicraniotomy and describe the surgical anatomy of the ON as seen through this approach. We also discuss the clinical applications of this approach. Methods Supraorbital approaches were performed on 10 preserved cadaveric heads (20 sides). First, 3.5-cm skin incisions were made along the supraciliary arch from the medial third of the orbit and extended laterally. A 2 × 3-cm bone flap was fashioned and extradural dissections were completed. A 180-degree unroofing of the ON was achieved, and the length and width of the proximal and distal portions of the optic canal (OC) were measured. Results The supraorbital minicraniotomy allowed for identification of the anterior clinoid process and other surgical landmarks and adequate drilling of the roof of the OC with a comfortable working angle. A 25-degree contralateral head rotation facilitated visualization of the ON. Conclusion The supraorbital approach is a minimally invasive and cosmetically favorable alternative to more extended approaches with longer operative times used for the management of ON decompression in posttraumatic or compressive optic neuropathy from skull base pathologies extending into the OC. The relative ease of this approach provides a relatively short learning curve for developing neurosurgeons. PMID:26225308

  9. ULTRASTRUCTURE OF THE PRAWN NERVE SHEATHS

    PubMed Central

    Doggenweiler, C. F.; Heuser, John E.

    1967-01-01

    The sheaths from freshly teased nerve fibers of the prawn exhibit a positive radial birefringence, consistent with their EM appearance as highly organized laminated structures composed of numerous thin cytoplasmic sheets or laminae bordered by unit membranes and arranged concentrically around the axon. The closely apposed membranes in these sheaths are fragile and often break down into rows of vesicles during fixation. Desmosome-like attachment zones occur in many regions of the sheath. The membranes within these zones resist vesiculation and thereby provide a "control" region for relating the type of vesicles formed in the fragile portions of the sheaths to the specific fixation conditions. It is proposed that during fixation the production of artifactual vesicles is governed by an interplay of three factors: (a) direct chemical action of the fixative on the polar strata of adjacent unit membranes, (b) osmotic forces applied to membranes during fixation, and (c) the pre-existing natural relations between adjacent membranes. It is found that permanganate best preserves the continuity of the membranes but will still produce vesicles if the fixative exerts severe osmotic forces. These results support other reports (19) of the importance of comparing tissues fixed by complementary procedures so that systematic artifacts will not be described as characteristic of the natural state. PMID:4166578

  10. Radiation-induced malignant and atypical peripheral nerve sheath tumors

    SciTech Connect

    Foley, K.M.; Woodruff, J.M.; Ellis, F.T.; Posner, J.B.

    1980-04-01

    The reported peripheral nerve complications of therapeutic irradiation in humans include brachial and lumbar plexus fibrosis and cranial and peripheral nerve atrophy. We have encountered 9 patients with malignant (7) and atypical (2) peripheral nerve tumors occurring in an irradiated site suggesting that such tumors represent another delayed effect of radiation treatment on peripheral nerve. In all instances the radio-theray was within an acceptable radiation dosage, yet 3 patients developed local radiation-induced skin and bony abnormalities. The malignant peripheral nerve sheath tumors developed only in the radiation port. Animal studies support the clinical observation that malignant peripheral nerve sheath tumors can occur as a delayed effect of irradiation.

  11. Hemimasticatory spasm treated with microvascular decompression of the trigeminal nerve.

    PubMed

    Chon, Kyu-Hyon; Lee, Jong-Myong; Koh, Eun-Jeong; Choi, Ha-Young

    2012-09-01

    Hemimasticatory spasm is a very rare disorder of the trigeminal nerve characterized by paroxysmal involuntary contraction of the jaw-closing muscles. The mechanisms leading to hemimasticatory spasm are still unclear. Recently, injection of botulinum toxin has become the treatment of choice due to its excellent results. We report a case of a successful treatment of hemimasticatory spasm via microvascular decompression of the motor branch of the trigeminal nerve.

  12. Arthroscopic suprascapular nerve decompression: transarticular and subacromial approach.

    PubMed

    Bhatia, Sanjeev; Chalmers, Peter N; Yanke, Adam B; Romeo, Anthony A; Verma, Nikhil N

    2012-12-01

    Entrapment of the suprascapular nerve (SSN) is an increasingly recognized entity that can occur due to traction or compression-related etiology. Traction injuries of the SSN are unlikely to respond to surgical management and frequently improve with rest and avoidance of overhead activity. Compression injuries, on the other hand, frequently require surgical decompression for pain relief. SSN entrapment caused by compression at the suprascapular notch by the transverse scapular ligament gives rise to pain and atrophy of both the supraspinatus and infraspinatus muscles. However, compression at the spinoglenoid notch is more insidious because pain fibers may not be involved, causing isolated external rotation weakness. We present our preferred surgical technique for safe decompression of the SSN at the suprascapular and spinoglenoid notch using a subacromial and intra-articular approach, respectively. The key to ensuring efficient and uncomplicated decompression of the SSN relies on an intimate knowledge of the neurovascular anatomy and related landmarks.

  13. Malignant Peripheral Nerve Sheath Tumor -A Rare Malignancy in Mandible.

    PubMed

    Majumdar, Sumit; Kotina, Sreekanth; Mahesh, Nirujogi; Uppala, Divya; Kumar, Singam Praveen

    2016-06-01

    Malignant Peripheral Nerve Sheath Tumor (MPNST) is biologically an aggressive tumor that is usually found in the extremities, trunk and infrequently found in the head and neck area particularly in the jaws, arising from the cells allied with nerve sheath. Mandibular MPNST may either arise from a preexisting neurofibroma or develop de novo. Because of the greater variability from case to case in overall appearance both clinically and histologically, a case of MPNST of the mandible in a 25-year-old female patient is reported. The lesion was excised and immunohistological studies (S-100 & Neuron specific enolase) were conducted to confirm the neural origin.

  14. Malignant Peripheral Nerve Sheath Tumor -A Rare Malignancy in Mandible

    PubMed Central

    Majumdar, Sumit; Kotina, Sreekanth; Uppala, Divya; Kumar, Singam Praveen

    2016-01-01

    Malignant Peripheral Nerve Sheath Tumor (MPNST) is biologically an aggressive tumor that is usually found in the extremities, trunk and infrequently found in the head and neck area particularly in the jaws, arising from the cells allied with nerve sheath. Mandibular MPNST may either arise from a preexisting neurofibroma or develop de novo. Because of the greater variability from case to case in overall appearance both clinically and histologically, a case of MPNST of the mandible in a 25-year-old female patient is reported. The lesion was excised and immunohistological studies (S-100 & Neuron specific enolase) were conducted to confirm the neural origin. PMID:27504425

  15. Ewing sarcoma mimicking a peripheral nerve sheath tumor.

    PubMed

    Mitchell, B D; Fox, B D; Viswanathan, A; Mitchell, A H; Powell, S Z; Cech, D A

    2010-10-01

    We describe the first patient with an extradural, extramedullary Ewing's sarcoma tumor mimicking a nerve sheath tumor with no overt evidence of metastasis. A 28-year-old woman with no past medical history presented with a progressive 3-year history of low back pain and right-sided lower extremity radiculopathy after having failed conservative therapies. MRI of the lumbar spine revealed a right-sided enhancing, dumbbell-shaped lesion at the right neural foramen appearing to originate from the L4 nerve root, suspicious for a peripheral nerve sheath tumor or schwannoma. The patient and findings are discussed in the context of the literature, including an update on the relatively recent diagnostic redesignation of the Ewing's sarcoma family tumors.

  16. Effect of optic nerve sheath fenestration for idiopathic intracranial hypertension on retinal nerve fiber layer thickness.

    PubMed

    Starks, Victoria; Gilliland, Grant; Vrcek, Ivan; Gilliland, Connor

    2016-01-01

    The objective of the study was to evaluate whether optic nerve sheath fenestration in patients with idiopathic intracranial hypertension was associated with improvement in visual field pattern deviation and optical coherence tomography retinal nerve fiber layer thickness.The records of 13 eyes of 11 patients who underwent optic nerve sheath fenestration were reviewed. The subjects were patients of a clinical practice in Dallas, Texas. Charts were reviewed for pre- and postoperative visual field pattern deviation (PD) and retinal nerve fiber layer thickness (RNFL).PD and RNFL significantly improved after surgery. Average PD preoperatively was 8.51 DB and postoperatively was 4.80 DB (p = 0.0002). Average RNFL preoperatively was 113.63 and postoperatively was 102.70 (p = 0.01). The preoperative PD and RNFL did not correlate strongly.Our results demonstrate that PD and RNFL are improved after optic nerve sheath fenestration. The pre- and postoperative RNFL values were compared to the average RNFL value of healthy optic nerves obtained from the literature. Post-ONSF RNFL values were significantly closer to the normal value than preoperative. RNFL is an objective parameter for monitoring the optic nerve after optic nerve sheath fenestration. This study adds to the evidence that OCT RNFL may be an effective monitoring tool for patients with IIH and that it continues to be a useful parameter after ONSF.

  17. Cystic change in primary paediatric optic nerve sheath meningioma.

    PubMed

    Narayan, Daniel; Rajak, Saul; Patel, Sandy; Selva, Dinesh

    2016-08-01

    Primary optic nerve sheath meningiomas (PONSM) are rare in children. Cystic meningiomas are an uncommon subgroup of meningiomas. We report a case of paediatric PONSM managed using observation alone that underwent cystic change and radiological regression. A 5-year-old girl presented with visual impairment and proptosis. Magnetic resonance (MR) imaging demonstrated a PONSM. The patient was left untreated and followed up with regular MR imaging. Repeat imaging at 16 years of age showed the tumour had started to develop cystic change. Repeat imaging at 21 years of age showed the tumour had decreased in size. PMID:27310300

  18. Microgravity-Driven Optic Nerve/Sheath Biomechanics Simulations

    NASA Technical Reports Server (NTRS)

    Ethier, C. R.; Feola, A.; Myers, J. G.; Nelson, E.; Raykin, J.; Samuels, B.

    2016-01-01

    Visual Impairment and Intracranial Pressure (VIIP) syndrome is a concern for long-duration space flight. Current thinking suggests that the ocular changes observed in VIIP syndrome are related to cephalad fluid shifts resulting in altered fluid pressures [1]. In particular, we hypothesize that increased intracranial pressure (ICP) drives connective tissue remodeling of the posterior eye and optic nerve sheath (ONS). We describe here finite element (FE) modeling designed to understand how altered pressures, particularly altered ICP, affect the tissues of the posterior eye and optic nerve sheath (ONS) in VIIP. METHODS: Additional description of the modeling methodology is provided in the companion IWS abstract by Feola et al. In brief, a geometric model of the posterior eye and optic nerve, including the ONS, was created and the effects of fluid pressures on tissue deformations were simulated. We considered three ICP scenarios: an elevated ICP assumed to occur in chronic microgravity, and ICP in the upright and supine positions on earth. Within each scenario we used Latin hypercube sampling (LHS) to consider a range of ICPs, ONH tissue mechanical properties, intraocular pressures (IOPs) and mean arterial pressures (MAPs). The outcome measures were biomechanical strains in the lamina cribrosa, optic nerve and retina; here we focus on peak values of these strains, since elevated strain alters cell phenotype and induce tissue remodeling. In 3D, the strain field can be decomposed into three orthogonal components, denoted as first, second and third principal strains. RESULTS AND CONCLUSIONS: For baseline material properties, increasing ICP from 0 to 20 mmHg significantly changed strains within the posterior eye and ONS (Fig. 1), indicating that elevated ICP affects ocular tissue biomechanics. Notably, strains in the lamina cribrosa and retina became less extreme as ICP increased; however, within the optic nerve, the occurrence of such extreme strains greatly increased as

  19. Primary malignant peripheral nerve sheath tumor at unusual location

    PubMed Central

    Panigrahi, Souvagya; Mishra, Sudhansu Sekhar; Das, Srikant; Dhir, Manmath Kumar

    2013-01-01

    Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma. Most arise in association with major nerve trunks. Their most common anatomical sites are the proximal portions of the upper and lower extremities and the trunk. MPNSTs have rarely been reported in literature to occur in other unusual body parts. We review all such cases reported till now in terms of site of origin, surgical treatment, adjuvant therapy and outcome and shortly describe our experience with two of these cases. Both of our case presented with lump at unusual sites resembling neurofibroma, one at orbitotemporal area and other in the paraspinal region with characteristic feature of neurofibroma with the exception that both had very short history of progression. They underwent gross total removal of the tumor with adjuvant radiotherapy postoperatively. At 6-month follow-up both are doing well with no evidence of recurrence. PMID:24174807

  20. Nocturnal ultrasound measurements of optic nerve sheath diameter correlate with intracranial pressure in children with craniosynostosis.

    PubMed

    Driessen, Caroline; van Veelen, Marie-Lise C; Lequin, Maarten; Joosten, Koen F M; Mathijssen, Irene M J

    2012-09-01

    Children with craniosynostosis are at risk for increased intracranial pressure, and additional possibilities to screen for increased intracranial pressure are required. The authors' aim was to use ultrasound measurements of the optic nerve sheath to understand and express the variability of intracranial pressure in syndromic craniosynostosis. Therefore, five pediatric patients with craniosynostosis underwent invasive 24-hour intracranial pressure monitoring and simultaneous optic nerve sheath measurements. In three patients, the intracranial pressure was abnormal, and during the second half of the night, the optic nerve sheath was increased in all three patients. The optic nerve sheath diameter changes during the night and is as dynamic as the intracranial pressure. To the best of their knowledge, the authors are the first to describe a real-time relationship of the optic nerve sheath with increased intracranial pressure in children.

  1. Excellent response of malignant peripheral nerve sheath tumour of retroperitoneum to radiation therapy

    PubMed Central

    Akhavan, Ali; Binesh, Fariba; Ghannadi, Fazlollah; Navabii, Hossein

    2012-01-01

    Malignant peripheral nerve sheath tumours are high-grade sarcomas originating from Schwann cells or nerve sheath cells. Most of these tumours are associated with major nerves of the body wall and extremities. The lower extremity and the retroperitoneum are the most common sites. Surgery is the cornerstone of treatment, however, radiation therapy is usually used as an adjuvant treatment. In this paper we present a 57-year-old Iranian woman with malignant peripheral nerve sheath tumour of retroperitoneum who was operated subtotally and then underwent radiation therapy which led to disappearance of all gross residual disease. PMID:23257269

  2. Cerebral malignant nerve sheath tumor, triton tumor variant: case report.

    PubMed

    Bornstein-Quevedo, Leticia; Peralta-Olvera, Fabiola; Marhx-Bracho, Alfonso; Rodríguez-Jurado, Rodolfo; De Leon-Bojorge, Beatriz

    2003-01-01

    A case of a cerebral malignant triton tumor in a 3-year-old boy with a 2-month history of frontal headache and no clinical evidence of neurofibromatosis is reported. The computed tomography (CT) scan showed a large, irregular tumor in the right parietooccipital lobe. A partial surgical resection was performed. Histologically, the tumor was highly cellular and consisted of spindle cells with hyperchromatic and pleomorphic nuclei. Focally, neoplastic cells with rhabdomyoblastic features were found. The immunohistochemical study showed that tumor cells were positive for S-100 protein and CD57, and the rhabdomyoblasts expressed desmin, Myo-D1, and myoglobin. During the postoperative period, a massive intraparenchymal hemorrhage was identified and surgical drainage was performed. The patient worsened and died 10 days after the first surgery. Postmortem study was not authorized. Six cases of cerebral malignant nerve sheath tumor have been described; however, primary intraparenchymal malignant triton tumor has not been previously described.

  3. Endoscopic Sciatic Nerve Decompression in the Prone Position-An Ischial-Based Approach.

    PubMed

    Jackson, Timothy J

    2016-06-01

    Deep gluteal syndrome is described as sciatic nerve entrapment in the region deep to the gluteus maximus muscle. The entrapment can occur from the piriformis muscle, fibrous bands, blood vessels, and hamstrings. Good clinical outcomes have been shown in patients treated by open and endoscopic means. Sciatic nerve decompression with or without piriformis release provides a surgical solution to a difficult diagnostic and therapeutic problem. Previous techniques have used open methods that can now performed endoscopically. The technique of an endoscopic approach to sciatic nerve decompression in the prone position is described as well as its advantages and common findings. Through this ischial-based approach, a familiar anatomy is seen and areas of sciatic nerve entrapment can be readily identified and safely decompressed. PMID:27656390

  4. Biomechanics of the Optic Nerve Sheath in VIIP Syndrome

    NASA Technical Reports Server (NTRS)

    Ethier, C. Ross; Raykin, Julia; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian C.

    2014-01-01

    Long-duration space flight carries the risk of developing Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath (ONS), optic nerve kinking and potentially permanent degradation of visual function. The slow onset of VIIP, its chronic nature, and certain clinical features strongly suggest that biomechanical factors acting on the ONS play a role in VIIP. Here we measure several relevant ONS properties needed to model VIIP biomechanics. The ONS (meninges) of fresh porcine eyes (n7) was reflected, the nerve proper was truncated near the sclera, and the meninges were repositioned to create a hollow cylinder of meningeal connective tissue attached to the posterior sclera. The distal end was cannulated, sealed, and pressure clamped (mimicking cerebrospinal fluid [CSF] pressure), while the eye was also cannulated for independent control of intraocular pressure (IOP). The meninges were inflated (CSF pressure cycling 7-50 mmHg) while ONS outer diameter was imaged. In another set of experiments (n4), fluid permeation rate across the meninges was recorded by observing the drainage of an elevated fluid reservoir (30 mmHg) connected to the meninges. The ONS showed behavior typical of soft tissues: viscoelasticity, with hysteresis in early preconditioning cycles and repeatable behavior after 4 cycles, and nonlinear stiffening, particularly at CSF pressures 15 mmHg (Figure). Tangent moduli measured from the loading curve were 372 101, 1199 358, and 2050 379 kPa (mean SEM) at CSF pressures of 7, 15 and 30 mmHg, respectively. Flow rate measurements through the intact meninges at 30mmHg gave a permeability of 1.34 0.46 lmincm2mmHg (mean SEM). The ONS is a tough, strain-stiffening connective tissue that is surprisingly permeable. The latter observation suggests that there could be significant CSF drainage through the ONS into the orbit, likely important

  5. Optic Nerve Sheath Mechanics and Permeability in VIIP Syndrome

    NASA Technical Reports Server (NTRS)

    Raykin, Julia; Best, Lauren; Gleason, Rudy; Mulugeta, Lealem; Myers, Jerry; Nelson, Emily; Samuels, Brian C.; Ethier, C. R.

    2014-01-01

    Long-duration space flight carries the risk of developing Visual Impairment and Intracranial Pressure (VIIP) syndrome, a spectrum of ophthalmic changes including posterior globe flattening, choroidal folds, distension of the optic nerve sheath (ONS), optic nerve kinking and potentially permanent degradation of visual function. The slow onset of VIIP, its chronic nature, and certain clinical features strongly suggest that biomechanical factors acting on the ONS play a role in VIIP. Here we measure several relevant ONS properties needed to model VIIP biomechanics. The ONS (meninges) of fresh porcine eyes (n7) was reflected, the nerve proper was truncated near the sclera, and the meninges were repositioned to create a hollow cylinder of meningeal connective tissue attached to the posterior sclera. The distal end was cannulated, sealed, and pressure clamped (mimicking cerebrospinal fluid [CSF] pressure), while the eye was also cannulated for independent control of intraocular pressure (IOP). The meninges were inflated (CSF pressure cycling 7-50 mmHg) while ONS outer diameter was imaged. In another set of experiments (n4), fluid permeation rate across the meninges was recorded by observing the drainage of an elevated fluid reservoir (30 mmHg) connected to the meninges. The ONS showed behavior typical of soft tissues: viscoelasticity, with hysteresis in early preconditioning cycles and repeatable behavior after 4 cycles, and nonlinear stiffening, particularly at CSF pressures 15 mmHg (Figure). Tangent moduli measured from the loading curve were 372 101, 1199 358, and 2050 379 kPa (mean SEM) at CSF pressures of 7, 15 and 30 mmHg, respectively. Flow rate measurements through the intact meninges at 30mmHg gave a permeability of 1.34 0.46 lmincm2mmHg (mean SEM). The ONS is a tough, strain-stiffening connective tissue that is surprisingly permeable. The latter observation suggests that there could be significant CSF drainage through the ONS into the orbit, likely important

  6. Ultrasonographic measurement of optic nerve sheath diameter in normal dogs.

    PubMed

    Lee, Hee-Chun; Choi, Ho-Jung; Choi, Min-Cheol; Yoon, Jung-Hee

    2003-12-01

    This study was carried out to assess the feasibility of ultrasonographic measurements of the optic nerve sheath diameter (ONSD) in normal dogs and evaluate the effect of breed, sex, body weight and age on biometry of ONSD. The ONSDs were evaluated in 15 dogs (10-50 months old) with normal eye (7 Yorkshire terrier and 8 Maltese). Ultrasonographic measurements of the ONSD were carried out at a constant position located 5 mm behind the optic disc. Eyes were collected immediately after euthanasia, and were used for saline immersion technique and direct measurement by calipers for biometry of ONSD. In this study, there was no significant difference of ONSD between the left and the right eyes, and was no significant difference among ONSD values obtained from ultrasonographical method, saline immersion technique and direct measurement (k=0.95). Also, there was no correlations between ONSD and sex, body weight and age, but was significant between the mean ONSD of Yorkshire terrier and Maltese (p<0.01). The mean ONSD of Yorkshire terrier was 2.10 +/- 0.22 mm and Maltese was 1.63 +/- 0.23 mm. This study suggests that ultrasonographic measurements is useful method for biometry of the ONSD in normal dogs and provides baseline information for the study of evaluating ONSD in various breeds and diagnosing several diseases with the change of the ONSD.

  7. Benign Nerve Sheath Myxoma in an Infant Misdiagnosed as Infantile Digital Fibromatosis.

    PubMed

    Güngör, Şule; Şişman, Servet; Kocaturk, Emek; Oguz Topal, Ilteris; Yıldırım, Selda

    2016-07-01

    Herein we present the case of a 16-month boy, clinically diagnosed with infantile digital fibromatosis, but 9 months after continued growth, the mass was excised and the histopathologic diagnosis was that of a benign nerve sheath myxoma. We present this case to emphasize that nerve sheath myxomas (also known as myxoid neurothekeoma) should be included in the differential diagnosis of dermal nodules in infants. PMID:27196676

  8. Analysis and Visualization of Nerve Vessel Contacts for Neurovascular Decompression

    NASA Astrophysics Data System (ADS)

    Süßmuth, Jochen; Piazza, Alexander; Enders, Frank; Naraghi, Ramin; Greiner, Günther; Hastreiter, Peter

    Neurovascular compression syndromes are caused by a pathological contact between cranial nerves and vascular structures at the surface of the brainstem. Aiming at improved pre-operative analysis of the target structures, we propose calculating distance fields to provide quantitative information of the important nerve-vessel contacts. Furthermore, we suggest reconstructing polygonal models for the nerves and vessels. Color-coding with the respective distance information is used for enhanced visualization. Overall, our new strategy contributes to a significantly improved clinical understanding.

  9. Weber's syndrome and sixth nerve palsy secondary to decompression illness: a case report.

    PubMed

    Padilla, W; Newton, H B; Barbosa, S

    2005-01-01

    We describe the first case of Weber's Syndrome to present as a manifestation of decompression illness in a recreational scuba diver. Weber's Syndrome is characterized by the presence of an oculomotor nerve palsy and contralateral hemiparesis. The patient was a 55 year-old male with a past medical history of a pulmonary cyst, in whom symptoms developed after a multilevel drift dive to a depth of 89 feet for 53 minutes, exceeding no-decompression limits. Symptom onset was within 30 minutes of surfacing and included the Weber's Syndrome, a sixth nerve palsy, dizziness, nausea, sensory loss, and ataxia. The patient received four U.S. Navy Treatment Tables with complete resolution of all neurological signs and symptoms. The mechanism of injury remains unclear, but may involve aspects of both air gas embolism and decompression sickness. Individuals with pre-existing pulmonary cysts may be at increased risk for dive-related complications.

  10. Characterization of Peripheral Nerve Sheath Tumors with 3T Proton MR Spectroscopy

    PubMed Central

    Fayad, L.M.; Wang, X.; Blakeley, J.O.; Durand, D.J.; Jacobs, M.A.; Demehri, S.; Subhawong, T.K.; Soldatos, T.; Barker, P.B.

    2014-01-01

    Background and Purpose The characterization of peripheral nerve sheath tumors is challenging. The purpose here was to investigate the diagnostic value of quantitative proton MR spectroscopy at 3T for the characterization of peripheral nerve sheath tumors as benign or malignant, compared with PET. Materials and Methods Twenty participants with 24 peripheral nerve sheath tumors underwent MR spectroscopy by use of a point-resolved sequence (TE, 135 ms). Six voxels were placed in 4 histologically proven malignant peripheral nerve sheath tumors and 22 voxels in 20 benign peripheral nerve sheath tumors (9 histologically proven, 11 with documented stability). The presence or absence of a trimethylamine signal was evaluated, the trimethylamine concentration estimated by use of phantom replacement methodology, and the trimethylamine fraction relative to Cr measured. MR spectroscopy results for benign and malignant peripheral nerve sheath tumors were compared by use of a Mann-Whitney test, and concordance or discordance with PET findings was recorded. Results In all malignant tumors and in 9 of 18 benign peripheral nerve sheath tumors, a trimethylamine peak was detected, offering the presence of trimethylamine as a sensitive (100%), but not specific (50%), marker of malignant disease. Trimethylamine concentrations (2.2 ± 2.8 vs 6.6 ± 5.8 institutional units; P < .049) and the trimethylamine fraction (27 ± 42 vs 88 ± 22%; P < .012) were lower in benign than malignant peripheral nerve sheath tumors. A trimethylamine fraction threshold of 50% resulted in 100% sensitivity (95% CI, 58.0%–100%) and 72.2% (95% CI, 59.5%–75%) specificity for distinguishing benign from malignant disease. MR spectroscopy and PET results were concordant in 12 of 16 cases, (2 false-positive results for MR spectroscopy and PET each). Conclusions Quantitative measurement of trimethylamine concentration by use of MR spectroscopy is feasible in peripheral nerve sheath tumors and shows promise as a

  11. Fractionated Stereotactic Radiotherapy in Patients With Optic Nerve Sheath Meningioma

    SciTech Connect

    Paulsen, Frank; Doerr, Stefan; Wilhelm, Helmut; Becker, Gerd; Bamberg, Michael; Classen, Johannes

    2012-02-01

    Purpose: To evaluate the effectiveness of fractionated stereotactic radiotherapy (SFRT) in the treatment of optic nerve sheath meningioma (ONSM). Methods and Materials: Between 1993 and 2005, 109 patients (113 eyes) with primary (n = 37) or secondary (n = 76) ONSM were treated according to a prospective protocol with SFRT to a median dose of 54 Gy. All patients underwent radiographic, ophthalmologic, and endocrine analysis before and after SFRT. Radiographic response, visual control, and late side effects were endpoints of the analysis. Results: Median time to last clinical, radiographic, and ophthalmologic follow up was 30.2 months (n = 113), 42.7 months (n = 108), and 53.7 months (n = 91), respectively. Regression of the tumor was observed in 5 eyes and progression in 4 eyes, whereas 104 remained stable. Visual acuity improved in 12, deteriorated in 11, and remained stable in 68 eyes. Mean visual field defects reduced from 33.6% (n = 90) to 17.8% (n = 56) in ipsilateral and from 10% (n = 94) to 6.7% (n = 62) in contralateral eyes. Ocular motility improved in 23, remained stable in 65, and deteriorated in 3 eyes. Radiographic tumor control was 100% at 3 years and 98% at 5 years. Visual acuity was preserved in 94.8% after 3 years and in 90.9% after 5 years. Endocrine function was normal in 90.8% after 3 years and in 81.3% after 5 years. Conclusions: SFRT represents a highly effective treatment for ONSM. Interdisciplinary counseling of the patients is recommended. Because of the high rate of preservation of visual acuity we consider SFRT the standard approach for the treatment of ONSM. Prolonged observation is warranted to more accurately assess late visual impairment. Moderate de-escalation of the radiation dose might improve the preservation of visual acuity and pituitary gland function.

  12. THE FINE STRUCTURAL ORGANIZATION OF NERVE FIBERS, SHEATHS, AND GLIAL CELLS IN THE PRAWN, PALAEMONETES VULGARIS

    PubMed Central

    Heuser, John E.; Doggenweiler, Carlos F.

    1966-01-01

    In view of reports that the nerve fibers of the sea prawn conduct impulses more rapidly than other invertebrate nerves and look like myelinated vertebrate nerves in the light microscope, prawn nerve fibers were studied with the electron microscope. Their sheaths are found to have a consistent and unique structure that is unlike vertebrate myelin in four respects: (1) The sheath is composed of 10 to 50 thin (200- to 1000-A) layers or laminae; each lamina is a cellular process that contains cytoplasm and wraps concentrically around the axon. The laminae do not connect to form a spiral; in fact, no cytoplasmic continuity has been demonstrated among them. (2) Nuclei of sheath cells occur only in the innermost lamina of the sheath; thus, they lie between the sheath and the axon rather than outside the sheath as in vertebrate myelinated fibers. (3) In regions in which the structural integrity of the sheath is most prominent, radially oriented stacks of desmosomes are formed between adjacent laminae. (4) An ∼200-A extracellular gap occurs around the axon and between the innermost sheath laminae, but it is separated from surrounding extracellular spaces by gap closure between the outer sheath laminae, as the membranes of adjacent laminae adhere to form external compound membranes (ECM's). Sheaths are interrupted periodically to form nodes, analogous to vertebrate nodes of Ranvier, where a new type of glial cell called the "nodal cell" loosely enmeshes the axon and intermittently forms tight junctions (ECM's) with it. This nodal cell, in turn, forms tight junctions with other glial cells which ramify widely within the cord, suggesting the possibility of functional axon-glia interaction. PMID:5968976

  13. Pathology in practice: Peripheral nerve sheath tumor in a Shubunkin goldfish

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Peripheral nerve sheath tumors (PNSTs) have been detected in many fish species, including goldfish, several species of snapper, coho salmon, the bicolor damselfish, and rainbow smelt. They originate from neural crest cells and generally occur along the subcutaneous nerves. A viral etiology has bee...

  14. Fully Endoscopic Vascular Decompression of the Facial Nerve for Hemifacial Spasm

    PubMed Central

    Eby, Joseph B.; Cha, Sung Tae; Shahinian, Hrayr K.

    2001-01-01

    Hemifacial spasm is an uncommon disorder manifesting as a unilateral, involuntary, sporadic contraction of the musculature innervated by the seventh cranial nerve. Although debated, the etiology of hemifacial spasm is generally accepted as compression of the facial nerve by vessels of the posterior circulation. Early surgical techniques were ineffective and fraught with morbidity. Over the past 25 years microvascular decompression surgery has allowed the safe and effective treatment of hemifacial spasm. Recent reports combining microsurgical and endoscopic techniques have documented the advantages of the endoscope in exposing the anatomy of this region. Enhanced visualization allows a less traumatic dissection and increases the surgeon's ability to locate nerve-vessel conflicts often difficult to identify through the limited view of the microscope. This article reviews the history of hemifacial spasm and describes the first three cases of fully endoscopic vascular decompression for hemifacial spasm, emphasizing the advantages of this novel surgical approach. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:17167620

  15. Treatment of Peripheral Neuropathy in Leprosy: The Case for Nerve Decompression.

    PubMed

    Wan, Eric L; Rivadeneira, Andres F; Jouvin, Renato Martinez; Dellon, A Lee

    2016-03-01

    Plastic surgery has a tradition of caring for patients with facial deformity and hand deformity related to leprosy. The approach, however, to the progressive deformity and disability related to chronic nerve compression is underappreciated in the world today. A cohort of patients with leprous neuropathy from an indigenous area of leprosy in Ecuador was evaluated for the presence of chronic peripheral nerve compression, and 12 patients were chosen for simultaneous upper and lower extremity, unilateral, nerve decompression at multiple levels along the course of each nerve. The results at 1 year of follow-up show that 6 patients improved into the excellent category and 4 patients improved into the good category for improved function. Based on the early results in this small cohort of patients with leprous neuropathy, an approach to peripheral nerve decompression, encompassing the concept of multiple crush at multiple levels of each nerve, seems to offer optimism to improve upper and lower extremity limb function. Long-term studies with quality-of-life outcomes would be welcome. PMID:27257567

  16. The coexistence of peripheral nerve sheath tumors and vitiligo: more than coincidence?

    PubMed

    Elsherif, Mohamed A; Spinner, Robert J; Miest, Rachel Y

    2016-01-01

    Neurocristopathies arise from abnormal migration, differentiation, or proliferation of neural crest derivatives, leading to diverse clinical and pathological features. They are classified into dysgenetic or neoplastic, and can affect single or multiple sites (simple versus complex). Examples include congenital melanocytic nevi, neuroblastoma, Hirshsprung's disease, Waardenburg's syndrome, neurofibromatosis (NF) 1 and multiple endocrine neoplasia (MEN) 2A and 2B. We report two cases of peripheral nerve sheath tumors associated with vitiligo and discuss the possible implicated embryologic, genetic and molecular mechanisms. To our knowledge, we also report the first case of de novo malignant peripheral nerve sheath tumor (MPNST) associated with vitiligo. PMID:26607956

  17. The coexistence of peripheral nerve sheath tumors and vitiligo: more than coincidence?

    PubMed

    Elsherif, Mohamed A; Spinner, Robert J; Miest, Rachel Y

    2016-01-01

    Neurocristopathies arise from abnormal migration, differentiation, or proliferation of neural crest derivatives, leading to diverse clinical and pathological features. They are classified into dysgenetic or neoplastic, and can affect single or multiple sites (simple versus complex). Examples include congenital melanocytic nevi, neuroblastoma, Hirshsprung's disease, Waardenburg's syndrome, neurofibromatosis (NF) 1 and multiple endocrine neoplasia (MEN) 2A and 2B. We report two cases of peripheral nerve sheath tumors associated with vitiligo and discuss the possible implicated embryologic, genetic and molecular mechanisms. To our knowledge, we also report the first case of de novo malignant peripheral nerve sheath tumor (MPNST) associated with vitiligo.

  18. Unusual delayed presentation of head trauma complicating outcome of facial nerve decompression surgery.

    PubMed

    Thakur, J S; Shekar, Vidya; Saluja, Manika; Mohindroo, N K

    2013-08-20

    Late presentation of head trauma is rare. A young boy presented with a traumatic facial paralysis after head trauma. A CT scan of the head showed temporal bone fracture without intracranial insult. Facial nerve decompression was performed and paralysis started improving. However, he presented with vertigo and sensorineural hearing loss after 2 months. Clinical examination also showed cerebellar sign. We suspected iatrogenic injury to the cochlea; however, brain MRI showed haemorrhage in the area of anterior inferior cerebellar artery. The patient was managed conservatively and the vertigo improved. This case stresses on unusual late presentation of head trauma and cerebellar artery injury that complicated the outcome of facial nerve paralysis.

  19. Decompression of the Sciatic Nerve Entrapment Caused by Post-Inflammatory Scarring

    PubMed Central

    Kim, Deog-ryeong; Jeun, Sin Soo; Lee, Sang-won

    2015-01-01

    A rare case of chronic pain of entrapment neuropathy of the sciatic nerve successfully relieved by surgical decompression is presented. A 71-year-old male suffered a chronic right buttock pain of duration of 7 years which radiating to the right distal leg and foot. His pain developed gradually over one year after underwenting drainage for the gluteal abscess seven years ago. A cramping buttock and intermittently radiating pain to his right foot on sitting, walking, and voiding did not respond to conventional treatment. An MRI suggested a post-inflammatory adhesion encroaching the proximal course of the sciatic nerve beneath the piriformis as it emerges from the sciatic notch. Upon exploration of the sciatic nerve, a fibrotic tendinous scar beneath the piriformis was found and released proximally to the sciatic notch. His chronic intractable pain was completely relieved within days after the decompression. However, thigh weakness and hypesthesia of the foot did not improve. This case suggest a need for of more prompt investigation and decompression of the chronic sciatic entrapment neuropathy which does not improve clinically or electrically over several months. PMID:25733994

  20. Redistribution of voltage-gated sodium channels after nerve decompression contributes to relieve neuropathic pain in chronic constriction injury.

    PubMed

    Tseng, To-Jung; Hsieh, Yu-Lin; Ko, Miau-Hwa; Hsieh, Sung-Tsang

    2014-11-17

    Nerve decompression is an important therapeutic strategy to relieve neuropathic pain and promote the peripheral nerve regeneration. To address these issues, we investigated the effects of nerve decompression on relief of neuropathic pain behaviors, redistribution of voltage-gated sodium channels (VGSCs), and skin reinnervation with chronic constriction injury (CCI). At post-operative week (POW) 4, animals were divided into a decompression group, in which the ligatures were removed, and a CCI group, in which the ligatures remained. Thermal hyperalgesia and mechanical allodynia at POW 8 had distinct reductions in decompression group compared to CCI group. At that time in CCI group, morphological evidence of pan VGSCs (Pan Nav) and isoforms of VGSCs (Nav1.6, Nav1.9, except for Nav1.8) were shown the widely distribution along the injured sciatic nerve. All of the VGSCs in decompression group became clustering around the node of Ranvier, similar to the pattern of control sciatic nerve at POW 8. Skin reinnervation was demonstrated by epidermal nerve density (END) for protein gene product 9.5 (PGP 9.5)-immunoreactive (IR) nerve fibers and a significant difference between groups only at POW 24 (p=0.01). Growth-associated protein 43 (GAP-43) is participated in the nerve fiber growth and sprouting, a difference in END for GAP-43-IR nerve fibers at POW 24 between groups were also significant (p=0.02). These observations demonstrated that nerve decompression was accompanied with the disappearance of neuropathic pain behaviors after CCI. Morphological studies provided the evidence that redistribution of VGSCs along the injured sciatic nerve but still with an incomplete skin reinnervation. These significant findings demonstrated a role of VGSCs in the pathogenesis of neuropathic pain, and gave an approaching in pharmacological basis of therapeutics. PMID:25038561

  1. Peripheral nerve sheath tumor in a subadult golden eagle (Aquila chrysaetos).

    PubMed

    Wernick, Morena Bernadette; Dennler, Matthias; Beckmann, Kathrin; Schybli, Martina; Albini, Sarah; Hoop, Richard K; Steffen, Frank; Kircher, Patrick; Hatt, Jean-Michel

    2014-03-01

    A 5-year-old, female golden eagle (Aquila chrysaetos) was admitted with tetraplegia that progressed to a nonambulatory, spastic tetraparesis after a few days of treatment. Clinical and radiologic examinations, including radiography, computed tomography scan, and myelography, were indicative of neoplasia involving a spinal nerve root. Postmortem magnetic resonance imaging and necropsy findings confirmed the diagnosis of a peripheral nerve sheath neoplasia, not, to our knowledge, previously reported in a raptor. PMID:24881155

  2. Surgical decompression in endocrine orbitopathy. Visual evoked potential evaluation and effect on the optic nerve.

    PubMed

    Clauser, Luigi C; Tieghi, Riccardo; Galie', Manlio; Franco, Filippo; Carinci, Francesco

    2012-10-01

    Endocrine orbitopathy (EO) represents the most frequent and important extrathyroidal stigma of Graves disease. This chronic autoimmune condition involves the orbital contents, including extraocular muscles, periorbital connective-fatty tissue and lacrimal gland. The increase of fat tissue and the enlargement of extraocular muscles within the bony confines of the orbit leads to proptosis, and in the most severe cases optic neuropathy, caused by compression and stretching of the optic nerve. The congestion and the pressure of the enlarged muscles, constrict the nerve and can lead to reduced sight or loss of vision with the so called "orbital apex syndrome". Generally surgical treatment of EO, based on fat and/or orbital wall expansion, is possible and effective in improving exophthalmos and diplopia. Since there are limited reports focussing on optic neuropathy recovery after fat and/or orbital walls decompression the Authors decided to perform a retrospective analysis on a series of patients affected by EO. The study population was composed of 10 patients affected by EO and presenting to the Unit of Cranio Maxillofacial Surgery, Center for Craniofacial Deformities & Orbital Surgery St. Anna Hospital and University, Ferrara, Italy, for evaluation and treatment. A complete Visual Evoked Potentials (VEP) evaluation was performed. There were seven women and three men with a median age of 55 years. Optic nerve VEP amplitude and latency were recorded as normal or pathological. Abnormal results were scored as moderate, mild and severe. Differences in VEP pre and post-operatively were recorded as present or absent (i.e. VEP Delta). Pearson chi square test was applied. There were 20 operated orbits. The first VEP evaluation was performed 3.2 months before surgery and post-operative VEP control was done after a mean of 18.7 months. Fat decompression was performed in all cases and eight patients had also bony decompression. VEP amplitude and latency were affected in 10 and 15

  3. Acute optic nerve sheath fenestration with the free-electron laser

    NASA Astrophysics Data System (ADS)

    Shen, Jin-Hui; Casagrande, Vivien A.; Joos, Karen M.; Shetlar, Debra J.; Robinson, Richard D.; Head, William S.; Mavity-Hudson, Julia A.; Nunnally, Amy H.

    1999-06-01

    Purpose: To determine if the free electron laser (FEL) energy can be delivered to a small space to perform optic nerve sheath fenestration with minimal acute nerve damage. Methods: A 530 mm hollow waveguide probe was designed. Optic nerve sheath fenestration (1.0 mm diameter) was performed in 8 rabbits using either the FEL (4 eyes, 6.45mm, 10 Hz, 2 mJ) or a knife (4 eyes). Within 2 hours following surgery, the animals were perfused with aldehyde fixative. The integrity of the optic nerve and glial response at the site of fenestration were evaluated on tissue selections with H&E, and antibodies to S100β or GFAP. Results: Surgery using the FEL probe was found to be technically superior to the knife. The glial reaction was limited to a zone adjacent to the fenestration and was similar in both the FEL and knife incisions. Conclusions: The FEL appears capable of efficiently performing an optic nerve sheath fenestration in a small space with minimal acute damage. Both the FEL and knife incisions result in a rapid glial response at the site of fenestration even when optic nerve integrity is not compromised.

  4. Morphometric analysis of connective tissue sheaths of sural nerve in diabetic and nondiabetic patients.

    PubMed

    Kundalić, Braca; Ugrenović, Slađana; Jovanović, Ivan; Stefanović, Natalija; Petrović, Vladimir; Kundalić, Jasen; Stojanović, Vesna; Živković, Vladimir; Antić, Vladimir

    2014-01-01

    One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.

  5. Morphometric analysis of connective tissue sheaths of sural nerve in diabetic and nondiabetic patients.

    PubMed

    Kundalić, Braca; Ugrenović, Slađana; Jovanović, Ivan; Stefanović, Natalija; Petrović, Vladimir; Kundalić, Jasen; Stojanović, Vesna; Živković, Vladimir; Antić, Vladimir

    2014-01-01

    One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves. PMID:25147820

  6. Acute optic nerve sheath fenestration in humans using the free electron laser (FEL): a case report

    NASA Astrophysics Data System (ADS)

    Joos, Karen M.; Mawn, Louise A.; Shen, Jin-Hui; Jansen, E. Duco; Casagrande, Vivien A.

    2002-06-01

    Our previous studies using rabbits and monkeys showed that the Amide II wavelength (6.45 micrometers ) produced by the FEL could efficiently produce an optic nerve sheath fenestration with minimal damage. In order to determine if the technology safely could be applied to human surgery, we used 2 blind human eyes during enucleation to compare the results of producing fenestrations with the FEL or a scissors. FDA and Vanderbilt IRB approvals, and individual patient consents were obtained. The FEL energy was transmitted to a human operating room. After disinsertion of the medial rectus muscle, an optic nerve sheath fenestration (2 mm diameter) was made with either the FEL (6.45 micrometers , 325 micrometers spot size, 30 Hz, 3 mJ) through a hollow waveguide surgical probe or with a scissors. The enucleation was then completed. The optic nerve was dissected from the globe and fixed. Specimens were examined histologically. Dural incisions were effective with both methods. FEL energy at 6.45 micrometers can be transmitted to an operating room and delivered to human ocular tissue through a hollow waveguide surgical probe. This FEL wavelength can produce an optic nerve sheath fenestration without acute direct damage to the nerve in this case report.

  7. Morphometric Analysis of Connective Tissue Sheaths of Sural Nerve in Diabetic and Nondiabetic Patients

    PubMed Central

    Kundalić, Braca; Ugrenović, Slađana; Jovanović, Ivan; Stefanović, Natalija; Petrović, Vladimir; Kundalić, Jasen; Stojanović, Vesna; Živković, Vladimir; Antić, Vladimir

    2014-01-01

    One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves. PMID:25147820

  8. Support of Nerve Conduction by Respiring Myelin Sheath: Role of Connexons.

    PubMed

    Ravera, Silvia; Bartolucci, Martina; Adriano, Enrico; Garbati, Patrizia; Ferrando, Sara; Ramoino, Paola; Calzia, Daniela; Morelli, Alessandro; Balestrino, Maurizio; Panfoli, Isabella

    2016-05-01

    Recently, we have demonstrated that myelin conducts an extramitochondrial oxidative phosphorylation, hypothesizing a novel supportive role for myelin in favor of the axon. We have also hypothesized that the ATP produced in myelin could be transferred thought gap junctions. In this work, by biochemical, immunohistochemical, and electrophysiological techniques, the existence of a connection among myelin to the axon was evaluated, to understand how ATP could be transferred from sheath to the axoplasm. Data confirm a functional expression of oxidative phosphorylation in isolated myelin. Moreover, WB and immunohistochemistry on optic nerve slices show that connexins 32 and 43 are present in myelin and colocalize with myelin basic protein. Interestingly, addition of carbenoxolone or oleamide, two gap junction blockers, causes a decrease in oxidative metabolism in purified myelin, but not in mitochondria. Similar effects were observed on conduction speed in hippocampal Schaffer collateral, in the presence of oleamide. Confocal analysis of optic nerve slices showed that lucifer yellow (that only passes through aqueous pores) signal was found in both the sheath layers and the axoplasma. In the presence of oleamide, but not with oleic acid, signal significantly decreased in the sheath and was lost inside the axon. This suggests the existence of a link among myelin and axons. These results, while supporting the idea that ATP aerobically synthesized in myelin sheath could be transferred to the axoplasm through gap junctions, shed new light on the function of the sheath.

  9. Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath

    PubMed Central

    Neven, Kars; Fernandez-Armenta, Juan; Andreu, David; Berruezo, Antonio

    2014-01-01

    Because of the close proximity of the phrenic nerve to the pericardium, phrenic nerve damage caused by epicardial ablation can easily occur. We report two cases of epicardial VT ablation where pericardial injection of saline, combined with the use of a steerable sheath, successfully prevents the phrenic nerve from being damaged. PMID:24669108

  10. Microvascular decompression of trigeminal nerve root for treatment of a patient with hemimasticatory spasm.

    PubMed

    Dou, Ning-Ning; Zhong, Jun; Zhou, Qiu-Meng; Zhu, Jin; Wang, Yong-Nan; Li, Shi-Ting

    2014-05-01

    Hemimasticatory spasm is a rare disease; with little knowledge of the pathogenesis, it has still been intractable today. We presented a 56-year-old woman with involuntary painful spasm in her left masseter muscle for 11 years. The patient was successfully treated with microvascular decompression surgery. An offending superior cerebellar artery was found to contact with the motor branch of the trigeminal nerve root, which was then removed away and pieces of soft wadding were interposed between the nerve and the vessel to assure the separation. Postoperatively, the symptom totally disappeared and no recurrence was observed during the 7 months' follow-up. The treatment as well as the pathogenesis of the disease was reviewed, and we put forward a new hypothesis.

  11. Optic nerve sheath fenestration for the treatment of papilledema secondary to cerebral venous thrombosis.

    PubMed

    Murdock, Jennifer; Tzu, Jonathan H; Schatz, Norman J; Lee, Wendy W

    2014-03-01

    A 16-year-old adolescent girl with multiple risk factors for thrombosis presented with acute onset of headache, decreased vision, and papilledema. Evaluation demonstrated cerebral venous thrombosis (CVT) involving the left transverse and sigmoid sinuses and left internal jugular vein. Following bilateral optic nerve sheath fenestration (ONSF), she experienced improvement in vision and resolution of papilledema. In selected cases, ONSF is an effective surgical option for the treatment of papilledema due to CVT after medical treatment has failed. PMID:24343230

  12. Lost in Translation: Ambiguity in Nerve Sheath Tumor Nomenclature and Its Resultant Treatment Effect

    PubMed Central

    Bernthal, Nicholas M.; Jones, Kevin B.; Monument, Michael J.; Liu, Ting; Viskochil, David; Randall, R. Lor

    2013-01-01

    There is much ambiguity surrounding the diagnosis of nerve sheath tumors, including atypical neurofibroma and low-grade MPNST, and yet, the distinction between these entities designates either benign or malignant behavior and thus carries presumed profound prognostic importance that often guides treatment. This study reviews the diagnostic criteria used to designate atypical neurofibroma from low-grade MPNSTs and reviews existing literature the natural history of each of these tumors to see if the distinction is, in fact, of importance. PMID:24216989

  13. Lost in translation: ambiguity in nerve sheath tumor nomenclature and its resultant treatment effect.

    PubMed

    Bernthal, Nicholas M; Jones, Kevin B; Monument, Michael J; Liu, Ting; Viskochil, David; Randall, R Lor

    2013-05-08

    There is much ambiguity surrounding the diagnosis of nerve sheath tumors, including atypical neurofibroma and low-grade MPNST, and yet, the distinction between these entities designates either benign or malignant behavior and thus carries presumed profound prognostic importance that often guides treatment. This study reviews the diagnostic criteria used to designate atypical neurofibroma from low-grade MPNSTs and reviews existing literature the natural history of each of these tumors to see if the distinction is, in fact, of importance.

  14. Gene profiling in the dynamic regulation of the lifespan of the myelin sheath structure in the optic nerve of rats.

    PubMed

    Xie, Fang; Fu, Han; Zhang, Jiu-Cong; Chen, Xue-Feng; Wang, Xiao-Liang; Chen, Jun

    2014-07-01

    Aging of the nervous system leads to impairments in cognition and motor skills, and is a major risk factor for several neurological disorders. Recently, numerous nerve function deficits that appear with aging have been found to be a consequence of myelin abnormalities; however, the genetic mechanism of the age‑related alterations in the myelin sheath has not yet been fully elucidated. In the present study, the morphology of the myelin sheath in the optic nerve of rats was analyzed at 10 time‑points throughout life. Marked alterations in the myelin sheath were observed in aging and aged optic nerves, and these became progressively more severe with time. To determine the biological processes affected by aging in the myelin sheath, the age‑related profiling of the myelin sheath in rat optic nerves was established using microarray hybridization at 10 time‑points throughout life, between birth and senescence. From the results, 3,826 transcripts associated with the age‑related alterations in the myelin sheath of the optic nerve were identified. It was found that the biological processes most significantly altered by aging were lipid metabolism, the immune response and transmitter transport. This suggests that the downregulation of lipid synthesis genes and the upregulation of immune and neurotransmitter transport genes in aging may be the genetic basis for the age‑related alterations observed in the myelin sheath.

  15. T2-weighted magnetic resonance imaging measurements of optic nerve sheath diameter in dogs with and without presumed intracranial hypertension.

    PubMed

    Scrivani, Peter V; Fletcher, Daniel J; Cooley, Stacy D; Rosenblatt, Alana J; Erb, Hollis N

    2013-01-01

    Intracranial hypertension is a cause of cerebral ischemia and neurologic deficits in dogs. Goals of this retrospective study were to test interobserver agreement for MRI measurements of optic nerve sheath diameter and associations between optic nerve sheath diameter, signalment data, and presumed intracranial hypertension status in a cohort of dogs. A veterinary radiologist interpreted scans of 100 dogs and dogs were assigned to groups based on presence or absence of at least two MRI characteristics of presumed intracranial hypertension. Two observers who were unaware of group status independently measured optic nerve diameter from transverse T2-weighted sequences. Mean optic nerve sheath diameter for all dogs was 3 mm (1-4 mm). The mean difference between observers was 0.3 mm (limits of agreement, -0.4 and 1.0 mm). There was no correlation between optic nerve sheath diameter and age for either observer (r = -0.06 to 0.00) but a moderate positive correlation was observed between optic nerve sheath diameter and body weight for both observers (r = 0.70-0.76). The 22 dogs with presumed intracranial hypertension weighed less than the 78 dogs without (P = 0.02) and were more often female (P = 0.04). Dogs with presumed intracranial hypertension had a larger ratio of optic nerve sheath diameter to body weight for each observer-side pair (P = 0.01-0.04) than dogs without. Findings indicated that the ratio of MRI optic nerve sheath diameter relative to body weight may be a repeatable predictor of intracranial hypertension in dogs.

  16. [Effective Microvascular Decompression of the Trigeminal Nerve in a Patient with SUNCT].

    PubMed

    Kikui, Shoji; Miyahara, Jun-Ichi; Sugiyama, Hanako; Kashiwaya, Yoshihiro; Takeshima, Takao

    2016-08-01

    A 43-year-old man presented with severe, saw-tooth pattern pain around the right eye that started with conjunctival injection, lacrimation and nasal discharge, lasting for about 1 hour, 4 months after the initial onset of lancinating pain in the same area. The patient was diagnosed with SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) according to the International Classification of Headache Disorders 3rd edition (beta version). The symptoms improved in 2 months but recurred 6 months later. He developed a toxic eruption after receiving a variety of antiepileptic agents including lamotrigine, which suggested refractory SUNCT. Head magnetic resonance imaging (MRI) showed neurovascular compression (NVC) involving the right trigeminal nerve. Microvascular decompression (MVD) was performed, and the pain was relieved postoperatively. MVD should be considered when treating refractory SUNCT because NVC may be involved in some cases. (Received February 29, 2016; Accepted April 4, 2016; Published August 1, 2016). PMID:27503824

  17. Optic Nerve Sheath as a Novel Mechanical Load on the Globe in Ocular Duction

    PubMed Central

    Demer, Joseph L.

    2016-01-01

    Purpose The optic nerve (ON) sheath's role in limiting duction has been previously unappreciated. This study employed magnetic resonance imaging (MRI) to demonstrate this constraint on adduction. Methods High-resolution, surface coil axial MRI was obtained in 11 normal adults, 14 subjects with esotropia (ET) having normal axial length (AL) < 25.8 mm, 13 myopic subjects with ET and mean AL 29.3 ± 3.3 (SD) mm, and 7 subjects with exotropia (XT). Gaze angles and ON lengths were measured for scans employing eccentric lateral fixation in which an ON became completely straightened. Results In all groups, ON straightening occurred only in the adducting, not abducting, eye. Adduction at ON straightening was 26.0 ± 8.8° in normal subjects, not significantly different from XT at 22.2 ± 11.8°. However, there was significant increase in comparable adduction in ET to 36.3 ± 9.3°, and in myopic ET to 33.6 ± 10.7° (P < 0.04). Optic nerve length at straightening was 27.6 ± 2.7 mm in normals, not significantly different from 28.2 ± 2.8 mm in ET and 27.8 ± 2.7 mm in XT. In myopic ET, ON length at straightening was significantly reduced to 24.0 ± 2.9 mm (P < 0.002) and was associated with globe retraction in adduction, suggesting ON tethering. Conclusions Large adduction may exhaust length redundancy in the normally sinuous ON and sheath, so that additional adduction must stretch the sheath and retract or deform the globe. These mechanical effects are most significant in ET with axial myopia, but may also exert traction on the posterior sclera absent strabismus or myopia. Tethering by the ON sheath in adduction is an important, novel mechanical load on the globe. PMID:27082297

  18. Potential of boron neutron capture therapy (BNCT) for malignant peripheral nerve sheath tumors (MPNST).

    PubMed

    Fujimoto, Takuya; Andoh, Tooru; Sudo, Tamotsu; Fujita, Ikuo; Fukase, Naomasa; Takeuchi, Tamotsu; Sonobe, Hiroshi; Inoue, Masayoshi; Hirose, Tkanori; Sakuma, Toshiko; Moritake, Hiroshi; Sugimoto, Tohru; Kawamoto, Teruya; Fukumori, Yoshinobu; Yamamoto, Satomi; Atagi, Shinji; Sakurai, Yoshinori; Kurosaka, Masahiro; Ono, Koji; Ichikawa, Hideki; Suzuki, Minoru

    2015-12-01

    Malignant peripheral nerve sheath tumors (MPNST) are relatively rare neoplasms with poor prognosis. At present there is no effective treatment for MPNST other than surgical resection. Nonetheless, the anti-tumor effect of boron neutron capture therapy (BNCT) was recently demonstrated in two patients with MPNST. Subsequently, tumor-bearing nude mice subcutaneously transplanted with a human MPNST cell line were injected with p-borono-L-phenylalanine (L-BPA) and subjected to BNCT. Pathological studies then revealed that the MPNST cells were selectively destroyed by BNCT.

  19. Preoperative Embolization of a Posterior Mediastinal Lipid-Poor Angiolipoma Mimicking a Paravertebral Nerve Sheath Tumor.

    PubMed

    Gorospe, Luis; García-Poza, Javier; González-Gordaliza, María Cristina; Cabañero-Sánchez, Alberto; Muñoz-Molina, Gemma María; Saldaña-Garrido, David

    2015-08-01

    Mediastinal angiolipomas are extremely rare tumors within the thorax, and only 6 cases have been previously reported in the literature. We describe the case of a lipid-poor angiolipoma within the posterior mediastinum of a 63-year-old man who complained of chest pain. Interestingly, initial imaging of the posterior mediastinal mass of our patient suggested a nerve sheath tumor. A specimen from a percutaneous transthoracic core needle biopsy confirmed an angiolipoma. We decided to preoperatively embolize the posterior mediastinal mass to reduce intraoperative bleeding and to facilitate the excision of the tumor.

  20. Radial tunnel syndrome. A retrospective review of 30 decompressions of the radial nerve.

    PubMed

    Lawrence, T; Mobbs, P; Fortems, Y; Stanley, J K

    1995-08-01

    Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery. PMID:7594982

  1. Electron microscope and low-angle x-ray diffraction studies of the nerve myelin sheath.

    PubMed

    FERNANDEZ-MORAN, H; FINEAN, J B

    1957-09-25

    1. A close correlation has been obtained between high resolution electron microscopy and low-angle x-ray diffraction studies of the myelin sheath of frog and rat peripheral and central nerves. Extensive studies were performed by application of both techniques to the same specimens, prepared for examination by OsO(4) or KMnO(4) fixation, and embedding either in methacrylate or in gelatin employing a new procedure. Controlled physical and chemical modifications of the myelin sheath prior to fixation were also investigated. 2. A correspondence was established between the layer spacings observed in electron micrographs and the fundamental radial repeating unit indicated by the low-angle x-ray diffraction patterns. The variations in relative intensities of the low-angle x-ray reflections could be related to the radial density distributions seen in the electron micrographs. 3. An analysis of the preparation procedures revealed that OsO(4) fixation introduces a greater shrinkage of the layer spacings and more pronounced changes in the density distribution within the layers than KMnO(4) fixation. The effects of methacrylate and gelatin embedding are described, and their relative merits considered in relation to the preservation of myelin structure by OsO(4) fixation. 4. The experimental modifications introduced by freezing and thawing of fresh whole nerve are described, particularly the enhancement of the intermediate lines and the dissociation of the layer components in the myelin sheath. A characteristic collapsing of the radial period of the sheath is observed after subjecting fresh nerve trunks to prolonged and intense ultracentrifugation. 5. Controlled extraction of fresh nerve with acetone at 0 degrees C., which preferentially removes cholesterol, produces characteristic, differentiated modifications of the myelin sheath structure. Electron microscopy reveals several types of modifications within a single preparation, including both expanded and collapsed layer

  2. Breast metastases from a malignant peripheral nerve sheath tumor of the kidney: An unusual presentation.

    PubMed

    Koppisetty, Shalini; Alessio, Ricardo C; Rajpurkar, Atul

    2016-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare soft tissue sarcomas of ectomesenchymal origin. They are commonly seen in association with neurofibromatosis type 1 (NF-1), but can also occur without a history of NF (isolated MPNST). MPNSTs are most commonly located on the extremities (brachial and sacral plexus), head and neck, and trunk regions and are rarely reported in genitourinary organs. These tumors are aggressive, with a high recurrence rate and distant metastases. MPNST involving the kidney is extremely rare, and review of the literature using PubMed from 2001 to 2014 revealed eight cases of MPNST involving the kidney (seven, primarily involving the kidney and one metastatic MPNST of the kidney). Herein, we describe a case of breast metastases from an MPNST of the kidney without a history of NF-1. The patient was initially diagnosed with a spindle cell neoplasm of the kidney with peripheral nerve sheath differentiation. Eventually, the patient developed a right breast mass that was diagnosed as metastatic MPNST. The patient refused any kind of treatment and died 6 months later in hospice care. PMID:27453670

  3. Breast metastases from a malignant peripheral nerve sheath tumor of the kidney: An unusual presentation

    PubMed Central

    Koppisetty, Shalini; Alessio, Ricardo C.; Rajpurkar, Atul

    2016-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare soft tissue sarcomas of ectomesenchymal origin. They are commonly seen in association with neurofibromatosis type 1 (NF-1), but can also occur without a history of NF (isolated MPNST). MPNSTs are most commonly located on the extremities (brachial and sacral plexus), head and neck, and trunk regions and are rarely reported in genitourinary organs. These tumors are aggressive, with a high recurrence rate and distant metastases. MPNST involving the kidney is extremely rare, and review of the literature using PubMed from 2001 to 2014 revealed eight cases of MPNST involving the kidney (seven, primarily involving the kidney and one metastatic MPNST of the kidney). Herein, we describe a case of breast metastases from an MPNST of the kidney without a history of NF-1. The patient was initially diagnosed with a spindle cell neoplasm of the kidney with peripheral nerve sheath differentiation. Eventually, the patient developed a right breast mass that was diagnosed as metastatic MPNST. The patient refused any kind of treatment and died 6 months later in hospice care. PMID:27453670

  4. Intercellular junctions between palisade nerve endings and outer root sheath cells of rat vellus hairs.

    PubMed

    Kaidoh, T; Inoué, T

    2000-05-15

    Hair follicles have a longitudinal set of sensory nerve endings called palisade nerve endings (PN). We examined the junctional structures between the PN and outer root sheath (ORS) cells of hair follicles in the rat external ear. Transmission electron microscopy of serial thin sections showed that the processes of the ORS cells penetrated the basal lamina of the hair follicle, forming intercellular junctions with the PN (PN-ORS junctions). Two types of junctions were found: junctions between nerve endings and ORS cells (N-ORS junctions) and those between Schwann cell processes and ORS cells (S-ORS junctions). The N-ORS junctions had two subtypes: 1) a short process or small eminence of the ORS cell was attached to the nerve ending (type I); or 2) a process of the ORS cell was invaginated into the nerve ending (type II). The S-ORS junctions also had two subtypes: 1) a short process or small eminence of the ORS cell was abutted on the Schwann cell process (type I); or 2) a process of the ORS cell was invaginated into the Schwann cell process (type II). Vesicles, coated pits, coated vesicles, and endosomes were sometimes seen in nerve endings, Schwann cells, and ORS cells near the junctions. Computer-aided reconstruction of the serial thin sections displayed the three-dimensional structure of these junctions. These results suggested that the PN-ORS junctions provided direct relationships between the PN and ORS in at least four different patterns. The discovery of these junctions shows the PN-ORS relationship to be closer than previously realized. We speculate that these junctions may have roles in attachment of the PN to the ORS, contributing to increases in the sensitivity of the PN, and in chemical signaling between the PN and ORS.

  5. Microsurgical management of giant malignant peripheral nerve sheath tumor of the scalp: two case reports and a literature review.

    PubMed

    Wang, Jun; Ou, Shao-wu; Guo, Zong-ze; Wang, Yun-jie; Xing, De-guang

    2013-10-10

    Malignant peripheral nerve sheath tumors of the scalp are rare lesions of the nervous system. Only 14 cases have been reported to date. The field of neurosurgery has struggled with diagnosing and treating these tumors. In this report, we present two cases of giant malignant peripheral nerve sheath tumors of the scalp and retrospectively analyze the clinical features, imaging findings, pathological features, and prognoses of these two patients. Each underwent microsurgery and radiotherapy. In addition, based on a literature review, we discuss the diagnostic and therapeutic strategies used to treat these unusual lesions.

  6. The effect of buffer molarity on the size, shape and sheath thickness of peripheral myelinated nerve fibres.

    PubMed

    Holland, G R

    1982-08-01

    Nineteen rats were perfused intracardially with a 2% glutaraldehyde solution in cacodylate buffers adjusted in molarity from 0 to 0.4 M. Ultrathin sections of the inferior alveolar nerve were photographed in the electron microscope. The circumference, a shape factor, small diameter and myelin sheath thickness of each myelinated nerve fibre were measured using a semi-automatic image analysis system. Statistical analysis of the data revealed that the nerve profiles increasingly deviate from a true circle with higher concentrations of buffer. The small diameter of the myelinated nerve fibres declines linearly with increasing buffer molarity whereas circumference is unaffected. Myelin sheath thickness is correlated with fibre size but is not affected by changes in buffer molarity. The use of fibre circumference is recommended to allow valid comparison of results between studies in which fixation protocols may differ.

  7. Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique into a Clinical Monitoring Tool for Spaceflight

    NASA Technical Reports Server (NTRS)

    Mason, Sara; Foy, Millennia; Sargsyan, Ashot; Garcia, Kathleen; Wear, Mary L.; Bedi, Deepak; Ernst, Randy; Van Baalen, Mary

    2015-01-01

    Ultrasonography is increasingly used to quickly measure optic nerve sheath diameter (ONSD) when increased intracranial pressure (ICP) is suspected. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound since 2009 as a proxy for ICP in non-acute monitoring for space medicine purposes. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before launch. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Our data characterize the distribution of baseline ONSD in the astronaut corps, its longitudinal trends in long-duration spaceflight, and the predictive power of this measure related to increased ICP outcomes.

  8. Malignant peripheral nerve sheath tumor arising in a traumatic neuroma: a case report.

    PubMed

    Kos, Zuzana; Robertson, Susan J; Purgina, Bibianna M; Verma, Shailendra; Gravel, Denis H

    2013-10-01

    A 67-year-old woman with a history of breast cancer presented with a soft tissue mass at the site of a remote, non-neoplastic lumbar surgery. Excisional biopsy revealed a traumatic neuroma. Five years later she re-presented with a rapidly growing, tender nodule at the same site. An excisional biopsy was again performed and revealed a tumor composed of malignant epithelioid and spindle cells merging imperceptibly with residual traumatic neuroma. The malignant cells were positive for vimentin, S-100 and micropthalmia transcription factor. They were negative for cytokeratins, muscle markers, Melan-A, HMB45, glial fibrillary acidic protein, and myelin basic protein. Electron microscopy showed no melanosomes. The diagnosis of malignant peripheral nerve sheath tumor arising within a long-standing traumatic neuroma was rendered and represents a hitherto unreported origin of this rare, aggressive soft tissue sarcoma.

  9. Malignant peripheral nerve sheath tumor presenting as orbito temporal lump: Case report and review of literature

    PubMed Central

    Panigrahi, Souvagya; Mishra, Sudhansu S.; Mishra, Sanjib; Das, Srikant

    2016-01-01

    Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma. The most common anatomical sites include the upper and lower extremities and trunk and less commonly the head and neck. To our knowledge, few patients with a cranial or facial MPNST have been reported. We report such a lesion in a 35-year-old woman who presented with left sided rapidly progressive proptosis and visual loss due to an orbital lump extending up to the temporal lobe. Cranial imaging showed a huge mass invading the orbital wall and temporal bone. The presumptive diagnosis was a malignant orbital tumor. Preoperative fine needle aspiration cytology of the orbital mass came to be neurofibroma. Near total resection of the tumor was done. Histopathology revealed MPNST which was subsequently confirmed on the basis of immunopositivity for S-100. The patient recovered uneventfully and was discharged 8 days after surgery with an advice to attend cancer institute for possible radiotherapy. PMID:27057226

  10. Malignant peripheral nerve sheath tumor presenting as orbito temporal lump: Case report and review of literature.

    PubMed

    Panigrahi, Souvagya; Mishra, Sudhansu S; Mishra, Sanjib; Das, Srikant

    2016-01-01

    Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma. The most common anatomical sites include the upper and lower extremities and trunk and less commonly the head and neck. To our knowledge, few patients with a cranial or facial MPNST have been reported. We report such a lesion in a 35-year-old woman who presented with left sided rapidly progressive proptosis and visual loss due to an orbital lump extending up to the temporal lobe. Cranial imaging showed a huge mass invading the orbital wall and temporal bone. The presumptive diagnosis was a malignant orbital tumor. Preoperative fine needle aspiration cytology of the orbital mass came to be neurofibroma. Near total resection of the tumor was done. Histopathology revealed MPNST which was subsequently confirmed on the basis of immunopositivity for S-100. The patient recovered uneventfully and was discharged 8 days after surgery with an advice to attend cancer institute for possible radiotherapy. PMID:27057226

  11. Malignant peripheral nerve sheath tumour in the nasopharynx of a cow.

    PubMed

    Sydler, T; Lesser, M; Waldern, N; Dennler, M; Bode-Lesniewska, B; Pospischil, A; Braun, U

    2013-11-01

    This case describes the findings in a Swiss Braunvieh cow with a malignant peripheral nerve sheath tumour (MPNST) in the nasopharynx. The major clinical signs were mixed dyspnoea with inspiratory and expiratory noises. Radiographic views of the head revealed an irregular mass with soft-tissue density in the nasopharynx originating from the dorsal pharynx and occupying and restricting the pharyngeal cavity. Endoscopic examination showed a lobulated mass obstructing almost the entire lumen of the aboral nasal passages and nasopharynx. Postmortem examination revealed a lobulated mass in the choanae with a broad attachment to the dorsal pharynx and histologically a soft tissue sarcoma with tumour cells positive for the S-100 and p75NTR (neurotrophin receptor) proteins and negative for CNPase. Electron microscopic examination showed few structures that indicated that the tumour originated from Schwann cells.

  12. Functional Expression of Electron Transport Chain and FoF1-ATP Synthase in Optic Nerve Myelin Sheath.

    PubMed

    Bartolucci, Martina; Ravera, Silvia; Garbarino, Greta; Ramoino, Paola; Ferrando, Sara; Calzia, Daniela; Candiani, Simona; Morelli, Alessandro; Panfoli, Isabella

    2015-11-01

    Our previous studies reported evidence for aerobic ATP synthesis by myelin from both bovine brainstem and rat sciatic nerve. Considering that the optic nerve displays a high oxygen demand, here we evaluated the expression and activity of the five Respiratory Complexes in myelin purified from either bovine or murine optic nerves. Western blot analyses on isolated myelin confirmed the expression of ND4L (subunit of Complex I), COX IV (subunit of Complex IV) and β subunit of F1Fo-ATP synthase. Moreover, spectrophotometric and in-gel activity assays on isolated myelin, as well as histochemical activity assays on both bovine and murine transversal optic nerve sections showed that the respiratory Complexes are functional in myelin and are organized in a supercomplex. Expression of oxidative phosphorylation proteins was also evaluated on bovine optic nerve sections by confocal and transmission electron microscopy. Having excluded a mitochondrial contamination of isolated myelin and considering the results form in situ analyses, it is proposed that the oxidative phosphorylation machinery is truly resident in optic myelin sheath. Data may shed a new light on the unknown trophic role of myelin sheath. It may be energy supplier for the axon, explaining why in demyelinating diseases and neuropathies, myelin sheath loss is associated with axonal degeneration.

  13. Medullary metastasis of a malignant peripheral nerve sheath tumor: A case report

    PubMed Central

    Hagi, Tomohito; Nakamura, Tomoki; Yokoji, Ayumu; Matsumine, Akihiko; Sudo, Akihiro

    2016-01-01

    The present study reports a case of medullary metastasis without lung metastasis that occurred as a result of a malignant peripheral nerve sheath tumor (MPNST). An 81-year-old woman presented with a MPNST in the left brachial plexus, arising from the cervical nerve root. The patient underwent carbon ion radiotherapy; however, tumor recurrence was identified in the left shoulder. Subsequently, the patient underwent wide excision. Three weeks subsequent to surgery, imbalance and dysarthria developed suddenly. Dysphagia emerged and left upper limb pain disappeared on the day after symptom development. Magnetic resonance imaging (MRI) revealed that this was due to metastasis to the medulla. Five days subsequent to the onset of dysarthria, the patient succumbed due to respiratory failure. To the best of our knowledge, no previous cases of medullary metastasis arising from a MPNST in the absence of lung metastasis have been reported. MRI is a useful examination tool for the identification of brain metastases; however, the high cost of MRI as a routine examination must be considered due to the rarity of brain metastases. Therefore, methods to detect brain metastasis warrant further investigation. PMID:27588138

  14. Visual Outcome and Tumor Control After Conformal Radiotherapy for Patients With Optic Nerve Sheath Meningioma

    SciTech Connect

    Arvold, Nils D.; Lessell, Simmons; Bussiere, Marc; Beaudette, Kevin; Rizzo, Joseph F.; Loeffler, Jay S.; Shih, Helen A.

    2009-11-15

    Purpose: Optic nerve sheath meningioma (ONSM) is a rare tumor that almost uniformly leads to visual dysfunction and even blindness without intervention. Because surgical extirpation carries a high risk of postoperative blindness, vision-sparing treatment strategies are desirable. Methods and Materials: We retrospectively reviewed the outcomes of 25 patients (25 optic nerves) with ONSM, treated at a single institution with conformal fractionated radiotherapy by either stereotactic photon or proton radiation. Primary endpoints were local control and visual acuity. Results: The patients presented with symptoms of visual loss (21) or orbital pain (3) or were incidentally diagnosed by imaging (3). The mean age was 44 years, and 64% were female patients. The indication for treatment was the development or progression of symptoms. Of the patients, 13 were treated with photons, 9 were treated with protons, and 3 received a combination of photons and protons. The median dose delivered was 50.4 gray equivalents (range, 45-59.4 gray equivalents). Median follow-up after radiotherapy was 30 months (range, 3-168 months), with 3 patients lost to follow-up. At most recent follow-up, 21 of 22 patients (95%) had improved (14) or stable (7) visual acuity. One patient had worsened visual acuity after initial postirradiation improvement. Of the 22 patients, 20 (95%) had no radiographic progression. Three patients had evidence of asymptomatic, limited retinopathy on ophthalmologic examination, and one had recurrent ONSM 11 years after treatment. Conclusions: Highly conformal, fractionated radiation therapy for symptomatic primary ONSM provides tumor control and improvement in visual function in most cases, with minimal treatment-induced morbidity. Longer follow-up is needed to assess the durability of tumor control and treatment-related late effects.

  15. Primary spinal intradural extraskeletal Ewing sarcoma mimicking a giant nerve sheath tumor: case report and review of the literature

    PubMed Central

    Zhao, Mingfei; Zhang, Buyi; Liang, Feng; Zhang, Jianmin

    2014-01-01

    Primary intradural extraskeletal Ewing sarcoma is a very rare form of malignant neoplasm. Only few cases have been reported on the literature. Here, we report a case of a 14-year-old boy who had a chief complaint of pain and tingling in the right lower limb. The patient initially seemed to have a giant nerve sheath tumor but was eventually diagnosed with intradural extraskeletal Ewing sarcoma arising from the nerve roots of the cauda equine. The literature with regard to primary spinal intradural extraskeletal Ewing sarcoma is reviewed. PMID:25674292

  16. Analyses on the misdiagnoses of 25 patients with unilateral optic nerve sheath meningioma

    PubMed Central

    Mao, Jun-Feng; Xia, Xiao-Bo; Tang, Xiang-Bo; Zhang, Xue-Yong; Wen, Dan

    2016-01-01

    AIM To investigate clinical features of optic nerve sheath meningioma (ONSM) that was misdiagnosed, and to find methods to reduce the misdiagnoses. METHODS Retrospective series study. Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan. 2008 to Jan. 2015 and the clinical records reviewed. RESULTS Patients were misdiagnosed with acute papillitis most frequently (n=17), immediately followed by optic atrophy (n=8), ischemic optic neuropathy (n=5), acute retrobulbar optic neuritis (n=5), optic disc vasculitis (n=3). For each patient, the minimum frequency of misdiagnoses was once and the maximum was 4 times. As for the lasting time of being misdiagnosed, the shortest was 1.5mo and the longest was 45mo. Twenty-one cases (84%) were once treated with glucocorticoids, and its side effects was found in seventeen patients. Twenty patients (80%) complained with varying degree of vision loss. When a definite diagnosis was made, sixteen cases (64%) showed slight exophthalmos and eighteen cases (72%) had the tubular ONSM. CONCLUSION ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic, and for most of these ONSMs are tubular. PMID:27672598

  17. Chromosomal imbalances in malignant peripheral nerve sheath tumor detected by metaphase and microarray comparative genomic hybridization.

    PubMed

    Nakagawa, Yasuko; Yoshida, Aki; Numoto, Kunihiko; Kunisada, Toshiyuki; Wai, Daniel; Ohata, Norihide; Takeda, Ken; Kawai, Akira; Ozaki, Toshifumi

    2006-02-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are highly malignant tumors affecting adolescents and adults. There have been a few reports on chromosomal aberrations of MPNSTs; however, the tumor-specific alteration remains unknown. We characterized the genomic alterations in 8 MPNSTs and 8 schwannomas by metaphase comparative genomic hybridization (CGH). In 5 of 8 MPNSTs, microarray CGH was added for more detailed analyses. Frequent gains were identified on 3q13-26, 5p13-14, and 12q11-23 and frequent losses were at 1p31, 10p, 11q24-qter, 16, and 17. Microarray CGH revealed frequent gains of EGFR, DAB2, MSH2, KCNK12, DDX15, CDK6, and LAMA3, and losses of CDH1, GLTSCR2, EGR1, CTSB, GATA3, and SULT2A1. These genes seem to be responsible for developing MPNSTs. The concordance rate between metaphase CGH and microarray CGH was 66%. Metaphase CGH was useful for identifying chromosomal alterations before applying microarray CGH. PMID:16391845

  18. Critical role of PTEN for development and progression of nerve sheath tumors in neurofibromatosis type 1.

    PubMed

    Mawrin, Christian

    2010-04-01

    Evaluation of: Gregorian C, Nakashima J, Dry SM et al.: PTEN dosage is essential for neurofibroma development and malignant transformation. Proc. Natl Acad. Sci. USA 106(46), 19479-19484 (2009). Neurofibromatosis type 1 (NF1) is among the most common inherited tumor-predisposing syndromes in humans. Development of malignant peripheral nerve sheath tumors (MPNSTs) from neurofibroma significantly affects the morbidity and mortality of NF1 patients. The authors demonstrate, using different genetically engineered mouse models, that loss of the tumor suppressor Pten in combination with overexpression of the K-ras oncogene is an important step in MPNST development. In both mouse and human tumors, the transition from low-grade neurofibromas to MPNST is associated with reduced Pten expression, deregulated mTOR signaling activity and increased proliferation. This tumor transition can be monitored by (18)F-fluoro-D-glucose-PET, offering close clinical monitoring of NF1 patients and thus early detection of MPNST development in the future. PMID:20373864

  19. Trp53 Haploinsufficiency Modifies EGFR-Driven Peripheral Nerve Sheath Tumorigenesis

    PubMed Central

    Rahrmann, Eric P.; Moriarity, Branden S.; Otto, George M.; Watson, Adrienne L.; Choi, Kwangmin; Collins, Margaret H.; Wallace, Margaret; Webber, Beau R.; Forster, Colleen L.; Rizzardi, Anthony E.; Schmechel, Stephen C.; Ratner, Nancy; Largaespada, David A.

    2015-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are genetically diverse, aggressive sarcomas that occur sporadically or in association with neurofibromatosis type 1 syndrome. Reduced TP53 gene expression and amplification/overexpression of the epidermal growth factor receptor (EGFR) gene occur in MPNST formation. We focused on determining the cooperativity between reduced TP53 expression and EGFR overexpression for Schwann cell transformation in vitro (immortalized human Schwann cells) and MPNST formation in vivo (transgenic mice). Human gene copy number alteration data, microarray expression data, and TMA analysis indicate that TP53 haploinsufficiency and increased EGFR expression co-occur in human MPNST samples. Concurrent modulation of EGFR and TP53 expression in HSC1λ cells significantly increased proliferation and anchorage-independent growth in vitro. Transgenic mice heterozygous for a Trp53-null allele and overexpressing EGFR in Schwann cells had a significant increase in neurofibroma and grade 3 PNST (MPNST) formation compared with single transgenic controls. Histological analysis of tumors identified a significant increase in pAkt expression in grade 3 PNSTs compared with neurofibromas. Array comparative genome hybridization analysis of grade 3 PNSTs identified recurrent focal regions of chromosomal gains with significant enrichment in genes involved in extracellular signal–regulated kinase 5 signaling. Collectively, altered p53 expression cooperates with overexpression of EGFR in Schwann cells to enhance in vitro oncogenic properties and tumorigenesis and progression in vivo. PMID:24832557

  20. Malignant peripheral nerve sheath tumor of the vulva, an unusual differential diagnosis for vulvar mass

    PubMed Central

    Özdal, Bülent; Öz, Murat; Korkmaz, Elmas; Ataoğlu, Ömür; Güngör, Tayfun; Meydanli, Mehmet Mutlu

    2014-01-01

    INTRODUCTION Malignant peripheral nerve sheath tumors (MPNSTs) are rare, up to one half of the MPNSTs occur in patients with neurofibromatosis type-1 (NF-1), while the rest are sporadic. Here, we present a 52-year-old woman with MPNST of the vulva without NF-1. We will discuss basics of the disease, treatment options and follow-up strategies. PRESENTATION OF CASE 52-year-old female admitted to our hospital with complaint of abnormal uterine bleeding and rapidly growing vulvar mass. Excisional biopsy of the mass showed MPNST of the vulva. Afterwards, the patient underwent radical vulvectomy with inguinofemoral lymph node dissection. Short after the surgery, multiple lung metastasis were shown and responded to chemotherapy, but rapid local recurrence occurred short after the completion of the chemotherapy. DISCUSSION The primary treatment option in MPNSTs is surgical excision with or without adjuvant therapy. There is not enough data about the role of systemic chemotherapy in the management of MPNSTs and it still remains controversial. CONCLUSION In general, radiation therapy has not been demonstrated to improve overall survival. Complete surgical resection of the primary tumor is the mainstay of the treatment. PMID:25290384

  1. Survivin Expression and Prognostic Significance in Pediatric Malignant Peripheral Nerve Sheath Tumors (MPNST)

    PubMed Central

    Boldrin, Daniela; Merlo, Anna; Gambini, Claudio; Ferrari, Andrea; Dall'Igna, Patrizia; Coffin, Cheryl M.; Martines, Annalisa; Bonaldi, Laura; De Salvo, Gian Luca; Zanovello, Paola; Rosato, Antonio

    2013-01-01

    Malignant peripheral nerve sheath tumors (MPNST) are very aggressive malignancies comprising approximately 5–10% of all soft tissue sarcomas. In this study, we focused on pediatric MPNST arising in the first 2 decades of life, as they represent one the most frequent non-rhabdomyosarcomatous soft tissue sarcomas in children. In MPNST, several genetic alterations affect the chromosomal region 17q encompassing the BIRC5/SURVIVIN gene. As cancer-specific expression of survivin has been found to be an effective marker for cancer detection and outcome prediction, we analyzed survivin expression in 35 tumor samples derived from young patients affected by sporadic and neurofibromatosis type 1-associated MPNST. Survivin mRNA and protein expression were assessed by Real-Time PCR and immunohistochemical staining, respectively, while gene amplification was analyzed by FISH. Data were correlated with the clinicopathological characteristics of patients. Survivin mRNA was overexpressed in pediatric MPNST and associated to a copy number gain of BIRC5; furthermore, increased levels of transcripts correlated with a higher FNCLCC tumor grade (grade 1 and 2 vs. 3, p = 0.0067), and with a lower survival probability (Log-rank test, p = 0.0038). Overall, these data support the concept that survivin can be regarded as a useful prognostic marker for pediatric MPNST and a promising target for therapeutic interventions. PMID:24303016

  2. Analyses on the misdiagnoses of 25 patients with unilateral optic nerve sheath meningioma

    PubMed Central

    Mao, Jun-Feng; Xia, Xiao-Bo; Tang, Xiang-Bo; Zhang, Xue-Yong; Wen, Dan

    2016-01-01

    AIM To investigate clinical features of optic nerve sheath meningioma (ONSM) that was misdiagnosed, and to find methods to reduce the misdiagnoses. METHODS Retrospective series study. Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan. 2008 to Jan. 2015 and the clinical records reviewed. RESULTS Patients were misdiagnosed with acute papillitis most frequently (n=17), immediately followed by optic atrophy (n=8), ischemic optic neuropathy (n=5), acute retrobulbar optic neuritis (n=5), optic disc vasculitis (n=3). For each patient, the minimum frequency of misdiagnoses was once and the maximum was 4 times. As for the lasting time of being misdiagnosed, the shortest was 1.5mo and the longest was 45mo. Twenty-one cases (84%) were once treated with glucocorticoids, and its side effects was found in seventeen patients. Twenty patients (80%) complained with varying degree of vision loss. When a definite diagnosis was made, sixteen cases (64%) showed slight exophthalmos and eighteen cases (72%) had the tubular ONSM. CONCLUSION ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic, and for most of these ONSMs are tubular.

  3. Critical role of PTEN for development and progression of nerve sheath tumors in neurofibromatosis type 1.

    PubMed

    Mawrin, Christian

    2010-04-01

    Evaluation of: Gregorian C, Nakashima J, Dry SM et al.: PTEN dosage is essential for neurofibroma development and malignant transformation. Proc. Natl Acad. Sci. USA 106(46), 19479-19484 (2009). Neurofibromatosis type 1 (NF1) is among the most common inherited tumor-predisposing syndromes in humans. Development of malignant peripheral nerve sheath tumors (MPNSTs) from neurofibroma significantly affects the morbidity and mortality of NF1 patients. The authors demonstrate, using different genetically engineered mouse models, that loss of the tumor suppressor Pten in combination with overexpression of the K-ras oncogene is an important step in MPNST development. In both mouse and human tumors, the transition from low-grade neurofibromas to MPNST is associated with reduced Pten expression, deregulated mTOR signaling activity and increased proliferation. This tumor transition can be monitored by (18)F-fluoro-D-glucose-PET, offering close clinical monitoring of NF1 patients and thus early detection of MPNST development in the future.

  4. Controversies: Optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension

    PubMed Central

    Spitze, Arielle; Lam, Peter; Al-Zubidi, Nagham; Yalamanchili, Sushma; Lee, Andrew G

    2014-01-01

    Background: Idiopathic intracranial hypertension (IIH) has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option – optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) shunting – for the long-term treatment of this syndrome. Purpose: To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH. Design: This was a retrospective review of the current literature in the English language indexed in PubMed. Methods: The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo-peritoneal shunting, and lumbo-peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics. Results: The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH-related visual loss and headache. Conclusion: The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway). This article will hopefully be helpful in allowing the reader to make a more informed decision until that time. PMID:25449938

  5. Prognostic roles for fibroblast growth factor receptor family members in malignant peripheral nerve sheath tumor

    PubMed Central

    Song, Fengju; Zheng, Hong; Chen, Kexin; Zhang, Wei; Yang, Jilong

    2016-01-01

    Background Malignant peripheral nerve sheath tumors (MPNST) are rare, highly malignant, and poorly understood sarcomas. The often poor outcome of MPNST highlights the necessity of identifying prognostic predictors for this aggressive sarcoma. Here, we investigate the role of fibroblast growth factor receptor (FGFR) family members in human MPNSTs. Results aCGH and bioinformatics analysis identified frequent amplification of the FGFR1 gene. FISH analysis revealed that 26.9% MPNST samples had amplification of FGFR1, with both focal and polysomy patterns observed. IHC identified that FGFR1 protein expression was positively correlated with FGFR1 gene amplification. High expression of FGFR1 protein was associated with better overall survival (OS) and was an independent prognostic predictor for OS of MPNST patients. Additionally, combined expression of FGFR1 and FGFR2 protein characterized a subtype of MPNST with better OS. FGFR4 protein was expressed 82.3% of MPNST samples, and was associated with poor disease-free survival. Materials and Methods We performed microarray-based comparative genomic hybridization (aCGH) profiling of two cohorts of primary MPNST tissue samples including 25 patients treated at The University of Texas MD Anderson Cancer Center and 26 patients from Tianjin Medical University Cancer Institute and Hospital. Fluorescence in situ hybridization (FISH) was used to validate the gene amplification detected by aCGH analysis. Another cohort of 63 formalin-fixed paraffin-embedded MPNST samples (including 52 samples for FISH assay) was obtained to explore FGFR1, 2, 3, and 4 protein expression by immunohistochemical (IHC) analysis. Conclusions Our integrated genomic and molecular studies provide evidence that FGFRs play different prognostic roles in MPNST. PMID:26993773

  6. Optic Nerve Sheath Diameter Remains Constant during Robot Assisted Laparoscopic Radical Prostatectomy

    PubMed Central

    Verdonck, Philip; Kalmar, Alain F.; Suy, Koen; Geeraerts, Thomas; Vercauteren, Marcel; Mottrie, Alex; De Wolf, Andre M.; Hendrickx, Jan F. A.

    2014-01-01

    Background During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD) measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF) shifts becomes exhausted. Methods After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA I–II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP) was calculated as the mean arterial (MAP) minus central venous pressure (CVP). Results The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times. Conclusion Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small. PMID:25369152

  7. Morphological spectrum of peripheral nerve sheath tumors: An insight into World Health Organization 2013 classification

    PubMed Central

    Chikkannaiah, Panduranga; Boovalli, Mythri M.; Nathiyal, Velusamy; Venkataramappa, Srinivasamurthy

    2016-01-01

    Introduction: Peripheral nerve sheath tumors (PNSTs) are neuroectodermal in origin. Now these tumors are classified under World Health Organization (WHO) classification of tumors of soft tissue and bone 2013. Objective: To study the morphological spectrum of PNST and to study the secondary degenerative changes associated with it. Materials and Methods: This study was conducted from January 2010 to June 2015. The gross details of tumor and patient's demographic profiles were reviewed. The hematoxylin and eosin stained slides were reassessed and the lesions were categorized and classified as per the WHO 2013 classification. The tumors were also assessed for secondary degenerative changes. Results: Our study comprised 143 cases of PNST. Age of the patients ranged from 5 to 75 years. 21–30 years is the most common age of occurrence with head and neck being the most common site. The PNSTs observed in the present study were neurofibroma (NF) (61.5%), schwannoma (36%), malignant PNST (2%), and granular cell tumor (0.5%). Nearly 10% of NF fulfilled the criteria for neurofibromatosis 1 (NF1). Rare tumors such as plexiform schwannoma and granular cell tumor were also observed. Malignant tumors were larger in dimension than benign. Myxoid, cystic, and hyaline changes were commonly associated with benign tumors while necrosis, hemorrhage, and mitotic activity were seen with malignant tumors. Conclusion: This series highlights the pathological variants of PNST along with their morphological changes and NF1 association. It is essential to be familiar with all these variants of PNST for accurate diagnosis as they have varied biological behavior. PMID:27365950

  8. Visual outcomes following optic nerve sheath fenestration via the medial transconjunctival approach.

    PubMed

    Vaidya, Neel S; Mahmoud, Ashraf M; Buzzacco, Dominic; Katz, Steven E

    2016-10-01

    This article determines the safety of optic nerve sheath fenestration (ONSF) for the treatment of patients with intracranial hypertension in the immediate 6-month post-operative period and its efficacy in reducing optic disk edema. Retrospective, non-comparative interventional case series. 207 eyes in 104 patients undergoing ONSF between the years 2005 and 2014. Papilledema grade based on modified Frisen scale and mean deviation of Humphrey visual field. 207 eyes of 104 patients (102 IIH, 2 IH due to dural sinus thrombosis) were included in the study. The patients were 96.1% female (N = 100) and 3.9% male (N = 4). The average patient age was 28.8 years (SD ± 9.5 years) and had a mean opening pressure of 39.85 cmH2O (SD ± 8.4 cmH2O). Mean follow-up period was 6.0 months (SD ± 5.9 months). Papilledema resolved in 76.1% of eyes at 1 week (N = 102 eyes), 75% of eyes at 1 month (N = 90 eyes), and 71% of eyes at 6 months (N = 94 eyes). Visual field comparison had a mean of the paired differences in MD at 1 week, 1 month, and 6 months of 1.59dB (P = 0.006), 2.53dB (P < 0.001), and 1.30dB (P = 0.016), respectively. ONSF is effective in reducing optic disk edema and does not cause vision loss in the 6-month post-operative period regardless of severity of IIH (as judged by elevation of opening pressure measured at pre-operative assessment). PMID:27541942

  9. Minimally invasive endoscopic decompression of the intermatatarsal nerve for Morton's neuroma

    PubMed Central

    Kubota, Mitsuaki; Ohno, Ryuichi; Ishijima, Muneaki; Hanyu, Ryo; Sakai, Kensuke; Sugawara, Yu; Ochi, Hironori; Mukasa, Humihiro; Kaneko, Kazuo

    2015-01-01

    Background We presented case reports of endoscopic decompression for a Morton intermetatarsal neuroma. Methods Three patients underwent surgery using an instrument designed to release the transverse carpal ligament for carpal tunnel syndrome. Each patient was 61, 56 and 24 years old. The mean follow up period was 1.5 years. Results All patients experienced reduced pain postoperatively. The postoperative scar was very small (only 1 cm). There is no loss of sensation, no hematoma and no infection. Conclusion This procedure is simple, and the postoperative morbidity for the patient is minimal. There is rapid recovery with minimal risk of complications that are associated with open techniques. Therefore endoscopic decompression for Morton neuroma offers many advantages and should be studied in a larger number of patients. PMID:26719604

  10. Predictive Factors for Vision Recovery after Optic Nerve Decompression for Chronic Compressive Neuropathy: Systematic Review and Meta-Analysis

    PubMed Central

    Carlson, Andrew P.; Stippler, Martina; Myers, Orrin

    2012-01-01

    Objectives Surgical optic nerve decompression for chronic compressive neuropathy results in variable success of vision improvement. We sought to determine the effects of various factors using meta-analysis of available literature. Design Systematic review of MEDLINE databases for the period 1990 to 2010. Setting Academic research center. Participants Studies reporting patients with vision loss from chronic compressive neuropathy undergoing surgery. Main outcome measures Vision outcome reported by each study. Odds ratios (ORs) and 95% confidence intervals (CIs) for predictor variables were calculated. Overall odds ratios were then calculated for each factor, adjusting for inter study heterogeneity. Results Seventy-six studies were identified. Factors with a significant odds of improvement were: less severe vision loss (OR 2.31[95% CI = 1.76 to 3.04]), no disc atrophy (OR 2.60 [95% CI = 1.17 to 5.81]), smaller size (OR 1.82 [95% CI = 1.22 to 2.73]), primary tumor resection (not recurrent) (OR 3.08 [95% CI = 1.84 to 5.14]), no cavernous sinus extension (OR 1.88 [95% CI = 1.03 to 3.43]), soft consistency (OR 4.91 [95% CI = 2.27 to 10.63]), presence of arachnoid plane (OR 5.60 [95% CI = 2.08 to 15.07]), and more extensive resection (OR 0.61 [95% CI = 0.4 to 0.93]). Conclusions Ophthalmologic factors and factors directly related to the lesion are most important in determining vision outcome. The decision to perform optic nerve decompression for vision loss should be made based on careful examination of the patient and realistic discussion regarding the probability of improvement. PMID:24436885

  11. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

  12. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal. PMID:27284515

  13. The dural sheath of the optic nerve: descriptive anatomy and surgical applications.

    PubMed

    Francois, P; Lescanne, E; Velut, S

    2011-01-01

    The aim of this work was to clarify the descriptive anatomy of the optic dural sheath using microanatomical dissections on cadavers. The orbit is the rostral part of the extradural neural axis compartment; the optic dural sheath forms the central portion of the orbit.In order to describe this specific anatomy, we carefully dissected 5 cadaveric heads (10 orbits) up to the meningeal structure of the orbit and its contents. 1 cadaveric head was reserved for electron microscopy to add to our knowledge of the collagen structure of the optic dural sheath.In this chapter, we describe the anatomy of the interperiostal-dural concept and the anatomy of the orbit. The optic dural sheath contains three portions: the intracranial, the intracanalicular and the intraorbital segment. Each one has specific anatomic relations which result in particular surgical considerations.

  14. The optic nerve sheath hemorrhage is a non-specific finding in cases of suspected child abuse.

    PubMed

    Leeuw, Marc De; Beuls, Emile; Jorens, Philippe G; Parizel, Paul; Jacobs, Werner

    2015-11-01

    In young infants, the triad consisting of acute encephalopathy, retinal hemorrhages, and a subdural hematoma is a nonspecific finding. It has traumatic and non-traumatic etiologies. The triad may be found among a vast spectrum of natural diseases. Optic nerve sheath hemorrhage in infants is typically detected at autopsy. It is a nonspecific finding that can be found in traumatic and non-traumatic etiologies. Neither the triad nor the ONSH are pathognomonic for an abusive head injury. Opposite to the triad, the spectrum of non-traumatic etiologies of ONSH is limited. In infants ONSH rarely occurs in spontaneous subarachnoidal hemorrhage or in infectious conditions. Our results show that the clinical significance of the optic nerve sheath hemorrhage in the forensic work-up of fatal cases of alleged abusive head injury is its limited differential diagnosis. Only after careful differential diagnosis ONSH may contribute to the diagnosis of AHT. However, the main limitation of our study is the sampling bias, as the eyes are usually removed when abusive head trauma is suspected. PMID:26386200

  15. A rare anatomical variant of the thenar branch discovered during open decompression of the median nerve.

    PubMed

    Vinding, Mads T; Tarnowski, Jan R; Benyahia, Mostafa

    2010-12-01

    We describe a rare anatomical variant of the thenar branch of the median nerve during open release of the carpal tunnel. The thenar branch originated from the ulnar side of the median nerve and traversed supraligamentously close to the top of the transverse ligament. A high resolution clinical photograph shows the relation between the anatomical structures when the thenar variant is present in the carpal tunnel. This is one of the dangers faced by surgeons when doing open or endoscopic release of the carpal tunnel.

  16. Influence of breaching the connective sheaths of the donor nerve on its myelinated sensory axons and on their sprouting into the end-to-side coapted nerve in the rat.

    PubMed

    Kovačič, Uroš; Zele, Tilen; Tomšič, Martin; Sketelj, Janez; Bajrović, Fajko F

    2012-12-10

    The influence of breaching the connective sheaths of the donor sural nerve on axonal sprouting into the end-to-side coapted peroneal nerve was examined in the rat. In parallel, the effect of these procedures on the donor nerve was assessed. The sheaths of the donor nerve at the coaptation site were either left completely intact (group A) or they were breached by epineurial sutures (group B), an epineurial window (group C), or a perineurial window (group D). In group A, the compound action potential (CAP) of sensory axons was detected in ~10% and 40% of the recipient nerves at 4 and 8 weeks, respectively, which was significantly less frequently than in group D at both recovery periods. In addition, the number of myelinated axons in the recipient nerve was significantly larger in group D than in other groups at 4 weeks. At 8 weeks, the number of axons in group A was only ~15% of the axon numbers in other groups (p<0.05). Focal subepineurial degenerative changes in the donor nerves were only seen after 4 weeks, but not later. The average CAP area and the total number of myelinated axons in the donor nerves were not different among the experimental groups. In conclusion, myelinated sensory axons are able to penetrate the epiperineurium of donor nerves after end-to-side nerve coaption; however, their ingrowth into recipient nerves is significantly enhanced by breaching the epiperineurial sheets at the coaptation site. Breaching does not cause permanent injury to the donor nerve.

  17. Peripheral nerve connections influence the appearance of neurosecretary material in neural sheath of ventral ganglion of the fly Sarcophaga bullata: an immunocytochemical study.

    PubMed

    Sivasubramanian, P; Sood, Prem Prakash

    2002-02-01

    This study examined the role of the brain and peripheral connections with the target organs in the appearance of neurosecretary material within the dorsal neural sheath of the ventral ganglion of the fly S. bullata. Specifically, the accumulation of the neuropeptide FMRFamide (the neurosecretary material) was examined by immunocytochemistry. Immunoreactions were performed on: (1) a normal intact ventral ganglion, (2) an isolated ventral ganglion that was cultured in vivo, and (3) a ventral ganglion that was isolated by transection from the brain, but retained its peripheral nerve connections. The results demonstrate that (a) the neurons of the ganglia survive and exhibit FMRFamide immune reaction independent of their peripheral connections, and (b) the accumulation of neuropeptide in the dorsal neural sheath is controlled by intact peripheral nerve connections with the ganglion. It is suggested that in the absence of their peripheral connections, the axons of FMRFamide immunoreactive neurons fail to invade the neural sheath resulting in the accumulation of neurosecretary material.

  18. Optic Nerve Sheath Diameter: Translating a Terrestrial Focused Technique Into a Clinical Monitoring Tool for Space Flight

    NASA Technical Reports Server (NTRS)

    Mason, Sara S.; Foy, Millennia; Sargsyan, Ashot; Garcia, Kathleen; Wear, Mary L.; Bedi, Deepak; Ernst, Randy; Van Baalen, Mary

    2014-01-01

    Emergency medicine physicians recently adopted the use of ultrasonography to quickly measure optic nerve sheath diameter (ONSD) as concomitant with increased intracranial pressure. NASA Space and Clinical Operations Division has been using ground and on-orbit ultrasound capabilities since 2009 to consider this anatomical measure as a proxy for intracranial pressure in the microgravity environment. In the terrestrial emergency room population, an ONSD greater than 0.59 cm is considered highly predictive of elevated intracranial pressure. However, this cut-off limit is not applicable to the spaceflight setting since over 50% of US Operating Segment (USOS) astronauts have an ONSD greater than 0.60 cm even before missions. Crew Surgeon clinical decision-making is complicated by the fact that many astronauts have history of previous spaceflights. Data will be presented characterizing the distribution of baseline ONSD in the astronaut corps, longitudinal trends in-flight, and the predictive power of this measure related to increased intracranial pressure outcomes.

  19. Simultaneous presentation of malignant peripheral nerve sheath tumor and moyamoya disease associated with neurofibromatosis type 1 in a child.

    PubMed

    Yoo, Sun Young; Hwang, Sun Mi; Lee, Min Kyung; Jo, Dae Sun; Hwang, Pyoung Han

    2015-01-01

    Neurofibromatosis type 1 (NF-1) is a rare hereditary disorder, which is inherited as an autosomal dominant trait. It is characterized by multiple caféau- lait spots of the skin, benign cutaneous neurofibromas, skeletal dysplasia and learning disability. The association of NF-1 with benign and malignant tumors is well established. The lifetime risk of patients with NF-1 developing malignant peripheral nerve sheath tumors (MPNSTs) has been estimated to be 8-13%. Such tumors can develop in any part of the body, but their occurrence in the gastrointestinal tract is rare. Patients with NF-1 have a wide spectrum of vascular abnormalities. Cerebrovascular lesions have been found in approximately 2.5% of children with NF1. We encountered a case of NF-1 with MPNSTs in the gastrointestinal tract and moyamoya disease.

  20. Divergent differentiation in malignant soft tissue neoplasms: the paradigm of liposarcoma and malignant peripheral nerve sheath tumor.

    PubMed

    Pytel, Peter; Taxy, Jerome B; Krausz, Thomas

    2005-01-01

    In tumors clonality does not always translate into morphologic uniformity. While most sarcomas exhibit only one line of histologic differentiation, a minority may display a strikingly diverse phenotype in addition to the main lineage. This phenomenon not only presents a diagnostic problem but also raises questions about the commitment of tumor cells toward a specific phenotype. Among sarcomas, malignant peripheral nerve sheath tumor (MPNST) and dedifferentiated liposarcoma are two entities in which divergent differentiation is a relatively frequent event. Diagnostically it is crucial to recognize the "primary" sarcoma in such tumors correctly and distinguish it from the "secondary" divergent elements. The presence of the latter could be the first morphologic clue to a specific sarcoma type. Even though it may be difficult to explain the pathogenesis of divergent differentiation, divergence still illustrates that the phenotype of a tumor cell is not set in stone but can be modulated or switched by a number of factors.

  1. Simultaneous presentation of malignant peripheral nerve sheath tumor and moyamoya disease associated with neurofibromatosis type 1 in a child.

    PubMed

    Yoo, Sun Young; Hwang, Sun Mi; Lee, Min Kyung; Jo, Dae Sun; Hwang, Pyoung Han

    2015-01-01

    Neurofibromatosis type 1 (NF-1) is a rare hereditary disorder, which is inherited as an autosomal dominant trait. It is characterized by multiple caféau- lait spots of the skin, benign cutaneous neurofibromas, skeletal dysplasia and learning disability. The association of NF-1 with benign and malignant tumors is well established. The lifetime risk of patients with NF-1 developing malignant peripheral nerve sheath tumors (MPNSTs) has been estimated to be 8-13%. Such tumors can develop in any part of the body, but their occurrence in the gastrointestinal tract is rare. Patients with NF-1 have a wide spectrum of vascular abnormalities. Cerebrovascular lesions have been found in approximately 2.5% of children with NF1. We encountered a case of NF-1 with MPNSTs in the gastrointestinal tract and moyamoya disease. PMID:26690608

  2. BET Bromodomain Inhibition Triggers Apoptosis of NF1-associated Malignant Peripheral Nerve Sheath Tumors through Bim Induction

    PubMed Central

    Patel, Amish J.; Liao, Chung-Ping; Chen, Zhiguo; Liu, Chiachi; Wang, Yong; Le, Lu Q.

    2014-01-01

    Summary Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are highly aggressive sarcomas that develop sporadically or in Neurofibromatosis type 1 (NF1) patients. There is no effective treatment for MPNSTs and they are typically fatal. To gain insights into MPNST pathogenesis, we utilized a novel MPNST mouse model that allowed us to study the evolution of these tumors at the transcriptome level. Strikingly, in MPNSTs we found upregulation of chromatin regulator Brd4, and show that BRD4 inhibition profoundly suppresses both growth and tumorigenesis. Our findings reveal new roles for BET bromodomains in MPNST development, and report a novel mechanism by which bromodomain inhibition induces apoptosis through induction of pro-apoptotic Bim, which may represent a paradigm shift in therapy for MPNST patients. Moreover, these findings indicate novel epigenetic mechanisms underlying the balance of anti-/pro-apoptotic molecules, and that bromodomain inhibition can shift this balance in favor of cancer cell apoptosis. PMID:24373973

  3. Constructing a statistical atlas of the radii of the optic nerve and cerebrospinal fluid sheath in young healthy adults

    NASA Astrophysics Data System (ADS)

    Harrigan, Robert L.; Plassard, Andrew J.; Mawn, Louise A.; Galloway, Robert L.; Smith, Seth A.; Landman, Bennett A.

    2015-03-01

    Optic neuritis is a sudden inflammation of the optic nerve (ON) and is marked by pain on eye movement, and visual symptoms such as a decrease in visual acuity, color vision, contrast and visual field defects. The ON is closely linked with multiple sclerosis (MS) and patients have a 50% chance of developing MS within 15 years. Recent advances in multi-atlas segmentation methods have omitted volumetric assessment. In the past, measuring the size of the ON has been done by hand. We utilize a new method of automatically segmenting the ON to measure the radii of both the ON and surrounding cerebrospinal fluid (CSF) sheath to develop a normative distribution of healthy young adults. We examine this distribution for any trends and find that ON and CSF sheath radii do not vary between 20-35 years of age and between sexes. We evaluate how six patients suffering from optic neuropathy compare to this distribution of controls. We find that of these six patients, five of them qualitatively differ from the normative distribution which suggests this technique could be used in the future to distinguish between optic neuritis patients and healthy controls

  4. A case of atypical McCune-Albright syndrome requiring optic nerve decompression.

    PubMed

    Yavuzer, R; Khilnani, R; Jackson, I T; Audet, B

    1999-10-01

    McCune-Albright syndrome (MAS) is a disease of noninheritable, genetic origin defined by the triad of café-au-lait pigmentation of the skin, precocious puberty, and polyostotic fibrous dysplasia. This syndrome, which affects young girls primarily, has also been reported with other endocrinopathies, and rarely with acromegaly and hyperprolactinemia. The fibrous dysplasia in MAS is of the polyostotic type and, apart from the characteristic sites such as the proximal aspects of the femur and the pelvis, the craniofacial region is frequently involved. A male patient with MAS presented with juvenile gigantism, precocious puberty, pituitary adenoma-secreting growth hormone and prolactin, hypothalamic pituitary gonadal and thyroid dysfunction, and polyostotic fibrous dysplasia causing optic nerve compression. Visual deterioration and its surgical management are presented. PMID:10517473

  5. Ras-Driven Transcriptome Analysis Identifies Aurora Kinase A as a Potential Malignant Peripheral Nerve Sheath Tumor Therapeutic Target

    PubMed Central

    Patel, Ami V.; Eaves, David; Jessen, Walter J.; Rizvi, Tilat A.; Ecsedy, Jeffrey A.; Qian, Mark G.; Aronow, Bruce J.; Perentesis, John P.; Serra, Eduard; Cripe, Timothy P.; Miller, Shyra J.; Ratner, Nancy

    2013-01-01

    Purpose Patients with Neurofibromatosis Type 1 (NF1) develop malignant peripheral nerve sheath tumors (MPNST) which are often inoperable and do not respond well to current chemotherapies or radiation. The goal of this study was to utilize comprehensive gene expression analysis to identify novel therapeutic targets. Experimental Design Nerve Schwann cells and/or their precursors are the tumorigenic cell types in MPNST due to the loss of the NF1 gene, which encodes the RasGAP protein neurofibromin. Therefore, we created a transgenic mouse model, CNP-HRas12V, expressing constitutively-active HRas in Schwann cells and defined a Ras-induced gene expression signature to drive a Bayesian factor regression model analysis of differentially expressed genes in mouse and human neurofibromas and MPNSTs. We tested functional significance of Aurora kinase over-expression in MPNST in vitro and in vivo using Aurora kinase shRNAs and compounds that inhibit Aurora kinase. Results We identified 2000 genes with probability of linkage to nerve Ras signaling of which 339 were significantly differentially expressed in mouse and human NF1-related tumor samples relative to normal nerves, including Aurora kinase A (AURKA). AURKA was dramatically over-expressed and genomically amplified in MPNSTs but not neurofibromas. Aurora kinase shRNAs and Aurora kinase inhibitors blocked MPNST cell growth in vitro. Furthermore, an AURKA selective inhibitor, MLN8237, stabilized tumor volume and significantly increased survival of mice with MPNST xenografts. Conclusion Integrative cross-species transcriptome analyses combined with preclinical testing has provided an effective method for identifying candidates for molecular-targeted therapeutics. Blocking Aurora kinases may be a viable treatment platform for MPNST. PMID:22811580

  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. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery.

    PubMed

    Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K

    2016-02-01

    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.

  8. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery.

    PubMed

    Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K

    2016-02-01

    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

  9. Navigated Transtubular Extraforaminal Decompression of the L5 Nerve Root at the Lumbosacral Junction: Clinical Data, Radiographic Features, and Outcome Analysis

    PubMed Central

    Stavrinou, P.; Härtl, R.; Krischek, B.; Kabbasch, C.; Mpotsaris, A.; Goldbrunner, R.

    2016-01-01

    Purpose. Extraforaminal decompression of the L5 nerve root remains a challenge due to anatomic constraints, severe level-degeneration, and variable anatomy. The purpose of this study is to introduce the use of navigation for transmuscular transtubular decompression at the L5/S1 level and report on radiological features and clinical outcome. Methods. Ten patients who underwent a navigation-assisted extraforaminal decompression of the L5 nerve root were retrospectively analyzed. Results. Six patients had an extraforaminal herniated disc and four had a foraminal stenosis. The distance between the L5 transverse process and the para-articular notch of the sacrum was 12.1 mm in patients with a herniated disc and 8.1 mm in those with a foraminal stenosis. One patient had an early recurrence and another developed dysesthesia that resolved after 3 months. There was a significant improvement from preoperative to postoperative NRS with the results being sustainable at follow-up. ODI was also significantly improved after surgery. According to the Macnab grading scale, excellent or good outcomes were obtained in 8 patients and fair ones in 2. Conclusions. The navigated transmuscular transtubular approach to the lumbosacral junction allows for optimal placement of the retractor and excellent orientation particularly for foraminal stenosis or in cases of complex anatomy. PMID:27127783

  10. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration.

    PubMed

    Rankin, Timothy M; Miller, John D; Gruessner, Angelika C; Nickerson, D Scott

    2015-07-01

    The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States.

  11. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration

    PubMed Central

    Rankin, Timothy M.; Miller, John D.; Gruessner, Angelika C.; Nickerson, D. Scott

    2015-01-01

    The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States. PMID:26055081

  12. Comprehensive establishment and characterization of orthoxenograft mouse models of malignant peripheral nerve sheath tumors for personalized medicine

    PubMed Central

    Castellsagué, Joan; Gel, Bernat; Fernández-Rodríguez, Juana; Llatjós, Roger; Blanco, Ignacio; Benavente, Yolanda; Pérez-Sidelnikova, Diana; García-del Muro, Javier; Viñals, Joan Maria; Vidal, August; Valdés-Mas, Rafael; Terribas, Ernest; López-Doriga, Adriana; Pujana, Miguel Angel; Capellá, Gabriel; Puente, Xose S; Serra, Eduard; Villanueva, Alberto; Lázaro, Conxi

    2015-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are soft-tissue sarcomas that can arise either sporadically or in association with neurofibromatosis type 1 (NF1). These aggressive malignancies confer poor survival, with no effective therapy available. We present the generation and characterization of five distinct MPNST orthoxenograft models for preclinical testing and personalized medicine. Four of the models are patient-derived tumor xenografts (PDTX), two independent MPNSTs from the same NF1 patient and two from different sporadic patients. The fifth model is an orthoxenograft derived from an NF1-related MPNST cell line. All MPNST orthoxenografts were generated by tumor implantation, or cell line injection, next to the sciatic nerve of nude mice, and were perpetuated by 7–10 mouse-to-mouse passages. The models reliably recapitulate the histopathological properties of their parental primary tumors. They also mimic distal dissemination properties in mice. Human stroma was rapidly lost after MPNST engraftment and replaced by murine stroma, which facilitated genomic tumor characterization. Compatible with an origin in a catastrophic event and subsequent genome stabilization, MPNST contained highly altered genomes that remained remarkably stable in orthoxenograft establishment and along passages. Mutational frequency and type of somatic point mutations were highly variable among the different MPNSTs modeled, but very consistent when comparing primary tumors with matched orthoxenografts generated. Unsupervised cluster analysis and principal component analysis (PCA) using an MPNST expression signature of ~1,000 genes grouped together all primary tumor–orthoxenograft pairs. Our work points to differences in the engraftment process of primary tumors compared with the engraftment of established cell lines. Following standardization and extensive characterization and validation, the orthoxenograft models were used for initial preclinical drug testing. Sorafenib (a

  13. Combinatorial therapy with tamoxifen and trifluoperazine effectively inhibits malignant peripheral nerve sheath tumor growth by targeting complementary signaling cascades.

    PubMed

    Brosius, Stephanie N; Turk, Amy N; Byer, Stephanie J; Longo, Jody Fromm; Kappes, John C; Roth, Kevin A; Carroll, Steven L

    2014-11-01

    Chemotherapeutic agents effective against malignant peripheral nerve sheath tumors (MPNSTs) are urgently needed. We recently found that tamoxifen potently impedes xenograft growth. In vitro, tamoxifen inhibits MPNST proliferation and survival in an estrogen receptor-independent manner; these effects are phenocopied by the calmodulin inhibitor trifluoperazine. The present study was performed to establish the mechanism of action of tamoxifen in vivo and optimize its therapeutic effectiveness. To determine if tamoxifen has estrogen receptor-dependent effects in vivo, we grafted MPNST cells in castrated and ovariectomized mice; xenograft growth was unaffected by reductions in sex hormones. To establish whether tamoxifen and trifluoperazine additively or synergistically impede MPNST growth, mice xenografted with neurofibromatosis type 1-associated or sporadic MPNST cells were treated with tamoxifen, trifluoperazine, or both drugs for 30 days. Both monotherapies inhibited graft growth by 50%, whereas combinatorial treatment maximally reduced graft mass by 90% and enhanced decreases in proliferation and survival. Kinomic analyses showed that tamoxifen and trifluoperazine have both shared and distinct targets in MPNSTs. In addition, trifluoperazine prevented tamoxifen-induced increases in serum/glucocorticoid regulated kinase 1, a protein linked to tamoxifen resistance. These findings suggest that combinatorial therapy with tamoxifen and trifluoperazine is effective against MPNSTs because these agents target complementary pathways that are essential for MPNST pathogenesis.

  14. Genomic and molecular aberrations in malignant peripheral nerve sheath tumor and their roles in personalized target therapy.

    PubMed

    Yang, Jilong; Du, Xiaoling

    2013-09-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are malignant tumors with a high rate of local recurrence and a significant tendency to metastasize. Its dismal outcome points to the urgent need to establish better therapeutic strategies for patients harboring MPNSTs. The investigations of genomic and molecular aberrations in MPNSTs which detect many chromosomal aberrations, pathway abnormalities, and specific molecular aberrant events would supply multiple potential therapy targets and contribute to achievement of personalized medicine. The involved genes in the significant gains aberrations include BIRC5, CCNE2, DAB2, DDX15, EGFR, DAB2, MSH2, CDK6, HGF, ITGB4, KCNK12, LAMA3, LOXL2, MET, and PDGFRA. The involved genes in the significant deletion aberrations include CDH1, GLTSCR2, EGR1, CTSB, GATA3, SULT2A1, GLTSCR2, HMMR/RHAMM, LICAM2, MMP13, p16/INK4a, RASSF2, NM-23H1, and TP53. These genetic aberrations involve in several important signaling pathways such as TFF, EGFR, ARF, IGF1R signaling pathways. The genomic and molecular aberrations of EGFR, IGF1R, SOX9, EYA4, TOP2A, ETV4, and BIRC5 exhibit great promise as personalized therapeutic targets for MPNST patients. PMID:23830351

  15. Standard-Fractionated Radiotherapy for Optic Nerve Sheath Meningioma: Visual Outcome Is Predicted by Mean Eye Dose

    SciTech Connect

    Abouaf, Lucie; Girard, Nicolas; Lefort, Thibaud; D'hombres, Anne; Tilikete, Caroline; Vighetto, Alain; Mornex, Francoise

    2012-03-01

    Purpose: Radiotherapy has shown its efficacy in controlling optic nerve sheath meningiomas (ONSM) tumor growth while allowing visual acuity to improve or stabilize. However, radiation-induced toxicity may ultimately jeopardize the functional benefit. The purpose of this study was to identify predictive factors of poor visual outcome in patients receiving radiotherapy for ONSM. Methods and Materials: We conducted an extensive analysis of 10 patients with ONSM with regard to clinical, radiologic, and dosimetric aspects. All patients were treated with conformal radiotherapy and subsequently underwent biannual neuroophthalmologic and imaging assessments. Pretreatment and posttreatment values of visual acuity and visual field were compared with Wilcoxon's signed rank test. Results: Visual acuity values significantly improved after radiotherapy. After a median follow-up time of 51 months, 6 patients had improved visual acuity, 4 patients had improved visual field, 1 patient was in stable condition, and 1 patient had deteriorated visual acuity and visual field. Tumor control rate was 100% at magnetic resonance imaging assessment. Visual acuity deterioration after radiotherapy was related to radiation-induced retinopathy in 2 patients and radiation-induced mature cataract in 1 patient. Study of radiotherapy parameters showed that the mean eye dose was significantly higher in those 3 patients who had deteriorated vision. Conclusions: Our study confirms that radiotherapy is efficient in treating ONSM. Long-term visual outcome may be compromised by radiation-induced side effects. Mean eye dose has to be considered as a limiting constraint in treatment planning.

  16. Telomerase activity is a biomarker for high grade malignant peripheral nerve sheath tumors in neurofibromatosis type 1 individuals.

    PubMed

    Mantripragada, Kiran K; Caley, Matthew; Stephens, Phil; Jones, Christopher J; Kluwe, Lan; Guha, Abhijit; Mautner, Victor; Upadhyaya, Meena

    2008-03-01

    Telomerase activity (TA) and the expression of its enzymatic subunits, which have been demonstrated in many tumors, remain poorly investigated in tumors associated with neurofibromatosis type 1 (NF1). In this study, we analysed the association of TA and the expression of telomerase RNA (TR) and telomerase reverse transcriptase (TERT) in 23 malignant peripheral nerve sheath tumors (MPNST) (17 high grade and 6 low grade tumors), 11 plexiform neurofibromas (PNF) and 6 dermal neurofibromas (DNF). TA was studied using telomerase repeat amplification protocol (TRAP) assay and expression of TR and TERT was investigated using reverse transcription PCR (RT-PCR) and real-time PCR. TA was detected in 14 out of 17 (82%) high grade MPNST, whereas all 6 low grade MPNST and 17 benign tumors were telomerase negative. The TERT transcripts were detected in all high grade MPNST, 50% of the low grade MPNST, and 4 benign tumors. However, the expression level of the TERT strikingly correlated with TA and high grade MPNST. Thus, while TERT expression was similar in both low grade MPNST and PNF (P = 0.115), it was significantly higher in high grade MPNST when compared to either low grade MPNST (P = 0.042), PNF (P = 0.001) or DNF tumors (P = 0.010). These findings indicate that TA and expression level of TERT are potential markers for high grade malignancy in NF1 patients.

  17. Forward genetic screen for malignant peripheral nerve sheath tumor formation identifies new genes and genetic pathways driving tumorigenesis

    PubMed Central

    Rahrmann, Eric P; Watson, Adrienne L; Keng, Vincent W; Choi, Kwangmin; Moriarity, Branden S; Beckmann, Dominic A; Wolf, Natalie; Sarver, Aaron; Collins, Margaret H; Moertel, Christopher L; Wallace, Margaret R; Gel, Bernat; Serra, Eduard; Ratner, Nancy; Largaespada, David A

    2013-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are sarcomas of Schwann cell-lineage origin that occur sporadically or in association with the inherited syndrome, Neurofibromatosis Type 1. To identify genetic drivers of MPNST development, we utilized the Sleeping Beauty (SB) transposon-based somatic mutagenesis system in mice with somatic loss of tumor protein p53 (Trp53) function and/or overexpression of epidermal growth factor receptor (EGFR). Common insertion site (CIS) analysis of 269 neurofibromas and 106 MPNSTs identified 695 and 87 sites with a statistically significant number of recurrent transposon insertions, respectively. Comparison to human data sets revealed novel and known driver genes for MPNST formation at these sites. Pairwise co-occurrence analysis of CIS-associated genes identified many cooperating mutations that are enriched for in Wnt/CTNNB1, PI3K/Akt/mTor, and growth factor receptor signaling pathways. Lastly, we identified several novel proto-oncogenes including forkhead box R2 (Foxr2), which we functionally validated as a proto-oncogene involved in MPNST maintenance. PMID:23685747

  18. Intraoperative monitoring during decompression of the spinal cord and spinal nerves using transcranial motor-evoked potentials: The law of twenty percent.

    PubMed

    Tanaka, Satoshi; Hirao, Jun; Oka, Hidehiro; Akimoto, Jiro; Takanashi, Junko; Yamada, Junichi

    2015-09-01

    Motor-evoked potential (MEP) monitoring was performed during 196 consecutive spinal (79 cervical and 117 lumbar) surgeries for the decompression of compressive spinal and spinal nerve diseases. MEP monitoring in spinal surgery has been considered sensitive to predict postoperative neurological recovery. In this series, transcranial stimulation consisted of trains of five pulses at a constant voltage (200-600 V). For the normalization of MEP, we recorded compound muscle action potentials (CMAP) after peripheral nerve stimulation, usually on the median nerve at the wrist 2 seconds before or after each transcranial stimulation of the motor area, for all operations. The sensitivity and specificity of MEP monitoring was 100% and 97.4%, respectively, or 96.9% with or without CMAP compensation (if the threshold of postoperative motor palsy was defined as 20% relative amplitude rate [RAR]). The mean RAR after CMAP normalization, of the most affected muscle in the patient group with excellent postoperative results (recovery rate of a Japan Orthopedic Association score of more than 50%) was significantly higher than that in the other groups (p=0.0224). All patients with an amplitude increase rate (AIR) with CMAP normalization of more than 20% achieved neurological recovery postoperatively. Our results suggest that if the RAR is more than 20%, postoperative motor palsy can be avoided in spinal surgery. If the AIR with normalization by CMAP after peripheral nerve stimulation is more than 20%, neurological recovery can be expected in spinal surgery. PMID:26142049

  19. Genomic amplification and high expression of EGFR are key targetable oncogenic events in malignant peripheral nerve sheath tumor

    PubMed Central

    2013-01-01

    Background The dismal outcome of malignant peripheral nerve sheath tumor (MPNST) highlights the necessity of finding new therapeutic methods to benefit patients with this aggressive sarcoma. Our purpose was to investigate epidermal growth factor receptor (EGFR) as a potential therapeutic target in MPNSTs. Patients and methods We performed a microarray based-comparative genomic hybridization (aCGH) profiling of two cohorts of primary MPNST tissue samples including 25 patients treated at The University of Texas MD Anderson Cancer Center (MD Anderson) and 26 patients from Tianjin Medical University Cancer Institute & Hospital (TMUCIH). Fluorescence in situ hybridization (FISH) method was used to validate the gene amplification detected by aCGH analysis. Another independent cohort of 56 formalin fixed paraffin embedded (FFPE) MPNST samples was obtained to explore EGFR protein expression by immunohistochemical analysis. Cell biology detection and validation were performed on human MPNST cell lines ST88-14 and STS26T. Results aCGH and pathway analysis of the 51 MPNSTs identified significant gene amplification events in EGFR pathway, including frequent amplifications of EGFR gene itself, which was subsequently validated by FISH assay. High expression of EGFR protein was associated with poor disease-free and overall survival of human MPNST patients. In human MPNST cell lines ST88-14 and STS26T, inhibition of EGFR by siRNA or Gefitinib led to decreased cell proliferation, migration, and invasion accompanied by attenuation of PI3K/AKT and MAPK pathways. Conclusion These results suggest that EGFR is a potential therapeutic target for MPNST. PMID:24341609

  20. Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study

    PubMed Central

    Sangani, Shruti V; Parikh, Samira

    2015-01-01

    CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis. Objectives: The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED). Materials and Methods: We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients. Results: The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42). These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001). Conclusion: The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME. PMID:25969641

  1. Classic Ras Proteins Promote Proliferation and Survival Via Distinct Phosphoproteome Alterations in Neurofibromin-Null Malignant Peripheral Nerve Sheath Tumor Cells

    PubMed Central

    Brossier, Nicole M.; Prechtl, Amanda M.; Longo, Jody Fromm; Barnes, Stephen; Wilson, Landon S.; Byer, Stephanie J.; Brosius, Stephanie N.; Carroll, Steven L.

    2015-01-01

    Neurofibromin, the tumor suppressor encoded by the neurofibromatosis type 1 (NF1) gene, potentially suppresses the activation of H-Ras, N-Ras and K-Ras. However, it is not known whether these classic Ras proteins are hyperactivated in NF1-null nerve sheath tumors, how they contribute to tumorigenesis and what signaling pathways mediate their effects. Here we show that H-Ras, N-Ras and K-Ras are coexpressed with their activators, (guanine nucleotide exchange factors), in neurofibromin-null malignant peripheral nerve sheath tumor (MPNST) cells and that all 3 Ras proteins are activated. Dominant negative (DN) H-Ras, a pan-inhibitor of the classic Ras family, inhibited MPNST proliferation and survival, but not migration. However, NF1-null MPNST cells were variably dependent on individual Ras proteins. In some lines, ablation of H-Ras, N-Ras and/or K-Ras inhibited mitogenesis. In others, ablation of a single Ras protein had no effect on proliferation; in these lines, ablation of a single Ras protein resulted in compensatory increases in the activation and/or expression of other Ras proteins. Using mass spectrometry-based phosphoproteomics, we identified 7 signaling networks affecting morphology, proliferation and survival that are regulated by DN H-Ras. Thus, neurofibromin loss activates multiple classic Ras proteins that promote proliferation and survival by regulating several distinct signaling cascades. PMID:25946318

  2. Classic Ras Proteins Promote Proliferation and Survival via Distinct Phosphoproteome Alterations in Neurofibromin-Null Malignant Peripheral Nerve Sheath Tumor Cells.

    PubMed

    Brossier, Nicole M; Prechtl, Amanda M; Longo, Jody Fromm; Barnes, Stephen; Wilson, Landon S; Byer, Stephanie J; Brosius, Stephanie N; Carroll, Steven L

    2015-06-01

    Neurofibromin, the tumor suppressor encoded by the neurofibromatosis type 1 (NF1) gene, potentially suppresses the activation of H-Ras, N-Ras, and K-Ras. However, it is not known whether these classic Ras proteins are hyperactivated in NF1-null nerve sheath tumors, how they contribute to tumorigenesis, and what signaling pathways mediate their effects. Here we show that H-Ras, N-Ras, and K-Ras are coexpressed with their activators (guanine nucleotide exchange factors) in neurofibromin-null malignant peripheral nerve sheath tumor (MPNST) cells, and that all 3 Ras proteins are activated. Dominant negative (DN) H-Ras, a pan-inhibitor of the classic Ras family, inhibited MPNST proliferation and survival, but not migration. However, NF1-null MPNST cells were variably dependent on individual Ras proteins. In some lines, ablation of H-Ras, N-Ras, and/or K-Ras inhibited mitogenesis. In others, ablation of a single Ras protein had no effect on proliferation; in these lines, ablation of a single Ras protein resulted in compensatory increases in the activation and/or expression of other Ras proteins. Using mass spectrometry-based phosphoproteomics, we identified 7 signaling networks affecting morphology, proliferation, and survival that are regulated by DN H-Ras. Thus, neurofibromin loss activates multiple classic Ras proteins that promote proliferation and survival by regulating several distinct signaling cascades.

  3. Triterpenoid saponin flaccidoside II from Anemone flaccida triggers apoptosis of NF1-associated malignant peripheral nerve sheath tumors via the MAPK-HO-1 pathway.

    PubMed

    Han, Lin-Tao; Fang, Yin; Cao, Yan; Wu, Feng-Hua; Liu, E; Mo, Guo-Yan; Huang, Fang

    2016-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are highly aggressive soft tissue neoplasms that are extremely rare and are frequently associated with neurofibromatosis type 1 patients. MPNSTs are typically fatal, and there is no effective treatment so far. In our previous study, we showed that flaccidoside II, one of the triterpenoid saponins isolated from Anemone flaccida Fr. Schmidt, has antitumor potential by inducing apoptosis. In the present study, we found that flaccidoside II inhibits proliferation and facilitates apoptosis in MPNST cell lines ST88-14 and S462. Furthermore, this study provides a mechanism by which the downregulation of heme oxygenase-1 via extracellular signal-regulated kinase-1/2 and p38 mitogen-activated protein kinase pathways is involved in the apoptotic role of flaccidoside II. This study suggested the potential of flaccidoside II as a novel pharmacotherapeutic approach for MPNSTs. PMID:27103823

  4. Triterpenoid saponin flaccidoside II from Anemone flaccida triggers apoptosis of NF1-associated malignant peripheral nerve sheath tumors via the MAPK-HO-1 pathway

    PubMed Central

    Han, Lin-tao; Fang, Yin; Cao, Yan; Wu, Feng-hua; Liu, E; Mo, Guo-yan; Huang, Fang

    2016-01-01

    Malignant peripheral nerve sheath tumors (MPNSTs) are highly aggressive soft tissue neoplasms that are extremely rare and are frequently associated with neurofibromatosis type 1 patients. MPNSTs are typically fatal, and there is no effective treatment so far. In our previous study, we showed that flaccidoside II, one of the triterpenoid saponins isolated from Anemone flaccida Fr. Schmidt, has antitumor potential by inducing apoptosis. In the present study, we found that flaccidoside II inhibits proliferation and facilitates apoptosis in MPNST cell lines ST88-14 and S462. Furthermore, this study provides a mechanism by which the downregulation of heme oxygenase-1 via extracellular signal-regulated kinase-1/2 and p38 mitogen-activated protein kinase pathways is involved in the apoptotic role of flaccidoside II. This study suggested the potential of flaccidoside II as a novel pharmacotherapeutic approach for MPNSTs. PMID:27103823

  5. Lack of SYT-SSX fusion transcripts in malignant peripheral nerve sheath tumors on RT-PCR analysis of 34 archival cases.

    PubMed

    Tamborini, Elena; Agus, Viviana; Perrone, Federica; Papini, Daniela; Romanò, Roberta; Pasini, Barbara; Gronchi, Alessandro; Colecchia, Maurizio; Rosai, Juan; Pierotti, Marco A; Pilotti, Silvana

    2002-05-01

    The translocation t(X;18) is currently regarded as a specific molecular marker of synovial sarcoma (SS). Recently, however, it has been reported that malignant peripheral nerve sheath tumors expressed this marker in 75% of the cases. To test independently this iconoclastic claim, a molecular analysis for the detection of the SYT-SSX fusion genes was carried out using archival material of 34 consecutive cases diagnosed as malignant peripheral nerve sheath tumors and treated in our Institute from 1998 to 2000. In four of these cases, the molecular analysis on fixed tissues was supplemented with an analysis on fresh frozen tissue. RNA extracted from formalin-fixed paraffin-embedded tissue blocks was evaluated for the presence of SYT-SSX1 and SYT-SSX2 fusion transcripts by RT-PCR. This analysis was extended to a wide variety of normal tissues simultaneously extracted and equally processed. Only two of the cases studied harbored SYT-SSX1 and SYT-SSX2 fusion transcripts, respectively. The diagnostic reevaluation of these two cases in light of the molecular data disclosed that one had the features of a monophasic SS and the other was compatible with that entity. Both of these tumors were strongly immunoreactive for bcl-2, confirming the diagnostic utility of this marker in this instance. Our results reaffirm the specificity of SYT-SSX for SS and suggest that an opposite claim made in a recent study may have been due to a faulty interpretation of the molecular results caused by a contamination of the samples. PMID:12004001

  6. Expression profiling of 519 kinase genes in matched malignant peripheral nerve sheath tumor/plexiform neurofibroma samples is discriminatory and identifies mitotic regulators BUB1B, PBK and NEK2 as overexpressed with transformation.

    PubMed

    Stricker, Thomas P; Henriksen, Kammi J; Tonsgard, James H; Montag, Anthony G; Krausz, Thomas N; Pytel, Peter

    2013-07-01

    About 50% of all malignant peripheral nerve sheath tumors (MPNSTs) arise as neurofibromatosis type 1 associated lesions. In those patients malignant peripheral nerve sheath tumors are thought to arise through malignant transformation of a preexisting plexiform neurofibroma. The molecular changes associated with this transformation are still poorly understood. We sought to test the hypothesis that dysregulation of expression of kinases contributes to this malignant transformation. We analyzed expression of all 519 kinase genes in the human genome using the nanostring nCounter system. Twelve cases of malignant peripheral nerve sheath tumor arising in a background of preexisting plexiform neurofibroma were included. Both components were separately sampled. Statistical analysis compared global changes in expression levels as well as changes observed in the pairwise comparison of samples taken from the same surgical specimen. Immunohistochemical studies were performed on tissue array slides to confirm expression of selected proteins. The expression pattern of kinase genes can separate malignant peripheral nerve sheath tumors and preexisting plexiform neurofibromas. The majority of kinase genes is downregulated rather than overexpressed with malignant transformation. The patterns of expression changes are complex without simple recurring alteration. Pathway analysis demonstrates that differentially expressed kinases are enriched for kinases involved in the direct regulation of mitosis, and several of these show increased expression in malignant peripheral nerve sheath tumors. Immunohistochemical studies for the mitotic regulators BUB1B, PBK and NEK2 confirm higher expression levels at the protein level. These results suggest that the malignant transformation of plexiform neurofibroma is associated with distinct changes in the expression of kinase genes. The patterns of these changes are complex and heterogeneous. There is no single unifying alteration. Kinases involved

  7. Fractionated Conformal Radiotherapy for Management of Optic Nerve Sheath Meningiomas: Long-Term Outcomes of Tumor Control and Visual Function at a Single Institution

    SciTech Connect

    Metellus, Philippe; Kapoor, Sumit; Kharkar, Siddharth; Batra, Sachin; Jackson, Juan F.; Kleinberg, Lawrence; Miller, Neil R.; Rigamonti, Daniele

    2011-05-01

    Purpose: To provide the long-term outcomes of patients treated with fractionated conformal radiotherapy (FCRT) for presumed optic nerve sheath meningiomas (ONSMs). Patients and Methods: Between 1995 and 2002, 9 patients with a presumed ONSM were treated with FCRT at our institution. The indications for FCRT were significant visual dysfunction at presentation, progression of visual dysfunction during a period of observation, tumor growth documented by sequential imaging, or a combination of these findings. In 2 patients, FCRT was performed as adjuvant therapy, and in 7, it was the initial and primary treatment. Results: Of the 9 patients, 6 were women and 3 were men, with a mean age of 47 years. All 9 patients had evidence of optic nerve dysfunction in the affected eye, characterized by reduced visual acuity, a visual field defect, and a relative afferent pupillary defect. In addition, 2 patients had proptosis and 1 had diplopia. The mean follow-up period was 98 {+-} 31.7 months (median, 90; range, 61-151). After FCRT, the visual function improved in the 7 patients who had undergone FCRT as the primary treatment. However, 2 patients who were blind in their affected eye at FCRT remained blind. In 4 of the 7 patients with improvement, the improvement was documented within 1-3 months after FCRT. The tumor control rate was 100%. Proptosis and diplopia also regressed in 100% of patients. At 2 years after FCRT, 1 patient had developed radiation retinopathy. Conclusion: The results of our study have shown that FCRT is a safe and effective treatment of ONSMs, affording satisfactory long-term tumor control, good functional outcome, and low treatment morbidity. FCRT should be considered the treatment of choice for patients with presumed ONSMs for whom the treatment has been deemed appropriate.

  8. Malignant Peripheral Nerve Sheath Tumor Invasion Requires Aberrantly Expressed Epidermal Growth Factor (EGF) Receptors and is Variably Enhanced by Multiple EGF Family Ligands

    PubMed Central

    Byer, Stephanie J.; Brossier, Nicole M.; Peavler, Lafe T.; Eckert, Jenell M.; Watkins, Stacey; Roth, Kevin A.; Carroll, Steven L.

    2013-01-01

    Aberrant epidermal growth factor receptor (EGFR) expression promotes the pathogenesis of malignant peripheral nerve sheath tumors (MPNSTs), the most common malignancy associated with neurofibromatosis type 1, but the mechanisms by which EGFR expression promotes MPNST pathogenesis are poorly understood. We hypothesized that inappropriately expressed EGFRs promote MPNST invasion and found that these kinases are concentrated in MPNST invadopodia in vitro. EGFR knockdown inhibited the migration of unstimulated MPNST cells in vitro and exogenous EGF further enhanced MPNST migration in a substrate-specific manner, promoting migration on laminin and, to a lesser extent, collagen. Thus, in this setting, EGF acts as a chemotactic factor. We also found that the 7 known EGFR ligands (EGF, betacellulin, epiregulin, heparin-binding EGF, transforming growth factor α [TGFα], amphiregulin, and epigen) variably enhanced MPNST migration in a concentration-dependent manner, with TGFα being particularly potent. With the exception of epigen, these factors similarly promoted the migration of non-neoplastic Schwann cells. Although transcripts encoding all 7 EGFR ligands were detected in human MPNST cells and tumor tissues, only TGFα was consistently overexpressed and was found to colocalize with EGFR in situ. These data indicate that constitutive EGFR activation, potentially driven by autocrine or paracrine TGFα signaling, promotes the aggressive invasive behavior characteristic of MPNSTs. PMID:23399900

  9. A novel NF1 mutation in a Chinese patient with giant café-au-lait macule in neurofibromatosis type 1 associated with a malignant peripheral nerve sheath tumor and bone abnormality.

    PubMed

    Tong, H-X; Li, M; Zhang, Y; Zhu, J; Lu, W-Q

    2012-08-29

    Neurofibromatosis type 1 (NF1; OMIM#162200) is a common neurocutaneous disorder that is characterized by multiple café-au-lait, skinfold freckling, Lisch nodules, and neurofibromas. Mutations in the NF1 gene, which encodes the neurofibromin protein, have been identified as the pathogenic gene of NF1. In this study, we present a clinical and molecular study of a Chinese patient with giant café-au-lait in NF1. The patient showed >6 café-au-lait spots on the body, axillary freckling, and multiple subcutaneous neurofibromas. He also had a malignant peripheral nerve sheath tumor and bone abnormalities. The germline mutational analysis of the NF1 gene revealed a novel missense mutation in exon 13. It is a novel heterozygous nucleotide G>A transition at position 2241 of the NF1 gene. We found no mutation in malignant peripheral nerve sheath tumor DNA from this patient. This expands the database for NF1 gene mutations in NF1. Its absence in the normal chromosomes suggests that it is responsible for the NF1 phenotype. To our knowledge, this is the first case of giant café-au-lait macule in NF1 associated with a malignant peripheral nerve sheath tumor and bone abnormality.

  10. Primary intraosseous hybrid nerve sheath tumor of femur: a hitherto undescribed occurrence in bone with secondary aneurysmal bone cyst formation resulting in pathological fracture.

    PubMed

    Chow, Louis Tsun Cheung

    2015-05-01

    Soft tissue perineurioma besides its pure form may coexist with schwannoma as hybrid nerve sheath tumor (HNST) which occurs in the limbs, head and neck, trunk and occasionally colon but origination in other organ sites has not been reported. We report the first case of primary intraosseous HNST. An 18-year-old man suffered from pathological fracture of his right femur after an impact which was preceded by a similar episode two weeks previously. Plain radiograph revealed a displaced fracture in the superior diaphysis of the right femur where an expansile osteolytic lesion with relatively well defined borders was seen. Histologic examination of the curetted lesion showed a well circumscribed spindle cell neoplasm displaying predominantly storiform but focally whorled patterns. In areas, the cells possessed thin wavy spindle nuclei and delicate elongated bipolar cytoplasmic processes supported in a fibromyxoid stroma. They stained positively for EMA, claudin, CD34, collagen 4 and focally for S100 but negatively for MUC4 and BCL-2, indicative of perineurial differentiation. Situated in the periphery of some of these perineurial whorls are spindle cells bearing plump tapering wavy nuclei and palely eosinophilic cytoplasm with indistinct cell borders. They stained intensely for S100 but negatively for EMA, claudin, CD34, collagen 4, MUC4 and BCL-2, consistent with schwannian differentiation. Focally, these two varieties of cells intimately intermingled with each other. Features of aneurysmal bone cyst (ABC) formation were present but no mitotic figures, establishing the final diagnosis of primary intraosseous HNST with secondary ABC formation. The patient remained well 7 months after curettage and internal fixation of his fracture.

  11. TAGLN expression is upregulated in NF1-associated malignant peripheral nerve sheath tumors by hypomethylation in its promoter and subpromoter regions

    PubMed Central

    PARK, GUN-HOO; LEE, SU-JIN; YIM, HYUNE; HAN, JAE-HO; KIM, HYON J.; SOHN, YOUNG-BAE; KO, JUNG MIN; JEONG, SEON-YONG

    2014-01-01

    Neurofibromatosis type 1 (NF1) caused by NF1 gene mutation is a commonly inherited autosomal dominant disorder. Malignant peripheral nerve sheath tumors (MPNSTs), a type of aggressive sarcoma, are a major cause of mortality in NF1 patients. The malignant transformation of benign plexiform neurofibromas (PNs) to MPNSTs is a marked peculiarity in NF1 patients, yet the pathogenesis remains poorly understood. We found that an actin-associated protein transgelin (SM22) was highly expressed in NF1-deficient MPNST tissues compared to NF1-deficient PN tissues using immunohistological staining and primary cultured MPNST cells in western blot analysis. We further found that this transgelin upregulation was caused by increased transcriptional expression of the TAGLN gene encoding transgelin. Comparison of DNA methylation values in the promoter and subpromoter regions of the TAGLN gene in three types of NF1-deficient primary-cultured cells, derived from an NF1 patient’s normal phenotype, a benign PN and MPNST tissues, revealed that the TAGLN gene was hypomethylated in the MPNST cells. Next, to determine the functional role of transgelin in MPNST pathogenesis, we manipulated the TAGLN gene expression and investigated the alteration of the RAS-mitogen-activated protein kinase (MAPK) signaling pathway in the normal-phenotypic and malignant tumor cells. The downregulation of TAGLN expression in NF1-deficient MPNST tumor cells through the treatment of the small interfering RNA resulted in a decrease in the RAS activation (GTP-RAS) and the downstream ERK1/2 activation (phosphorylated ERK1/2), while the overexpression of TAGLN in normal-phenotypic NF1-deficient cells caused an increase in RAS and ERK1/2 activation. These results indicate that upregulation of transgelin caused by hypomethylation of the TAGLN gene is closely involved in tumor progression in NF1. PMID:25109740

  12. Genomic and Molecular Characterization of Malignant Peripheral Nerve Sheath Tumor Identifies the IGF1R Pathway as a Primary Target for Treatment

    PubMed Central

    Yang, Jilong; Ylipää, Antti; Sun, Yan; Zheng, Hong; Chen, Kexin; Nykter, Matti; Trent, Jonathan; Ratner, Nancy; Lev, Dina C.; Zhang, Wei

    2011-01-01

    Purpose Malignant peripheral nerve sheath tumor (MPNST) is a rare sarcoma that lacks effective therapeutic strategies. We gain insight into the most recurrent genetically altered pathways with the purpose of scanning possible therapeutic targets. Experimental design We performed a microarray based-comparative genomic hybridization (aCGH) profiling of two cohorts of primary MPNST tissue samples including 25 patients treated at The University of Texas MD Anderson Cancer Center and 26 patients from Tianjin Cancer Hospital. IHC and cell biology detection and validation were performed on human MPNST tissues and cell lines. Results Genomic characterization of 51 MPNST tissue samples identified several frequently amplified regions harboring 2,599 genes and regions of deletion including 4,901 genes. At the pathway level, we identified a significant enrichment of copy number–altering events in the insulin-like growth factor 1 receptor (IGF1R) pathway, including frequent amplifications of the IGF1R gene itself. To validate the IGF1R pathway as a potential target in MPNSTs, we first confirmed that high IGF1R protein correlated with worse tumor-free survival in an independent set of samples using immunohistochemistry. Two MPNST cell lines (ST88-14 and STS26T) were used to determine the effect of attenuating IGF1R. Inhibition of IGF1R in ST88-14 cells using small interfering RNAs or an IGF1R inhibitor, MK-0646, led to significant decreases in cell proliferation, invasion, and migration accompanied by attenuation of the PI3K/AKT and MAPK pathways. Conclusion These integrated genomic and molecular studies provide evidence that the IGF1R pathway is a potential therapeutic target for patients with MPNST. PMID:22042973

  13. MicroRNAome profiling in benign and malignant neurofibromatosis type 1-associated nerve sheath tumors: evidences of PTEN pathway alterations in early NF1 tumorigenesis

    PubMed Central

    2013-01-01

    Background Neurofibromatosis type 1 (NF1) is a common dominant tumor predisposition syndrome affecting 1 in 3,500 individuals. The hallmarks of NF1 are the development of peripheral nerve sheath tumors either benign (dermal and plexiform neurofibromas) or malignant (MPNSTs). Results To comprehensively characterize the role of microRNAs in NF1 tumorigenesis, we analyzed 377 miRNAs expression in a large panel of dermal and plexiform neurofibromas, and MPNSTs. The most significantly upregulated miRNA in plexiform neurofibromas was miR-486-3p that targets the major tumor suppressor gene, PTEN. We confirmed PTEN downregulation at mRNA level. In plexiform neurofibromas, we also report aberrant expression of four miRNAs involved in the RAS-MAPK pathway (miR-370, miR-143, miR-181a, and miR-145). In MPNSTs, significant deregulated miRNAs were involved in PTEN repression (miR-301a, miR-19a, and miR-106b), RAS-MAPK pathway regulation (Let-7b, miR-195, and miR-10b), mesenchymal transition (miR-200c, let-7b, miR-135a, miR-135b, and miR-9), HOX genes expression (miR-210, miR-196b, miR-10a, miR-10b, and miR-9), and cell cycle progression (miR-195, let-7b, miR-20a, miR-210, miR-129-3p, miR-449a, and miR-106b). Conclusion We confirmed the implication of PTEN in genesis of plexiform neurofibromas and MPNSTs in NF1. Markedly deregulated miRNAs might have potential diagnostic or prognostic value and could represent novel strategies for effective pharmacological therapies of NF1 tumors. PMID:23848554

  14. Endoscopic Decompression of the First Branch of the Lateral Plantar Nerve and Release of the Plantar Aponeurosis for Chronic Heel Pain.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Entrapment of the first branch of the lateral plantar nerve is a commonly missed cause of recalcitrant plantar heel pain. The diagnosis is made on a clinical ground with maximal tenderness at the site of nerve entrapment. Treatment of the nerve entrapment is similar to that for plantar fasciitis, with rest, activity modification, nonsteroidal anti-inflammatory drugs, stretching exercise, and local steroid injection. Surgical release of the deep abductor hallucis fascia is indicated when conservative treatment failed. Endoscopic release of the nerve through the dorsal and plantar portals, as well as endoscopic plantar aponeurosis release, is a feasible approach. PMID:27656382

  15. Optic nerve sheath diameter threshold by ocular ultrasonography for detection of increased intracranial pressure in Korean adult patients with brain lesions

    PubMed Central

    Lee, Si Un; Jeon, Jin Pyeong; Lee, Hannah; Han, Jung Ho; Seo, Mingu; Byoun, Hyoung Soo; Cho, Won-Sang; Ryu, Ho Geol; Kang, Hyun-Seung; Kim, Jeong Eun; Kim, Heung Cheol; Jang, Kyung-Sool

    2016-01-01

    Abstract Optic nerve sheath diameter (ONSD) seen on ocular US has been associated with increased intracranial pressure (IICP). However, most studies have analyzed normal range of ONSD and its optimal cut-off point for IICP in Caucasian populations. Considering ONSD differences according to ethnicity, previous results may not accurately reflect the association between IICP and ONSD in Koreans. Therefore, we conducted this study to investigate normal range of ONSD and its optimal threshold for detecting IICP in Korean patients. This prospective multicenter study was performed for patients with suspected IICP. ONSD was measured 3 mm behind the globe using a 13-MHz US probe. IICP was defined as significant brain edema, midline shift, compression of ventricle or basal cistern, effacement of sulci, insufficient gray/white differentiation, and transfalcine herniation by radiologic tests. The results of the ONSD are described as the median (25th–75th percentile). The differences of ONSD according to disease entity were analyzed. A receiver operator characteristic (ROC) curve was generated to determine the optimal cut-off point for identifying IICP. A total of 134 patients were enrolled. The patients were divided into 3 groups as follows: patients with IICP, n = 81 (60.5%); patients without IICP, n = 27 (20.1%); and control group, n = 26 (19.4%). ONSD in patients with IICP (5.9 mm [5.8–6.2]) is significantly higher than those without IICP (5.2 mm [4.8–5.4]) (P < 0.01) and normal control group (4.9 mm [4.6–5.2]) (P < 0.001). Between patients without IICP and normal control group, the difference of ONSD did not reach statistical significance (P = 0.31). ONSD >5.5 mm yielded a sensitivity of 98.77% (95% CI: 93.3%–100%) and a specificity of 85.19% (95% CI: 66.3%–95.8%). In conclusion, the optimal cut-off point of ONSD for identifying IICP was 5.5 mm. ONSD seen on ocular US can be a feasible method for detection and serial monitoring of ICP in

  16. Open Anterior Release of the Superior Transverse Scapular Ligament for Decompression of the Suprascapular Nerve During Brachial Plexus Surgery.

    PubMed

    Elzinga, Kate E; Curran, Matthew W T; Morhart, Michael J; Chan, K Ming; Olson, Jaret L

    2016-07-01

    Reconstruction of the suprascapular nerve (SSN) after brachial plexus injury often involves nerve grafting or a nerve transfer. To restore shoulder abduction and external rotation, a branch of the spinal accessory nerve is commonly transferred to the SSN. To allow reinnervation of the SSN, any potential compression points should be released to prevent a possible double crush syndrome. For that reason, the authors perform a release of the superior transverse scapular ligament at the suprascapular notch in all patients undergoing reconstruction of the upper trunk of the brachial plexus. Performing the release through a standard anterior open supraclavicular approach to the brachial plexus avoids the need for an additional posterior incision or arthroscopic procedure. PMID:27113908

  17. PTEN and NF1 inactivation in Schwann cells produces a severe phenotype in the peripheral nervous system that promotes the development and malignant progression of peripheral nerve sheath tumors

    PubMed Central

    Keng, Vincent W.; Rahrmann, Eric P.; Watson, Adrienne L.; Tschida, Barbara R.; Moertel, Christopher L.; Jessen, Walter J.; Rizvi, Tilat A.; Collins, Margaret H.; Ratner, Nancy; Largaespada, David A.

    2012-01-01

    The genetic evolution from a benign neurofibroma to a malignant sarcoma in patients with neurofibromatosis type 1 (NF1) syndrome remains unclear. Schwann cells and/or their precursor cells are believed to be the primary pathogenic cell in neurofibromas because they harbor biallelic neurofibromin 1 (NF1) gene mutations. However, the phosphatase and tensin homolog (Pten) and neurofibromatosis 1 (Nf1) genes recently were found to be co-mutated in high-grade peripheral nerve sheath tumors (PNSTs) in mice. In this study, we created transgenic mice that lack both Pten and Nf1 in Schwann cells and Schwann cell precursor cells in order to validate the role of these two genes in PNST formation in vivo. Haploinsufficiency or complete loss of Pten dramatically accelerated neurofibroma development and led to the development of higher-grade PNSTs in the context of Nf1 loss. Pten dosage, together with Nf1 loss, was sufficient for the progression from low-grade to high-grade PNSTs. Genetic analysis of human sporadic malignant pheripheral nerve sheath tumors (MPNSTs) also revealed down-regulation of PTEN expression, suggesting that Pten-regulated pathways are major tumor suppressive barriers to neurofibroma progression. Together, our findings establish a novel mouse model that can rapidly recapitulate the onset of human neurofibroma tumorigenesis and the progression to MPNSTs. PMID:22700876

  18. Endoscopically Assisted Anterior Subcutaneous Transposition of Ulnar Nerve.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Ulnar nerve compression at the elbow is the most common neuropathy of the upper extremity. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve and endoscopic anterior transposition of ulnar nerve have been reported. This article describes a technique of endoscopically assisted anterior subcutaneous transposition of ulnar nerve that is composed of an open release and mobilization of the ulnar nerve at and distal to the cubital tunnel and endoscopic release and mobilization of the ulnar nerve proximal to the cubital tunnel. PMID:27656391

  19. MRI in decompression illness.

    PubMed

    Hierholzer, J; Tempka, A; Stroszczynski, C; Amodio, F; Hosten, N; Haas, J; Felix, R

    2000-05-01

    We report a case of decompression illness in which the patient developed paraparesis during scuba diving after rapid ascent. MRI of the spine revealed a focal intramedullary lesion consistent with the symptoms. The pathophysiological and radiological aspects of spinal decompression illness are discussed.

  20. Surgical decompression for notalgia paresthetica: a case report.

    PubMed

    Williams, Eric H; Rosson, Gedge D; Elsamanoudi, Ibrahim; Dellon, A Lee

    2010-01-01

    Notalgia paresthetica is a rare nerve compression. From the Greek word noton, meaning "back," and algia, meaning "pain," "notalgia paresthetica" implies that symptoms of burning pain, itching, and/or numbness in the localized region between the spinous processes of T2 through T6 and the medial border of the scapula constitute a nerve compression syndrome. The compressed nerve is the dorsal branch of the spinal nerve. It is compressed by the paraspinous muscles and fascia against the transverse process of these spinal segments. This is the first report of symptomatic relief by decompression of this nerve. PMID:19790177

  1. Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome

    PubMed Central

    KIM, Kyongsong; ISU, Toyohiko; MORIMOTO, Daijiro; SASAMORI, Toru; SUGAWARA, Atsushi; CHIBA, Yasuhiro; ISOBE, Masahiro; KOBAYASHI, Shiro; MORITA, Akio

    2014-01-01

    Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion. PMID:25367582

  2. APPARATUS FOR SHEATHING RODS

    DOEpatents

    Ford, W.K.; Wyatt, M.; Plail, S.

    1961-08-01

    An arrangement is described for sealing a solid body of nuclear fuel, such as a uranium metal rod, into a closelyfitting thin metallic sheath with an internal atmosphere of inert gas. The sheathing process consists of subjecting the sheath, loaded with the nuclear fuel body, to the sequential operations of evacuation, gas-filling, drawing (to entrap inert gas and secure close contact between sheath and body), and sealing. (AEC)

  3. Communication through plasma sheaths

    SciTech Connect

    Korotkevich, A. O.; Newell, A. C.; Zakharov, V. E.

    2007-10-15

    We wish to transmit messages to and from a hypersonic vehicle around which a plasma sheath has formed. For long distance transmission, the signal carrying these messages must be necessarily low frequency, typically 2 GHz, to which the plasma sheath is opaque. The idea is to use the plasma properties to make the plasma sheath appear transparent.

  4. Inner ear decompression sickness.

    PubMed

    Farmer, J C; Thomas, W G; Youngblood, D G; Bennett, P B

    1976-09-01

    With recent increases in commercial, military, and sport diving to deeper depths, inner ear injuries during such exposures have been encountered more frequently and noted during several phases of diving: during compression, at stable deep depths, with excessive noise exposure in diving, and during decompression. The pathophysiology of these injuries differs, depending upon the phase of diving in which the injuries occur. In this report, 23 cases of hearing loss, tinnitus, and/or vertigo occurring during or shortly after decompression are presented. Thirteen of these cases occurred in helium-oxygen dives involving a change to air during the latter stages of decompression. A significant correlation is present between prompt recompression treatment, relief of symptoms, and lack of residual deficits. Current knowledge indicates that the management of otologic decompression sickness should include: 1. prompt recompression to at least 99 feet deeper than the symptom onset depth; 2. recompression using the previous helium-oxygen mixture when the injuries occur during or shortly after a switch from helium-oxygen to air during the latter stages of decompression; 3. the use of parenteral diazepam for symptom relief and cyclic inhalations of oxygen enriched treatment gases; and 4. the avoidance of further diving by divers who exhibit permanent inner ear injuries after the acute symptoms have subsided.

  5. Distal nerve entrapment following nerve repair.

    PubMed

    Schoeller, T; Otto, A; Wechselberger, G; Pommer, B; Papp, C

    1998-04-01

    Failure of nerve repair or poor functional outcome after reconstruction can be influenced by various causes. Besides improper microsurgical technique, fascicular malalignment and unphysiologic tension, we found in our clinical series that a subclinical nerve compression distal to the repair site can seriously impair regeneration. We concluded that the injured nerve, whether from trauma or microsurgical intervention, could be more susceptible to distal entrapment in the regenerative stage because of its disturbed microcirculation, swelling and the increase of regenerating axons followed by increased nerve volume. In two cases we found the regenerating nerve entrapped at pre-existing anatomical sites of narrowing resulting in impaired functional recovery. In both cases the surgical therapy was decompression of the distal entrapped nerve and this was followed by continued regeneration. Thorough clinical and electrophysiologic follow-up is necessary to detect such adverse compression effects and to distinguish between the various causes of failed regeneration. Under certain circumstances primary preventive decompression may be beneficial if performed at the time of nerve coaptation.

  6. Treatment of hemimasticatory spasm with microvascular decompression.

    PubMed

    Wang, Yong-Nan; Dou, Ning-Ning; Zhou, Qiu-Meng; Jiao, Wei; Zhu, Jin; Zhong, Jun; Li, Shi-Ting

    2013-01-01

    Hemimasticatory spasm is a rare disorder characterized by paroxysmal involuntary contraction of the jaw-closing muscles. As the ideology and pathogenesis of the disease are still unclear, there has been no treatment that could give rise to a good outcome so far. Herein, we tried to use surgical management to cure the disease. Six patients with the disease were included in this study. These patients underwent microvascular decompression of the motor fibers of the trigeminal root. After the operation, all faces of the patients felt relaxed at varied degrees, except for 1 patient. Our study showed that microvascular decompression of the trigeminal nerve could lead to a better outcome. However, a control study with a large sample is needed before this technique is widely used.

  7. Return of the sheath.

    PubMed

    Felstein, I

    1980-10-01

    The history of the condom is reviewed with attention directed to the medical perspective that the return of the sheath to use is hopeful in terms of venereal disease control improvements. By 1950, condom manufacturers could claim that 1/2 of all the married couples using contraception included the sheath as a major or ancillary method in both the United States and the British Isles. The introduction of the oral contraceptive led to the sheath losing a large measure of its once universal popularity. Simultaneously there was a marked increase in venereal infections with a dramatic rise in gonorrhea and non-specific urethritis. Venereologists have been disturbed by the decline of sheath usage. The manufacturers of the sheath did not accept the reduction in sales. Taking advantage of the changed attitudes to sexuality and sex aids, manufacturers began to make colored sheaths and to vary textures in order to raise or lower sensitivity, increase or decrease friction, and add or diminish lubrication. Shapes have also been varied, and several attachments to the sheath have included clitoral stimulators and vulval stretchers. Improved marketing has seen retailing of condoms in open areas. PMID:6903257

  8. Glancing angle RF sheaths

    NASA Astrophysics Data System (ADS)

    D'Ippolito, D. A.; Myra, J. R.

    2013-10-01

    RF sheaths occur in tokamaks when ICRF waves encounter conducting boundaries. The sheath plays an important role in determining the efficiency of ICRF heating, the impurity influxes from the edge plasma, and the plasma-facing component damage. An important parameter in sheath theory is the angle θ between the equilibrium B field and the wall. Recent work with 1D and 2D sheath models has shown that the rapid variation of θ around a typical limiter can lead to enhanced sheath potentials and localized power deposition (hot spots) when the B field is near glancing incidence. The physics model used to obtain these results does not include some glancing-angle effects, e.g. possible modification of the angular dependence of the Child-Langmuir law and the role of the magnetic pre-sheath. Here, we report on calculations which explore these effects, with the goal of improving the fidelity of the rf sheath BC used in analytical and numerical calculations. Work supported by US DOE grants DE-FC02-05ER54823 and DE-FG02-97ER54392.

  9. [Surgical management of trigeminal neuralgia, hemifacial spasm, paroxysmal tinnitus and nystagmus by neurovascular decompression].

    PubMed

    Isu, T; Abe, H; Nakagawa, Y; Aida, T; Tsuru, M; Ito, T; Murai, H

    1983-11-01

    Trigeminal neuralgia, facial spasm, tinnitus, vertigo, and glossopharyngeal neuralgia are believed to be the symptoms complex of hyperactive dysfunction of the cranial nerve caused by vascular cross compression at the root entry (exit) zone of the appropriate nerve. Posterior cranial fossa approach for the neurovascular decompression was enhanced by Jannetta et al (1975). From their experiences of surgery, they emphasized that these symptoms were relieved by surgery. In this report, we will discuss the etiology of the disease, the neurotological examination, the angiographic findings, the operative findings and results in a series of 10 patients who have undergone neurovascular decompression. The series consisted of 4 cases with trigeminal neuralgia, 5 cases with facial spasm, and 1 case with paroxysmal tinnitus accompanied by facial spasm. The postoperative progress in these all patients was excellent and relieved of the symptoms. There was neither mortality nor any significant complication. We stress that the neurovascular decompression surgery is now well justified as the definite treatment for the trigeminal neuralgia and facial spasm, because the surgery can be performed easily and safely by the neurosurgeons. The indication of the neurovascular decompression for the acoustic nerve and glossopharyngeal nerve is still controversial. In our own case, tinnitus was paroxysmal and complicated with facial spasm, not synchronous with facial spasm, but with nystagmus. This selective synchronism between tinnitus and nystagmus is a particular feature of our clinical instance. This particular clinical experience may provide some highly significant suggestions in considering the applicability of neurovascular decompression to the acoustic nerve. PMID:6671636

  10. Ulnar nerve tuberculoma.

    PubMed

    Ramesh Chandra, V V; Prasad, Bodapati Chandramowliswara; Varaprasad, Gangumolu

    2013-01-01

    The authors report a very rare case of tuberculoma involving the ulnar nerve. The patient, a 7-year-old girl, presented with swelling over the medial aspect of her right forearm just below the elbow joint, with features of ulnar nerve palsy, including paresthesias along the little and ring fingers and claw hand deformity. There was a history of trauma and contact with a contagious case of tuberculosis. There were no other signs of tuberculosis. At surgical exploration the ulnar nerve was found to be thickened, and on opening the sheath there was evidence of caseous material enclosed in a fibrous capsule compressing and displacing the nerve fibers. The lesion, along with the capsule, was subtotally removed using curettage, and a part of the capsule that was densely adherent to the nerve fibers was left in the patient. Histopathological examination of the specimen was consistent with tuberculoma. The patient received adequate antitubercular treatment and showed significant improvement.

  11. Facial Nerve Neuroma Management

    PubMed Central

    Weber, Peter C.; Osguthorpe, J. David

    1998-01-01

    Three facial nerve neuromas were identified in the academic year 1994-1995. Each case illustrates different management dilemmas. One patient with a grade III facial nerve palsy had a small geniculate ganglion neuroma with the dilemma of decompression versus resection clear nerve section margins. The second patient underwent facial neuroma resection with cable graft reconstruction, but the permanent sections were positive. The last patient had a massive neuroma in which grafting versus other facial reconstructive options were considered. These three cases illustrate some of the major controversies in facial nerve neuroma management. We discuss our decision-making plan and report our results. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171043

  12. Transient overvoltages on cable sheaths

    NASA Astrophysics Data System (ADS)

    Dabringhaus, H. G.

    1983-08-01

    Transient overvoltage on the sheaths of high voltage cables with single point sheath earthing or cross bonding of the cable sheaths involve danger for the cable and the joints. The investigations of transient overvoltages in the case of a switching operation on a 110 kV single core oil filled cable with single sided sheath earthing are reported. A comparison between measured transient voltage variations and those calculated with the help of a traveling wave analyzer program shows very good agreement. The investigations showed that with single point sheath earthing, the unearthed sheath end ought to be protected against overvoltages.

  13. Microvascular decompression for intractable singultus.

    PubMed

    Saito, Atsushi; Hatayama, Toru; Kon, Hiroyuki; Nakamura, Taigen; Sasaki, Tatsuya

    2016-10-01

    Intractable singultus due to cerebrovascular disease is very rare. We report a case of intractable singultus that improved after microvascular decompression and present a literature review. The patient was a 58-year-old man with a 30-year history of persistent singultus. Its frequency and duration gradually increased and it was resistant to multiple medical treatments. Microvascular decompression to relieve pressure on the anterolateral surface of the lower medulla oblongata from the vertebral artery resulted in the resolution of singultus. Patients with intractable idiopathic singultus who fail to respond to medical therapy need to be considered for the evaluation of cerebrovascular diseases and microvascular decompression. PMID:27335312

  14. Sheath energy transmission in a collisional plasma with collisionless sheath

    SciTech Connect

    Tang, Xian-Zhu Guo, Zehua

    2015-10-15

    Sheath energy transmission governs the plasma energy exhaust onto a material surface. The ion channel is dominated by convection, but the electron channel has a significant thermal conduction component, which is dominated by the Knudsen layer effect in the presence of an absorbing wall. First-principle kinetic simulations reveal a robustly supersonic sheath entry flow. The ion sheath energy transmission and the sheath potential are accurately predicted by a sheath model of truncated bi-Maxwellian electron distribution. The electron energy transmission is further enhanced by a parallel heat flux of the perpendicular degrees of freedom.

  15. Dorsal displacement of the ulnar nerve after a displaced distal radius fracture: case report.

    PubMed

    Sohal, Jennifer Kaur R; Chia, Benjamin; Catalano, Louis W

    2009-03-01

    We report on a patient in whom ulnar nerve palsy developed after a closed distal radius fracture due to displacement of the ulnar nerve dorsal to the ulnar styloid. After delayed exploration and decompression of the ulnar nerve, the patient had recovery of both motor and sensory function of the ulnar nerve.

  16. The longitudinal epineural incision and complete nerve transection method for modeling sciatic nerve injury

    PubMed Central

    Cheng, Xing-long; Wang, Pei; Sun, Bo; Liu, Shi-bo; Gao, Yun-feng; He, Xin-ze; Yu, Chang-yu

    2015-01-01

    Injury severity, operative technique and nerve regeneration are important factors to consider when constructing a model of peripheral nerve injury. Here, we present a novel peripheral nerve injury model and compare it with the complete sciatic nerve transection method. In the experimental group, under a microscope, a 3-mm longitudinal incision was made in the epineurium of the sciatic nerve to reveal the nerve fibers, which were then transected. The small, longitudinal incision in the epineurium was then sutured closed, requiring no stump anastomosis. In the control group, the sciatic nerve was completely transected, and the epineurium was repaired by anastomosis. At 2 and 4 weeks after surgery, Wallerian degeneration was observed in both groups. In the experimental group, at 8 and 12 weeks after surgery, distinct medullary nerve fibers and axons were observed in the injured sciatic nerve. Regular, dense myelin sheaths were visible, as well as some scarring. By 12 weeks, the myelin sheaths were normal and intact, and a tight lamellar structure was observed. Functionally, limb movement and nerve conduction recovered in the injured region between 4 and 12 weeks. The present results demonstrate that longitudinal epineural incision with nerve transection can stably replicate a model of Sunderland grade IV peripheral nerve injury. Compared with the complete sciatic nerve transection model, our method reduced the difficulties of micromanipulation and surgery time, and resulted in good stump restoration, nerve regeneration, and functional recovery. PMID:26692866

  17. Recognising and managing decompression illness.

    PubMed

    Caton-Richards, Michelle

    2013-11-01

    Seen primarily in scuba divers who have breathed compressed air, decompression illness is a rare but potentially fatal condition. Prompt recognition and treatment of the illness, and urgent referral of patients to hyperbaric chambers, can mean the difference between full recovery and paralysis or death. This article describes decompression illness and how to recognise it, and discusses the treatment that patients require for the best chance of recovery with no adverse effects. It also includes a case study of a patient who developed this condition after a dive. PMID:24219686

  18. Recognising and managing decompression illness.

    PubMed

    Caton-Richards, Michelle

    2013-11-01

    Seen primarily in scuba divers who have breathed compressed air, decompression illness is a rare but potentially fatal condition. Prompt recognition and treatment of the illness, and urgent referral of patients to hyperbaric chambers, can mean the difference between full recovery and paralysis or death. This article describes decompression illness and how to recognise it, and discusses the treatment that patients require for the best chance of recovery with no adverse effects. It also includes a case study of a patient who developed this condition after a dive.

  19. 21 CFR 884.5320 - Glans sheath.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... sheath. (a) Identification. A glans sheath device is a sheath which covers only the glans penis or part... the entire shaft of the penis. It is indicated only for the prevention of pregnancy and not for...

  20. 21 CFR 884.5320 - Glans sheath.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... sheath. (a) Identification. A glans sheath device is a sheath which covers only the glans penis or part... the entire shaft of the penis. It is indicated only for the prevention of pregnancy and not for...

  1. Challenging diagnosis of peripillous sheaths.

    PubMed

    Gnarra, Maria; Saraceni, Pierluigi; Rossi, Alfredo; Murabit, Amera; Caradonna, Emanuela; Fania, Luca; Feliciani, Claudio

    2014-01-01

    Peripillous sheaths, or hair casts, are asymptomatic, white, cylindrical concretions that encircle the hair without adhering to it. They are infrequently documented in the literature, are often misdiagnosed, and generate avoidable apprehension and expense for parents and caregivers. Dermoscopy is the standard for a rapid, noninvasive, cost-effective diagnosis. We describe a case of peripillous sheaths presenting in a boy. PMID:24846654

  2. Electromagnetic induction between axons and their schwann cell myelin-protein sheaths.

    PubMed

    Goodman, G; Bercovich, D

    2013-12-01

    Two concepts have long dominated vertebrate nerve electrophysiology: (a) Schwann cell-formed myelin sheaths separated by minute non-myelinated nodal gaps and spiraling around axons of peripheral motor nerves reduce current leakage during propagation of trains of axon action potentials; (b) "jumping" by action potentials between successive nodes greatly increases signal conduction velocity. Long-held and more recent assumptions and issues underlying those concepts have been obscured by research emphasis on axon-sheath biochemical symbiosis and nerve regeneration. We hypothesize: mutual electromagnetic induction in the axon-glial sheath association, is fundamental in signal conduction in peripheral and central myelinated axons, explains the g-ratio and is relevant to animal navigation.

  3. Interspinous Process Decompression: Expanding Treatment Options for Lumbar Spinal Stenosis

    PubMed Central

    Nunley, Pierce D.; Shamie, A. Nick; Blumenthal, Scott L.; Orndorff, Douglas; Geisler, Fred H.

    2016-01-01

    Interspinous process decompression is a minimally invasive implantation procedure employing a stand-alone interspinous spacer that functions as an extension blocker to prevent compression of neural elements without direct surgical removal of tissue adjacent to the nerves. The Superion® spacer is the only FDA approved stand-alone device available in the US. It is also the only spacer approved by the CMS to be implanted in an ambulatory surgery center. We computed the within-group effect sizes from the Superion IDE trial and compared them to results extrapolated from two randomized trials of decompressive laminectomy. For the ODI, effect sizes were all very large (>1.0) for Superion and laminectomy at 2, 3, and 4 years. For ZCQ, the 2-year Superion symptom severity (1.26) and physical function (1.29) domains were very large; laminectomy effect sizes were very large (1.07) for symptom severity and large for physical function (0.80). Current projections indicate a marked increase in the number of patients with spinal stenosis. Consequently, there remains a keen interest in minimally invasive treatment options that delay or obviate the need for invasive surgical procedures, such as decompressive laminectomy or fusion. Stand-alone interspinous spacers may fill a currently unmet treatment gap in the continuum of care and help to reduce the burden of this chronic degenerative condition on the health care system.

  4. Spaceflight Decompression Sickness Contingency Plan

    NASA Technical Reports Server (NTRS)

    Dervay, Joseph P.

    2007-01-01

    A viewgraph presentation on the Decompression Sickness (DCS) Contingency Plan for manned spaceflight is shown. The topics include: 1) Approach; 2) DCS Contingency Plan Overview; 3) Extravehicular Activity (EVA) Cuff Classifications; 4) On-orbit Treatment Philosophy; 5) Long Form Malfunction Procedure (MAL); 6) Medical Checklist; 7) Flight Rules; 8) Crew Training; 9) Flight Surgeon / Biomedical Engineer (BME) Training; and 10) DCS Emergency Landing Site.

  5. [Severe decompression sickness in divers].

    PubMed

    Beuster, W; van Laak, U

    1999-01-01

    The term "decompression illness (DCI)" is a disorder which arises from the presence of ectopic gas bubbles following decompression. Scuba diving poses the risk of two typically clinical syndromes: decompression sickness (DCS) and arterial gas embolism (AGE). DCS results from the formation of gas bubbles in the tissues of the body and in the blood due to rapid reduction of the environmental pressure. AGE is caused by pulmonary overinflation if the breathing gas cannot be exhaled adequately during the ascent. Although the pathophysiological mechanisms of these two disorders are quite different, both of them lead to the same result: inert gas bubbles that may cause impairment of vital functions due to hypoxia. Recognizing the signs and symptoms of DCI is the first step of the therapy. The emergency treatment contains: basic life support, advanced life support--if necessary, horizontal positioning of the victim, administration of 100% normobaric oxygen via face mask or endotracheal tube, rehydration, rapid transportation to the nearest emergency department/hyperbaric facility for definitive treatment in order to prevent serious neurological sequelae.

  6. Cardiopulmonary Changes with Moderate Decompression in Rats

    NASA Technical Reports Server (NTRS)

    Robinson, R.; Little, T.; Doursout, M.-F.; Butler, B. D.; Chelly, J. E.

    1996-01-01

    Sprague-Dawley rats were compressed to 616 kPa for 120 min then decompressed at 38 kPa/min to assess the cardiovascular and pulmonary responses to moderate decompression stress. In one series of experiments the rats were chronically instrumented with Doppler ultrasonic probes for simultaneous measurement of blood pressure, cardiac output, heart rate, left and right ventricular wall thickening fraction, and venous bubble detection. Data were collected at base-line, throughout the compression/decompression protocol, and for 120 min post decompression. In a second series of experiments the pulmonary responses to the decompression protocol were evaluated in non-instrumented rats. Analyses included blood gases, pleural and bronchoalveolar lavage (BAL) protein and hemoglobin concentration, pulmonary edema, BAL and lung tissue phospholipids, lung compliance, and cell counts. Venous bubbles were directly observed in 90% of the rats where immediate post-decompression autopsy was performed and in 37% using implanted Doppler monitors. Cardiac output, stroke volume, and right ventricular wall thickening fractions were significantly decreased post decompression, whereas systemic vascular resistance was increased suggesting a decrease in venous return. BAL Hb and total protein levels were increased 0 and 60 min post decompression, pleural and plasma levels were unchanged. BAL white blood cells and neutrophil percentages were increased 0 and 60 min post decompression and pulmonary edema was detected. Venous bubbles produced with moderate decompression profiles give detectable cardiovascular and pulmonary responses in the rat.

  7. Biomechanical evaluation of an interfacet joint decompression and stabilization system.

    PubMed

    Leasure, Jeremi M; Buckley, Jenni

    2014-07-01

    A majority of the middle-aged population exhibit cervical spondylosis that may require decompression and fusion of the affected level. Minimally invasive cervical fusion is an attractive option for decreasing operative time, morbidity, and mortality rates. A novel interfacet joint spacer (DTRAX facet screw system, Providence Medical) promises minimally invasive deployment resulting in decompression of the neuroforamen and interfacet fusion. The present study investigates the effectiveness of the device in minimizing intervertebral motion to promote fusion, decompression of the nerve root during bending activity, and performance of the implant to adhere to anatomy during repeated bending loads. We observed flexion, extension, lateral bending, and axial rotation resonant overshoot mode (ROM) in cadaver models of c-spine treated with the interfacet joint spacer (FJ spacer) as stand-alone and supplementing anterior plating. The FJ spacer was deployed bilaterally at single levels. Specimens were placed at the limit of ROM in flexion, extension, axial bending, and lateral bending. 3D images of the foramen were taken and postprocessed to quantify changes in foraminal area. Stand-alone spacer specimens were subjected to 30,000 cycles at 2 Hz of nonsimultaneous flexion-extension and lateral bending under compressive load and X-ray imaged at regular cycle intervals for quantitative measurements of device loosening. The stand-alone FJ spacer increased specimen stiffness in all directions except extension. 86% of all deployments resulted in some level of foraminal distraction. The rate of effective distraction was maintained in flexed, extended, and axially rotated postures. Two specimens demonstrated no detectable implant loosening (<0.25 mm). Three showed unilateral subclinical loosening (0.4 mm maximum), and one had subclinical loosening bilaterally (0.5 mm maximum). Results of our study are comparable to previous investigations into the stiffness of other stand

  8. Radiation therapy for primary optic nerve meningiomas

    SciTech Connect

    Smith, J.L.; Vuksanovic, M.M.; Yates, B.M.; Bienfang, D.C.

    1981-06-01

    Optic nerve sheath meningiomas, formerly thought to be rare, have been encountered with surprising frequency since the widespread use of computed tomography. Early diagnosis led to an enthusiastic surgical approach to these lesions, but this has been tempered by the realization that even in the best of hands, blindness followed such surgery with distressing frequency. Optic nerve sheath meningiomas may be divided into primary, secondary, and multiple meningioma groups. Five patients with primary optic nerve sheath meningiomas treated with irradiation therapy are presented in this report. Improvement in visual acuity, stabilization to increase in the visual field, and decrease in size to total regression of optociliary veins, have been documented following irradiation therapy of the posterior orbital and intracanalicular portions of the optic nerve in some of these cases. Although each patient must be carefully individualized, there is no question that visual palliation can be achieved in some cases of optic nerve sheath meningioma. Further investigation of this therapeutic modality in selected cases in advised.

  9. Laminated magnet field coil sheath

    DOEpatents

    Skaritka, John R.

    1987-12-01

    a method for manufacturing a magnet cable trim coil in a sheath assembly for use in a cryogenic particle accelerator. A precisely positioned pattern of trim coil turns is bonded to a flexible substrate sheath that is capable of withstanding cryogenic operating conditions. In the method of the invention the flexible sheath, with the trim coil pattern precisely positioned thereon, is accurately positioned at a precise location relative to a bore tube assembly of an accelerator and is then bonded to the bore tube with a tape suitable for cryogenic application. The resultant assembly can be readily handled and installed within an iron magnet yoke assembly of a suitable cryogenic particle accelerator.

  10. Laminated magnet field coil sheath

    DOEpatents

    Skaritka, J.R.

    1987-05-15

    A method for manufacturing a magnetic cable trim coil in a sheath assembly for use in a cryogenic particle accelerator. A precisely positioned pattern of trim coil turns is bonded to a flexible substrate sheath that is capable of withstanding cryogenic operating conditions. In the method of the invention the flexible substrate sheath, with the trim coil pattern precisely location relative to a bore tube assembly of an accelerator and is then bonded to the bore tube with a tape suitable for cryogenic application. The resultant assembly can be readily handled and installed within an iron magnet yoke assembly of a suitable cryogenic particle accelerator. 1 fig.

  11. Nerve Regeneration in the Peripheral Nervous System versus the Central Nervous System and the Relevance to Speech and Hearing after Nerve Injuries

    ERIC Educational Resources Information Center

    Gordon, Tessa; Gordon, Karen

    2010-01-01

    Schwann cells normally form myelin sheaths around axons in the peripheral nervous system (PNS) and support nerve regeneration after nerve injury. In contrast, nerve regeneration in the central nervous system (CNS) is not supported by the myelinating cells known as oligodendrocytes. We have found that: 1) low frequency electrical stimulation can be…

  12. Mechanism of lung damage in explosive decompression.

    PubMed

    Topliff, E D

    1976-05-01

    It is known that pressure equalization via the trachea may diminish or prevent lung damage in explosive decompression. In this report, evidence is presented which demonstrates that closure of the trachea does not affect lethality in mice exposed to maximally rapid decompression. This observation suggests that in maximally rapid decompression the lungs and thorax may be treated as a closed system to which Boyle's Law might be applicable. PMID:1275842

  13. [Surgical treatment of trigeminal neuralgia--neurovascular decompression established by Jannetta].

    PubMed

    Isu, T; Abe, H; Nakagawa, Y; Mitsumori, K; Nakagawa, T; Sakuragi, M; Tsuru, M; Ito, T

    1985-01-01

    The etiology of trigeminal neuralgia has been unknown. However, recently, trigeminal neuralgia is believed to be caused by vascular cross compression at the root entry zone of the trigeminal nerve. Posterior cranial fossa approach for the neurovascular decompression was enhanced by Jannetta et al. They emphasized that the pain was relieved by surgery. In this report, we will discuss the operative findings and results in a series of 8 patients who have undergone neurovascular decompression. The postoperative progress in all of these patients was excellent and relieved of the pain. There was neither mortality nor any significant complication. We stress that the neurovascular decompression surgery is now well justified as the definite treatment for the trigeminal neuralgia. PMID:3988235

  14. [Orbital decompression for Graves' ophthalmopathy].

    PubMed

    Boulétreau, P; Breton, P; Freidel, M

    2005-04-01

    Graves' ophthalmopathy is a complex orbital condition with a controversial pathogenesis. It is the clinical expression of a discordance between the inextensible orbit and hypertrophic muscular and fatty elements within the orbit responding to immunological stimulation. The relationship between the orbital and its content can be improved by surgical expansion which increases the useful volume of the orbit. This procedure can be combined with lipectomy to decrease the volume of the orbital contents. We briefly recall the history of surgical decompression techniques and present our experience with Graves' ophthalmopathy patients.

  15. Morphology of human intracardiac nerves: an electron microscope study

    PubMed Central

    PAUZIENE, NERINGA; PAUZA, DAINIUS H.; STROPUS, RIMVYDAS

    2000-01-01

    Since many human heart diseases involve both the intrinsic cardiac neurons and nerves, their detailed normal ultrastructure was examined in material from autopsy cases without cardiac complications obtained no more than 8 h after death. Many intracardiac nerves were covered by epineurium, the thickness of which was related to nerve diameter. The perineurial sheath varied from nerve to nerve and, depending on nerve diameter, contained up to 12 layers of perineurial cells. The sheaths of the intracardiac nerves therefore become progressively attenuated during their course in the heart. The intraneural capillaries of the human heart differ from those in animals in possessing an increased number of endothelial cells. A proportion of the intraneural capillaries were fenestrated. The number of unmyelinated axons within unmyelinated nerve fibres was related to nerve diameter, thin cardiac nerves possessing fewer axons. The most distinctive feature was the presence of stacks of laminated Schwann cell processes unassociated with axons that were more frequent in older subjects. Most unmyelinated and myelinated nerve fibres showed normal ultrastructure, although a number of profiles displayed a variety of different axoplasmic contents. Collectively, the data provide baseline information on the normal structure of intracardiac nerves in healthy humans which may be useful for assessing the degree of nerve damage both in autonomic and sensory neuropathies in the human heart. PMID:11117629

  16. Graphics processing unit-assisted lossless decompression

    DOEpatents

    Loughry, Thomas A.

    2016-04-12

    Systems and methods for decompressing compressed data that has been compressed by way of a lossless compression algorithm are described herein. In a general embodiment, a graphics processing unit (GPU) is programmed to receive compressed data packets and decompress such packets in parallel. The compressed data packets are compressed representations of an image, and the lossless compression algorithm is a Rice compression algorithm.

  17. [Decompression sickness after diving and following flying].

    PubMed

    Laursen, S B; Grønfeldt, W; Jacobsen, E

    1999-07-26

    A case of delayed symptoms of decompression sickness (DCS) after diving and flying is reported. The diver presented with classical signs of type 2 DCS, probably caused by air travel 16 hours after SCUBA diving. Treatment with hyperbaric oxygen (HBO) in a decompression chamber was successful. Guidelines to prevent DCS for recreational divers who plan to fly after diving are presented.

  18. Dust in the magnetized sheath

    SciTech Connect

    Pandey, B. P.; Samarian, A.; Vladimirov, S. V.

    2007-09-15

    In the present work the structure of the magnetized sheath is investigated in the multifluid framework. The ambient magnetic field is assumed parallel to the wall and the effect of the plasma magnetization, plasma ionization, and plasma-neutral collisions on the sheath is examined. It is shown that the width of the non-neutral boundary layer is dependent on the collision frequencies as well as on the plasma magnetization. The size of the sheath layer can decrease with the increase in magnetic field. The increase in the ion-neutral collision can also adversely affect the sheath size. The equilibrium and levitation of the dust particles in a collisional magnetized sheath are shown to depend on the collision frequencies and on the magnetization. Further, the increase in the collision or magnetization invariably leads to the presence of the positively charged grains near the plasma wall suggesting that the grain levitation inside the charged layer is implicitly dependent on the plasma parameters in a nontrivial way.

  19. Xenon Blocks Neuronal Injury Associated with Decompression

    PubMed Central

    Blatteau, Jean-Eric; David, Hélène N.; Vallée, Nicolas; Meckler, Cedric; Demaistre, Sebastien; Lambrechts, Kate; Risso, Jean-Jacques; Abraini, Jacques H.

    2015-01-01

    Despite state-of-the-art hyperbaric oxygen (HBO) treatment, about 30% of patients suffering neurologic decompression sickness (DCS) exhibit incomplete recovery. Since the mechanisms of neurologic DCS involve ischemic processes which result in excitotoxicity, it is likely that HBO in combination with an anti-excitotoxic treatment would improve the outcome in patients being treated for DCS. Therefore, in the present study, we investigated the effect of the noble gas xenon in an ex vivo model of neurologic DCS. Xenon has been shown to provide neuroprotection in multiple models of acute ischemic insults. Fast decompression compared to slow decompression induced an increase in lactate dehydrogenase (LDH), a well-known marker of sub-lethal cell injury. Post-decompression administration of xenon blocked the increase in LDH release induced by fast decompression. These data suggest that xenon could be an efficient additional treatment to HBO for the treatment of neurologic DCS. PMID:26469983

  20. Xenon Blocks Neuronal Injury Associated with Decompression.

    PubMed

    Blatteau, Jean-Eric; David, Hélène N; Vallée, Nicolas; Meckler, Cedric; Demaistre, Sebastien; Lambrechts, Kate; Risso, Jean-Jacques; Abraini, Jacques H

    2015-01-01

    Despite state-of-the-art hyperbaric oxygen (HBO) treatment, about 30% of patients suffering neurologic decompression sickness (DCS) exhibit incomplete recovery. Since the mechanisms of neurologic DCS involve ischemic processes which result in excitotoxicity, it is likely that HBO in combination with an anti-excitotoxic treatment would improve the outcome in patients being treated for DCS. Therefore, in the present study, we investigated the effect of the noble gas xenon in an ex vivo model of neurologic DCS. Xenon has been shown to provide neuroprotection in multiple models of acute ischemic insults. Fast decompression compared to slow decompression induced an increase in lactate dehydrogenase (LDH), a well-known marker of sub-lethal cell injury. Post-decompression administration of xenon blocked the increase in LDH release induced by fast decompression. These data suggest that xenon could be an efficient additional treatment to HBO for the treatment of neurologic DCS. PMID:26469983

  1. Cascaded target normal sheath acceleration

    SciTech Connect

    Wang, W. P.; Shen, B. F.; Zhang, X. M.; Wang, X. F.; Xu, J. C.; Zhao, X. Y.; Yu, Y. H.; Yi, L. Q.; Shi, Y.; Zhang, L. G.; Xu, T. J.; Xu, Z. Z.

    2013-11-15

    A cascaded target normal sheath acceleration (TNSA) scheme is proposed to simultaneously increase energy and improve energy spread of a laser-produced mono-energetic proton beam. An optimum condition that uses the maximum sheath field to accelerate the center of the proton beam is theoretically found and verified by two-dimensional particle-in-cell simulations. An initial 10 MeV proton beam is accelerated to 21 MeV with energy spread decreased from 5% to 2% under the optimum condition during the process of the cascaded TNSA. The scheme opens a way to scale proton energy lineally with laser energy.

  2. libpolycomp: Compression/decompression library

    NASA Astrophysics Data System (ADS)

    Tomasi, Maurizio

    2016-04-01

    Libpolycomp compresses and decompresses one-dimensional streams of numbers by means of several algorithms. It is well-suited for time-ordered data acquired by astronomical instruments or simulations. One of the algorithms, called "polynomial compression", combines two widely-used ideas (namely, polynomial approximation and filtering of Fourier series) to achieve substantial compression ratios for datasets characterized by smoothness and lack of noise. Notable examples are the ephemerides of astronomical objects and the pointing information of astronomical telescopes. Other algorithms implemented in this C library are well known and already widely used, e.g., RLE, quantization, deflate (via libz) and Burrows-Wheeler transform (via libbzip2). Libpolycomp can compress the timelines acquired by the Planck/LFI instrument with an overall compression ratio of ~9, while other widely known programs (gzip, bzip2) reach compression ratios less than 1.5.

  3. Plasma sheath criterion in thermal electronegative plasmas

    SciTech Connect

    Ghomi, Hamid; Khoramabadi, Mansour; Ghorannevis, Mahmod; Shukla, Padma Kant

    2010-09-15

    The sheath formation criterion in electronegative plasma is examined. By using a multifluid model, it is shown that in a collisional sheath there will be upper as well as lower limits for the sheath velocity criterion. However, the parameters of the negative ions only affect the lower limit.

  4. Nerve biopsy

    MedlinePlus

    ... Loss of axon tissue Metabolic neuropathies Necrotizing vasculitis Sarcoidosis Risks Allergic reaction to the local anesthetic Discomfort ... Neurosarcoidosis Peripheral neuropathy Primary amyloidosis Radial nerve dysfunction Sarcoidosis Tibial nerve dysfunction Update Date 6/1/2015 ...

  5. Evidence Report: Risk of Decompression Sickness (DCS)

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Norcross, Jason R.; Wessel, James H., III; Klein, Jill S.; Dervay, Joseph P.; Gernhardt, Michael L.

    2016-01-01

    Given that tissue inert gas partial pressure is often greater than ambient pressure during phases of a mission, primarily during extravehicular activity (EVA), there is a possibility of decompression sickness (DCS).

  6. Rehabilitation of the trigeminal nerve

    PubMed Central

    Iro, Heinrich; Bumm, Klaus; Waldfahrer, Frank

    2005-01-01

    When it comes to restoring impaired neural function by means of surgical reconstruction, sensory nerves have always been in the role of the neglected child when compared with motor nerves. Especially in the head and neck area, with its either sensory, motor or mixed cranial nerves, an impaired sensory function can cause severe medical conditions. When performing surgery in the head and neck area, sustaining neural function must not only be highest priority for motor but also for sensory nerves. In cases with obvious neural damage to sensory nerves, an immediate neural repair, if necessary with neural interposition grafts, is desirable. Also in cases with traumatic trigeminal damage, an immediate neural repair ought to be considered, especially since reconstructive measures at a later time mostly require for interposition grafts. In terms of the trigeminal neuralgia, commonly thought to arise from neurovascular brainstem compression, a pharmaceutical treatment is considered as the state of the art in terms of conservative therapy. A neurovascular decompression of the trigeminal root can be an alternative in some cases when surgical treatment is sought after. Besides the above mentioned therapeutic options, alternative treatments are available. PMID:22073060

  7. Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach.

    PubMed

    Haba, Katsuhiko; Ikeda, Masato; Soma, Mariko; Yamashima, Tetsumori

    2005-02-01

    Lumbar canal stenosis due to hypertrophy and calcification of the facet joints and/or ligamentum flavum is a common condition in the elderly. Although a large number of individuals are symptom-free, the degenerative process, usually encroaching on both central and lateral pathways, may lead to symptoms of itself or decompensate a preexisting narrow canal. Even at an advanced age, decompression surgery is effective for symptomatic stenosis. Less invasive procedures preserving maximal bony and ligamentous structures have recently been recommended to reduce associated morbidity. This paper introduces a unilateral surgical approach for bilateral decompression by ligamentectomy, partial facetectomy and foraminal unroofing. Using a specially designed, one-side retractor, after the ipsilateral nerve root decompression the contralateral dural sac and nerve roots were approached through an 8 x 15 mm window in the interspinous ligament. The contralateral ligamentum flavum, facet joints and foraminal roof were resected, preserving the supraspinous ligament complex and much of the contralateral musculature. This technique, preserving anatomy and biomechanical function of the lumbar spine, is useful for surgery on multilevel lumbar canal stenoses.

  8. Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia.

    PubMed

    Schaller, Bernhard

    2005-01-01

    The trigemino-cardiac reflex (TCR) is a well-recognized phenomenon consisting of bradycardia, arterial hypotension, apnea, and gastric hypermotility during ocular surgery or other manipulations in and around the orbit. Thus far, it could bee shown that central stimulation of the trigeminal nerve during transsphenoidal surgery and surgery for tumors in the cerebellopontine angle can lead to TCR. In cases of microvascular trigeminal decompression for trigeminal neuralgia, no data of the possible occurrence of TCR are available. TCR was defined as a drop in mean arterial blood pressure (MABP) and the heart rate (HR) of more than 20% to the baseline values before the stimulus and coinciding with the manipulation of the trigeminal nerve. Electronic anesthetic recorded perioperative HR and MABP values were reviewed retrospectively in 28 patients who received microvascular trigeminal decompression in cases of trigeminal neuralgia and were divided into two subgroups on the basis of occurrence of TCR during surgery. Of the 28 patients, 5 (18%) showed evidence of TCR during manipulation at the trigeminal radix by separation from microvascular structures. Their HR fell 46% and their MABP 57% during operative procedures near the trigeminal nerve as compared with levels immediately before the stimulus. After cessation of manipulation, HR and MABP returned (spontaneously) to levels before the stimulus. Risk factors of TCR were compared with results from the literature. In conclusion, the present results give evidence of TCR during manipulation of the central part of the trigeminal nerve during microvascular trigeminal decompression in cases of trigeminal neuralgia under a standardized anesthetic protocol.

  9. Facial nerve paralysis after cervical traction.

    PubMed

    So, Edmund Cheung

    2010-10-01

    Cervical traction is a frequently used treatment in rehabilitation clinics for cervical spine problems. This modality works, in principle, by decompressing the spinal cord or its nerve roots by applying traction on the cervical spine through a harness placed over the mandible (Olivero et al., Neurosurg Focus 2002;12:ECP1). Previous reports on treatment complications include lumbar radicular discomfort, muscle injury, neck soreness, and posttraction pain (LaBan et al., Arch Phys Med Rehabil 1992;73:295-6; Lee et al., J Biomech Eng 1996;118:597-600). Here, we report the first case of unilateral facial nerve paralysis developed after 4 wks of intermittent cervical traction therapy. Nerve conduction velocity examination revealed a peripheral-type facial nerve paralysis. Symptoms of facial nerve paralysis subsided after prednisolone treatment and suspension of traction therapy. It is suspected that a misplaced or an overstrained harness may have been the cause of facial nerve paralysis in this patient. Possible causes were (1) direct compression by the harness on the right facial nerve near its exit through the stylomastoid foramen; (2) compression of the right external carotid artery by the harness, causing transient ischemic injury at the geniculate ganglion; or (3) coincidental herpes zoster virus infection or idiopathic Bell's palsy involving the facial nerve.

  10. Cdc42 regulates Schwann cell radial sorting and myelin sheath folding through NF2/merlin-dependent and independent signaling.

    PubMed

    Guo, Li; Moon, Chandra; Zheng, Yi; Ratner, Nancy

    2013-11-01

    The Rho family GTPase Cdc42 has been implicated in developmental Schwann cell (SC) proliferation, providing sufficient SCs for radial sorting of axons preceding SC differentiation in the peripheral nervous system. We generated Cdc42 conditional knockout (Cdc42-CKO) mice and confirmed aberrant axon sorting in Cdc42-CKO nerves. In adult Cdc42-CKO nerves, blood vessels were enlarged, and mature Remak bundles containing small axons were absent. Abnormal infoldings and outfoldings of myelin sheaths developed in Cdc42-CKO nerves, mimicking pathological features of Charcot-Marie-Tooth (CMT) disease. The NF2/merlin tumor suppressor has been implicated up- and down-stream of Cdc42. In Cdc42-CKO;NF2-del double mutant mice, radial sorting defects seen in Cdc42-CKO nerves were rescued, while changes in myelin sheaths in Cdc42-CKO nerves were not. Phosphorylation of Focal adhesion kinase (FAK) and P-GSK3β, as well as expression of β-catenin were decreased in Cdc42-CKO nerves, and these changes were rescued by NF2/merlin mutation in Cdc42-CKO;NF2-del double mutant mice. Thus, Cdc42 regulates SC radial sorting in vivo through NF2/merlin dependent signaling pathways, while Cdc42 modulation of myelin sheath folding is NF2/merlin independent.

  11. Gold ink coating of thermocouple sheaths

    DOEpatents

    Ruhl, H. Kenneth

    1992-01-01

    A method is provided for applying a gold ink coating to a thermocouple sheath which includes the steps of electropolishing and oxidizing the surface of the thermocouple sheath, then dipping the sheath into liquid gold ink, and finally heat curing the coating. The gold coating applied in this manner is highly reflective and does not degrade when used for an extended period of time in an environment having a temperature over 1000.degree. F. Depending on the application, a portion of the gold coating covering the tip of the thermocouple sheath is removed by abrasion.

  12. Orbital decompression for Graves' orbitopathy in England

    PubMed Central

    Perros, P; Chandler, T; Dayan, C M; Dickinson, A J; Foley, P; Hickey, J; MacEwen, C J; Lazarus, J H; McLaren, J; Rose, G E; Uddin, J M; Vaidya, B

    2012-01-01

    Aims The purpose of this study was to obtain data on orbital decompression procedures performed in England, classed by hospital and locality, to evaluate regional variation in care. Methods Data on orbital decompression taking place in England over a 2-year period between 2007 and 2009 were derived from CHKS Ltd and analysed by the hospital and primary care trust. Results and conclusions In all, 44% of these operations took place in hospitals with an annual workload of 10 or fewer procedures. Analysis of the same data by primary care trust suggests an almost 30-fold variance in the rates of decompression performed per unit population. Expertise available to patients with Graves' orbitopathy and rates of referral for specialist care in England appears to vary significantly by geographic location. These data, along with other outcome measures, will provide a baseline by which progress can be judged. PMID:22157920

  13. Decompressive laparotomy for abdominal compartment syndrome

    PubMed Central

    Kimball, E.; Malbrain, M.; Nesbitt, I.; Cohen, J.; Kaloiani, V.; Ivatury, R.; Mone, M.; Debergh, D.; Björck, M.

    2016-01-01

    Background The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. Methods This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28‐day and 1‐year all‐cause mortality. Changes in intra‐abdominal pressure (IAP) and organ function, and laparotomy‐related morbidity were secondary endpoints. Results Thirty‐three patients were included in the study (20 men). Twenty‐seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20–32). Median IAP was 23 (21–27) mmHg before decompressive laparotomy, decreasing to 12 (9–15), 13 (8–17), 12 (9–15) and 12 (9–14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non‐survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28‐day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non‐survivors were no different from survivors, except that they tended to be older and on mechanical ventilation. Conclusion Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome. PMID:26891380

  14. Human Vagus Nerve Branching in the Cervical Region

    PubMed Central

    Hammer, Niels; Glätzner, Juliane; Feja, Christine; Kühne, Christian; Meixensberger, Jürgen; Planitzer, Uwe; Schleifenbaum, Stefan; Tillmann, Bernhard N.; Winkler, Dirk

    2015-01-01

    Background Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. Materials and Methods Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. Results Cervical vagus nerve branching was observed in 29% of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79 mm vs. 3.78 mm) and cross-sections (7.24 mm2 vs. 5.28 mm2). Discussion Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation. PMID:25679804

  15. Evidence Report: Risk of Decompression Sickness (DCS)

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Norcross, Jason R.; Wessel, James H. III; Abercromby, Andrew F. J.; Klein, Jill S.; Dervay, Joseph P.; Gernhardt, Michael L.

    2013-01-01

    The Risk of Decompression Sickness (DCS) is identified by the NASA Human Research Program (HRP) as a recognized risk to human health and performance in space, as defined in the HRP Program Requirements Document (PRD). This Evidence Report provides a summary of the evidence that has been used to identify and characterize this risk. Given that tissue inert gas partial pressure is often greater than ambient pressure during phases of a mission, primarily during extravehicular activity (EVA), there is a possibility that decompression sickness may occur.

  16. Acute kidney injury due to decompression illness

    PubMed Central

    Viecelli, Andrea; Jamboti, Jagadish; Waring, Andrew; Banham, Neil; Ferrari, Paolo

    2014-01-01

    Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. We report the first case of acute kidney injury in a 27-year-old diver following three rapid ascents. He presented with transient neurological symptoms and abdominal pain followed by rapidly progressive acute kidney injury (creatinine peak 1210 µmol/L) due to arterial air emboli. He received supportive care and 100% oxygen followed by hyperbaric therapy and recovered fully. Arterial air emboli caused by rapid decompression can affect multiple organs including the kidneys. Early transfer to a hyperbaric unit is important as complications may present delayed. PMID:25852912

  17. Decompression-Induced Crystallization of Hydrous Basalt

    NASA Astrophysics Data System (ADS)

    Teasdale, R.; Brooker, R. A.

    2014-12-01

    Decompression-induced crystallization of hydrous basalt during magma ascent from 1.5 kb (150 MPa) is quantified using isothermal decompression TZM experiments. The starting composition is a synthetic glass based on the 1921 Kilauea basalt, with 1% H2O added. In all cases, the liquidus phase is aluminous spinel, followed by clinopyroxene, then plagioclase. The plagioclase liquidus temperatures for isobaric (equilibrium) experiments range from 1175°C (at 1.5 kb) to 1217°C (at 200b), which are 35-75°C hotter than predicted by MELTS (Ghiorso & Sack 1995). Experiments were decompressed at 1kb/hr and quenched at 800, 400, 200, or 100b for three temperatures (1160°, 1150°, and 1140°C). Plagioclase crystals formed during decompression have long axes that range from less than 1 micron to 20 microns. Increasing decompression yields larger plagioclase crystal sizes and aspect ratios for experiments at equal temperatures. However, the number of crystals does not vary systematically, indicating that crystallization is dominated by growth rather than nucleation during decompression. Plagioclase compositions for experiments were measured with University of Bristol's Electron Microprobe and the Hyperprobe with Field Emission Gun. Plagioclase compositions from equilibrium experiments (An60-An80) span the range of those from decompression experiments (An60-An73). Equilibrium experiments generated higher An compositions at lower pressures (500b) than at higher pressure (1.5kb) but do not systematically vary with temperature. Variations in plagioclase compositions are minimal above H2O saturation (100-200°C, based on Papale et al., 2006). Below H2O saturation, An content decreases slightly, by approximately 4% An. One application of this work is better characterization of groundmass crystallization in hydrous basalt as it traverses the conduit during eruption. This work also provides a means of distinguishing groundmass plagioclase related to decompression from crystals

  18. Decompression Sickness in Sport Scuba Diving.

    PubMed

    Davis, J C; Bracker, M D

    1988-02-01

    In brief: Sport scuba diving in inland bodies of water has gained in popularity, and travelers to remote areas can fly home soon after a diving trip. Thus it is not unusual to see a case of decompression sickness in an emergency care facility, regardless of its location. Symptoms of decompression sickness may occur minutes or hours after diving with compressed gas. They include marked fatigue, pruritic mottled skin lesions, pain (joints, back, abdomen), weakness or paralysis of isolated or regional muscle groups, paresthesia, urinary retention, loss of anal sphincter control, dyspnea, coughing, vertigo, and substernal pain. Most patients respond quickly to prompt treatment in hyperbaric chambers, and the symptoms resolve completely.

  19. Significant Scoliosis Regression following Syringomyelia Decompression

    PubMed Central

    Mollano, Anthony V; Weinstein, Stuart L; Menezes, Arnold H

    2005-01-01

    We present the case of a 5-year-old boy presenting with a 54-degree scoliosis secondary to a Chiari I malformation with a holocord syringomyelia extending from C1 to T10. Neurosurgical treatment involved posterior fossa craniectomy with decompression, and partial C1 laminectomy. At follow-up 7 years later, at age 12, radiographs revealed only a 4-degree scoliosis, and follow-up MRI revealed a deflated syrinx. We report this case to reveal the most significant scoliosis regression seen in our experience that may occur in younger patients after neurosurgical syringomyelia decompression for Chiari I hindbrain herniation. PMID:16089074

  20. Introduction: peripheral nerve surgery--biology, entrapment, and injuries.

    PubMed

    Friedman, Allan H; Elias, W Jeffrey; Midha, Rajiv

    2009-02-01

    Surgery aimed at repairing damaged peripheral nerves has a long history. Refuting the time-honored nihilism of Hippocrates and Galen that an injured nerve cannot regain function, a few adventurous medieval surgeons attempted to repair severed nerves. However, the ability of a peripheral nerve repair to restore function was not generally accepted until 1800. Neurosurgeons, beginning with Harvey Cushing, have had an interest in repairing damaged peripheral nerves. Significant progress in the treatment of peripheral nerve injuries resulted from experience with the numerous injuries that occurred during World Wars I and II. Surgeons steadily defined the anatomy of peripheral nerves and developed techniques for decompressing and repairing peripheral nerves. Kline and Dejonge developed an intraoperative electrophysiological technique for detecting axons regenerating across a damaged segment of nerve. In the second 2 decades of the 20th century, distal nerve transfers were rediscovered whereby the proximal end of a less essential nerve is used to reinnervate the distal end of a nerve, providing a more vital function. PMID:19435439

  1. Microvascular decompression for trigeminal neuralgia with special reference to delayed recurrence.

    PubMed

    Goya, T; Wakisaka, S; Kinoshita, K

    1990-07-01

    Thirty-five patients with trigeminal neuralgia underwent microvascular decompression. Complete remission was obtained in 33 patients, while one was fair and another unchanged postoperatively. The clinical and operative findings were reviewed, analyzing the direction of vascular compression of the trigeminal nerve and the distribution of pain in the peripheral regions. There were some weak correlations between the direction of vascular compression and the distribution of pain. Neuralgia in the region of second branch of the trigeminal nerve (V2) or in the regions of V2 and third branch of the nerve (V3) was caused by compression from the ventral or ventro-rostral direction, in the region of first branch of the nerve from the ventro-caudal direction, and in the V3 region from the ventral, rostral, and dorsal directions of the nerve in general. In two patients who had had complete remission after first operation, trigeminal neuralgia recurred. They had typical intermittent painful attacks with a background of continuous dull pain or painful dysesthesia caused by Ivalon sponges inserted between the nerve and the offending vessel. Complete remission was again obtained after removal of these sponge pieces. We would like to stress continuous dull pain or painful dysesthesia in cases of delayed recurrence as indicators for re-exploration. PMID:1701856

  2. Proton hopping: a proposed mechanism for myelinated axon nerve impulses.

    PubMed

    Kier, Lemont B; Tombes, Robert M

    2013-04-01

    Myelinated axon nerve impulses travel 100 times more rapidly than impulses in non-myelinated axons. Increased speed is currently believed to be due to 'hopping' or 'saltatory propagation' along the axon, but the mechanism by which impulses flow has never been adequately explained. We have used modeling approaches to simulate a role for proton hopping in the space between the plasma membrane and myelin sheath as the mechanism of nerve action-potential flow.

  3. Sheath insulator test thermal analysis

    NASA Astrophysics Data System (ADS)

    Lee, Celia C. M.

    Thermal models were developed for Instrumented Fast Reactor Component Sheath Insulator (IFAC-SI) test to aid in the design and fabrication of the experiment which is part of the Thermionic Fuel Element Verification Program. The actual experiment with two heat pipes in one test capsule is described by Miskolczy and Lee (1990). Two-dimensional finite element models were used in conjunction with other explicit programs to determine the necessary fin design and argon filling conditions of the vapor controlled heat pipes used to maintain desired operating temperatures. Four two-dimensional finite element models were developed: an axisymmetric capsule model; a radial sheath insulator model; a radial fin model, and an axial fin model. All finite element models were verified by comparing results between models and explicit one-dimensional heat-flow calculations. This thermal analysis package of 2D FEMs and explicit programs predicts the best geometry and placement of fins to compensate for uncertainties from internal gamma heating, emissivity of niobium, and outer sodium temperature.

  4. Sheath insulator test thermal analysis

    NASA Astrophysics Data System (ADS)

    Lee, Celia C. M.

    1991-01-01

    Thermal models were developed for Instrumented Fast Reactor Component Sheath Insulator (IFAC-SI) test to aid in the design and fabrication of the experiment which is part of the Thermionic Fuel Element (TFE) Verification Program. The actual experiment with two heat pipes in one test capsule is described by Miskolczy and Lee (1990). Two-dimensional finite element models were used in conjunction with other explicit programs to determine the necessary fin design and argon filling conditions of the vapor controlled heat pipes used to maintain desired operating temperatures. Four two-dimensional finite element models were developed: an axisymmetric capsule model; a radial sheath insulator model; a radial fin model, and an axial fin model. All finite element models were verified by comparing results between models and explicity one-dimensional heat-flow calculations. Additional programs were written to calculate the thermal expansion of the capsule components and argon volumes for operating temperatures. This thermal analysis package of two-dimensional finite element models and explicit programs predicts the best geometry and placement of fins to compensate for uncertainties from internal gamma heating, emissivity of niobium, and outer sodium temperature.

  5. Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy

    PubMed Central

    Yoshida, Munehito; Yamada, Hiroshi; Nakagawa, Yukihiro; Maio, Kazuhiro; Kawai, Masaki; Iwasaki, Hiroshi

    2009-01-01

    Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges for the aspiring endoscopic surgeons, the most critical of which is mastering hand–eye coordination. With training in live animal and cadaver surgery, the technical progress has reduced the problem of morbidity following surgery. The authors have performed microendoscopic decompression surgery on more than 2,000 patients for lumbar spinal canal stenosis. Fifty-one patients underwent the posterior decompression surgery using microendoscopy for cervical myelopathy at authors’ institute. The average age was 62.9 years. The criteria for exclusion were cervical myelopathy with tumor, trauma, severe ossification of posterior longitudinal ligament, rheumatoid arthritis, pyogenic spondylitises, destructive spondylo-arthropathies, and other combined spinal lesions. The items evaluated were neurological evaluation, recovery rates; these were calculated following examination using the Hirabayashi’s method with the criteria proposed by the Japanese Orthopaedic Association scoring system (JOA score). The mean follow-up period was 20.3 months. The average of JOA score was 10.1 points at the initial examination and 13.6 points at the final follow-up. The average recovery rate was 52.5%. The recovery rate according to surgical levels was, respectively, 56.5% in one level, 46.3% in two levels and 54.1% in more than three levels. The complications were as follows: one patient sustained a pin-hole-like dura mater injury inflicted by a high-speed air-drill during surgery, one patient developed an epidural hematoma 3 days after surgery, and two patients had the C5 nerve root palsy after surgery. The epidural

  6. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Abdominal decompression chamber. 884.5225 Section... Devices § 884.5225 Abdominal decompression chamber. (a) Identification. An abdominal decompression chamber is a hoodlike device used to reduce pressure on the pregnant patient's abdomen for the relief...

  7. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false PVHO-Decompression chambers. 197.332 Section 197.332... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Equipment § 197.332 PVHO—Decompression chambers. Each decompression chamber must— (a) Meet the requirements of § 197.328; (b) Have internal...

  8. [Ethmoidal mucocele after transpalpebral bony orbital decompression].

    PubMed

    Gire, J; Facon, F; Guigou, S; Fauquier, S; Malet, T

    2012-10-01

    We report a case of a late ethmoidal mucocele occurring after transpalpebral bony orbital decompression. A 39-year-old man presented with a recurrence of a right-sided proptosis without signs of orbital inflammation. The patient had undergone bilateral transpalpebral bony orbital decompression for dysthyroid orbitopathy 2 years prior. Orbital CT scan showed a large mucocele in the supero-lateral right ethmoidal sinus with lateral extension to the medial rectus. The patient was therefore referred to an ear, nose and throat (ENT) surgeon, who performed an anterior ethmoidectomy with marsupialization and drainage of the mucocele via an endoscopic approach. A complete postoperative resolution of proptosis was observed without recurrence of the mucocele to date, approximately 6 months postoperative. Sinus complications occurring after orbital decompression may include sinusitis, hematoma, imploding antrum syndrome and mucoceles. Recurrent proptosis secondary to an ethmoidal mucocele is a rare event after bony orbital decompression surgery, with only two cases reported in the international literature. Management requires ophthalmologic diagnosis and collaboration between the ophthalmologist and otorhinolaryngologist.

  9. Spontaneous extracranial decompression of epidural hematoma.

    PubMed

    Neely, John C; Jones, Blaise V; Crone, Kerry R

    2008-03-01

    Epidural hematoma (EDH) is a common sequela of head trauma in children. An increasing number are managed nonsurgically, with close clinical and imaging observation. We report the case of a traumatic EDH that spontaneously decompressed into the subgaleal space, demonstrated on serial CT scans that showed resolution of the EDH and concurrent enlargement of the subgaleal hematoma.

  10. Rapid decompression in the EA-6B.

    PubMed

    Hudson, S J; Todd, J S

    1998-08-01

    A Grumman EA-6B aircraft experienced a rapid pressurization failure at 27,000 feet. All four crew members had removed their oxygen masks and were breathing cabin air pressurized to 8,000 feet before the incident. Although none of the crew members developed signs or symptoms of decompression sickness, the potential for adversity was realized by all. Altitude decompression sickness (DCS) and pulmonary overinflation syndrome (POIS) represent potentially fatal complications of rapid decompression or uncontrolled ascent in aircraft. The signs and symptoms of DCS range from mild joint pain to eventual cardiopulmonary collapse and death. The symptoms of POIS are usually more abrupt and lethal. The medical management of DCS and POIS includes (1) maintenance of airway and cardiopulmonary resuscitation if necessary: (2) administration of 100% oxygen; (3) descent as per Naval Aviation Training and Operating Procedures Standardization guidelines; (4) horizontal body position; (5) maintenance of fluid intake; and (6) early medical evaluation by a flight surgeon or other physician qualified in the management of DCS. Symptoms of DCS may appear up to 24 hours after decompression, and continued monitoring or grounding of exposed individuals during this time is essential. Many controllable factors may predispose to DCS/POIS, and preventive measures should be taken to ensure maximum reduction of risk.

  11. Multiple Fibromas of Tendon Sheath: Unusual Presentation

    PubMed Central

    Park, Se Young; Jin, Seon Pil; Yeom, Bora; Kim, Shin Woo; Cho, So Yun

    2011-01-01

    Fibroma of the tendon sheath is an uncommon soft tissue tumor presenting as a solitary, slow-growing, firm, painless, small nodule, which shows strong attachment to the tendon or tendon sheath. It is usually localized on fingers and hand tendons in adults between the age of 20 and 40 years old. This case concerns a 61-year-old man presenting with a 5-year history of multiple cutaneous nodules on both palms and soles. Skin biopsy confirmed fibroma of the tendon sheath. Blood tests showed a high titer of rheumatoid factor and positivity to anti-nuclear antibody. No case of fibroma of the tendon sheath occurring multifocally on both palms and soles has been previously reported. Herein, we report on a very rare case of multiple fibromas of the tendon sheath arising from palms and soles, which supports the pathogenetic hypothesis that this tumor may be a reactive process rather than a true neoplasm. PMID:22028571

  12. Mononeuropathy of the medial branch of the deep peroneal nerve in a scuba diver.

    PubMed

    Sander, H W

    1999-01-01

    Peripheral mononeuropathies occur only rarely in association with decompression illness. The sites previously reported to be affected are areas of potential entrapment in which a peripheral nerve traverses a confined area. In these instances, the pathophysiology has been presumed to be mechanical pressure in an enclosed space by a gas bubble. A rare case is now presented of a peripheral mononeuropathy of the medial branch of the deep peroneal nerve in a scuba diver following surfacing from a 195 foot dive. This case differs from prior reports of mononeuropathy in association with decompression illness in that the affected nerve does not traverse a confined site in which mechanical compression by a gas bubble is likely. The mechanism of injury is hypothesized to be a manifestation of decompression illness with a gas bubble causing blood flow obstruction and an ischemic infarct.

  13. INDIRECT ARTHROSCOPIC DECOMPRESSION OF SPINOGLENOID CYST WITH SUPRASCAPULAR NEUROPATHY: REPORT OF TWO CASES AND LITERATURE REVIEW

    PubMed Central

    Fernandes, Marcos Rassi; Fernandes, Rui José

    2015-01-01

    Suprascapular nerve compression is rare and should be considered in the differential diagnosis of patients with shoulder pain and external rotation deficit. Spinoglenoidal cysts may cause compression, and posterosuperior glenoid labrum lesions are the most likely hypothesis to explain their appearance. Magnetic resonance imaging and electromyography define the diagnosis. Indirect arthroscopic decompression of the cyst and repair of the glenoid labrum enable complete neurological recovery. The authors report two cases of isolated paralysis of the infraspinatus muscle caused by compression due to spinoglenoidal cysts that were treated by means of arthroscopy, and present the pre and postoperative assessments. PMID:27022558

  14. Nerve conduction

    MedlinePlus

    ... fascicles) that contain hundreds of individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The ... tree-like structures that receive signals from other neurons and from special sensory cells that sense the ...

  15. Nerve injuries about the elbow in the athlete.

    PubMed

    Harris, Joshua D; Lintner, David M

    2014-09-01

    The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery.

  16. Nerve injuries about the elbow in the athlete.

    PubMed

    Harris, Joshua D; Lintner, David M

    2014-09-01

    The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery. PMID:25077754

  17. Ulnar nerve entrapment at the wrist.

    PubMed

    Earp, Brandon E; Floyd, W Emerson; Louie, Dexter; Koris, Mark; Protomastro, Paul

    2014-11-01

    Presentation of ulnar nerve entrapment at the wrist varies based on differential anatomy and the site or sites of compression. Therefore, an understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand. The etiologies of ulnar nerve compression include soft-tissue tumors; repetitive or acute trauma; the presence of anomalous muscles and fibrous bands; arthritic, synovial, endocrine, and metabolic conditions; and iatrogenic injury. In addition to a thorough history and physical examination, which includes motor, sensory, and vascular assessments, imaging and electrodiagnostic studies facilitate the diagnosis of ulnar nerve lesions at the wrist. Nonsurgical management is appropriate for a distal compression lesion caused by repetitive activity, but surgical decompression is indicated if symptoms persist or worsen over 2 to 4 months. PMID:25344595

  18. Flexor Tendon Sheath Ganglions: Results of Surgical Excision

    PubMed Central

    Spencer, Edwin E.

    2007-01-01

    The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient’s medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath. PMID:18780066

  19. Endothelial dysfunction correlates with decompression bubbles in rats.

    PubMed

    Zhang, Kun; Wang, Dong; Jiang, Zhongxin; Ning, Xiaowei; Buzzacott, Peter; Xu, Weigang

    2016-09-12

    Previous studies have documented that decompression led to endothelial dysfunction with controversial results. This study aimed to clarify the relationship between endothelial dysfunction, bubble formation and decompression rate. Rats were subjected to simulated air dives with one of four decompression rates: one slow and three rapid. Bubble formation was detected ultrasonically following decompression for two hours, before measurement of endothelial related indices. Bubbles were found in only rapid-decompressed rats and the amount correlated with decompression rate with significant variability. Serum levels of ET-1, 6-keto-PGF1α, ICAM-1, VCAM-1 and MDA, lung Wet/Dry weight ratio and histological score increased, serum NO decreased following rapid decompression. Endothelial-dependent vasodilatation to Ach was reduced in pulmonary artery rings among rapid-decompressed rats. Near all the above changes correlated significantly with bubble amounts. The results suggest that bubbles may be the causative agent of decompression-induced endothelial damage and bubble amount is of clinical significance in assessing decompression stress. Furthermore, serum levels of ET-1 and MDA may serve as sensitive biomarkers with the capacity to indicate endothelial dysfunction and decompression stress following dives.

  20. Endothelial dysfunction correlates with decompression bubbles in rats.

    PubMed

    Zhang, Kun; Wang, Dong; Jiang, Zhongxin; Ning, Xiaowei; Buzzacott, Peter; Xu, Weigang

    2016-01-01

    Previous studies have documented that decompression led to endothelial dysfunction with controversial results. This study aimed to clarify the relationship between endothelial dysfunction, bubble formation and decompression rate. Rats were subjected to simulated air dives with one of four decompression rates: one slow and three rapid. Bubble formation was detected ultrasonically following decompression for two hours, before measurement of endothelial related indices. Bubbles were found in only rapid-decompressed rats and the amount correlated with decompression rate with significant variability. Serum levels of ET-1, 6-keto-PGF1α, ICAM-1, VCAM-1 and MDA, lung Wet/Dry weight ratio and histological score increased, serum NO decreased following rapid decompression. Endothelial-dependent vasodilatation to Ach was reduced in pulmonary artery rings among rapid-decompressed rats. Near all the above changes correlated significantly with bubble amounts. The results suggest that bubbles may be the causative agent of decompression-induced endothelial damage and bubble amount is of clinical significance in assessing decompression stress. Furthermore, serum levels of ET-1 and MDA may serve as sensitive biomarkers with the capacity to indicate endothelial dysfunction and decompression stress following dives. PMID:27615160

  1. Disposable sheath that facilitates endoscopic Raman spectroscopy.

    PubMed

    Wang, Wenbo; Short, Michael; Tai, Isabella T; Zeng, Haishan

    2016-02-01

    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  2. Optical properties of nonextensive inhomogeneous plasma sheath

    NASA Astrophysics Data System (ADS)

    Mousavi, A.; Esfandiari-Kalejahi, A.; Akbari-Moghanjoughi, M.

    2016-07-01

    Propagation of electromagnetic wave through an inhomogeneous magnetized nonextensive plasma sheath is numerically examined for a realistic density profile of a reentry problem around a hypersonic vehicle. The effect of nonextensivity and inhomogeneity on radio wave communication is studied parametrically. Variation of reflection and transmission coefficients, total attenuation, and total phase shift over the plasma sheath with respect to the strength of applied magnetic field are derived and compared for different values of q-nonextensive parameter. The obtained results for inhomogeneous plasma sheath are compared with previously obtained results of authors for homogeneous plasma sheath. The comparison shows that radio communication in the inhomogeneous plasma sheath is more advantageous than that in the homogeneous case. The transmission coefficient of a plasma sheath with superthermal electrons ( /1 3 < q < 1 ) has larger value compared to that with q > 1. Moreover, for ω c e > ω , the minimum value of total attenuation corresponds to the range /1 3 < q < 1 . An interesting result is that nonextensivity effect on wave propagation in plasma sheath depends on the strength of the ambient magnetic field. The effect of nonextensivity on attenuation coefficient is found to be negligible for ω c e < ω while it is significant for ω c e > ω .

  3. Disposable sheath that facilitates endoscopic Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Wang, Wenbo; Short, Michael; Tai, Isabella T.; Zeng, Haishan

    2016-02-01

    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  4. Ambulation Increases Decompression Sickness in Altitude Exposure

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Pollock, N. W.; Natoli, M. J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    INTRODUCTION - Exercise accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of exercise are likely critical to the net effect. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a 4.3 psi exposure in non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity (CEVIS and ISLE). Additional work is required to investigate whether exercise normal to 1 G environments increases the risk of DCS over microgravity simulation. METHODS - The CEVIS protocol was replicated with one exception. Our subjects completed controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining non-ambulatory throughout. Decompression stress was graded with aural Doppler (Spencer 0-IV scale). Two-dimensional echocardiographic imaging was used to look for left heart gas emboli (the presence of which prompted test termination). Venous blood was collected at three points to correlate Doppler measures of decompression stress with microparticle (cell fragment) accumulation. Fisher Exact Tests compared test and control groups. Trial suspension would occur when DCS risk >15% or grade IV venous gas emboli (VGE) risk >20% (at 70% confidence). RESULTS - Eleven person-trials were completed (9 male, 2 female) when DCS prompted suspension. DCS was greater than in CEVIS trials (3/11 [27%] vs. 0/45 [0%], respectively, p=0.03). Statistical significance was not reached for peak grade IV VGE (2/11 [18%] vs. 3/45 [7%], p=0.149) or cumulative grade IV VGE observations per subject-trial (8/128 [6%] vs. 26/630 [4%], p=0.151). Microparticle data were collected for 5/11 trials (3 with DCS outcomes), with widely varying patterns that could not be resolved statistically

  5. Theory of the electron sheath and presheath

    SciTech Connect

    Scheiner, Brett; Baalrud, Scott D.; Yee, Benjamin T.; Hopkins, Matthew M.; Barnat, Edward V.

    2015-12-30

    Here, electron sheaths are commonly found near Langmuir probes collecting the electron saturation current. The common assumption is that the probe collects the random flux of electrons incident on the sheath, which tacitly implies that there is no electron presheath and that the flux collected is due to a velocity space truncation of the electron velocity distribution function (EVDF). This work provides a dedicated theory of electron sheaths, which suggests that they are not so simple. Motivated by EVDFs observed in particle-in-cell(PIC) simulations, a 1D model for the electron sheath and presheath is developed. In the model, under low temperature plasma conditions (Te >> Ti), an electron pressure gradient accelerates electrons in the presheath to a flow velocity that exceeds the electron thermal speed at the sheath edge. This pressure gradient generates large flow velocities compared to what would be generated by ballistic motion in response to the electric field. It is found that in many situations, under common plasma conditions, the electron presheath extends much further into the plasma than an analogous ion presheath. PIC simulations reveal that the ion density in the electron presheath is determined by a flow around the electron sheath and that this flow is due to 2D aspects of the sheath geometry. Simulations also indicate the presence of ion acoustic instabilities excited by the differential flow between electrons and ions in the presheath, which result in sheath edge fluctuations. The 1D model and time averaged PIC simulations are compared and it is shown that the model provides a good description of the electron sheath and presheath.

  6. Theory of the electron sheath and presheath

    DOE PAGESBeta

    Scheiner, Brett; Baalrud, Scott D.; Yee, Benjamin T.; Hopkins, Matthew M.; Barnat, Edward V.

    2015-12-30

    Here, electron sheaths are commonly found near Langmuir probes collecting the electron saturation current. The common assumption is that the probe collects the random flux of electrons incident on the sheath, which tacitly implies that there is no electron presheath and that the flux collected is due to a velocity space truncation of the electron velocity distribution function (EVDF). This work provides a dedicated theory of electron sheaths, which suggests that they are not so simple. Motivated by EVDFs observed in particle-in-cell(PIC) simulations, a 1D model for the electron sheath and presheath is developed. In the model, under low temperaturemore » plasma conditions (Te >> Ti), an electron pressure gradient accelerates electrons in the presheath to a flow velocity that exceeds the electron thermal speed at the sheath edge. This pressure gradient generates large flow velocities compared to what would be generated by ballistic motion in response to the electric field. It is found that in many situations, under common plasma conditions, the electron presheath extends much further into the plasma than an analogous ion presheath. PIC simulations reveal that the ion density in the electron presheath is determined by a flow around the electron sheath and that this flow is due to 2D aspects of the sheath geometry. Simulations also indicate the presence of ion acoustic instabilities excited by the differential flow between electrons and ions in the presheath, which result in sheath edge fluctuations. The 1D model and time averaged PIC simulations are compared and it is shown that the model provides a good description of the electron sheath and presheath.« less

  7. Theory of the electron sheath and presheath

    NASA Astrophysics Data System (ADS)

    Scheiner, Brett; Baalrud, Scott D.; Yee, Benjamin T.; Hopkins, Matthew M.; Barnat, Edward V.

    2015-12-01

    Electron sheaths are commonly found near Langmuir probes collecting the electron saturation current. The common assumption is that the probe collects the random flux of electrons incident on the sheath, which tacitly implies that there is no electron presheath and that the flux collected is due to a velocity space truncation of the electron velocity distribution function (EVDF). This work provides a dedicated theory of electron sheaths, which suggests that they are not so simple. Motivated by EVDFs observed in particle-in-cell (PIC) simulations, a 1D model for the electron sheath and presheath is developed. In the model, under low temperature plasma conditions ( Te≫Ti ), an electron pressure gradient accelerates electrons in the presheath to a flow velocity that exceeds the electron thermal speed at the sheath edge. This pressure gradient generates large flow velocities compared to what would be generated by ballistic motion in response to the electric field. It is found that in many situations, under common plasma conditions, the electron presheath extends much further into the plasma than an analogous ion presheath. PIC simulations reveal that the ion density in the electron presheath is determined by a flow around the electron sheath and that this flow is due to 2D aspects of the sheath geometry. Simulations also indicate the presence of ion acoustic instabilities excited by the differential flow between electrons and ions in the presheath, which result in sheath edge fluctuations. The 1D model and time averaged PIC simulations are compared and it is shown that the model provides a good description of the electron sheath and presheath.

  8. Optic Nerve Monitoring

    PubMed Central

    Schumann, Paul; Kokemüller, Horst; Tavassol, Frank; Lindhorst, Daniel; Lemound, Juliana; Essig, Harald; Rücker, Martin; Gellrich, Nils-Claudius

    2013-01-01

    Orbital and anterior skull base surgery is generally performed close to the prechiasmatic visual pathway, and clear strategies for detecting and handling visual pathway damage are essential. To overcome the common problem of a missed clinical examination because of an uncooperative or unresponsive patient, flash visual evoked potentials and electroretinograms should be used. These electrophysiologic examination techniques can provide evidence of intact, pathologic, or absent conductivity of the visual pathway when clinical assessment is not feasible. Visual evoked potentials and electroretinograms are thus essential diagnostic procedures not only for primary diagnosis but also for intraoperative evaluation. A decision for or against treatment of a visual pathway injury has to be made as fast as possible due to the enormous importance of the time elapsed with such injuries; this can be achieved additionally using multislice spiral computed tomography. The first-line conservative treatment of choice for such injuries is megadose methylprednisolone therapy. Surgery is used to decompress the orbital compartment by exposure of the intracanalicular part of the optic nerve in the case of optic canal compression. Modern craniomaxillofacial surgery requires detailed consideration of the diagnosis and treatment of traumatic visual pathway damage with the ultimate goal of preserving visual acuity. PMID:24436741

  9. Effects of electron emission on sheath potential

    NASA Astrophysics Data System (ADS)

    Dow, Ansel; Khrabrov, Alexander; Kaganovich, Igor; Schamis, Hanna

    2015-11-01

    We investigate the potential profile of a sheath under the influence of surface electron emission. The plasma and sheath profiles are simulated using the Large Scale Plasma (LSP) particle-in-cell code. Using one dimensional models we corroborate the analytical relationship between sheath potential and plasma electron and emitted electron temperatures derived earlier. This work was made possible by funding from the Department of Energy for the Summer Undergraduate Laboratory Internship (SULI) program. This work is supported by the US DOE Contract No. DE-AC02-09CH11466.

  10. Side-welded fast response sheathed thermocouple

    DOEpatents

    Carr, Kenneth R.

    1981-01-01

    A method of fabricating the measuring junction of a grounded-junction sheathed thermocouple to obtain fast time response and good thermal cycling performance is provided. Slots are tooled or machined into the sheath wall at the measuring junction, the thermocouple wires are laser-welded into the slots. A thin metal closure cap is then laser-welded over the end of the sheath. Compared to a conventional grounded-junction thermocouple, the response time is 4-5 times faster and the thermal shock and cycling capabilities are substantially improved.

  11. Side-welded fast response sheathed thermocouple

    DOEpatents

    Carr, K.R.

    A method of fabricating the measuring junction of a grounded-junction sheathed thermocouple to obtain fast time response and good thermal cycling performance is provided. Slots are tooled or machined into the sheath wall at the measuring junction, the thermocouple wires are laser-welded into the slots. A thin metal closure cap is then laser-welded over the end of the sheath. Compared to a conventional grounded-junction thermocouple, the response time is 4 to 5 times faster and the thermal shock and cycling capabilities are substantially improved.

  12. Pathology: whales, sonar and decompression sickness.

    PubMed

    Piantadosi, Claude A; Thalmann, Edward D

    2004-04-15

    We do not yet know why whales occasionally strand after sonar has been deployed nearby, but such information is important for both naval undersea activities and the protection of marine mammals. Jepson et al. suggest that a peculiar gas-forming disease afflicting some stranded cetaceans could be a type of decompression sickness (DCS) resulting from exposure to mid-range sonar. However, neither decompression theory nor observation support the existence of a naturally occurring DCS in whales that is characterized by encapsulated, gas-filled cavities in the liver. Although gas-bubble formation may be aggravated by acoustic energy, more rigorous investigation is needed before sonar can be firmly linked to bubble formation in whales.

  13. Percutaneous endoscopic decompression for lumbar spinal stenosis.

    PubMed

    Ahn, Yong

    2014-11-01

    Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery.

  14. Behavioral and electrophysiological recovery following cryogenic nerve injury.

    PubMed

    Kalichman, M W; Myers, R R

    1987-06-01

    Postthoracotomy pain can be reduced by cryoanalgesia of intercostal nerves. The technique involves focal freezing of peripheral nerves to interrupt pain pathways, producing immediate functional changes that recover as the nerves regenerate. To assess the time-course of functional changes that follow nerve injury, unilateral freeze lesions of sciatic nerve were induced in rats with a cryosurgical unit. The contralateral nerves were used as sham-operated controls. Following nerve injury, behavioral and electrophysiologic tests were repeated to 90 days. The acute effect of nerve injury was a decrease in behavioral measures of hind limb function (P less than 0.05), an increase in electrical threshold to elicit hind limb contraction (P less than 0.005), and an absence of stimulus-evoked compound action potential (P less than 0.005). Morphologic changes included substantial endoneurial edema associated with Wallerian degeneration. Remyelination occurred subsequently during the following 35 days. Although all physiologic measures returned toward normal, nerve conduction velocities were still much slower in the experimental group. In a second study, the long-term effects of cryogenic injury were compared with neurolytic injury with 10% procaine HCl, both of which produced a conduction velocity deficit that persisted at least 90 days after the initial injury. These behavioral and electrophysiologic results complement previous reports of morphologic deficits in the nerves including incomplete recovery of nerve fiber diameter and increased thickness of the perineurial sheath. PMID:3582553

  15. Cerebrospinal Fluid Leakage after Thoracic Decompression

    PubMed Central

    Hu, Pan-Pan; Liu, Xiao-Guang; Yu, Miao

    2016-01-01

    Objective: The objective of this study is to review cerebrospinal fluid leakage (CSFL) after thoracic decompression and describe its regular and special features. Data Sources: Literature cited in this review was retrieved from PubMed and Medline and was primarily published during the last 10 years. “Cerebrospinal fluid”, “leakage”, “dural tears”, and “thoracic decompression” were the indexed terms. Relevant citations in the retrieved articles were also screened to include more data. Study Selection: All retrieved literature was scrutinized, and four categories were recorded: incidence and risk factors, complications, treatment modalities, and prognosis. Results: CSFL is much more frequent after thoracic decompression than after cervical and lumbar spinal surgeries. Its occurrence is related to many clinical factors, especially the presence of ossified ligaments and the adhesion of the dural sac. While its impact on the late neurological recovery is currently controversial, CSFL increases the risk of other perioperative complications, such as low intracranial pressure symptoms, infection, and vascular events. The combined use of primary repairs during the operation and conservative treatment postoperatively is generally effective for most CSFL cases, whereas lumbar drains and reoperations should be implemented as rescue options for refractory cases only. Conclusions: CSFL after thoracic decompression has not been specifically investigated, so the present study provides a systematic and comprehensive review of the issue. CSFL is a multi-factor-related complication, and pathological factors play a decisive role. The importance of CSFL is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In addition, though the required treatment resources are not special for CSFL after thoracic decompression, most CSFL cases are conservatively curable, and surgeons should be

  16. [Surgical decompression for massive cerebellar infarction].

    PubMed

    Ogasawara, K; Koshu, K; Nagamine, Y; Fujiwara, S; Mizoi, K; Yoshimoto, T

    1995-01-01

    The authors report 10 patients with progressive neurological deterioration due to massive cerebellar infarctions. Computerized tomography scans confirmed obstructive hydrocephalus and brain stem compression. All 10 patients (seven men, three women; mean age, 59 years) were treated by external ventricular drainage and decompressive suboccipital craniectomy. After discharge from the hospital, they were followed up (23-101 months) and their functional independence was evaluated by the Barthel Index. The condition of three patients with brain-stem infarction had deteriorated despite decompressive surgery. Two of these died during the acute stage and one because severely disabled. The remaining seven patients showed neurological improvement during the postoperative period. Four patients with preoperative Japan Coma Scale of 100 returned to their previous jobs within the follow-up period and three patients with preoperative Japan Coma Scale of 200 required some assistance in daily activities. It is suggested that decompressive surgery may be beneficial for massive cerebellar infarction. The postoperative prognosis depends mainly on the presence or absence of coexisting brain-stem infarction. It is possible that, without brain-stem infarction, patients who remained in a "dependent" state may have recovered better if they had been operated on earlier.

  17. Endothelial dysfunction correlates with decompression bubbles in rats

    PubMed Central

    Zhang, Kun; Wang, Dong; Jiang, Zhongxin; Ning, Xiaowei; Buzzacott, Peter; Xu, Weigang

    2016-01-01

    Previous studies have documented that decompression led to endothelial dysfunction with controversial results. This study aimed to clarify the relationship between endothelial dysfunction, bubble formation and decompression rate. Rats were subjected to simulated air dives with one of four decompression rates: one slow and three rapid. Bubble formation was detected ultrasonically following decompression for two hours, before measurement of endothelial related indices. Bubbles were found in only rapid-decompressed rats and the amount correlated with decompression rate with significant variability. Serum levels of ET-1, 6-keto-PGF1α, ICAM-1, VCAM-1 and MDA, lung Wet/Dry weight ratio and histological score increased, serum NO decreased following rapid decompression. Endothelial-dependent vasodilatation to Ach was reduced in pulmonary artery rings among rapid-decompressed rats. Near all the above changes correlated significantly with bubble amounts. The results suggest that bubbles may be the causative agent of decompression–induced endothelial damage and bubble amount is of clinical significance in assessing decompression stress. Furthermore, serum levels of ET-1 and MDA may serve as sensitive biomarkers with the capacity to indicate endothelial dysfunction and decompression stress following dives. PMID:27615160

  18. Recreational technical diving part 2: decompression from deep technical dives.

    PubMed

    Doolette, David J; Mitchell, Simon J

    2013-06-01

    Technical divers perform deep, mixed-gas 'bounce' dives, which are inherently inefficient because even a short duration at the target depth results in lengthy decompression. Technical divers use decompression schedules generated from modified versions of decompression algorithms originally developed for other types of diving. Many modifications ostensibly produce shorter and/or safer decompression, but have generally been driven by anecdote. Scientific evidence relevant to many of these modifications exists, but is often difficult to locate. This review assembles and examines scientific evidence relevant to technical diving decompression practice. There is a widespread belief that bubble algorithms, which redistribute decompression in favour of deeper decompression stops, are more efficient than traditional, shallow-stop, gas-content algorithms, but recent laboratory data support the opposite view. It seems unlikely that switches from helium- to nitrogen-based breathing gases during ascent will accelerate decompression from typical technical bounce dives. However, there is evidence for a higher prevalence of neurological decompression sickness (DCS) after dives conducted breathing only helium-oxygen than those with nitrogen-oxygen. There is also weak evidence suggesting less neurological DCS occurs if helium-oxygen breathing gas is switched to air during decompression than if no switch is made. On the other hand, helium-to-nitrogen breathing gas switches are implicated in the development of inner-ear DCS arising during decompression. Inner-ear DCS is difficult to predict, but strategies to minimize the risk include adequate initial decompression, delaying helium-to-nitrogen switches until relatively shallow, and the use of the maximum safe fraction of inspired oxygen during decompression.

  19. Laboratory simulations of photoelectron sheaths

    NASA Astrophysics Data System (ADS)

    Dove, A.; Wang, X.; Robertson, S. H.; Poppe, A.; Horanyi, M.

    2011-12-01

    Surfaces of airless natural bodies, such as the Moon and asteroids, and spacecraft in space are exposed to solar ultraviolet radiation that creates a photoelectron sheath that dominates the near-surface plasma environment. In order to reproduce and investigate this photoelectron layer, we conduct experiments in vacuum with Xe excimer lamps that emit UV light at ~172 nm (7.21 eV) which is of sufficient intensity to create a photoelectron layer with a characteristic length on the order of several centimeters. We utilize surfaces, such as Zr and CeO2 that have a low work function and a high photoelectron emission yield to maximize the electron density. In order to repel stray electrons that are produced by other surfaces in the chamber, and to define a reference potential, a negatively biased grid is placed 7.5 cm above the surface. The surface and the grid are used as a retarding potential analyzer to determine the energy distribution of the electrons emitted from the surface. When the grid is biased to -20 V, the emitted electrons have an approximately Maxwellian energy distribution with a characteristic temperature of 1.4 ± 0.3 eV. A Langmuir probe is also used as a diagnostic tool to find the effective electron temperature and electron density within the pure electron plasma, and is moved in order to probe different heights above the surface. The derived densities and potentials are compared with those predicted by 1-D PIC code simulations.

  20. Dynamics of dust in the sheath of weakly electronegative plasmas

    SciTech Connect

    Wang Zhengxiong; Wang Xiaogang; Liu Jinyuan; Liu Yue

    2005-01-15

    The dynamics of dust in the sheath of weakly electronegative plasmas are investigated with the single dust model as well as the self-consistently variable dust charge. It is shown that when the dust particles enter the sheath region from the sheath edge with different initial velocities they may display different motion states: levitation in the sheath, returning from the sheath edge, and traversing the sheath region, under action of electrostatic, gravitational, ion-drag, and neutral collision forces. Furthermore, the electronegativity also plays an important role in the dust particle motion states in the sheath besides affecting the distributions of the spatial potential and the charging of the dust particles.

  1. Instrumented Sheath Insulator Experiment (IFAC-SI)

    NASA Astrophysics Data System (ADS)

    Lee, Celia; Miskolczy, Gabor; Lieb, David P.; Witt, Tony

    The Instrumented Fast-Reactor Accelerated Component-Sheath Insulator test (IFAC-SI) is a key experiment of the Thermionic Fuel Element Verification Program designed to allow continuous monitoring of sheath insulator specimens with an applied voltage during the in-reactor test. This paper describes the IFAC-SI experiment test setting, including shear insulator samples, heat pipes, fins, and enclosing container, and discusses the thermal models and their effects on the experimental design.

  2. Poly(lactic-co-glycolic acid) conduit for repair of injured sciatic nerve: A mechanical analysis

    PubMed Central

    Yu, Tao; Zhao, Changfu; Li, Peng; Liu, Guangyao; Luo, Min

    2013-01-01

    Tensile stress and tensile strain directly affect the quality of nerve regeneration after bridging nerve defects by poly(lactic-co-glycolic acid) conduit transplantation and autogenous nerve grafting for sciatic nerve injury. This study collected the sciatic nerve from the gluteus maximus muscle from fresh human cadaver, and established 10-mm-long sciatic nerve injury models by removing the ischium, following which poly(lactic-co-glycolic acid) conduits or autogenous nerve grafts were transplanted. Scanning electron microscopy revealed that the axon and myelin sheath were torn, and the vessels of basilar membrane were obstructed in the poly(lactic-co-glycolic acid) conduit-repaired sciatic nerve following tensile testing. There were no significant differences in tensile tests with autogenous nerve graft-repaired sciatic nerve. Following poly(lactic-co-glycolic acid) conduit transplantation for sciatic nerve repair, tensile test results suggest that maximum tensile load, maximum stress, elastic limit load and elastic limit stress increased compared with autogenous nerve grafts, but elastic limit strain and maximum strain decreased. Moreover, the tendencies of stress-strain curves of sciatic nerves were similar after transplantation of poly(lactic-co-glycolic acid) conduits or autogenous nerve grafts. Results showed that after transplantation in vitro for sciatic nerve injury, poly(lactic-co-glycolic acid) conduits exhibited good intensity, elasticity and plasticity, indicating that poly(lactic-co-glycolic acid) conduits are suitable for sciatic nerve injury repair. PMID:25206505

  3. Poly(lactic-co-glycolic acid) conduit for repair of injured sciatic nerve: A mechanical analysis.

    PubMed

    Yu, Tao; Zhao, Changfu; Li, Peng; Liu, Guangyao; Luo, Min

    2013-07-25

    Tensile stress and tensile strain directly affect the quality of nerve regeneration after bridging nerve defects by poly(lactic-co-glycolic acid) conduit transplantation and autogenous nerve grafting for sciatic nerve injury. This study collected the sciatic nerve from the gluteus maximus muscle from fresh human cadaver, and established 10-mm-long sciatic nerve injury models by removing the ischium, following which poly(lactic-co-glycolic acid) conduits or autogenous nerve grafts were transplanted. Scanning electron microscopy revealed that the axon and myelin sheath were torn, and the vessels of basilar membrane were obstructed in the poly(lactic-co-glycolic acid) conduit-repaired sciatic nerve following tensile testing. There were no significant differences in tensile tests with autogenous nerve graft-repaired sciatic nerve. Following poly(lactic-co-glycolic acid) conduit transplantation for sciatic nerve repair, tensile test results suggest that maximum tensile load, maximum stress, elastic limit load and elastic limit stress increased compared with autogenous nerve grafts, but elastic limit strain and maximum strain decreased. Moreover, the tendencies of stress-strain curves of sciatic nerves were similar after transplantation of poly(lactic-co-glycolic acid) conduits or autogenous nerve grafts. Results showed that after transplantation in vitro for sciatic nerve injury, poly(lactic-co-glycolic acid) conduits exhibited good intensity, elasticity and plasticity, indicating that poly(lactic-co-glycolic acid) conduits are suitable for sciatic nerve injury repair.

  4. Role of arterioles in management of microvascular decompression in patients with hemifacial spasm.

    PubMed

    Zhu, Jin; Li, Shi-Ting; Zhong, Jun; Guan, Hong-Xin; Ying, Ting-Ting; Yang, Min; Yang, Xiaosheng; Zhou, Qiumeng; Jiao, Wei

    2012-03-01

    Although microvascular decompression (MVD) is accepted as an effective therapy for hemifacial spasm (HFS), some operations fail. While performing MVD, many surgeons focus on the large arteries but ignore the arterioles. Failure to identify involved arterioles may account for unsuccessful MVD. We aimed to refine the MVD surgery and improve post-operative outcomes by proper management of involved arterioles. Clinical data were collected from 69 consecutive patients who underwent MVD. Intraoperative electromyography (EMG) was employed for each MVD. Each operation was reviewed with a focus on the involved arterioles. All patients were followed up for between nine and 12 months. An abnormal muscle response (AMR) wave was identified by EMG in all patients before decompression, but vanished in most patients as soon as the involved arteries were removed from the cranial nerve (CN). However, in nine of 69 patients, the AMR did not immediately disappear. Further dissection and exploration of the entire CN VII identified an arteriole in contact with, or in some patients embedded in, the nerve. Once the arteriole was isolated from the CN, the AMR disappeared. After surgery, spasms ceased in all patients and no recurrence was found up to the one-year follow-up. To achieve a positive post-operative outcome, exploration of the entire CN VII is necessary, with a focus on the small arterioles. AMR can be a good adjuvant to identify the involved arterioles.

  5. Protective sheath for a continuous measurement thermocouple

    DOEpatents

    Phillippi, R.M.

    1991-12-03

    Disclosed is a protective thermocouple sheath of a magnesia graphite refractory material for use in continuous temperature measurements of molten metal in a metallurgical ladle and having a basic slag layer thereon. The sheath includes an elongated torpedo-shaped sheath body formed of a refractory composition and having an interior borehole extending axially therethrough and adapted to receive a thermocouple. The sheath body includes a lower end which is closed about the borehole and forms a narrow, tapered tip. The sheath body also includes a first body portion integral with the tapered tip and having a relatively constant cross section and providing a thin wall around the borehole. The sheath body also includes a second body portion having a relatively constant cross section larger than the cross section of the first body portion and providing a thicker wall around the borehole. The borehole terminates in an open end at the second body portion. The tapered tip is adapted to penetrate the slag layer and the thicker second body portion and its magnesia constituent material are adapted to withstand chemical attack thereon from the slag layer. The graphite constituent improves thermal conductivity of the refractory material and, thus, enhances the thermal responsiveness of the device. 4 figures.

  6. Protective sheath for a continuous measurement thermocouple

    DOEpatents

    Phillippi, R. Michael

    1991-01-01

    Disclosed is a protective thermocouple sheath of a magnesia graphite refractory material for use in continuous temperature measurements of molten metal in a metallurgical ladle and having a basic slag layer thereon. The sheath includes an elongated torpedo-shaped sheath body formed of a refractory composition and having an interior borehole extending axially therethrough and adapted to receive a thermocouple. The sheath body includes a lower end which is closed about the borehole and forms a narrow, tapered tip. The sheath body also includes a first body portion integral with the tapered tip and having a relatively constant cross section and providing a thin wall around the borehole. The sheath body also includes a second body portion having a relatively constant cross section larger than the cross section of the first body portion and providing a thicker wall around the borehole. The borehole terminates in an open end at the second body portion. The tapered tip is adapted to penetrate the slag layer and the thicker second body portion and its magnesia constituent material are adapted to withstand chemical attack thereon from the slag layer. The graphite constituent improves thermal conductivity of the refractory material and, thus, enhances the thermal responsiveness of the device.

  7. Dust particle dynamics in magnetized plasma sheath

    SciTech Connect

    Davoudabadi, M.; Mashayek, F.

    2005-07-15

    In this paper, the structure of a plasma sheath in the presence of an oblique magnetic field is investigated, and dynamics of a dust particle embedded in the sheath is elaborated. To simulate the sheath, a weakly collisional two-fluid model is implemented. For various magnitudes and directions of the magnetic field and chamber pressures, different plasma parameters including the electron and ion densities, ion flow velocity, and electric potential are calculated. A complete set of forces acting on the dust particle originating from the electric field in the sheath, the static magnetic field, gravity, and ion and neutral drags is taken into account. Through the trapping potential energy, the particle stable and unstable equilibria are studied while the particle is stationary inside the sheath. Other features such as the possibility of the dust levitation and trapping in the sheath, and the effect of the Lorentz force on the charged dust particle motion are also examined. An interesting feature is captured for the variation of the particle charge as a function of the magnetic field magnitude.

  8. Theory of the Electron Sheath and Presheath

    NASA Astrophysics Data System (ADS)

    Scheiner, Brett; Baalrud, Scott; Yee, Benjamin; Hopkins, Matthew; Barnat, Edward

    2015-09-01

    Electron sheaths are commonly found near Langmuir probes collecting the electron saturation current. The common assumption is that the probe collects the random flux of electrons incident on the sheath, which tacitly implies that there is no electron presheath and that the flux collected is due to a velocity space truncation of the velocity distribution function (VDF). This work provides a dedicated theory of electron sheaths, which suggests that electron sheaths are not so simple. Motivated by VDFs observed in recent Particle-In-Cell (PIC) simulations, we develop a 1D model for the electron sheath and presheath. In the model, under low temperature plasma conditions, an electron pressure gradient accelerates electrons in the presheath to a flow velocity that exceeds the electron thermal speed at the sheath edge. This pressure gradient allows the generation of large flows compared to those that would be generated by the electric field alone. It is due to this pressure gradient that the electron presheath extends much further into the plasma (nominally by a factor of √{mi /me }) than an analogous ion presheath. Results of the model are compared with PIC simulations. This work was supported by the Office of Fusion Energy Science at the U.S. Department of Energy under contract DE-AC04-94SL85000 and by the Office of Science Graduate Student Research (SCGSR) program under Contract Number DE-AC05-06OR23100.

  9. Peripheral Nerve Disorders

    MedlinePlus

    ... spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain ... body. There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. ...

  10. Nerve biopsy (image)

    MedlinePlus

    Nerve biopsy is the removal of a small piece of nerve for examination. Through a small incision, a sample ... is removed and examined under a microscope. Nerve biopsy may be performed to identify nerve degeneration, identify ...

  11. How to Patch Active Plasma and Collisionless Sheath: Practical Guide

    SciTech Connect

    Kaganovich, Igor D.

    2002-08-22

    Most plasmas have a very thin sheath compared with the plasma dimension. This necessitates separate calculations of the plasma and sheath. The Bohm criterion provides the boundary condition for calculation of plasma profiles. To calculate sheath properties, a value of electric field at the plasma-sheath interface has to be specified in addition to the Bohm criterion. The value of the boundary electric field and robust procedure to approximately patch plasma and collisionless sheath with a very good accuracy are reported.

  12. A simple protocol for paraffin-embedded myelin sheath staining with osmium tetroxide for light microscope observation.

    PubMed

    Di Scipio, Federica; Raimondo, Stefania; Tos, Pierluigi; Geuna, Stefano

    2008-07-01

    Experimental investigation of peripheral nerve fiber regeneration is attracting more and more attention among both basic and clinical researchers. Assessment of myelinated nerve fiber morphology is a pillar of peripheral nerve regeneration research. The gold standard for light microscopic imaging of myelinated nerve fibers is toluidine blue staining of resin-embedded semithin sections. However, many researchers are unaware that the dark staining of myelin sheaths typically produced by this procedure is due to osmium tetroxide postfixation and not due to toluidine blue. In this article, we describe a simple pre-embedding protocol for staining myelin sheaths in paraffin-embedded nerve specimens using osmium tetroxide. The method involves immersing the specimen in 2% osmium tetroxide for 2 h after paraformaldehyde fixation, followed by routine dehydration and paraffin embedding. Sections can then be observed directly under the microscope or counterstained using routine histological methods. Particularly good results were obtained with Masson's trichrome counterstain, which permits the imaging of connective structures in nerves that are not detectable in toluidine blue-stained resin sections. Finally, we describe a simple protocol for osmium etching of sections, which makes further immunohistochemical analysis possible on the same specimens. Taken together, our results suggest that the protocol described in this article is a valid alternative to the conventional resin embedding-based protocol: it is much cheaper, can be adopted by any histological laboratory, and allows immunohistochemical analysis to be conducted.

  13. [Reappraise the value of orbital decompression for thyroid associated ophthalmopathy].

    PubMed

    Xiao, Li-hua

    2012-08-01

    Compressive optic neuropathy and exposure keratopathy is classical indications of orbital decompression surgery for thyroid associated ophthalmopathy. Recently, its therapeutic value should extend to cosmetic requirement, the entity of congestive orbitopathy, ocular hypertension and hormonal resistance. In order to improve the safe and efficacy of orbital decompressions, we need the graded decompression plans and the modified areas of bone removal. The preferred area of bone removal is deep lateral wall. In serious patients, a combined medial, inferior and deep lateral wall decompression is recommended. There have also been technical advances in the cosmetic incisions such as transconjunctival, eyelid crease or endoscopic access. Removing periorbital fat is a supplement skill for bony decompression. The removed amount and indications should be regulated strictly. Individual operative project is the tendency of development of orbital decompressions.

  14. Tolerance of the carotid-sheath contents to brachytherapy: an experimental study

    SciTech Connect

    Werber, J.L.; Sood, B.; Alfieri, A.; McCormick, S.A.; Vikram, B. )

    1991-06-01

    Tumor invasion of the carotid artery is a potential indication for brachytherapy, which delivers a high dose of irradiation to residual tumor while limiting the dose to adjacent healthy tissues. The tolerance of carotid-sheath contents to varying doses of brachytherapy, however, has not been clearly established. In order to evaluate brachytherapy effects on carotid-sheath contents, after-loading catheters were implanted bilaterally in 3 groups of 6 rabbits each (18 rabbits). Iridium 192 brachytherapy doses of either 5000 cGy (rad), 9000 cGy, or 13,000 cGy were delivered unilaterally, with the contralateral neck serving as a nonirradiated control in each animal. There were no carotid ruptures and wound healing was normal. Two animals from each group were killed at 6, 20, and 48 weeks. Even at the highest dose (13,000 cGy), nerve conduction studies performed on the vagus nerve prior to sacrifice revealed no increased latency, histologic changes were minimal, and carotid arteries were patent. These observations suggest that the carotid-sheath contents in healthy rabbits could tolerate high doses (up to 13,000 cGy) of low-dose-rate interstitial brachytherapy without complications.

  15. Malignant granular cell tumor of the lateral femoral cutaneous nerve: report of a case with cytogenetic analysis.

    PubMed

    Di Tommaso, Luca; Magrini, Elisabetta; Consales, Alessandro; Poppi, Massimo; Pasquinelli, Gianandrea; Dorji, Tsering; Benedetti, Giovanni; Baccarini, Paola

    2002-12-01

    Malignant granular cell tumors (MGCTs) are rare neoplasms of uncertain histogenesis. We report a case of MGCT involving a peripheral nerve with peritoneal and omental dissemination in which cytogenetic findings are available. Our results show that MGCTs share some cytogenetic abnormalities with malignant peripheral nerve sheath tumors (MPNSTs), supporting the hypothesis that they may represent histogenetically related lesions.

  16. [Morphometric analysis of the sciatic nerve and its principal branches in the pigeon (Columba livia)].

    PubMed

    Vita, G; Muglia, U; Ciriaco, E; Gugliotta, M A; Abbate, F; Laurà, R; Germanà, G P; Germanà, G

    1991-01-01

    The methodological approach used in this study is to characterize the number, the density and the diameter distribution of myelinated fibers (MFs) and unmyelinated fibers (UMFs) in sciatic nerve and its main branches of pigeon. The results have shown that the fiber composition is quite variable because in pigeon there are relatively MF with thin myelin sheaths and MF with thicker sheaths. Our data suggest that morphometric analysis could represent a helpful methodological approach to better characterize these systems.

  17. [Neurologic accident of decompression: a new indication of transesophageal echocardiography].

    PubMed

    Boussuges, A; Blanc, P; Habib, G

    1995-05-20

    Decompression sickness in a 33-year-old SCUBA diver led to neurological lesions with brain damage. The existence of a patent foramen ovale detected with a transoesophageal contrast echocardiography suggested paradoxal gas embolism. This observation emphasizes the intest of transoesophageal contrast echocardiography in decompression sickness as discussed in the literature. Its widely utilization would permit a better understanding of the pathophysiology of decompression sickness. It also may help the physician in deciding whether or not to authorize further diving.

  18. Spatial domain entertainment audio decompression/compression

    NASA Astrophysics Data System (ADS)

    Chan, Y. K.; Tam, Ka Him K.

    2014-02-01

    The ARM7 NEON processor with 128bit SIMD hardware accelerator requires a peak performance of 13.99 Mega Cycles per Second for MP3 stereo entertainment quality decoding. For similar compression bit rate, OGG and AAC is preferred over MP3. The Patent Cooperation Treaty Application dated 28/August/2012 describes an audio decompression scheme producing a sequence of interleaving "min to Max" and "Max to min" rising and falling segments. The number of interior audio samples bound by "min to Max" or "Max to min" can be {0|1|…|N} audio samples. The magnitudes of samples, including the bounding min and Max, are distributed as normalized constants within the 0 and 1 of the bounding magnitudes. The decompressed audio is then a "sequence of static segments" on a frame by frame basis. Some of these frames needed to be post processed to elevate high frequency. The post processing is compression efficiency neutral and the additional decoding complexity is only a small fraction of the overall decoding complexity without the need of extra hardware. Compression efficiency can be speculated as very high as source audio had been decimated and converted to a set of data with only "segment length and corresponding segment magnitude" attributes. The PCT describes how these two attributes are efficiently coded by the PCT innovative coding scheme. The PCT decoding efficiency is obviously very high and decoding latency is basically zero. Both hardware requirement and run time is at least an order of magnitude better than MP3 variants. The side benefit is ultra low power consumption on mobile device. The acid test on how such a simplistic waveform representation can indeed reproduce authentic decompressed quality is benchmarked versus OGG(aoTuv Beta 6.03) by three pair of stereo audio frames and one broadcast like voice audio frame with each frame consisting 2,028 samples at 44,100KHz sampling frequency.

  19. Infraorbital nerve transpositioning into orbital floor: a modified technique to minimize nerve injury following zygomaticomaxillary complex fractures

    PubMed Central

    Kotrashetti, Sharadindu Mahadevappa; Kale, Tejraj Pundalik; Bhandage, Supriya

    2015-01-01

    Objectives Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. Materials and Methods In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. Results There was no evidence of sensory disturbance during their three month follow-up in any of the patient. Conclusion Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve. PMID:25922818

  20. Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

    PubMed Central

    Saper, Michael; Kasik, Connor; Dietzel, Douglas

    2015-01-01

    Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example. PMID:26870637

  1. Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome.

    PubMed

    Saper, Michael; Kasik, Connor; Dietzel, Douglas

    2015-12-01

    Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example. PMID:26870637

  2. Analytic gain in probabilistic decompression sickness models.

    PubMed

    Howle, Laurens E

    2013-11-01

    Decompression sickness (DCS) is a disease known to be related to inert gas bubble formation originating from gases dissolved in body tissues. Probabilistic DCS models, which employ survival and hazard functions, are optimized by fitting model parameters to experimental dive data. In the work reported here, I develop methods to find the survival function gain parameter analytically, thus removing it from the fitting process. I show that the number of iterations required for model optimization is significantly reduced. The analytic gain method substantially improves the condition number of the Hessian matrix which reduces the model confidence intervals by more than an order of magnitude. PMID:24209920

  3. Analytic gain in probabilistic decompression sickness models.

    PubMed

    Howle, Laurens E

    2013-11-01

    Decompression sickness (DCS) is a disease known to be related to inert gas bubble formation originating from gases dissolved in body tissues. Probabilistic DCS models, which employ survival and hazard functions, are optimized by fitting model parameters to experimental dive data. In the work reported here, I develop methods to find the survival function gain parameter analytically, thus removing it from the fitting process. I show that the number of iterations required for model optimization is significantly reduced. The analytic gain method substantially improves the condition number of the Hessian matrix which reduces the model confidence intervals by more than an order of magnitude.

  4. Clinical and Radiological Comparison between Ipsilateral and Contralateral Side Canal Decompression Using an Unilateral Laminotomy Approach

    PubMed Central

    Park, Woong Bae; Lee, Sang Won; Sung, Jae Hoon; Yang, Seung Ho; Kim, IL Sub

    2016-01-01

    Objective To compare the clinical and radiological outcome of both sides using the unilateral approach. Methods Unilateral laminotomy was performed to achieve bilateral decompression. Thirty-nine patients who underwent this procedure were analyzed prospectively using the Oswestry Disability Index (ODI), the visual analog scale (VAS) pain score to evaluate symptoms in both legs, and the radiological morphometric index to calculate the anteriorposterior diameter and midcanal width. The incidence of complications from this approach was then evaluated. Results The mean follow-up time was 12.2 months. The mean ODI was 48.4 preoperatively and 14.2 postoperatively. The mean dural sac widening of the ipsilateral side (187.0%) was significantly larger (p<0.01) than that of the the contralateral side (145.6%). The VAS improvement ratio ([preoperative VAS score-postoperative VAS score]/[preoperative VAS score]×100) for the pain in each leg was 75.4%(ipsilateral side) and 73.7%(contralateral side). While the VAS improvement ratio for pain in each side was significantly reduced, the difference in the VAS ratio between sides was statistically insignificant (p=0.64). There were 2 cases (5.1%) of dural tearing during the procedure, 1 case (2.6%) of transient paresthesia of nerve roots, and 2 cases (5.1%) of transient paresthesia of the contralateral nerve root. The transient paresthesias of nerve roots never lasted more than 2 weeks. Conclusion This technique allows for significant decompression of the contralateral canal and excellent clinical outcomes without troublesome complications. Although ipsilateral the dural sac widening was significantly larger than contralateral side, the difference in the clinical outcome between sides was statistically insignificant. PMID:27437011

  5. Late sciatic nerve axonotmesis following acetabular reconstruction plate.

    PubMed

    Moreta, J; Foruria, X; Labayru, F

    2016-01-01

    Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement.

  6. Polarization force-induced changes in the dust sheath formation

    SciTech Connect

    Mayout, Saliha; Bentabet, Karima; Tribeche, Mouloud

    2015-09-15

    The modifications arising in the dusty plasma sheath structure due to the presence of polarization forces acting on the dust grains are investigated. The corresponding appropriate Bohm criterion for sheath formation is obtained. It is found that the critical Mach number, beyond which the dusty plasma electrostatic sheath sets in, decreases whenever the polarization effects become important. In addition, when the polarization force dominates over the electrical one, the dust plasma sheath cannot set in. This happens whenever the dust grain size exceeds a critical threshold. Moreover, the sheath electrostatic potential-gradient becomes abruptly steep, and the sheath thickness becomes broader as the polarization force effects strengthen.

  7. Colonic Fermentation Promotes Decompression sickness in Rats

    PubMed Central

    de Maistre, Sébastien; Vallée, Nicolas; Gempp, Emmanuel; Lambrechts, Kate; Louge, Pierre; Duchamp, Claude; Blatteau, Jean-Eric

    2016-01-01

    Massive bubble formation after diving can lead to decompression sickness (DCS). During dives with hydrogen as a diluent for oxygen, decreasing the body’s H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. So we set out to investigate if colonic fermentation leading to endogenous hydrogen production promotes DCS in fasting rats. Four hours before an experimental dive, 93 fasting rats were force-fed, half of them with mannitol and the other half with water. Exhaled hydrogen was measured before and after force-feeding. Following the hyperbaric exposure, we looked for signs of DCS. A higher incidence of DCS was found in rats force-fed with mannitol than in those force-fed with water (80%, [95%CI 56, 94] versus 40%, [95%CI 19, 64], p < 0.01). In rats force-fed with mannitol, metronidazole pretreatment reduced the incidence of DCS (33%, [95%CI 15, 57], p = 0.005) at the same time as it inhibited colonic fermentation (14 ± 35 ppm versus 118 ± 90 ppm, p = 0.0001). Pre-diveingestion of mannitol increased the incidence of DCS in fasting rats when colonic fermentation peaked during the decompression phase. More generally, colonic fermentation in rats on a normal diet could promote DCS through endogenous hydrogen production. PMID:26853722

  8. Colonic Fermentation Promotes Decompression sickness in Rats.

    PubMed

    de Maistre, Sébastien; Vallée, Nicolas; Gempp, Emmanuel; Lambrechts, Kate; Louge, Pierre; Duchamp, Claude; Blatteau, Jean-Eric

    2016-01-01

    Massive bubble formation after diving can lead to decompression sickness (DCS). During dives with hydrogen as a diluent for oxygen, decreasing the body's H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. So we set out to investigate if colonic fermentation leading to endogenous hydrogen production promotes DCS in fasting rats. Four hours before an experimental dive, 93 fasting rats were force-fed, half of them with mannitol and the other half with water. Exhaled hydrogen was measured before and after force-feeding. Following the hyperbaric exposure, we looked for signs of DCS. A higher incidence of DCS was found in rats force-fed with mannitol than in those force-fed with water (80%, [95%CI 56, 94] versus 40%, [95%CI 19, 64], p < 0.01). In rats force-fed with mannitol, metronidazole pretreatment reduced the incidence of DCS (33%, [95%CI 15, 57], p = 0.005) at the same time as it inhibited colonic fermentation (14 ± 35 ppm versus 118 ± 90 ppm, p = 0.0001). Pre-diveingestion of mannitol increased the incidence of DCS in fasting rats when colonic fermentation peaked during the decompression phase. More generally, colonic fermentation in rats on a normal diet could promote DCS through endogenous hydrogen production.

  9. [Posterior fossa microvascular decompression for hemifacial spasm and trigeminal neuralgia--some improvements on operative devices and technique].

    PubMed

    Hongo, K; Kobayashi, S; Takemae, T; Sugita, K

    1985-12-01

    Microvascular decompression has been widely used as a method for the treatment of hemifacial spasm and trigeminal neuralgia. We have experienced 30 such cases in the last 2 years; 25 of them were hemifacial spasm and 5 trigeminal neuralgia. Excellent results were obtained in 26 cases; the remaining two cases, both hemifacial spasm, were partially cured. Mild facial paresis appeared several days after the operation in 3 patients. In all the cases, the facial paresis recovered completely within several weeks. The cause of the facial paresis was not known. In 2 cases a slight hearing deficits were noticed after surgery, which has been gradually improving over several months. As this operation is functional surgery, operative complications must be avoided as much as possible. It has been our policy that we first try medical treatment and/or some kinds of nerve block and if no effects are obtained, we recommend the microvascular decompression. For microvascular decompression, suboccipital craniectomy is performed in lateral position. From the point of view of surgical technique, we stress several important points as follows: The head is elevated about 30 degrees, and it is kept approximately horizontal and should not be excessively rotated. Craniectomy is made as far laterally as the sigmoid sinus; its shape is elongated oval. Retraction of the cerebellum should not be done in the direction of the cranial nerves to avoid post-operative hearing deficit. Two tapered retractors are effectively used for cerebellar retraction. A third slim, tapered retractor is useful for holding an offending artery when exploring the root exit zone or placing a sponge for decompression.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4088451

  10. Crystallization kinetics in magmas during decompression

    NASA Astrophysics Data System (ADS)

    Arzilli, Fabio; Burton, Mike; Carroll, Michael R.

    2016-04-01

    Many variables play a role during magma crystallization at depth or in a volcanic conduit, and through experimentally derived constraints we can better understand pre- and syn-eruptive magma crystallization behavior. The thermodynamic properties of magmas have been extensively investigated as a function of T, P, fO2 and magma composition [1], and this allows estimation of the stability of equilibrium phases and physical parameters (e.g., density, viscosity). However, many natural igneous rocks contain geochemical, mineralogical and textural evidence of disequilibrium, suggesting that magmas frequently follow non-equilibrium, time-dependent pathways that are recorded in the geochemical and petrographic characteristics of the rocks. There are currently no suitable theoretical models capable of calculating nucleation and growth rates in disequilibrium conditions without experimental constraints. The aim of this contribution is provide quantitative data on growth and nucleation rates of feldspar crystals in silicate melts obtained through decompression experiments, in order to determine the magma evolution in pre- and sin-eruptive conditions. Decompression is one of the main processes that induce the crystallization of feldspar during the magma ascent in the volcanic conduit. Decompression experiments have been carried out on trachytic and basaltic melts to investigate crystallization kinetics of feldspar as a function of the effect of the degassing, undercooling and time on nucleation and crystal growth process [2; 3]. Furthermore, feldspar is the main crystals phase present in magmas, and its abundance can strongly vary with small changes in pressure, temperature and water content in the melt, implying appreciable variations in the textures and in the crystallization kinetics. Crystallization kinetics of trachytic melts show that long experiment durations involve more nucleation events of alkali feldspar than short experiment durations [2]. This is an important

  11. Cardiovascular Pressures with Venous Gas Embolism and Decompression

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Robinson, R.; Sutton, T.; Kemper, G. B.

    1995-01-01

    Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.

  12. Evaluation of quality of life in patients with Graves´ ophthalmopathy, before and after orbital decompression.

    PubMed

    Iacobæus, Lykke; Sahlin, Sven

    2016-06-01

    Graves' ophthalmopathy (GO) is a potentially sight threatening orbital disease that can have a large negative impact on the quality of life of the patient. Studies on long-term effects of GO on the quality of life are few. The aim of this study is to evaluate the health-related quality of life in patients with GO, before and after orbital decompression surgery. This is a prospective, longitudinal, interventional study in which patients who had orbital decompression were given the Graves´ ophthalmopathy quality of life questionnaire (GO-QOL) before and after surgery. The GO-QOL is a disease specific instrument to measure health-related quality of life. The answers are transformed into scores from 0-100 on 2 subscales. Higher score indicates better health. An additional patient satisfaction questionnaire was also given post-surgery. A significant, long-term, improvement in quality of life after orbital decompression was noted (p < 0.001, paired t-test). 50 patients were included and follow-up time was 5.3 ± 1.2 years (mean ± SD). The QOL-scores increased 28 ± 35 and 26 ± 31 points, respectively, on the two subscales, "visual functioning" and "appearance" (mean ± SD). The patient satisfaction questionnaire showed that 88% of the patients would recommend orbital decompression to a fellow patient. Persistent disturbing oscillopsia was seen in 2% and persistent disturbing infraorbital nerve hypoesthesia in 8% of the patients. Orbital decompression surgery has a positive effect on quality of life for patients with severe GO. The GO-QOL questionnaire showed significant improvement in QOL-scores even many years after surgery.

  13. Sciatic nerve repair using adhesive bonding and a modified conduit

    PubMed Central

    Liang, Xiangdang; Cai, Hongfei; Hao, Yongyu; Sun, Geng; Song, Yaoyao; Chen, Wen

    2014-01-01

    When repairing nerves with adhesives, most researchers place glue directly on the nerve stumps, but this method does not fix the nerve ends well and allows glue to easily invade the nerve ends. In this study, we established a rat model of completely transected sciatic nerve injury and repaired it using a modified 1 cm-length conduit with inner diameter of 1.5 mm. Each end of the cylindrical conduit contains a short linear channel, while the enclosed central tube protects the nerve ends well. Nerves were repaired with 2-octyl-cyanoacrylate and suture, which complement the function of the modified conduit. The results demonstrated that for the same conduit, the average operation time using the adhesive method was much shorter than with the suture method. No significant differences were found between the two groups in sciatic function index, motor evoked potential latency, motor evoked potential amplitude, muscular recovery rate, number of medullated nerve fibers, axon diameter, or medullary sheath thickness. Thus, the adhesive method for repairing nerves using a modified conduit is feasible and effective, and reduces the operation time while providing an equivalent repair effect. PMID:25206861

  14. Microanatomy and Histological Features of Central Myelin in the Root Exit Zone of Facial Nerve

    PubMed Central

    Yoo, Chan-Jong; Han, Seong-Rok; Choi, Chan-Young

    2014-01-01

    Objective The aim of this study was to evaluate the microanatomy and histological features of the central myelin in the root exit zone of facial nerve. Methods Forty facial nerves with brain stem were obtained from 20 formalin fixed cadavers. Among them 17 facial nerves were ruined during preparation and 23 root entry zone (REZ) of facial nerves could be examined. The length of medial REZ, from detach point of facial nerve at the brain stem to transitional area, and the thickness of glial membrane of central myelin was measured. We cut brain stem along the facial nerve and made a tissue block of facial nerve REZ. Each tissue block was embedded with paraffin and serially sectioned. Slices were stained with hematoxylin and eosin (H&E), periodic acid-Schiff, and glial fibrillary acid protein. Microscopy was used to measure the extent of central myelin and thickness of outer glial membrane of central myelin. Thickness of glial membrane was examined at two different points, the thickest area of proximal and distal REZ. Results Special stain with PAS and GFAP could be differentiated the central and peripheral myelin of facial nerve. The length of medial REZ was mean 2.6 mm (1.6-3.5 mm). The glial limiting membrane of brain stem is continued to the end of central myelin. We called it glial sheath of REZ. The thickness of glial sheath was mean 66.5 µm (40-110 µm) at proximal REZ and 7.4 µm (5-10 µm) at distal REZ. Conclusion Medial REZ of facial nerve is mean 2.6 mm in length and covered by glial sheath continued from glial limiting membrane of brain stem. Glial sheath of central myelin tends to become thin toward transitional zone. PMID:25132929

  15. Surgical treatment of painful lesions of the inferior alveolar nerve.

    PubMed

    Biglioli, Federico; Allevi, Fabiana; Lozza, Alessandro

    2015-10-01

    Nerve-related complications are being reported with increasing frequency following oral and dental surgery, and typically involve the inferior alveolar nerve (IAN). We assess herein the etiology of neuropathic pain related to IAN injuries, and describe the various surgical treatment techniques available. Between 2007 and 2013, 19 patients were referred to the Maxillofacial Surgery Department of San Paolo Hospital (Milan, Italy) with pain in the area supplied by the IAN, which developed following endodontic treatment, oral surgery and maxillofacial surgery. All patients underwent IAN surgery by several different microsurgical procedures. Most of the patients affected by pain before surgery experienced complete or partial amelioration of symptoms. All patients receiving sural nerve grafts were pain-free 12 months after surgery. In five patients the operation was unsuccessful. In 78.94% of cases, a significant increase in nerve function was observed. Pain following IAN surgical damage may be addressed by microsurgery; nerve substitution with a sural nerve interpositional graft appears to represent the most efficacious procedure. Scar releasing, nerve decompression and nerve substitution using vein grafts are less effective. Removal of endodontic material extravasated into the mandibular canal is mandatory and effective in patients experiencing severe pain. Surgery should be performed within 12 months postoperatively, ideally during the first few weeks after symptoms onset. PMID:26315275

  16. Low-Level Laser-Accelerated Peripheral Nerve Regeneration within a Reinforced Nerve Conduit across a Large Gap of the Transected Sciatic Nerve in Rats

    PubMed Central

    Shen, Chiung-Chyi; Yang, Yi-Chin; Huang, Tsung-Bin; Chan, Shiuh-Chuan; Liu, Bai-Shuan

    2013-01-01

    This study proposed a novel combination of neural regeneration techniques for the repair of damaged peripheral nerves. A biodegradable nerve conduit containing genipin-cross-linked gelatin was annexed using beta-tricalcium phosphate (TCP) ceramic particles (genipin-gelatin-TCP, GGT) to bridge the transection of a 15 mm sciatic nerve in rats. Two trigger points were irradiated transcutaneously using 660 nm of gallium-aluminum arsenide phosphide (GaAlAsP) via laser diodes for 2 min daily over 10 consecutive days. Walking track analysis showed a significant improvement in sciatic functional index (SFI) (P < 0.01) and pronounced improvement in the toe spreading ability of rats undergoing laser stimulation. Electrophysiological measurements (peak amplitude and area) illustrated by compound muscle action potential (CMAP) curves demonstrated that laser stimulation significantly improved nerve function and reduced muscular atrophy. Histomorphometric assessments revealed that laser stimulation accelerated nerve regeneration over a larger area of neural tissue, resulting in axons of greater diameter and myelin sheaths of greater thickness than that observed in rats treated with nerve conduits alone. Motor function, electrophysiological reactions, muscular reinnervation, and histomorphometric assessments all demonstrate that the proposed therapy accelerated the repair of transected peripheral nerves bridged using a GGT nerve conduit. PMID:23737818

  17. Low-Level Laser-Accelerated Peripheral Nerve Regeneration within a Reinforced Nerve Conduit across a Large Gap of the Transected Sciatic Nerve in Rats.

    PubMed

    Shen, Chiung-Chyi; Yang, Yi-Chin; Huang, Tsung-Bin; Chan, Shiuh-Chuan; Liu, Bai-Shuan

    2013-01-01

    This study proposed a novel combination of neural regeneration techniques for the repair of damaged peripheral nerves. A biodegradable nerve conduit containing genipin-cross-linked gelatin was annexed using beta-tricalcium phosphate (TCP) ceramic particles (genipin-gelatin-TCP, GGT) to bridge the transection of a 15 mm sciatic nerve in rats. Two trigger points were irradiated transcutaneously using 660 nm of gallium-aluminum arsenide phosphide (GaAlAsP) via laser diodes for 2 min daily over 10 consecutive days. Walking track analysis showed a significant improvement in sciatic functional index (SFI) (P < 0.01) and pronounced improvement in the toe spreading ability of rats undergoing laser stimulation. Electrophysiological measurements (peak amplitude and area) illustrated by compound muscle action potential (CMAP) curves demonstrated that laser stimulation significantly improved nerve function and reduced muscular atrophy. Histomorphometric assessments revealed that laser stimulation accelerated nerve regeneration over a larger area of neural tissue, resulting in axons of greater diameter and myelin sheaths of greater thickness than that observed in rats treated with nerve conduits alone. Motor function, electrophysiological reactions, muscular reinnervation, and histomorphometric assessments all demonstrate that the proposed therapy accelerated the repair of transected peripheral nerves bridged using a GGT nerve conduit. PMID:23737818

  18. Ambulation Increases Decompression Sickness in Spacewalk Simulations

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is

  19. 56. POWDER MAGAZINE, VIEW OF INTACT WOOD SHEATHING ON THE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    56. POWDER MAGAZINE, VIEW OF INTACT WOOD SHEATHING ON THE SOUTHWEST REAR VENTILATION PASSAGE. (SHEATHING HELP CONTROL HUMIDITY AND DECREASE DANGER OF MAETAL STRIKING STONE AND SPARKING.) - Fort Monroe, Fortress, Hampton, Hampton, VA

  20. Carpal tunnel syndrome caused by a giant cell tumour of the flexor tendon sheath.

    PubMed

    Meek, Marcel F; Sheikh, Zahid A; Quinton, David N

    2014-02-01

    A 76-year-old woman developed right carpal tunnel syndrome after being conservatively treated for tenosynovitis of the flexor tendons with associated mild carpal tunnel syndrome. A magnetic resonance imaging scan showed a tumour in the carpal tunnel. Re-exploration showed that the median nerve was being compressed by a giant cell tumour of the flexor tendon sheaths. Appropriate imaging is advised in patients with additional findings (such as swelling) or in patients with secondary carpal tunnel syndrome and incomplete response to conservative treatment, to exclude a space-occupying lesion.

  1. [Carpal tunnel syndrome and "trigger wrist" revealing a tendinous sheath fibroma].

    PubMed

    Benhima, M A; Ait Essi, F; Abkari, I; Najeb, Y; Fikry, T

    2014-02-01

    The tendinous sheath fibroma (TSF) is a rare benign tumor, exceptionally responsible for carpal tunnel syndrome and "trigger" wrist: we found this association less than ten times in the English and French literature. We report the case of a 63-year-old right-handed carpenter who featured a triggering phenomenon of the right wrist during the flexion-extension movements and compression of the median nerve at the carpal tunnel, secondary to a TSF of the flexor digitorum superficialis. The diagnosis was suspected at the sonography and MRI, the tumor was excised and proven histologically to be a TSF. One year later, the patient remained free of symptoms.

  2. Low-level laser irradiation improves functional recovery and nerve regeneration in sciatic nerve crush rat injury model.

    PubMed

    Wang, Chau-Zen; Chen, Yi-Jen; Wang, Yan-Hsiung; Yeh, Ming-Long; Huang, Mao-Hsiung; Ho, Mei-Ling; Liang, Jen-I; Chen, Chia-Hsin

    2014-01-01

    The development of noninvasive approaches to facilitate the regeneration of post-traumatic nerve injury is important for clinical rehabilitation. In this study, we investigated the effective dose of noninvasive 808-nm low-level laser therapy (LLLT) on sciatic nerve crush rat injury model. Thirty-six male Sprague Dawley rats were divided into 6 experimental groups: a normal group with or without 808-nm LLLT at 8 J/cm(2) and a sciatic nerve crush injury group with or without 808-nm LLLT at 3, 8 or 15 J/cm(2). Rats were given consecutive transcutaneous LLLT at the crush site and sacrificed 20 days after the crush injury. Functional assessments of nerve regeneration were analyzed using the sciatic functional index (SFI) and hindlimb range of motion (ROM). Nerve regeneration was investigated by measuring the myelin sheath thickness of the sciatic nerve using transmission electron microscopy (TEM) and by analyzing the expression of growth-associated protein 43 (GAP43) in sciatic nerve using western blot and immunofluorescence staining. We found that sciatic-injured rats that were irradiated with LLLT at both 3 and 8 J/cm(2) had significantly improved SFI but that a significant improvement of ROM was only found in rats with LLLT at 8 J/cm(2). Furthermore, the myelin sheath thickness and GAP43 expression levels were significantly enhanced in sciatic nerve-crushed rats receiving 808-nm LLLT at 3 and 8 J/cm(2). Taken together, these results suggest that 808-nm LLLT at a low energy density (3 J/cm(2) and 8 J/cm(2)) is capable of enhancing sciatic nerve regeneration following a crush injury. PMID:25119457

  3. 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

  4. Swimming exercise in the acute or late phase after sciatic nerve crush accelerates nerve regeneration.

    PubMed

    Teodori, Rosana Macher; Betini, Joice; de Oliveira, Larissa Salgado; Sobral, Luciane Lobato; Takeda, Sibele Yoko Mattozo; de Lima Montebelo, Maria Imaculada

    2011-01-01

    There is no consensus about the best time to start exercise after peripheral nerve injury. We evaluated the morphological and functional characteristics of the sciatic nerves of rats that began to swim immediately after crush nerve injury (CS1), those that began to swim 14 days after injury (CS14), injured rats not submitted to swimming (C), and uninjured rats submitted to swimming (S). After 30 days the number of axons in CS1 and CS14 was lower than in C (P < 0.01). The diameter of axons and nerve fibers was larger in CS1 (P < 0.01) and CS14 (P < 0.05) than in C, and myelin sheath thickness was lower in all crushed groups (P < 0.05). There was no functional difference between CS1 and CS14 (P > 0.05). Swimming exercise applied during the acute or late phase of nerve injury accelerated nerve regeneration and synaptic elimination after axonotmesis, suggesting that exercise may be initiated immediately after injury.

  5. Swimming Exercise in the Acute or Late Phase after Sciatic Nerve Crush Accelerates Nerve Regeneration

    PubMed Central

    Teodori, Rosana Macher; Betini, Joice; de Oliveira, Larissa Salgado; Sobral, Luciane Lobato; Takeda, Sibele Yoko Mattozo; Montebelo, Maria Imaculada de Lima

    2011-01-01

    There is no consensus about the best time to start exercise after peripheral nerve injury. We evaluated the morphological and functional characteristics of the sciatic nerves of rats that began to swim immediately after crush nerve injury (CS1), those that began to swim 14 days after injury (CS14), injured rats not submitted to swimming (C), and uninjured rats submitted to swimming (S). After 30 days the number of axons in CS1 and CS14 was lower than in C (P < 0.01). The diameter of axons and nerve fibers was larger in CS1 (P < 0.01) and CS14 (P < 0.05) than in C, and myelin sheath thickness was lower in all crushed groups (P < 0.05). There was no functional difference between CS1 and CS14 (P > 0.05). Swimming exercise applied during the acute or late phase of nerve injury accelerated nerve regeneration and synaptic elimination after axonotmesis, suggesting that exercise may be initiated immediately after injury. PMID:21876821

  6. Radio-frequency sheath-plasma interactions with magnetic field tangency points along the sheath surface

    SciTech Connect

    Kohno, H.; Myra, J. R.; D'Ippolito, D. A.

    2013-08-15

    Computer simulations of radio-frequency (RF) waves propagating across a two-dimensional (2D) magnetic field into a conducting boundary are described. The boundary condition for the RF fields at the metal surface leads to the formation of an RF sheath, which has previously been studied in one-dimensional models. In this 2D study, it is found that rapid variation of conditions along the sheath surface promote coupling of the incident RF branch (either fast or slow wave) to a short-scale-length sheath-plasma wave (SPW). The SPW propagates along the sheath surface in a particular direction dictated by the orientation of the magnetic field with respect to the surface, and the wave energy in the SPW accumulates near places where the background magnetic field is tangent to the surface.

  7. Radio-frequency sheath-plasma interactions with magnetic field tangency points along the sheath surface

    NASA Astrophysics Data System (ADS)

    Kohno, H.; Myra, J. R.; D'Ippolito, D. A.

    2013-08-01

    Computer simulations of radio-frequency (RF) waves propagating across a two-dimensional (2D) magnetic field into a conducting boundary are described. The boundary condition for the RF fields at the metal surface leads to the formation of an RF sheath, which has previously been studied in one-dimensional models. In this 2D study, it is found that rapid variation of conditions along the sheath surface promote coupling of the incident RF branch (either fast or slow wave) to a short-scale-length sheath-plasma wave (SPW). The SPW propagates along the sheath surface in a particular direction dictated by the orientation of the magnetic field with respect to the surface, and the wave energy in the SPW accumulates near places where the background magnetic field is tangent to the surface.

  8. Bubble dynamics in perfused tissue undergoing decompression.

    PubMed

    Meisel, S; Nir, A; Kerem, D

    1981-02-01

    A mathematical model describing bubble dynamics in a perfused tissue undergoing decompression is presented, taking into account physical expansion and inward diffusion from surrounding supersaturated tissue as growth promoting factors and tissue gas elimination by perfusion, tissue elasticity, surface tension and inherent unsaturation as resolving driving forces. The expected behavior after a step reduction of pressure of a bubble initially existing in the tissue, displaying both growth and resolution has been demonstrated. A strong perfusion-dependence of bubble resolution time at low perfusion rates is apparent. The model can account for various exposure pressures and saturation fractions of any inert gas-tissue combination for which a set of physical and physiological parameters is available.

  9. Threshold altitude resulting in decompression sickness

    NASA Technical Reports Server (NTRS)

    Kumar, K. V.; Waligora, James M.; Calkins, Dick S.

    1990-01-01

    A review of case reports, hypobaric chamber training data, and experimental evidence indicated that the threshold for incidence of altitude decompression sickness (DCS) was influenced by various factors such as prior denitrogenation, exercise or rest, and period of exposure, in addition to individual susceptibility. Fitting these data with appropriate statistical models makes it possible to examine the influence of various factors on the threshold for DCS. This approach was illustrated by logistic regression analysis on the incidence of DCS below 9144 m. Estimations using these regressions showed that, under a noprebreathe, 6-h exposure, simulated EVA profile, the threshold for symptoms occurred at approximately 3353 m; while under a noprebreathe, 2-h exposure profile with knee-bends exercise, the threshold occurred at 7925 m.

  10. 30 CFR 75.1314 - Sheathed explosive units.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Sheathed explosive units. 75.1314 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1314 Sheathed explosive units. (a) A separate instantaneous detonator shall be used to fire each sheathed explosive...

  11. 30 CFR 75.1314 - Sheathed explosive units.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Sheathed explosive units. 75.1314 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1314 Sheathed explosive units. (a) A separate instantaneous detonator shall be used to fire each sheathed explosive...

  12. 30 CFR 75.1314 - Sheathed explosive units.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Sheathed explosive units. 75.1314 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1314 Sheathed explosive units. (a) A separate instantaneous detonator shall be used to fire each sheathed explosive...

  13. 30 CFR 75.1314 - Sheathed explosive units.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Sheathed explosive units. 75.1314 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1314 Sheathed explosive units. (a) A separate instantaneous detonator shall be used to fire each sheathed explosive...

  14. 30 CFR 75.1314 - Sheathed explosive units.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Sheathed explosive units. 75.1314 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1314 Sheathed explosive units. (a) A separate instantaneous detonator shall be used to fire each sheathed explosive...

  15. Transcranial Doppler ultrasound and the etiology of neurologic decompression sickness during altitude decompression

    NASA Technical Reports Server (NTRS)

    Norfleet, W. T.; Powell, M. R.; Kumar, K. Vasantha; Waligora, J.

    1993-01-01

    The presence of gas bubbles in the arterial circulation can occur from iatrogenic mishaps, cardiopulmonary bypass devices, or following decompression, e.g., in deep-sea or SCUBA diving or in astronauts during extravehicular activities (EVA). We have examined the pathophysiology of neurological decompression sickness in human subjects who developed a large number of small gas bubbles in the right side of the heart as a result of hypobaric exposures. In one case, gas bubbles were detected in the middle cerebral artery (MCA) and the subject developed neurological symptoms; a 'resting' patent foramen ovalae (PFO) was found upon saline contrast echocardiography. A PFO was also detected in another individual who developed Spencer Grade 4 precordial Doppler ultrasound bubbles, but no evidence was seen of arterialization of bubbles upon insonation of either the MCA or common carotid artery. The reason for this difference in the behavior of intracardiac bubbles in these two individuals is not known. To date, we have not found evidence of right-to-left shunting of bubbles through pulmonary vasculature. The volume of gas bubbles present following decompression is examined and compared with the number arising from saline contrast injection. The estimates are comparable.

  16. Decompression sickness ('the bends') in sea turtles.

    PubMed

    García-Párraga, D; Crespo-Picazo, J L; de Quirós, Y Bernaldo; Cervera, V; Martí-Bonmati, L; Díaz-Delgado, J; Arbelo, M; Moore, M J; Jepson, P D; Fernández, Antonio

    2014-10-16

    Decompression sickness (DCS), as clinically diagnosed by reversal of symptoms with recompression, has never been reported in aquatic breath-hold diving vertebrates despite the occurrence of tissue gas tensions sufficient for bubble formation and injury in terrestrial animals. Similarly to diving mammals, sea turtles manage gas exchange and decompression through anatomical, physiological, and behavioral adaptations. In the former group, DCS-like lesions have been observed on necropsies following behavioral disturbance such as high-powered acoustic sources (e.g. active sonar) and in bycaught animals. In sea turtles, in spite of abundant literature on diving physiology and bycatch interference, this is the first report of DCS-like symptoms and lesions. We diagnosed a clinico-pathological condition consistent with DCS in 29 gas-embolized loggerhead sea turtles Caretta caretta from a sample of 67. Fifty-nine were recovered alive and 8 had recently died following bycatch in trawls and gillnets of local fisheries from the east coast of Spain. Gas embolization and distribution in vital organs were evaluated through conventional radiography, computed tomography, and ultrasound. Additionally, positive response following repressurization was clinically observed in 2 live affected turtles. Gas embolism was also observed postmortem in carcasses and tissues as described in cetaceans and human divers. Compositional gas analysis of intravascular bubbles was consistent with DCS. Definitive diagnosis of DCS in sea turtles opens a new era for research in sea turtle diving physiology, conservation, and bycatch impact mitigation, as well as for comparative studies in other air-breathing marine vertebrates and human divers.

  17. Microvascular decompression for glossopharyngeal neuralgia using intraoperative neurophysiological monitoring: Technical case report

    PubMed Central

    Motoyama, Yasushi; Nakagawa, Ichiro; Takatani, Tsunenori; Park, Hun-Soo; Kotani, Yukiko; Tanaka, Yoshitaka; Gurung, Pritam; Park, Young-Soo; Nakase, Hiroyuki

    2016-01-01

    Background: Glossopharyngeal neuralgia (GN) is a rare functional disorder representing around 1% of cases of trigeminal neuralgia. Lancinating throat and ear pain while swallowing are the typical manifestations, and are initially treated using anticonvulsants such as carbamazepine. Medically refractory GN is treated surgically. Microvascular decompression (MVD) is reportedly effective against GN, superseding rhizotomy and tractotomy. Methods: We encountered three patients with medically refractory GN who underwent MVD using intraoperative neurophysiological monitoring (IONM). The offending vessels were the posterior inferior cerebellar arteries, which were confirmed intraoperatively via a transcondylar fossa approach to be affecting the root exit zones of the glossopharyngeal and vagus nerves. As IONM, facial motor-evoked potentials (MEPs) and brainstem auditory-evoked potentials were monitored during microsurgery in all three patients. Pharyngeal and vagal MEPs were added for two patients to avoid postoperative dysphagia. Results: GN disappeared immediately after surgery with complete preservation of hearing acuity and facial nerve function. Transient mild swallowing disturbance was observed in 1 patient without pharyngeal or vagal MEPs, whereas the remaining two patients with pharyngeal and vagal MEPs demonstrated no postoperative dysphagia. Conclusion: Although control of severe pain is expected in surgical intervention for GN, lower cranial nerves are easily damaged because of their fragility, even in MVD. IONM including pharyngeal and vagal MEPs appears very useful for avoiding postoperative sequelae during MVD for GN. PMID:26862458

  18. Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar.

    PubMed

    Scala, Rudy; Cucchi, Alessandro; Cappellina, Luca; Ghensi, Paolo

    2014-01-01

    Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN). We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day. PMID:25099006

  19. Successful Reconstruction of Nerve Defects Using Distraction Neurogenesis with a New Experimental Device

    PubMed Central

    Yousef, Mohamed Abdelhamid Ali; Dionigi, Paolo; Marconi, Stefania; Calligaro, Alberto; Cornaglia, Antonia Icaro; Alfonsi, Enrico; Auricchio, Ferdinando

    2015-01-01

    Introduction: Repair of peripheral nerve injuries is an intensive area of challenge and research in modern reconstructive microsurgery. Intensive research is being carried out to develop effective alternatives to the standard nerve autografting, avoiding its drawbacks. The aim of the study was to evaluate the effectiveness of a newly designed mechanical device for the reconstruction of the sciatic nerve in rats in comparison to nerve autografting and to assess the pain during the period of distraction neurogenesis. Methods: Fourteen Sprague Dawley rats were used and randomly assigned into 2 groups with 7 rats in each group; group A (Nerve Autografting group) in which a 10-mm segment of the sciatic nerve was resected and rotated 180 degrees, then primary end-to-end neurorrhaphy was performed in the reverse direction; group B (Nerve Lengthening group) in which the mechanical device was inserted after surgical resection of 10 mm of the sciatic nerve, then secondary end-to-end neurorrhaphy was performed after completing the nerve lengthening. Thirteen weeks later, assessment of the functional sciatic nerve recovery using static sciatic index (SSI) was performed. Furthermore, fourteen weeks after the nerve resection, assessment of the nerve regeneration with electrophysiological study and histological analysis were performed. Also, gastrocnemius wet weight was measured. For pain assessment in group B, Rat Grimace Scale (RGS) score was used. Results: Significantly better functional recovery rate (using the SSI) was reported in the nerve lengthening group in comparison to autografting group. Also, a statistically significant higher nerve conduction velocity was detected in the nerve lengthening group. On histological analysis of the distal nerve section at 3 mm distal to the nerve repair site, significant myelin sheath thickness was detected in the nerve lengthening group. Discussion: Distraction neurogenesis with the new experimental device is a reliable therapeutic

  20. Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis.

    PubMed

    Skovrlj, Branko; Guzman, Javier Z; Caridi, John; Cho, Samuel K

    2016-02-01

    Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach. PMID:26835214

  1. Assessment of nerve ultrastructure by fibre-optic confocal microscopy.

    PubMed

    Cushway, T R; Lanzetta, M; Cox, G; Trickett, R; Owen, E R

    1996-01-01

    Fibre-optic technology combined with confocality produces a microscope capable of optical thin sectioning. In this original study, tibial nerves have been stained in a rat model with a vital dye, 4-(4-diethylaminostyryl)-N-methylpyridinium iodide, and analysed by fibre-optic confocal microscopy to produce detailed images of nerve ultrastructure. Schwann cells, nodes of Ranvier and longitudinal myelinated sheaths enclosing axons were clearly visible. Single axons appeared as brightly staining longitudinal structures. This allowed easy tracing of multiple signal axons within the nerve tissue. An accurate measurement of internodal lengths was easily accomplished. This technique is comparable to current histological techniques, but does not require biopsy, thin sectioning or tissue fixing. This study offers a standard for further in vivo microscopy, including the possibility of monitoring the progression of nerve regeneration following microsurgical neurorraphy. PMID:9393664

  2. [A case of retroperitoneal schwannoma of the vagus nerve].

    PubMed

    Yoo, Byoung Kwan; Yoo, Kyo Sang; Park, Chul Sung; Lee, Jung Wha; Yoo, Ji Youn; Moon, Joon Ho; Jung, Jae One; Kim, Jong Pyo; Kim, Kyoung Oh; Park, Cheol Hee; Hahn, Tae Ho; Park, Sang Hoon; Kim, Jong Hyeok; Min, Soo Kee; Yang, Dae Hyun; Park, Choong Kee

    2005-10-01

    Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was referred to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.

  3. Nerve Impulses in Plants

    ERIC Educational Resources Information Center

    Blatt, F. J.

    1974-01-01

    Summarizes research done on the resting and action potential of nerve impulses, electrical excitation of nerve cells, electrical properties of Nitella, and temperature effects on action potential. (GS)

  4. Ocular bubble formation as a method of assessing decompression stress.

    PubMed

    Mekjavić, I B; Campbell, D G; Jaki, P; Dovsak, P A

    1998-01-01

    Tear film bubble formation and ultrasound reflectivity of the lens-vitreous humor compartments were monitored following simulated dives in a hyperbaric chamber. the sensitivity of these methods in determining decompression stress was compared with the results of precordial Doppler ultrasound. In addition, the utility of these diagnostic techniques in testing decompression dive profiles was evaluated. Eleven divers completed two series of chamber dives according to the decompression schedule of the Professional Association of Diving Instructors. The first dive series comprised dives to 70 feet of seawater (fsw) for 15, 29, and 40 min. The second series comprised maximum duration no-stop decompression dives to 40 fsw for 140 min, 70 fsw for 40 min, 90 fsw for 25 min, and 120 fsw for 13 min. Before and immediately after each dive, the following measurements were obtained from each subject: eye surface tear film bubble counts with a slit-lamp microscope, lens and vitreous humor reflectivity using A- and B-mode ophthalmic ultrasonic scan, and precordial Doppler ultrasonic detection of venous gas bubbles. Tear film bubble assessment and ocular scanning ultrasound were observed to be more sensitive in detecting decompression stress than the conventional Doppler ultrasonic surveillance of the precordial region. In contrast to precordial Doppler ultrasonic surveillance, which failed to detect any significant changes in circulating bubbles, tear film bubble formation displayed a dose-response relationship with increasing duration of the 70-fsw dives. Reflectivity changes of the lens-vitreous humor interface were not significant until the no-stop decompression limit was reached. In addition, for each of the no-stop decompression limit dives, increases in the average tear film bubble formation and lens-vitreous humor interface reflectivity were similar. Ocular bubble observations may provide a practical and objective ocular bubble index for analyzing existing decompression

  5. Optic nerve diameters and perimetric thresholds in idiopathic intracranial hypertension.

    PubMed Central

    Salgarello, T.; Tamburrelli, C.; Falsini, B.; Giudiceandrea, A.; Colotto, A.

    1996-01-01

    AIMS/BACKGROUND--Idiopathic intracranial hypertension (IIH) is a central nervous disorder characterised by abnormally increased cerebrospinal fluid (CSF) pressure leading to optic nerve compression. An indirect estimate of increased CSF pressure can be obtained by the ultrasonographic determination of optic nerve sheaths diameters. Computerised static perimetry is regarded as the method of choice for monitoring the course of the optic neuropathy in IIH. The aims were to compare the echographic optic nerve diameters (ONDs) and the perimetric thresholds of patients with IIH with those of age-matched controls, and to examine the correlation between these two variables in individual patients with papilloedema. METHODS--Standardised A-scan echography of the mid orbital optic nerve transverse diameters and automated threshold perimetry (Humphrey 30-2) were performed in 20 patients with IIH with variable degree of papilloedema (according to the Frisén scheme) and no concomitant ocular diseases. Echographic and perimetric results were compared with those obtained from 20 age-matched controls. RESULTS--When compared with controls, patients with IIH showed a significant increase in mean ONDs and significantly reduced mean perimetric sensitivities. In individual patients with papilloedema, the transverse ONDs correlated negatively with Humphrey mean deviation values and positively with pattern standard deviation values. CONCLUSION--These results indicate that OND changes in IIH are associated with perimetric threshold losses, and suggest that IIH functional deficits may be related to the degree of distension of optic nerve sheaths as a result of an increased CSF pressure. PMID:8759260

  6. Spectrum of superficial nerve-related tumor and tumor-like lesions: MRI features.

    PubMed

    Wadhwa, Vibhor; Lee, Pearlene P; Strome, Glenn M; Suh, Kyung Jin; Carrino, John A; Chhabra, Avneesh

    2014-04-01

    Superficial soft-tissue masses arising from skin appendages, metastasis, and inflammatory lesions have been widely reported. However, nerve-related superficial mass-like lesions other than peripheral nerve sheath tumors are less commonly described. High resolution magnetic resonance imaging (MRI) is an excellent non-invasive tool for the evaluation of such lesions. In this article, the authors discuss the entire spectrum of these lesions and also outline a systemic diagnostic approach.

  7. The Effect of Microvascular Decompression for Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia

    PubMed Central

    Kang, Jeong-Han; Kang, Dong-Wan; Chung, Sang Sup

    2012-01-01

    Objective Hemifacial spasm (HFS) caused by vertebrobasilar dolichoectasia (VBD) is very rare, and in theses cases, it is difficult to decompress the nerve from its vascular compression. The objective of this study was to investigate the outcome of microvascular decompression (MVD) for HFS caused by VBD. Methods There were 10 patients of HFS caused by VBD at our hospital between September 1978 and September 2008. We evaluated magnetic resonance angiography (MRA) and time of flight magnetic resonance imaginge (TOF MRI) findings using the criteria for VBD. We compared the clinical outcomes of MVD for the 10 patients with VBD with the overall outcomes of the total 2058 MVDs performed for HFS. Results The results of MVD for HFS caused by VBD were successful in 90.9% of cases. The postoperative complication rate in VBD was 45.5%. Offending vessels in patients with VBD were identified visually during surgery. Adverse effects after MVD were found in 4 patients. We found that the diameter of VBD was significantly greater in patients with complications than in those with no complications (p=0.028). Conclusion Our data shows that MVD may be a good treatment modality for HFS caused by VBD but care must be taken to avoid adverse effects from the procedure. It is important to detach the dolichoectatic artery from its surrounding structures sufficiently to allow it to be easily movable. In addition, attempts should be made to lessen the retraction of the cerebellum during release of the dolichoectatic artery. PMID:23091664

  8. Gene-environment mismatch in decompression sickness and air embolism.

    PubMed

    Alcock, Joe; Brainard, Andrew H

    2010-08-01

    Decompression sickness causes injury and death in SCUBA divers when air bubbles obstruct the flow of blood. Platelets aggregate in response to gas and promote inflammation. Inflammation in decompression sickness may have its origin in the innate immune system's response to pathogens. Bubbles are often found in tissues during gas-forming infections and in infection-prone states. In these diseases, intravascular gas offers a signal of infection to immune cells. Platelet activation by gas may often accompany a beneficial immune response to pathogens. Pathologic bubble-platelet interaction in decompression illness may be an example of gene-environment mismatch.

  9. Incidence of decompression illness in amateur scuba divers.

    PubMed

    Wilmshurst, P; Allen, C; Parish, T

    This paper reports changes in the incidence and manifestations of decompression illness in amateur scuba divers in the United Kingdom (UK) between 1981 and 1993, a period during which the popularity of the sport increased. Since 1981, there has been a trend to increased annual incidence of decompression illness, but the large yearly fluctuations reflect a considerable annual variation in the numbers of dives. The need for recompression facilities to treat decompression illness in amateur scuba divers in the UK should take account of this greater public participation in the sport, and should also allow for large annual fluctuations related to meteorological and financial factors.

  10. [Development of Researches on Acupuncture Treatment of Peripheral Nerve Injury].

    PubMed

    Tao, Xing; Ma, Tie-ming

    2016-02-01

    Peripheral nerve injury is a common clinical disease. Acupuncture therapy has been demonstrated to be effective in improving nerve injury in clinical practice, but its underlying mechanisms in prompting tissue repair basically remain unknown. In the present paper, the authors reviewed some descriptions of traditional Chinese medicine on peripheral nerve injury and treatment, and recent development of researches on acupuncture treatment of it in both clinical practice and animal studies. Clinical trials demonstrated that acupuncture treatment can relieve nerve injury induced pain, ameliorate both sensory and motor functions. Experimental studies showed that acupuncture stimulation may promote nerve repair by reducing desquamation of medullary sheath of nerve fibers, inhibiting apoptosis of nerve cells, and up-regulating expression of myelin basic protein, Slit-1 protein and gene, etc. In addition, acupuncture intervention may also improve the microenvironment of neural regeneration including increase of the proliferation and differentiation of Schwann cells and release of various types of neurotrophic factors. However, its mechanisms underlying accelerating rehabilitation of peripheral nerve injury need being researched further. PMID:27141630

  11. Engineering a multimodal nerve conduit for repair of injured peripheral nerve

    NASA Astrophysics Data System (ADS)

    Quigley, A. F.; Bulluss, K. J.; Kyratzis, I. L. B.; Gilmore, K.; Mysore, T.; Schirmer, K. S. U.; Kennedy, E. L.; O'Shea, M.; Truong, Y. B.; Edwards, S. L.; Peeters, G.; Herwig, P.; Razal, J. M.; Campbell, T. E.; Lowes, K. N.; Higgins, M. J.; Moulton, S. E.; Murphy, M. A.; Cook, M. J.; Clark, G. M.; Wallace, G. G.; Kapsa, R. M. I.

    2013-02-01

    Injury to nerve tissue in the peripheral nervous system (PNS) results in long-term impairment of limb function, dysaesthesia and pain, often with associated psychological effects. Whilst minor injuries can be left to regenerate without intervention and short gaps up to 2 cm can be sutured, larger or more severe injuries commonly require autogenous nerve grafts harvested from elsewhere in the body (usually sensory nerves). Functional recovery is often suboptimal and associated with loss of sensation from the tissue innervated by the harvested nerve. The challenges that persist with nerve repair have resulted in development of nerve guides or conduits from non-neural biological tissues and various polymers to improve the prognosis for the repair of damaged nerves in the PNS. This study describes the design and fabrication of a multimodal controlled pore size nerve regeneration conduit using polylactic acid (PLA) and (PLA):poly(lactic-co-glycolic) acid (PLGA) fibers within a neurotrophin-enriched alginate hydrogel. The nerve repair conduit design consists of two types of PLGA fibers selected specifically for promotion of axonal outgrowth and Schwann cell growth (75:25 for axons; 85:15 for Schwann cells). These aligned fibers are contained within the lumen of a knitted PLA sheath coated with electrospun PLA nanofibers to control pore size. The PLGA guidance fibers within the nerve repair conduit lumen are supported within an alginate hydrogel impregnated with neurotrophic factors (NT-3 or BDNF with LIF, SMDF and MGF-1) to provide neuroprotection, stimulation of axonal growth and Schwann cell migration. The conduit was used to promote repair of transected sciatic nerve in rats over a period of 4 weeks. Over this period, it was observed that over-grooming and self-mutilation (autotomy) of the limb implanted with the conduit was significantly reduced in rats implanted with the full-configuration conduit compared to rats implanted with conduits containing only an alginate

  12. Histopathological effects of radiosurgery on a human trigeminal nerve

    PubMed Central

    Al-Otaibi, Faisal; Alhindi, Hindi; Alhebshi, Adnan; Albloushi, Monirah; Baeesa, Saleh; Hodaie, Mojgan

    2013-01-01

    Background: Radiosurgery is a well-established treatment modality for medically refractory trigeminal neuralgia. The exact mechanism of pain relief after radiosurgery is not clearly understood. Histopathology examination of the trigeminal nerve in humans after radiosurgery is rarely performed and has produced controversial results. Case Description: We report on a 45-year-old female who received radiosurgery treatment for trigeminal neuralgia by Cyberknife. A 6-mm portion of the cisternal segment of trigeminal nerve received a dose of 60 Gy. The clinical benefit started 10 days after therapy and continued for 8 months prior to a recurrence of her previous symptoms associated with mild background pain. She underwent microvascular decompression and partial sensory root sectioning. Atrophied trigeminal nerve rootlets were grossly noted intraoperatively under surgical microscope associated with changes in trigeminal nerve color to gray. A biopsy from the inferolateral surface of the nerve proximal to the midcisternal segment showed histological changes in the form of fibrosis and axonal degeneration. Conclusion: This case study supports the evidence of histological damage of the trigeminal nerve fibers after radiosurgery therapy. Whether or not the presence and degree of nerve damage correlate with the degree of clinical benefit and side effects are not revealed by this study and need to be explored in future studies. PMID:24605252

  13. Decompression sickness and arterial gas embolism in sports scuba divers.

    PubMed

    Gorman, D F

    1989-07-01

    Diving underwater with breathing apparatus is an increasingly popular sport. Consequently, the number of diving-related accidents, including both decompression sickness and arterial gas embolism, have increased. Though both involve bubbles, decompression sickness is a disease which involves gas bubbles forming in tissues and venous blood, while arterial gas embolism results from the introduction of gas bubbles directly into the arterial circulation. Although the pathologies and natural histories of decompression sickness and arterial gas embolism are different, the treatment of these conditions is essentially the same. Compression in a recompression chamber is the definitive treatment of both decompression sickness and arterial gas embolism, and any delay before treatment must be minimised if a good outcome is desired.

  14. Bubble growth and mechanical properties of tissue in decompression.

    PubMed

    Vann, R D; Clark, H G

    1975-09-01

    A survey of decompression literature leads to the conclusion that when tissue is subjected to gaseous supersaturation, pre-existing gas micronuclei grow into the gas bubbles which are routinely observed in decompression studies. These micronuclei may originate from mechanically induced tribonucleation or cavitation within joints. A new tissue model for decompression sickness based upon failure theory in rubber is proposed. The model shows theoretically that pre-existing sea-level nuclei can be stabilized at depth by elastic forces in tissue. These same elastic forces restrain the growth of nuclei when supersaturation occurs. Mechanical stress will lower the gaseous supersaturation required for growth of nuclei. Gaseous supersaturation, mechanical stress, and the elastic properties of various tissues interact to produce unbounded bubble growth leading to tissue lesions when combined gaseous and mechanical supersaturation exceeds a threshold value. The recommendation is made that the high levels of supersaturation generally used for the decompression of men be reduced.

  15. Analysis of gas composition of intravascular bubbles produced by decompression.

    PubMed

    Ishiyama, A

    1983-06-01

    The gas composition of intravascular bubbles produced by decompression was investigated in rabbits using gas chromatography. The animals were exposed to 8 ATA for 30 min. All samples of bubbles were taken from the animals under 0.2 ATA pressure gradient so that no air could enter the sampling system from the outside. The percentage of carbon dioxide in the bubbles tended to decrease at first and then increased with post-decompression time. On the other hand, the percentage of oxygen tended to change in the opposite manner. Actual analysis of bubbles in the living decompressed animals indicates that carbon dioxide may be an outstanding factor in the initiation and early growth of bubbles. In view of this, Haldane's classical maximum supersaturation limit for avoiding decompression sickness should be examined and possibly modified for gases other than nitrogen.

  16. Secondary optic nerve tumors.

    PubMed

    Christmas, N J; Mead, M D; Richardson, E P; Albert, D M

    1991-01-01

    Secondary tumors of the optic nerve are more common than primary optic nerve tumors. The involvement of the optic nerve may arise from direct invasion from intraocular malignancies, from hematopoietic malignancy, from meningeal carcinomatosis, or from distant primary tumors. Orbital tumors rarely invade the optic nerve, and brain tumors involve it only in their late stages.

  17. Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting.

    PubMed

    Michael, Alex P; Espinosa, Jose

    2016-01-01

    Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option. PMID:27446619

  18. Patterns and Variations in Microvascular Decompression for Trigeminal Neuralgia

    PubMed Central

    TODA, Hiroki; GOTO, Masanori; IWASAKI, Koichi

    2015-01-01

    Microvascular decompression (MVD) is a highly effective surgical treatment for trigeminal neuralgia (TN). Although there is little prospective clinical evidence, accumulated observational studies have demonstrated the benefits of MVD for refractory TN. In the current surgical practice of MVD for TN, there have been recognized patterns and variations in surgical anatomy and various decompression techniques. Here we provide a stepwise description of surgical procedures and relevant anatomical characteristics, as well as procedural options. PMID:25925756

  19. Cases from the aerospace medicine residents' teaching file. Decompression sickness.

    PubMed

    Taylor, G N

    2000-12-01

    Decompression sickness is an uncommon but serious risk associated with flying and SCUBA diving with potential for significant morbidity and mortality. It can occur in both novice and experienced individuals. This case illustrates an atypical presentation of decompression sickness in an experienced amateur SCUBA diver. Clinical suspicion must be high, since the presenting symptoms can be nonspecific as in this case. Early recognition and treatment are important for maximum recovery.

  20. Heliox treatment for spinal decompression sickness following air dives.

    PubMed

    Douglas, J D; Robinson, C

    1988-07-01

    Enforced delay in treatment of spinal decompression sickness following scuba diving can result in paraplegia. Poor response from initial recompression to 18 m presents the clinician with a difficult management problem. Theoretical objections have been raised to the use of He-O2 as treatment regimen. We report 3 cases that show He-O2 to be an excellent method of treatment in spinal decompression sickness after air diving.

  1. [Scuba diving: barotrauma, decompression sickness, pulmonary contra-indications].

    PubMed

    Héritier, F; Russi, E

    1993-02-01

    The practice of scuba diving is associated with two specific medical problems: barotrauma directly related to changes in ambient pressure, and decompression sickness related to the uptake and the release of inert gases by the body. Neurological symptoms are frequent in severe diving accidents. They may arise following either barotrauma or decompression sickness, and often require urgent treatment in a hyperbaric chamber. Asthma, chronic obstructive pulmonary disease, and spontaneous pneumothorax increase the risk of lung barotrauma and represent contraindications to diving.

  2. Experimental Investigations of the Lunar Photoelectron Sheath

    NASA Astrophysics Data System (ADS)

    Dove, A.; Sternovsky, Z.; Wang, X.; Robertson, S. H.; Lapanse, C.; Horanyi, M.; Collette, A.

    2010-12-01

    Solar ultraviolet radiation incident upon the dayside lunar surface produces a photoelectron gas that dominates the near-surface plasma environment, with a typical density of 60 cm-3 and a characteristic scale-length of ~1 m. It has traditionally been difficult to produce a photoelectron gas with sufficient density in a laboratory settings to study its properties. In our initial experiments, the characterization of the photoelectron density above a Zr surface (work function W=4.4 eV) illuminated by Xe excimer lamps (peak emission at a wavelength of 172 nm) indicated that a sheath with a Debye length on the order of 10 cm formed. We characterize the photoelectron population above the surface by utilizing an emissive probe to map the electric potential distribution above the surface, and a Langmuir probe to determine the number density and temperature of the photoelectrons. A grid is placed 7.5 cm above the Zr surface to repel photoelectrons emitted from the chamber walls. Emissive probe measurements show a potential dip of about 2 V extending ~1 cm above the zirconium surface. The size of this potential well is dependent on the number of lamps illuminating the surface, as the density of photoelectrons above the surface increases with greater illumination. The electrons in the sheath have a Maxwellian distribution with an electron temperature around 1 eV (maximum energies are expected to be approximately 2.8 eV). We will use this experimental apparatus to characterize the photoelectron sheath above other surfaces; powders, such as CeO2 have similar work functions, but different photoelectric yields. Lunar soil simulants are expected to have approximately an order of magnitude smaller yield than metallic surfaces, which will act to increase the characteristic length of the photoelectron sheath above the surface. The experiments and accompanying computer simulations are used to guide the development of new instrument concepts for future in situ plasma measurements on

  3. Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment

    PubMed Central

    Ohtori, Seiji; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Orita, Sumihisa; Kamoda, Hiroto; Arai, Gen; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Ochiai, Nobuyasu; Kishida, Shunji; Masuda, Yoshitada; Ochi, Shigehiro; Kikawa, Takashi; Takaso, Masashi; Aoki, Yasuchika; Toyone, Tomoaki; Suzuki, Takane; Takahashi, Kazuhisa

    2010-01-01

    Diffusion-weighted imaging (DWI) can provide valuable structural information about tissues that may be useful for clinical applications in evaluating lumbar foraminal nerve root entrapment. Our purpose was to visualize the lumbar nerve root and to analyze its morphology, and to measure its apparent diffusion coefficient (ADC) in healthy volunteers and patients with lumbar foraminal stenosis using 1.5-T magnetic resonance imaging. Fourteen patients with lumbar foraminal stenosis and 14 healthy volunteers were studied. Regions of interest were placed at the fourth and fifth lumbar root at dorsal root ganglia and distal spinal nerves (at L4 and L5) and the first sacral root and distal spinal nerve (S1) on DWI to quantify mean ADC values. The anatomic parameters of the spinal nerve roots can also be determined by neurography. In patients, mean ADC values were significantly higher in entrapped roots and distal spinal nerve than in intact ones. Neurography also showed abnormalities such as nerve indentation, swelling and running transversely in their course through the foramen. In all patients, leg pain was ameliorated after selective decompression (n = 9) or nerve block (n = 5). We demonstrated the first use of DWI and neurography of human lumbar nerves to visualize and quantitatively evaluate lumbar nerve entrapment with foraminal stenosis. We believe that DWI is a potential tool for diagnosis of lumbar nerve entrapment. PMID:20632042

  4. Neurovascular compression in cranial nerve and systemic disease.

    PubMed Central

    Jannetta, P J

    1980-01-01

    As we age, our arteries elongate and our brains "sag." As a consequence of these processes, redundant arterial loops and bridging or intrinsic hindbrain veins may cause cross-compression of cranial nerve root entry zones in the cerebellopontine angle. This pulsatile compression can be seen to produce hyperactive dysfunction of the cranial nerve. Symptoms of trigeminal or glossopharyngeal neuralgia (somatic sensory), hemifacial spasm (somatic motor), tinnitus and vertigo (special sensory) and some cases of "essential" hypertension are caused by these vessels compressing cranial nerves V, IX--X, VII, VIII, and left X and medulla oblongata. Using microsurgical techniques, the symptoms may be relieved by vascular decompression, findings and results in 695 paients are briefly reviewed and correlated. A chronic primate model of "essential" hypertension is briefly described. PMID:6968543

  5. Inhibition of nerve conduction by electromagnetic induction of the frog sciatic nerve-gastrocnemius muscle preparation.

    PubMed

    Wali, F A; Brain, A I

    1989-01-01

    The effect of electromagnetic induction (EMI) on impulse conduction and muscle contraction was studied in isolated sciatic nerve-gastrocnemius muscle preparation of the frog. Electrical stimulation (ES) of the sciatic nerve, at 0.5 Hz with 0.6 V (supramaximal) and 1-ms pulse duration, produced twitch contractions (3.5 +/- 0.4 g tension, mean +/- S.E., n = 8 frogs), which were reduced or blocked by EMI, applied to the nerve via an induction coil, from a d.c. source of 1.5-4 V, at a frequency of 100 min-1, for 2- to 4-min duration. Recovery of the blocked twitches was obtained within 4-5 min, after the cessation of the EMI and washing out the preparation in Ringer solution. The inhibition of the twitch tension by EMI was compared to that produced by an effective concentration of a local anaesthetic, lignocaine (1 microM), which is known to block conduction, by blocking ionic fluxes across the nerve membrane. It is possible that EMI also interferes with the ionic fluxes, and in prolonged duration, may produce changes in the myelin sheath (or the Schwann cells) of the nerve membrane. A comparison of ES with EMI was made, and it was concluded that EMI inhibited electrically induced neuromuscular transmission at the frog neuromuscular junction.

  6. Two Types of Magnetohydrodynamic Sheath Jets

    NASA Astrophysics Data System (ADS)

    Kaburaki, Osamu

    2009-06-01

    Recent observations of astrophysical jets emanating from various galactic nuclei strongly suggest that a double-layered structure, or a spine-sheath structure, is likely to be their common feature. We propose that such a sheath jet structure can be formed magnetohydrodynamically within a valley of the magnetic pressures, which is formed between the peaks due to the poloidal and toroidal components, with the centrifugal force acting on the rotating sheath plasma being balanced by the hoop stress of the toroidal field. The poloidal field concentrated near the polar axis is maintained by a converging plasma flow toward the jet region, and the toroidal field is developed outside the jet cone owing to the poloidal current circulating through the jet. Under such situations, the set of magnetohydrodynamic (MHD) equations allows two main types of solutions, at least, in the region far from the footpoint. The first type solution describes the jets of marginally bound nature. This type is realized when the jet temperature decreases like a virial one, and neither the pressure-gradient nor the MHD forces, which are both determined consistently, cannot completely overcome the gravity, even at infinity. The second type is realized under an isothermal situation, and the gravity is cancelled exactly by the pressure-gradient force. Hence, the jets of this type are accelerated purely by the MHD force. It is also suggested that these two types correspond, respectively, to the jets from type I and II radio galaxies in the Fanaroff-Riley classification.

  7. Decompression to altitude: assumptions, experimental evidence, and future directions.

    PubMed

    Foster, Philip P; Butler, Bruce D

    2009-02-01

    Although differences exist, hypobaric and hyperbaric exposures share common physiological, biochemical, and clinical features, and their comparison may provide further insight into the mechanisms of decompression stress. Although altitude decompression illness (DCI) has been experienced by high-altitude Air Force pilots and is common in ground-based experiments simulating decompression profiles of extravehicular activities (EVAs) or astronauts' space walks, no case has been reported during actual EVAs in the non-weight-bearing microgravity environment of orbital space missions. We are uncertain whether gravity influences decompression outcomes via nitrogen tissue washout or via alterations related to skeletal muscle activity. However, robust experimental evidence demonstrated the role of skeletal muscle exercise, activities, and/or movement in bubble formation and DCI occurrence. Dualism of effects of exercise, positive or negative, on bubble formation and DCI is a striking feature in hypobaric exposure. Therefore, the discussion and the structure of this review are centered on those highlighted unresolved topics about the relationship between muscle activity, decompression, and microgravity. This article also provides, in the context of altitude decompression, an overview of the role of denitrogenation, metabolic gases, gas micronuclei, stabilization of bubbles, biochemical pathways activated by bubbles, nitric oxide, oxygen, anthropometric or physiological variables, Doppler-detectable bubbles, and potential arterialization of bubbles. These findings and uncertainties will produce further physiological challenges to solve in order to line up for the programmed human return to the Moon, the preparation for human exploration of Mars, and the EVAs implementation in a non-zero gravity environment.

  8. Use of ultrasound in altitude decompression modeling

    NASA Technical Reports Server (NTRS)

    Olson, Robert M.; Pilmanis, Andrew A.

    1993-01-01

    A model that predicts the probability of developing decompression sickness (DCS) with various denitrogenation schedules is being developed by the Armstrong Laboratory, using human data from previous exposures. It was noted that refinements are needed to improve the accuracy and scope of the model. A commercially developed ultrasonic echo imaging system is being used in this model development. Using this technique, bubbles images from a subject at altitude can be seen in the gall bladder, hepatic veins, vena cava, and chambers of the heart. As judged by their motion and appearance in the vena cava, venous bubbles near the heart range in size from 30 to 300 M. The larger bubbles skim along the top, whereas the smaller ones appear as faint images near the bottom of the vessel. Images from growing bubbles in a model altitude chamber indicate that they grow rapidly, going from 20 to 100 M in 3 sec near 30,000 ft altitude. Information such as this is valuable in verifying those aspects of the DCS model dealing with bubble size, their growth rate, and their site of origin.

  9. Arthroscopic Decompression for a Giant Meniscal Cyst.

    PubMed

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    The authors report the case of a giant medial meniscal cyst in an osteoarthritic knee of an 82-year-old woman that was successfully treated with only arthroscopic cyst decompression. The patient noticed a painful mass on the medial side of the right knee that had been gradually growing for 5 years. Magnetic resonance imaging showed an encapsulated large medial cystic mass measuring 80×65×40 mm that was adjacent to the medial meniscus. An accompanying horizontal tear was also detected in the middle and posterior segments of the meniscus. The medial meniscus was resected up to the capsular attachment to create bidirectional flow between the joint and the cyst with arthroscopic surgery. Magnetic resonance imaging performed 14 months postoperatively showed that the cyst had completely disappeared, and no recurrence was observed during a 2-year follow-up period. An excellent result could be obtained by performing limited meniscectomy to create a channel leading to the meniscal cyst, even though the cyst was large. Among previously reported cases of meniscal cysts, this case is the largest to be treated arthroscopically without open excision.

  10. [Diagnostics and treatment of acute odontogenic osteomyelitis of the mandible considering functional state of inferior alveolar nerve].

    PubMed

    Malanchuk, V A; Pavlovskiĭ, L L

    2013-01-01

    Evaluation of functional impairment of inferior alveolar nerve in acute odontogenic inflammatory processes was carried out in this clinical study by means of stimulation electroneurography. Possibility of early diagnosis of acute odontogenic osteomyelitis by this method and effectiveness of decompression osteoperforation for its treatment was shown.

  11. Radio frequency sheaths in an oblique magnetic field

    SciTech Connect

    Myra, J. R.; D'Ippolito, D. A.

    2015-06-15

    The physics of radio-frequency (rf) sheaths near a conducting surface is studied for plasmas immersed in a magnetic field that makes an oblique angle θ with the surface. A set of one-dimensional equations is developed that describes the dynamics of the time-dependent magnetic presheath and non-neutral Debye sheath. The model employs Maxwell-Boltzmann electrons, and the magnetization and mobility of the ions is determined by the magnetic field strength, and wave frequency, respectively. The angle θ, assumed to be large enough to insure an electron-poor sheath, is otherwise arbitrary. Concentrating on the ion-cyclotron range of frequencies, the equations are solved numerically to obtain the rectified (dc) voltage, the rf voltage across the sheath, and the rf current flowing through the sheath. As an application of this model, the sheath voltage-current relation is used to obtain the rf sheath impedance, which in turn gives an rf sheath boundary condition for the electric field at the sheath-plasma interface that can be used in rf wave codes. In general, the impedance has both resistive and capacitive contributions, and generalizes previous sheath boundary condition models. The resistive part contributes to parasitic power dissipation at the wall.

  12. Radio frequency sheaths in an oblique magnetic field

    DOE PAGESBeta

    Myra, James R.; D'Ippolito, Daniel A.

    2015-06-01

    The physics of radio-frequency (rf) sheaths near a conducting surface is studied for plasmas immersed in a magnetic field that makes an oblique angle θ with the surface. A set of one-dimensional equations is developed that describe the dynamics of the time-dependent magnetic presheath and non-neutral Debye sheath. The model employs Maxwell-Boltzmann electrons, and the magnetization and mobility of the ions is determined by the magnetic field strength, and wave frequency, respectively. The angle, θ assumed to be large enough to insure an electron-poor sheath, is otherwise arbitrary. Concentrating on the ion-cyclotron range of frequencies, the equations are solved numericallymore » to obtain the rectified (dc) voltage, the rf voltage across the sheath and the rf current flowing through the sheath. As an application of this model, the sheath voltage-current relation is used to obtain the rf sheath impedance, which in turn gives an rf sheath boundary condition for the electric field at the sheath-plasma interface that can be used in rf wave codes. In general the impedance has both resistive and capacitive contributions, and generalizes previous sheath boundary condition models. The resistive part contributes to parasitic power dissipation at the wall.« less

  13. Radio frequency sheaths in an oblique magnetic field

    SciTech Connect

    Myra, James R.; D'Ippolito, Daniel A.

    2015-06-01

    The physics of radio-frequency (rf) sheaths near a conducting surface is studied for plasmas immersed in a magnetic field that makes an oblique angle θ with the surface. A set of one-dimensional equations is developed that describe the dynamics of the time-dependent magnetic presheath and non-neutral Debye sheath. The model employs Maxwell-Boltzmann electrons, and the magnetization and mobility of the ions is determined by the magnetic field strength, and wave frequency, respectively. The angle, θ assumed to be large enough to insure an electron-poor sheath, is otherwise arbitrary. Concentrating on the ion-cyclotron range of frequencies, the equations are solved numerically to obtain the rectified (dc) voltage, the rf voltage across the sheath and the rf current flowing through the sheath. As an application of this model, the sheath voltage-current relation is used to obtain the rf sheath impedance, which in turn gives an rf sheath boundary condition for the electric field at the sheath-plasma interface that can be used in rf wave codes. In general the impedance has both resistive and capacitive contributions, and generalizes previous sheath boundary condition models. The resistive part contributes to parasitic power dissipation at the wall.

  14. Are Human Peripheral Nerves Sensitive to X-Ray Imaging?

    PubMed Central

    Scopel, Jonas Francisco; de Souza Queiroz, Luciano; O’Dowd, Francis Pierce; Júnior, Marcondes Cavalcante França; Nucci, Anamarli; Hönnicke, Marcelo Gonçalves

    2015-01-01

    Diagnostic imaging techniques play an important role in assessing the exact location, cause, and extent of a nerve lesion, thus allowing clinicians to diagnose and manage more effectively a variety of pathological conditions, such as entrapment syndromes, traumatic injuries, and space-occupying lesions. Ultrasound and nuclear magnetic resonance imaging are becoming useful methods for this purpose, but they still lack spatial resolution. In this regard, recent phase contrast x-ray imaging experiments of peripheral nerve allowed the visualization of each nerve fiber surrounded by its myelin sheath as clearly as optical microscopy. In the present study, we attempted to produce high-resolution x-ray phase contrast images of a human sciatic nerve by using synchrotron radiation propagation-based imaging. The images showed high contrast and high spatial resolution, allowing clear identification of each fascicle structure and surrounding connective tissue. The outstanding result is the detection of such structures by phase contrast x-ray tomography of a thick human sciatic nerve section. This may further enable the identification of diverse pathological patterns, such as Wallerian degeneration, hypertrophic neuropathy, inflammatory infiltration, leprosy neuropathy and amyloid deposits. To the best of our knowledge, this is the first successful phase contrast x-ray imaging experiment of a human peripheral nerve sample. Our long-term goal is to develop peripheral nerve imaging methods that could supersede biopsy procedures. PMID:25757086

  15. Novel Anti-Adhesive CMC-PE Hydrogel Significantly Enhanced Morphological and Physiological Recovery after Surgical Decompression in an Animal Model of Entrapment Neuropathy

    PubMed Central

    Urano, Hideki; Iwatsuki, Katsuyuki; Yamamoto, Michiro; Ohnisi, Tetsuro; Kurimoto, Shigeru; Endo, Nobuyuki; Hirata, Hitoshi

    2016-01-01

    We developed a novel hydrogel derived from sodium carboxymethylcellulose (CMC) in which phosphatidylethanolamine (PE) was introduced into the carboxyl groups of CMC to prevent perineural adhesions. This hydrogel has previously shown excellent anti-adhesive effects even after aggressive internal neurolysis in a rat model. Here, we confirmed the effects of the hydrogel on morphological and physiological recovery after nerve decompression. We prepared a rat model of chronic sciatic nerve compression using silicone tubing. Morphological and physiological recovery was confirmed at one, two, and three months after nerve decompression by assessing motor conduction velocity (MCV), the wet weight of the tibialis anterior muscle and morphometric evaluations of nerves. Electrophysiology showed significantly quicker recovery in the CMC-PE group than in the control group (24.0 ± 3.1 vs. 21.0± 2.1 m/s (p < 0.05) at one months and MCV continued to be significantly faster thereafter. Wet muscle weight at one month significantly differed between the CMC-PE (BW) and control groups (0.148 ± 0.020 vs. 0.108 ± 0.019%BW). The mean wet muscle weight was constantly higher in the CMC-PE group than in the control group throughout the experimental period. The axon area at one month was twice as large in the CMC-PE group compared with the control group (24.1 ± 17.3 vs. 12.3 ± 9 μm2) due to the higher ratio of axons with a larger diameter. Although the trend continued throughout the experimental period, the difference decreased after two months and was not statistically significant at three months. Although anti-adhesives can reduce adhesion after nerve injury, their effects on morphological and physiological recovery after surgical decompression of chronic entrapment neuropathy have not been investigated in detail. The present study showed that the new anti-adhesive CMC-PE gel can accelerate morphological and physiological recovery of nerves after decompression surgery. PMID:27741280

  16. Continuous intraoperative monitoring of abnormal muscle response in microvascular decompression for hemifacial spasm; a real-time navigator for complete relief.

    PubMed

    Hirono, Seiichiro; Yamakami, Iwao; Sato, Motoki; Kado, Ken; Fukuda, Kazumasa; Nakamura, Takao; Higuchi, Yoshinori; Saeki, Naokatsu

    2014-04-01

    Intermittent monitoring of abnormal muscle response (iAMR) has been reported to be useful for improving the surgical outcome of microvascular decompression (MVD) for hemifacial spasm (HFS). However, iAMR has not elucidated the relationship between AMR change and the corresponding surgical procedure, or the pathogenesis of AMR and HFS. The purpose of this study is to clarify the usefulness of continuous AMR monitoring (cAMR) for improving the surgical results of MVD and for understanding the relationship between AMR change and corresponding surgical procedure, and the pathogenesis of AMR and HFS. Fifty consecutive patients with HFS treated by MVD under cAMR monitoring, which continuously records AMR every minute throughout the surgical period, were retrospectively analyzed. The patients were assessed for the presence of HFS 1 week after the surgery and at final follow-up. Forty-six patients showed the complete disappearance of HFS. In 32, AMR disappeared abruptly and simultaneously with decompression of an offending vessel. AMR showed dynamic and various changes including temporary disappearance, or sudden, gradual, or componential disappearance before and during the decompression procedure, and even during the dural and skin closure after the initial decompression procedure. Facial spasm remained in four patients despite permanent AMR disappearance. cAMR monitoring improves the outcome of MVD. Although the main cause of HFS and AMR is vascular compression at the facial nerve, hyperexcitability of the facial nucleus is also involved in the pathogenesis of HFS and AMR. The proportional involvement of these causes differs between patients.

  17. Suprascapular nerve entrapment at the spinoglenoid notch in a professional baseball pitcher.

    PubMed

    Cummins, C A; Bowen, M; Anderson, K; Messer, T

    1999-01-01

    Suprascapular nerve injuries at the spinoglenoid notch are uncommon. The true incidence of this lesion is unknown; however, it appears to be more common in athletes who participate in sports involving overhead activities. When a patient is being evaluated for posterior shoulder pain and infraspinatus muscle weakness, electrodiagnostic studies are an essential part of the evaluation. Electromyography will identify an injury to the suprascapular nerve as well as assist in localizing the site of injury. In addition, imaging studies are also indicated to help exclude other diagnoses that can mimic a suprascapular nerve injury. The initial management should consist of cessation of the aggravating activity along with an organized shoulder rehabilitation program. If the patient fails to improve with 6 months to 1 year of nonoperative management, surgical exploration of the suprascapular nerve should be considered. Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function.

  18. Nerve Injuries in Athletes.

    PubMed

    Collins, K; Storey, M; Peterson, K; Nutter, P

    1988-01-01

    In brief: Nerve injuries in athletes may be serious and may delay or prevent an athlete's return to his or her sport. Over a two-year period, the authors evaluated the condition of 65 patients who had entrapments of a nerve or nerve root, documented with electromyography. They describe four case histories: Two patients had radial nerve entrapments, one caused by baseball pitching and the other by kayaking; one football player had combined suprascapular neuropathy and upper trunk brachial plexopathy; and one patient had carpal tunnel syndrome of a median nerve secondary to rowing. Sports-related peripheral nerve lesions of the lower extremity were not seen during the study period. Based on a literature review, the nerve injuries discussed represent the spectrum of nerve entrapments likely to be seen in US clinics. The authors conclude that peripheral nerve lesions should be considered in the differential diagnosis of sports injuries, particularly at the shoulder, elbow, and wrist.

  19. Electron microscope and x-ray diffraction studies of the effects of dehydration on the structure of nerve myelin. II. Optic nerve.

    PubMed

    FINEAN, J B

    1960-09-01

    The dehydration of rat optic nerve has been studied by allowing specimens to become partially or fully dried before fixation and preparation for electron microscopy. A correlation is established between electron micrographs of the myelin sheath and corresponding small-angle x-ray diffraction patterns. The modifications of the optic nerve myelin layers during drying were very similar to those described in more detail for the myelin of frog sciatic nerve. The most striking difference was that the system of fine layers characteristic of the fully dried myelin was much more extensive in the case of the optic nerve, and the layer thickness was significantly greater than the corresponding layer in the frog sciatic nerve preparation. The significance of these correlations is discussed.

  20. Dynamic Heating and Decompression Experiments on Dacite and Rhyolite Magmas

    NASA Astrophysics Data System (ADS)

    Andrews, B. J.; Waters, L.; Grocke, S. B.

    2015-12-01

    Mineral reaction rims, zoned crystals, and myriad growth or dissolution textures provide evidence for changes in magma pressure, temperature, or composition. Quantifying the magnitudes, timescales and length scales of those variations is a fundamental challenge of volcanology and igneous petrology; experiments provide quantitative insights into how magmas react to changes in pressure and temperature that can be used to address that challenge. We use single-step and dynamic experiments conducted in cold seal pressure vessels to study the responses of dacite and rhyolite magmas to heating and decompression events. During single-step decompression (or heating) experiments, conditions are changed nearly instantaneously from the initial to final state in one step, or several smaller steps, whereas "dynamic experiments" have continuous variation in pressure and/or temperature. These two types of experiments yield useful and complementary information describing crystal nucleation, growth, and reaction rates in response to changing (as opposed to steady state) conditions. Here we discuss isothermal decompression experiments that show substantial path-dependence for runs with equivalent time-averaged decompression rates as slow as 0.27 MPa/h for >500 h. Continuous decompression experiments often contain fewer but larger plagioclase crystals than are present in single-step runs, and those new crystals often show complex growth textures. Our results suggest that even slow changes in storage conditions can disrupt melt structure and greatly retard nucleation provided the changes are steady. We hypothesize that if the decompression path remains steady and continuous (absent a stall on and/or rapid decompression), the magma can remain in a growth-dominated regime even though it is far from equilibrium.

  1. Sheath insulator final test report, TFE Verification Program

    SciTech Connect

    Not Available

    1994-07-01

    The sheath insulator in a thermionic cell has two functions. First, the sheath insulator must electrically isolate the collector form the outer containment sheath tube that is in contact with the reactor liquid metal coolant. Second, The sheath insulator must provide for high uniform thermal conductance between the collector and the reactor coolant to remove away waste heat. The goals of the sheath insulator test program were to demonstrate that suitable ceramic materials and fabrication processes were available, and to validate the performance of the sheath insulator for TFE-VP requirements. This report discusses the objectives of the test program, fabrication development, ex-reactor test program, in-reactor test program, and the insulator seal specifications.

  2. The role of water in the structure of peripheral nerve myelin.

    PubMed

    FINEAN, J B

    1957-01-25

    In the study of the drying kinetics of nerve fibres, at least five "phases" of water evaporation can be distinguished. A consideration of the accompanying changes in low-angle x-ray diffraction patterns permits a tentative identification of the "phases" and a quantitative interpretation of the data in terms of the water distribution in nerve fibres. These results suggest that the myelin sheath of frog sciatic nerve contains 40 to 50 per cent water, and it is suggested further that the greater part of this water is "organised" in relation to the hydrophilic groups of the lipide and protein components.

  3. Decompression sickness following breath-hold diving.

    PubMed

    Schipke, J D; Gams, E; Kallweit, Oliver

    2006-01-01

    Despite convincing evidence of a relationship between breath-hold diving and decompression sickness (DCS), the causal connection is only slowly being accepted. Only the more recent textbooks have acknowledged the risks of repetitive breath-hold diving. We compare four groups of breath-hold divers: (1) Japanese and Korean amas and other divers from the Pacific area, (2) instructors at naval training facilities, (3) spear fishers, and (4) free-dive athletes. While the number of amas is likely decreasing, and Scandinavian Navy training facilities recorded only a few accidents, the number of spear fishers suffering accidents is on the rise, in particular during championships or using scooters. Finally, national and international associations (e.g., International Association of Free Drives [IAFD] or Association Internationale pour Le Developpment De L'Apnee [AIDA]) promote free-diving championships including deep diving categories such as constant weight, variable weight, and no limit. A number of free-diving athletes, training for or participating in competitions, are increasingly accident prone as the world record is presently set at a depth of 171 m. This review presents data found after searching Medline and ISI Web of Science and using appropriate Internet search engines (e.g., Google). We report some 90 cases in which DCS occurred after repetitive breath-hold dives. Even today, the risk of suffering from DCS after repetitive breath-hold diving is often not acknowledged. We strongly suggest that breath-hold divers and their advisors and physicians be made aware of the possibility of DCS and of the appropriate therapeutic measures to be taken when DCS is suspected. Because the risk of suffering from DCS increases depending on depth, bottom time, rate of ascent, and duration of surface intervals, some approaches to assess the risks are presented. Regrettably, none of these approaches is widely accepted. We propose therefore the development of easily manageable

  4. Kinetic model for the collisionless sheath of a collisional plasma

    NASA Astrophysics Data System (ADS)

    Tang, Xian-Zhu; Guo, Zehua

    2016-08-01

    Collisional plasmas typically have mean-free-path still much greater than the Debye length, so the sheath is mostly collisionless. Once the plasma density, temperature, and flow are specified at the sheath entrance, the profile variation of electron and ion density, temperature, flow speed, and conductive heat fluxes inside the sheath is set by collisionless dynamics, and can be predicted by an analytical kinetic model distribution. These predictions are contrasted here with direct kinetic simulations, showing good agreement.

  5. Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients.

    PubMed

    Thirumala, Parthasarathy D; Shah, Aalap C; Nikonow, Tara N; Habeych, Miguel E; Balzer, Jeffrey R; Crammond, Donald J; Burkhart, Lois; Chang, Yue-Fang; Gardner, Paul; Kassam, Amin B; Horowitz, Michael B

    2011-02-01

    Hemifacial spasm is a socially disabling condition that manifests as intermittent involuntary twitching of the eyelid and progresses to muscle contractions of the entire hemiface. Patients receiving microvascular decompression of the facial nerve demonstrate an abnormal lateral spread response (LSR) in peripheral branches during facial electromyography. The authors retrospectively evaluate the prognostic value of preoperative clinical characteristics and the efficacy of intraoperative monitoring in predicting short- and long-term relief after microvascular decompression for hemifacial spasm. Microvascular decompression was performed in 293 patients with hemifacial spasm, and LSR was recorded during intraoperative facial electromyography monitoring. In 259 (87.7%) of the 293 patients, the LSR was attainable. Patient outcome was evaluated on the basis of whether the LSR disappeared or persisted after decompression. The mean follow-up period was 54.5 months (range, 9-102 months). A total of 88.0% of patients experienced immediate postoperative relief of spasm; 90.8% had relief at discharge, and 92.3% had relief at follow-up. Preoperative facial weakness and platysmal spasm correlated with persistent postoperative spasm, with similar trends at follow-up. In 207 patients, the LSR disappeared intraoperatively after decompression (group I), and in the remaining 52 patients, the LSR persisted intraoperatively despite decompression (group II). There was a significant difference in spasm relief between both groups within 24 hours of surgery (94.7% vs. 67.3%) (P < 0.0001) and at discharge (94.2% vs. 76.9%) (P = 0.001), but not at follow-up (93.3% vs. 94.4%) (P = 1.000). Multivariate logistic regression analysis demonstrated independent predictability of residual LSR for present spasm within 24 hours of surgery and at discharge but not at follow-up. Facial electromyography monitoring of the LSR during microvascular decompression is an effective tool in ensuring a complete

  6. Sheath structure in electronegative plasmas with finite positive ion temperature

    NASA Astrophysics Data System (ADS)

    Palop, J. I. Fernández; Ballesteros, J.; Hernández, M. A.; Crespo, R. Morales; del Pino, S. Borrego

    2004-05-01

    An earlier theoretical work, concerning the sheath structure in electronegative plasmas, is extended to include the effect of the positive ion thermal motion. A significant change is observed in the quantities characterizing the sheath with respect to the cold ion assumption. The sheath is contracted when the positive ion thermal motion is considered causing a decrease in the sheath thickness. The ion saturation current and the floating potential are shown to be distinguished quantities in plasma diagnosis of electronegative plasmas by using plane Langmuir probes.

  7. Rarefaction solitons initiated by sheath instability

    SciTech Connect

    Levko, Dmitry

    2015-09-15

    The instability of the cathode sheath initiated by the cold energetic electron beam is studied by the one-dimensional fluid model. Numerical simulations show the generation of travelling rarefaction solitons at the cathode. It is obtained that the parameters of these solitons strongly depend on the parameters of electron beam. The “stretched” variables are derived using the small-amplitude analysis. These variables are used in order to obtain the Korteweg-de Vries equation describing the propagation of the rarefaction solitons through the plasma with cold energetic electron beam.

  8. Target normal sheath acceleration sheath fields for arbitrary electron energy distribution

    SciTech Connect

    Schmitz, Holger

    2012-08-15

    Relativistic electrons, generated by ultraintense laser pulses, travel through the target and form a space charge sheath at the rear surface which can be used to accelerate ions to high energies. If the laser pulse duration is comparable or shorter than the time needed for the electrons to travel through the target, the electrons will not have the chance to form an equilibrium distribution but must be described by a non-equilibrium distribution. We present a kinetic theory of the rear sheath for arbitrary electron distribution function f(E), where E is the electron energy, and evaluate it for different shapes of f(E). We find that the far field is mainly determined by the high energy tail of the distribution, a steep decay of f(E) for high energies results in a small electric field and vice versa. The model is extended to account for electrons escaping the sheath region thereby allowing a finite potential drop over the sheath. The consequences of the model for the acceleration of ions are discussed.

  9. The characteristics of RF modulated plasma boundary sheaths: An analysis of the standard sheath model

    NASA Astrophysics Data System (ADS)

    Naggary, Schabnam; Brinkmann, Ralf Peter

    2015-09-01

    The characteristics of radio frequency (RF) modulated plasma boundary sheaths are studied on the basis of the so-called ``standard sheath model.'' This model assumes that the applied radio frequency ωRF is larger than the plasma frequency of the ions but smaller than that of the electrons. It comprises a phase-averaged ion model - consisting of an equation of continuity (with ionization neglected) and an equation of motion (with collisional ion-neutral interaction taken into account) - a phase-resolved electron model - consisting of an equation of continuity and the assumption of Boltzmann equilibrium -, and Poisson's equation for the electrical field. Previous investigations have studied the standard sheath model under additional approximations, most notably the assumption of a step-like electron front. This contribution presents an investigation and parameter study of the standard sheath model which avoids any further assumptions. The resulting density profiles and overall charge-voltage characteristics are compared with those of the step-model based theories. The authors gratefully acknowledge Efe Kemaneci for helpful comments and fruitful discussions.

  10. Common peroneal nerve dysfunction

    MedlinePlus

    ... toe-out movements Tests of nerve activity include: Electromyography (EMG, a test of electrical activity in muscles) Nerve ... Peroneal neuropathy. In: Preston DC, Shapiro BE, eds. Electromyography and Neuromuscular Disorders . 3rd ed. Philadelphia, PA: Elsevier; ...

  11. Nerve conduction velocity

    MedlinePlus

    ... to measure the speed of the nerve signals. Electromyography (recording from needles placed into the muscles) is ... Often, the nerve conduction test is followed by electromyography (EMG). In this test, needles are placed into ...

  12. Electromechanical Nerve Stimulator

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Supplee, Frank H., Jr.; Prass, Richard L.

    1993-01-01

    Nerve stimulator applies and/or measures precisely controlled force and/or displacement to nerve so response of nerve measured. Consists of three major components connected in tandem: miniature probe with spherical tip; transducer; and actuator. Probe applies force to nerve, transducer measures force and sends feedback signal to control circuitry, and actuator positions force transducer and probe. Separate box houses control circuits and panel. Operator uses panel to select operating mode and parameters. Stimulator used in research to characterize behavior of nerve under various conditions of temperature, anesthesia, ventilation, and prior damage to nerve. Also used clinically to assess damage to nerve from disease or accident and to monitor response of nerve during surgery.

  13. Nerve Injuries in Athletes.

    ERIC Educational Resources Information Center

    Collins, Kathryn; And Others

    1988-01-01

    Over a two-year period this study evaluated the condition of 65 athletes with nerve injuries. These injuries represent the spectrum of nerve injuries likely to be encountered in sports medicine clinics. (Author/MT)

  14. Paranodal dysmyelination in peripheral nerves of Trembler mice.

    PubMed

    Rosenbluth, Jack; Bobrowski-Khoury, Natasha

    2014-04-01

    Subtle defects in paranodes of myelinated nerve fibers can cause significant physiological malfunction. We have investigated myelinated fibers in the peripheral nervous system (PNS) of the Trembler mouse, a model of CMT-1A neuropathy, for evidence of such defects. Ultrastructural analysis shows that the "transverse bands," which attach the myelin sheath to the axon at the paranodal axoglial junction, are grossly diminished in number in Trembler nerve fibers. Although paranodes often appear to be greatly elongated, it is only a short region immediately adjacent to the node of Ranvier that displays transverse bands. Where transverse bands are missing, the junctional gap widens, thus reducing resistance to short circuiting of nodal action currents during saltatory conduction and increasing the likelihood that axonal K(+) channels under the myelin sheath will be activated. In addition, we find evidence that structural domains in Trembler axons are incompletely differentiated, consistent with diminution in nodal Na channel density, which could further compromise conduction. Deficiency of transverse bands may also increase susceptibility to disruption of the paranodal junction and retraction of the myelin sheath. We conclude that Trembler PNS myelinated fibers display subtle defects in paranodal and nodal regions that could contribute significantly to conduction defects and increased risk of myelin detachment.

  15. CNS Myelin Sheath Lengths Are an Intrinsic Property of Oligodendrocytes.

    PubMed

    Bechler, Marie E; Byrne, Lauren; Ffrench-Constant, Charles

    2015-09-21

    Since Río-Hortega's description of oligodendrocyte morphologies nearly a century ago, many studies have observed myelin sheath-length diversity between CNS regions. Myelin sheath length directly impacts axonal conduction velocity by influencing the spacing between nodes of Ranvier. Such differences likely affect neural signal coordination and synchronization. What accounts for regional differences in myelin sheath lengths is unknown; are myelin sheath lengths determined solely by axons or do intrinsic properties of different oligodendrocyte precursor cell populations affect length? The prevailing view is that axons provide molecular cues necessary for oligodendrocyte myelination and appropriate sheath lengths. This view is based upon the observation that axon diameters correlate with myelin sheath length, as well as reports that PNS axonal neuregulin-1 type III regulates the initiation and properties of Schwann cell myelin sheaths. However, in the CNS, no such instructive molecules have been shown to be required, and increasing in vitro evidence supports an oligodendrocyte-driven, neuron-independent ability to differentiate and form initial sheaths. We test this alternative signal-independent hypothesis--that variation in internode lengths reflects regional oligodendrocyte-intrinsic properties. Using microfibers, we find that oligodendrocytes have a remarkable ability to self-regulate the formation of compact, multilamellar myelin and generate sheaths of physiological length. Our results show that oligodendrocytes respond to fiber diameters and that spinal cord oligodendrocytes generate longer sheaths than cortical oligodendrocytes on fibers, co-cultures, and explants, revealing that oligodendrocytes have regional identity and generate different sheath lengths that mirror internodes in vivo.

  16. The risks of scuba diving: a focus on Decompression Illness.

    PubMed

    Hall, Jennifer

    2014-11-01

    Decompression Illness includes both Decompression Sickness (DCS) and Pulmonary Overinflation Syndrome (POIS), subsets of diving-related injury related to scuba diving. DCS is a condition in which gas bubbles that form while diving do not have adequate time to be resorbed or "off-gassed," resulting in entrapment in specific regions of the body. POIS is due to an overly rapid ascent to the surface resulting in the rupture of alveoli and subsequent extravasation of air bubbles into tissue planes or even the cerebral circulation. Divers must always be cognizant of dive time and depth, and be trained in the management of decompression. A slow and controlled ascent, plus proper control of buoyancy can reduce the dangerous consequences of pulmonary barotrauma. The incidence of adverse effects can be diminished with safe practices, allowing for the full enjoyment of this adventurous aquatic sport.

  17. The risks of scuba diving: a focus on Decompression Illness.

    PubMed

    Hall, Jennifer

    2014-11-01

    Decompression Illness includes both Decompression Sickness (DCS) and Pulmonary Overinflation Syndrome (POIS), subsets of diving-related injury related to scuba diving. DCS is a condition in which gas bubbles that form while diving do not have adequate time to be resorbed or "off-gassed," resulting in entrapment in specific regions of the body. POIS is due to an overly rapid ascent to the surface resulting in the rupture of alveoli and subsequent extravasation of air bubbles into tissue planes or even the cerebral circulation. Divers must always be cognizant of dive time and depth, and be trained in the management of decompression. A slow and controlled ascent, plus proper control of buoyancy can reduce the dangerous consequences of pulmonary barotrauma. The incidence of adverse effects can be diminished with safe practices, allowing for the full enjoyment of this adventurous aquatic sport. PMID:25478296

  18. The Risks of Scuba Diving: A Focus on Decompression Illness

    PubMed Central

    2014-01-01

    Decompression Illness includes both Decompression Sickness (DCS) and Pulmonary Overinflation Syndrome (POIS), subsets of diving-related injury related to scuba diving. DCS is a condition in which gas bubbles that form while diving do not have adequate time to be resorbed or “off-gassed,” resulting in entrapment in specific regions of the body. POIS is due to an overly rapid ascent to the surface resulting in the rupture of alveoli and subsequent extravasation of air bubbles into tissue planes or even the cerebral circulation. Divers must always be cognizant of dive time and depth, and be trained in the management of decompression. A slow and controlled ascent, plus proper control of buoyancy can reduce the dangerous consequences of pulmonary barotrauma. The incidence of adverse effects can be diminished with safe practices, allowing for the full enjoyment of this adventurous aquatic sport. PMID:25478296

  19. Mechanisms underlying spinal cord damage in decompression sickness.

    PubMed

    Hallenbeck, J M; Bove, A A; Elliott, D H

    1975-04-01

    Decompression sickness, which damaged the spinal cord, was produced in anesthetized dogs using a compression chamber. Cerebrospinal fluid pressure and several intravascular and intracardiac pressures were monitored during the course of the simulated dives. Manometric responses to forcible lung inflation and abdominal compression were measured both predive and postdive after signs of spinal cord damage were evident. Cinevenography of the epidural vertebral venous system was performed both predive and postdive. Histopathologic studies of the brains and cords of both predive and postdive. Histopathologic studies of the brains and cords of paretic animals were carried out. The results indicate that the epidural vertebral venous system becomes obstructed during spinal cord damaging decompression sickness and strongly suggests that spinal cord infarction in decompression sickness is caused by obstruction of cord venous drainage at the level of the epidural vertebral venous system. PMID:1168317

  20. High-altitude decompression illness: case report and discussion.

    PubMed

    Allan, G Michael; Kenny, David

    2003-10-14

    Decompression illness (DCI) can occur in a variety of contexts, including scuba diving and flight in nonpressurized aircraft. It is characterized by joint pain, neurologic injury, and respiratory or constitutional symptoms. To prepare flight crews for accidental decompression events, the Canadian Armed Forces regularly conducts controlled and supervised depressurization exercises in specialized chambers. We present the cases of 3 Canadian Armed Forces personnel who successfully completed such decompression exercises but experienced DCI after they took a 3-hour commercial flight 6 hours after the completion of training. All 3 patients were treated in a hyperbaric oxygen chamber. The pathophysiology, diagnosis and management of DCI and the travel implications for military personnel who have undergone such training exercises are discussed. Although DCI is relatively uncommon, physicians may see it and should be aware of its presentation and treatment.

  1. [Inner ear decompression sickness following a scuba dive].

    PubMed

    Satoh, M; Kitahara, S; Inouye, T; Ikeda, T

    1992-04-01

    Inner ear decompression sickness (IEDCS) is one form of Type II decompression sickness. Most cases of IEDCS have been associated with saturation dives, so there are very few reports of occurrence following shallow scuba dives. We present here the case of a diver who suffered from IEDCS following a shallow scuba dive (30m), and was successfully treated by the protocol outlined in U.S. Navy treatment table 6. This case suggests that there is the possibility of occurrence of IEDCS, even following a shallow scuba dive, if proper decompression procedures are not adhered to. In addition, detailed analysis of diving profiles should be used to distinguish the inner ear dysfunction seen in some divers from inner ear barotrauma which may be attributable to IEDCS.

  2. [Determination of divers' resistance to decompression gas formation].

    PubMed

    Miasnikov, A An; Shitov, A Iu; Chernov, V I; Zhil'tsova, I I; Iur'ev, A Iu; Miasnikov, A Al

    2013-02-01

    The aim of the study was to determine the correlation between the state of the individual functions of the organism and the intensity of decompression venous gas embolism after high air pressure exposure. The analysis of the guidelines defining the procedure of divers' medical examination was made and 320 divers were surveyed. Indices of the divers' central nervous and cardiovascular systems were measured before and after their immersion into a hyperbaric chamber. The study found that the conduct divers' on-resistance to unfavorable scuba dive should be provided by the military-medical commission, so the position of diving doctor should be put to it staff. It was revealed that the rate of simple visual-motor reaction, measured before the diving can serve as an indicator of human resistance to decompression gassing. The formula for determining the stability of decompression gassing of men aged 20-30 years in terms of state of organism functions was proposed.

  3. A critical review of physiological bubble formation in hyperbaric decompression.

    PubMed

    Papadopoulou, Virginie; Eckersley, Robert J; Balestra, Costantino; Karapantsios, Thodoris D; Tang, Meng-Xing

    2013-05-01

    Bubbles are known to form in the body after scuba dives, even those done well within the decompression model limits. These can sometimes trigger decompression sickness and the dive protocols should therefore aim to limit bubble formation and growth from hyperbaric decompression. Understanding these processes physiologically has been a challenge for decades and there are a number of questions still unanswered. The physics and historical background of this field of study is presented and the latest studies and current developments reviewed. Heterogeneous nucleation is shown to remain the prime candidate for bubble formation in this context. The two main theories to account for micronuclei stability are then to consider hydrophobicity of surfaces or tissue elasticity, both of which could also explain some physiological observations. Finally the modeling relevance of the bubble formation process is discussed, together with that of bubble growth as well as multiple bubble behavior.

  4. [Anterior clinoid process mucocele causing optic nerve compression].

    PubMed

    Moisseiev, Elad; Regenbogen, Michael; Segev, Yoram

    2013-02-01

    A mucocele is a collection of mucus lined by mucus-secreting epithelium of a paranasal sinus. The anterior clinoid process may become pneumatized during the development of the skull base. Rarely, an anterior clinoid process mucocele may form in this air space. We report a patient with anterior clinoid process mucocele who presented with visual loss and limited motility in the affected eye, and underwent surgery to decompress the orbital apex and optic nerve. We also review the literature regarding this rare diagnosis.

  5. (-)-Epigallocatechin-3-gallate (EGCG) attenuates peripheral nerve degeneration in rat sciatic nerve crush injury.

    PubMed

    Renno, Waleed M; Al-Maghrebi, May; Alshammari, Ahmad; George, Preethi

    2013-02-01

    Recently, we have shown that green tea (GT) consumption improves both reflexes and sensation in unilateral chronic constriction injury to the sciatic nerve. Considering the substantial neuroprotective properties of GT polyphenols, we sought to investigate whether (-)-epigallocatechin-3-gallate (EGCG) could protect the sciatic nerve and improve functional impairments induced by a crushing injury. We also examined whether neuronal cell apoptosis induced by the crushing injury is affected by EGCG treatment. Histological examination of sciatic nerves from EGCG-treated (50mg/kg; i.p.) showed that axonotmized rats had a remarkable axonal and myelin regeneration with significant decrease in the number of myelinated axonal fibers compared to vehicle-treated crush group. Similarly, ultrastructural evaluation of EGCG-treated nerves displayed normal unmyelinated and myelinated axons with regular myelin sheath thickness and normalized appearance of Schmidt-Lantermann clefts. Extracellular matrix displayed normal collagen fibers appearance with distinctively organized distribution similar to sham animals. Analysis of foot position and extensor postural thrust test showed a progressive and faster recovery in the EGCG-treated group compared to vehicle-treated animals. EGCG-treated rats showed significant increase in paw withdrawal thresholds to mechanical stimulation compared to vehicle-treated crush group. EGCG treatment also restored the mRNA expression of Bax, Bcl-2 and survivin but not that of p53 to sham levels on days 3 and 7 post-injury. Our results demonstrate that EGCG treatment enhanced functional recovery, advanced morphological nerve rescue and accelerated nerve regeneration following crush injury partly due to the down regulation of apoptosis related genes. PMID:23313191

  6. Decompression surgery for spinal metastases: a systematic review.

    PubMed

    Bakar, Dara; Tanenbaum, Joseph E; Phan, Kevin; Alentado, Vincent J; Steinmetz, Michael P; Benzel, Edward C; Mroz, Thomas E

    2016-08-01

    OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that

  7. Spinal Cord Decompression Sickness in a Sport Scuba Diver.

    PubMed

    Zwingelberg, K M

    1981-10-01

    In brief: A 26-year-old diver suffered spinal cord decompression sickness even though he did not exceed the time and depth limits set in standard US Navy diving tables. This case shows that when dives are strenuous and almost reach time and depth limits they may exceed the parameters of the tables. The case also illustrates the importance of rapid diagnosis and hyperbaric oxygen treatment of pressure-related diving casualties. The author says optimum treatment of decompression sickness depends on a high level of suspicion, an accurate diving history, and prompt treatment with hyperbaric oxygen.

  8. Inner ear decompression sickness following a shallow scuba dive.

    PubMed

    Reissman, P; Shupak, A; Nachum, Z; Melamed, Y

    1990-06-01

    Inner Ear Decompression Sickness (IEDCS)--manifested by tinnitus, vertigo, nausea, vomiting, and hearing loss--is usually associated with deep air or mixed gas dives, and accompanied by other CNS symptoms of decompression sickness (DCS). Early recompression treatment is required in order to avoid permanent inner ear damage. We present an unusual case of a scuba diver suffering from IEDCS as the only manifestation of DCS following a short shallow scuba dive, successfully treated by U.S. Navy treatment table 6 and tranquilizers. This case suggests that diving medical personnel should be more aware of the possible occurrence of IEDCS among the wide population of sport scuba divers.

  9. Pathophysiology and treatment of decompression sickness and gas embolism.

    PubMed

    Loewenherz, J W

    1992-09-01

    Decompression sickness and cerebral gas embolism can present as dramatic and profound sudden onset injuries in patients engaged in tunnel work and compressed gas diving, including scuba. The history and management of these illnesses span centuries. The pathophysiology relates to occurrence of gas bubbles in extrapulmonic sites. Decompression sickness is due to supersaturation of the tissue with dissolved gas and subsequent evolution of gas bubbles. Gas embolism results from the direct transit of molecular gas from a pulmonary or intravascular origin into the arterial circulation causing occlusion of a distal locus. Treatment relates to increasing hydrostatic pressure, thus maximizing the gradient for gas reabsorption and dissolution and subsequently gas excretion via the lungs.

  10. Decompression experiments identify kinetic controls on explosive silicic eruptions

    USGS Publications Warehouse

    Mangan, M.T.; Sisson, T.W.; Hankins, W.B.

    2004-01-01

    Eruption intensity is largely controlled by decompression-induced release of water-rich gas dissolved in magma. It is not simply the amount of gas that dictates how forcefully magma is propelled upwards during an eruption, but also the rate of degassing, which is partly a function of the supersaturation pressure (??Pcritical) triggering gas bubble nucleation. High temperature and pressure decompression experiments using rhyolite and dacite melt reveal compositionally-dependent differences in the ??Pcritical of degassing that may explain why rhyolites have fueled some of the most explosive eruptions on record.

  11. Non-equilibrium and unsteady fluid degassing during slow decompression

    NASA Astrophysics Data System (ADS)

    Hammer, Julia E.; Manga, Michael; Cashman, Katharine V.

    Decompression experiments were performed on corn syrup-water solutions in order to investigate the effect of viscosity on processes of vesiculation and degassing at low to moderate degrees of volatile supersaturation. Repeat experiments demonstrated similar long term vesiculation behavior at moderate decompression rates despite highly variable initial nucleation styles. Results suggest that magmas may not necessarily achieve chemical equilibrium by vapor exsolution and may require viscosity-dependent critical supersaturations in order to vesiculate. Vesiculation also increased the ambient pressure and decreased supersaturations, resulting in unsteady degassing.

  12. Multispectral photoacoustic imaging of nerves with a clinical ultrasound system

    NASA Astrophysics Data System (ADS)

    Mari, Jean Martial; West, Simeon; Beard, Paul C.; Desjardins, Adrien E.

    2014-03-01

    Accurate and efficient identification of nerves is of great importance during many ultrasound-guided clinical procedures, including nerve blocks and prostate biopsies. It can be challenging to visualise nerves with conventional ultrasound imaging, however. One of the challenges is that nerves can have very similar appearances to nearby structures such as tendons. Several recent studies have highlighted the potential of near-infrared optical spectroscopy for differentiating nerves and adjacent tissues, as this modality can be sensitive to optical absorption of lipids that are present in intra- and extra-neural adipose tissue and in the myelin sheaths. These studies were limited to point measurements, however. In this pilot study, a custom photoacoustic system with a clinical ultrasound imaging probe was used to acquire multi-spectral photoacoustic images of nerves and tendons from swine ex vivo, across the wavelength range of 1100 to 1300 nm. Photoacoustic images were processed and overlaid in colour onto co-registered conventional ultrasound images that were acquired with the same imaging probe. A pronounced optical absorption peak centred at 1210 nm was observed in the photoacoustic signals obtained from nerves, and it was absent in those obtained from tendons. This absorption peak, which is consistent with the presence of lipids, provides a novel image contrast mechanism to significantly enhance the visualization of nerves. In particular, image contrast for nerves was up to 5.5 times greater with photoacoustic imaging (0.82 +/- 0.15) than with conventional ultrasound imaging (0.148 +/- 0.002), with a maximum contrast of 0.95 +/- 0.02 obtained in photoacoustic mode. This pilot study demonstrates the potential of photoacoustic imaging to improve clinical outcomes in ultrasound-guided interventions in regional anaesthesia and interventional oncology.

  13. The connective tissue and glial framework in the optic nerve head of the normal human eye: light and scanning electron microscopic studies.

    PubMed

    Oyama, Tokuhide; Abe, Haruki; Ushiki, Tatsuo

    2006-12-01

    The arrangement of connective tissue components (i.e., collagen, reticular, and elastic fibers) and glial elements in the optic nerve head of the human eye was investigated by the combined use of light microscopy and scanning electron microscopy (SEM). Light-microscopically, the optic nerve head could be subdivided into four parts from the different arrangements of the connective tissue framework: a surface nerve fiber layer, and prelaminar, laminar, and postlaminar regions. The surface nerve fiber layer only possessed connective tissue elements around blood vessels. In the prelaminar region, collagen fibrils, together with delicate elastic fibers, formed thin interrupted sheaths for accommodating small nerve bundles. Immunohistochemistry for the glial fibrillary acidic protein (GFAP) showed that GFAP-positive cells formed columnar structures (i.e., glial columns), with round cell bodies piled up into layers. These glial columns were located in the fibrous sheaths of collagen fibrils and elastic fibers. In the laminar region, collagen fibrils and elastic fibers ran transversely to the optic nerve axis to form a thick membranous layer - the lamina cribrosa - which had numerous round openings for accommodating optic nerve fiber bundles. GFAP-positive cellular processes also ran transversely in association with collagen and elastin components. The postlaminar region had connective tissues which linked the lamina cribrosa with fibrous sheaths for accommodating nerve bundles in the extraocular optic nerve, where GFAP-positive cells acquired characteristics typical of fibrous astrocytes. These findings indicate that collagen fibrils, as a whole, form a continuous network which serves as a skeletal framework of the optic nerve head for protecting optic nerve fibers from mechanical stress as well as for sustaining blood vessels in the optic nerve. The lamina cribrosa containing elastic fibers are considered to be plastic against the mechanical force affected by elevation

  14. Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review

    PubMed Central

    Senger, Jenna-Lynn; Classen, Dale; Bruce, Garth; Kanthan, Rani

    2014-01-01

    A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy. FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with ‘incessant crying’. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed. PMID:25332651

  15. Sheath structure transition controlled by secondary electron emission

    NASA Astrophysics Data System (ADS)

    Schweigert, I. V.; Langendorf, S. J.; Walker, M. L. R.; Keidar, M.

    2015-04-01

    In particle-in-cell Monte Carlo collision (PIC MCC) simulations and in an experiment we study sheath formation over an emissive floating Al2O3 plate in a direct current discharge plasma at argon gas pressure 10-4 Torr. The discharge glow is maintained by the beam electrons emitted from a negatively biased hot cathode. We observe three types of sheaths near the floating emissive plate and the transition between them is driven by changing the negative bias. The Debye sheath appears at lower voltages, when secondary electron emission is negligible. With increasing applied voltage, secondary electron emission switches on and a first transition to a new sheath type, beam electron emission (BEE), takes place. For the first time we find this specific regime of sheath operation near the floating emissive surface. In this regime, the potential drop over the plate sheath is about four times larger than the temperature of plasma electrons. The virtual cathode appears near the emissive plate and its modification helps to maintain the BEE regime within some voltage range. Further increase of the applied voltage U initiates the second smooth transition to the plasma electron emission sheath regime and the ratio Δφs/Te tends to unity with increasing U. The oscillatory behavior of the emissive sheath is analyzed in PIC MCC simulations. A plasmoid of slow electrons is formed near the plate and transported to the bulk plasma periodically with a frequency of about 25 kHz.

  16. Anode Sheath Switching in a Carbon Nanotube Arc Plasma

    SciTech Connect

    Abe Fetterman, Yevgeny Raitses, and Michael Keidar

    2008-04-08

    The anode ablation rate is investigated as a function of anode diameter for a carbon nanotube arc plasma. It is found that anomalously high ablation occurs for small anode diameters. This result is explained by the formation of a positive anode sheath. The increased ablation rate due to this positive anode sheath could imply greater production rate for carbon nanotubes.

  17. A generalized BC for radio-frequency sheaths

    NASA Astrophysics Data System (ADS)

    D'Ippolito, D. A.; Myra, J. R.

    2015-12-01

    A new radio-frequency (rf) sheath boundary condition (BC) is described and applied to the problem of far field sheaths. The new BC generalizes the one presently used in rf codes to include: (1) an arbitrary magnetic field angle, (2) the full complex impedance, (3) mobile ions, (4) unmagnetized ions, and (5) the magnetic pre-sheath. For a given wave-propagation (macro) problem, root-finding is used to match the impedance of the rf wave with that of the micro-sheath problem. For a model far-field sheath problem, it is shown that the structure of the (multiple) roots with the new BC is similar to that with the capacitive BC, but the location of the resonance changes when the full impedance is used.

  18. Gas insulated transmission line having low inductance intercalated sheath

    DOEpatents

    Cookson, Alan H.

    1978-01-01

    A gas insulated transmission line including an outer sheath, an inner conductor disposed within the outer sheath, and an insulating gas between the inner conductor and the outer sheath. The outer sheath comprises an insulating tube having first and second ends, and having interior and exterior surfaces. A first electrically conducting foil is secured to the interior surface of the insulating tube, is spirally wound from one tube end to the second tube end, and has a plurality of overlapping turns. A second electrically conducting foil is secured to the exterior surface of the insulating tube, and is spirally wound in the opposite direction from the first electrically conducting foil. By winding the foils in opposite directions, the inductances within the intercalated sheath will cancel each other out.

  19. An Everting Ureteral Access Sheath: Concepts and In Vitro Testing

    NASA Astrophysics Data System (ADS)

    Lee, Keith L.; Stoller, Marshall L.

    2007-04-01

    Ureteral access sheaths have been a recent innovation in facilitating ureteral stone surgery. Once properly placed, access sheaths allow the movement of ureteroscopes and other instruments through the ureter with minimal injury to the urothelium. However, there are shortcomings of the current device designs. Initial sheath placement requires significant force, and shear stress can injure the ureter. In addition, inadvertent advancement of the outer sheath without the inner introducer stylet can tear and avulse the ureter. A novel eversion design incorporating a lubricous film provides marked improvement over current access sheaths. In bench top and animal models, the eversion shealths require less force during advancement, cause less injury to the urothelial tissue, and have a lower potential of introducing extraneous materials (e.g., microbes) into a simulated urinary tract. While, the everting design provides important advantages over traditional non-everting designs, further preclinical and clinical trials are required.

  20. Similarities and distinctions of CIR and Sheath

    NASA Astrophysics Data System (ADS)

    Yermolaev, Yuri; Lodkina, Irina; Nikolaeva, Nadezhda; Yermolaev, Michael

    2016-04-01

    On the basis of OMNI data and our catalog of large scale solar wind (SW) streams during 1976-2000 [Yermolaev et al., 2009] we study the average temporal profiles for two types of compressed regions: CIR (corotating interaction region - compressed region before High Speed Stream (HSS)) and Sheath (compressed region before fast Interplanetary CMEs (ICMEs), including Magnetic Cloud (MC) and Ejecta). As have been shown by Nikolaeva et al, [2015], the efficiency of magnetic storm generation is ~50% higher for Sheath and CIR than for ICME (MC and Ejecta), i.e. reaction magnetosphere depends on type of driver. To take into account the different durations of SW types, we use the double superposed epoch analysis (DSEA) method: rescaling the duration of the interval for all types in such a manner that, respectively, beginning and end for all intervals of selected type coincide [Yermolaev et al., 2010; 2015]. Obtained data allows us to suggest that the formation of all types of compression regions has the same physical mechanism irrespective of piston (HSS or ICME) type and differences are connected with geometry and full jumps of speed in edges of compression regions. If making the natural assumption that the gradient of speed is directed approximately on normal to the piston, CIR has the largest angle between the gradient of speed and the direction of average SW speed, and ICME - the smallest angle. The work was supported by the Russian Foundation for Basic Research, projects 13-02-00158, 16-02-00125 and by Program of Presidium of the Russian Academy of Sciences. References: Nikolaeva, N. S. , Yu. I. Yermolaev, and I. G. Lodkina (2015), Modeling of the Corrected Dst* Index Temporal Profile on the Main Phase of the Magnetic Storms Generated by Different Types of Solar Wind, Cosmic Research, Vol. 53, No. 2, pp. 119-127. Yermolaev, Yu. I., N. S. Nikolaeva, I. G. Lodkina, and M. Yu. Yermolaev (2009), Catalog of Large-Scale Solar Wind Phenomena during 1976-2000, Cosmic Research

  1. Improvement of long-term blindness caused by compression from inner-third sphenoid wing meningioma after optic canal decompression: An extremely rare case report

    PubMed Central

    Tamura, Ryota; Takahashi, Satoshi; Horikoshi, Tomo; Yoshida, Kazunari

    2016-01-01

    Background: There has been no previous case report of a patient whose visual acuity improved after long-term blindness caused by tumor invasion into the optic canal. Case Description: A 65-year-old Asian woman presented with a 6-month history of blindness caused by a meningioma located on the inner third of the sphenoid ridge. An operation was performed to prevent further tumor invasion into the cavernous sinus and contralateral optic nerve. During surgery, optic canal decompression was performed using an epidural approach. Subtotal removal of the tumor was achieved. Two days after the surgery, her left visual acuity recovered from blindness. Conclusion: Normally, long-term blindness caused by optic nerve compression by a brain tumor is regarded as irreversible, and even a surgical excision of the optic nerve is performed in some cases. However, because we experienced a case in which the patient recovered from long-term blindness after optic canal decompression, we believe that this surgical procedure should definitely be considered as an option. PMID:27413579

  2. Bladder outlet reconstruction: fate of the silicone sheath.

    PubMed

    Kropp, B P; Rink, R C; Adams, M C; Keating, M A; Mitchell, M E

    1993-08-01

    The placement of a 1.5 cm. wide silicone sheath around a newly constructed urethra/bladder neck to ensure maintenance of repair length and to facilitate future placement of a sphincter cuff was reported by our institution in 1985. We present our long-term followup and new recommendations for use of the silicone sheath. A total of 15 silicone sheaths was placed between March 1981 and July 1984. Of the sheaths 14 were placed at the time of urinary reconstruction around the Young-Dees-Leadbetter bladder neck repair and 1 was placed after erosion of an artificial urinary sphincter cuff. Of the 15 sheaths 10 have eroded into the urethra and 4 sheaths remain in situ. Another sheath was replaced 2 years after its original insertion with an artificial urinary sphincter cuff. Mean time to erosion was 48.2 months, with a range of 2 to 108 months. Long-term followup of 10 patients revealed that 4 ultimately required ligation of the bladder neck and construction of continent stoma after erosion, 1 is dry after placement of a bulbar artificial urinary sphincter, 2 remain dry after removal of the eroded sheath alone, 2 required bladder neck revision to achieve continence after erosion and the most recent patient remains diverted with a suprapubic tube. All 4 patients with sheaths still remaining are dry without evidence of erosion (mean duration 116 months). These long-term results using a silicone wrap around a newly constructed bladder neck reveal an unacceptably high rate of erosion. Therefore, we no longer recommend or support the use of the silicone sheath in the manner we have described for bladder neck reconstruction. PMID:8326628

  3. 46 CFR Appendix A to Part 197 - Air No-Decompression Limits

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Air No-Decompression Limits A Appendix A to Part 197... STANDARDS GENERAL PROVISIONS Pt. 197, App. A Appendix A to Part 197—Air No-Decompression Limits The following table gives the depth versus bottom time limits for single, no-decompression, air dives...

  4. 46 CFR Appendix A to Part 197 - Air No-Decompression Limits

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Air No-Decompression Limits A Appendix A to Part 197... STANDARDS GENERAL PROVISIONS Pt. 197, App. A Appendix A to Part 197—Air No-Decompression Limits The following table gives the depth versus bottom time limits for single, no-decompression, air dives...

  5. 46 CFR Appendix A to Part 197 - Air No-Decompression Limits

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Air No-Decompression Limits A Appendix A to Part 197... STANDARDS GENERAL PROVISIONS Pt. 197, App. A Appendix A to Part 197—Air No-Decompression Limits The following table gives the depth versus bottom time limits for single, no-decompression, air dives...

  6. A Log Logistic Survival Model Applied to Hypobaric Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny

    2001-01-01

    Decompression sickness (DCS) is a complex, multivariable problem. A mathematical description or model of the likelihood of DCS requires a large amount of quality research data, ideas on how to define a decompression dose using physical and physiological variables, and an appropriate analytical approach. It also requires a high-performance computer with specialized software. I have used published DCS data to develop my decompression doses, which are variants of equilibrium expressions for evolved gas plus other explanatory variables. My analytical approach is survival analysis, where the time of DCS occurrence is modeled. My conclusions can be applied to simple hypobaric decompressions - ascents lasting from 5 to 30 minutes - and, after minutes to hours, to denitrogenation (prebreathing). They are also applicable to long or short exposures, and can be used whether the sufferer of DCS is at rest or exercising at altitude. Ultimately I would like my models to be applied to astronauts to reduce the risk of DCS during spacewalks, as well as to future spaceflight crews on the Moon and Mars.

  7. Does temperature increase or decrease in adiabatic decompression of magma?

    NASA Astrophysics Data System (ADS)

    Kilinc, A. I.; Ghiorso, M. S.; Khan, T.

    2011-12-01

    We have modeled adiabatic decompression of an andesitic and a basaltic magma as an isentropic process using the Melts algorithm. Our modeling shows that during adiabatic decompression temperature of andesitic magma increases but temperature of basaltic magma decreases. In an isentropic process entropy is constant so change of temperature with pressure can be written as dT/dP=T (dV/dT)/Cp where T (dV/dT)/Cp is generally positive. If delta P is negative so is delta T. In general, in the absence of phase change, we expect the temperature to decrease with adiabatic decompression. The effect of crystallization is to turn a more entropic phase (liquid) into a less entropic phase (solid), which must be compensated by raising the temperature. If during adiabatic decompression there is small amount or no crystallization, T (dV/dT)/Cp effect which lowers the temperature overwhelms the small amount of crystallization, which raises the temperature, and overall system temperature decreases.

  8. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Equipment § 197.332 PVHO—Decompression chambers... minimum pressure capability of— (1) 6 ATA, when used for diving to 300 fsw; or (2) The maximum depth of the dive, when used for diving operations deeper than 300 fsw, unless a closed bell meeting...

  9. Decompressive Craniectomy and Traumatic Brain Injury: A Review

    PubMed Central

    Alvis-Miranda, Hernando; Castellar-Leones, Sandra Milena; Moscote-Salazar, Luis Rafael

    2013-01-01

    Intracranial hypertension is the largest cause of death in young patients with severe traumatic brain injury. Decompressive craniectomy is part of the second level measures for the management of increased intracranial pressure refractory to medical management as moderate hypothermia and barbiturate coma. The literature lack of concepts is their indications. We present a review on the state of the art. PMID:27162826

  10. Air embolism and decompression sickness in scuba divers.

    PubMed

    Whitcraft, D D; Karas, S

    1976-05-01

    The recognition and prompt treatment of air embolism and decompression sickness by the emergency physician can do much to reverse the unfavorable outcome of these two medical emergencies. Recognition depends on the physician maintaining a high index of suspicion. While the primary treatment for these disorders is recompression, other forms of therapy are outlined which must be instituted promptly.

  11. Does arthroscopic subacromial decompression improve quality of life

    PubMed Central

    Whiteman, A; Wilson, J; Paul, E; Roy, B

    2015-01-01

    Introduction There has been a significant rise in the volume of subacromial decompression surgery performed in the UK. This study aimed to determine whether arthroscopic subacromial decompression improves health related quality of life in a cost effective manner. Methods Patients undergoing arthroscopic subacromial decompression surgery for impingement were enrolled between 2012 and 2014. The Oxford shoulder score and the EQ-5D™ instruments were completed prior to and following surgery. A cost–utility analysis was performed. Results Eighty-three patients were eligible for the study with a mean follow-up duration of 15 months (range: 4–27 months). The mean Oxford shoulder score improved by 13 points (95% confidence interval [CI]: 11–15 points). The mean health utility gain extrapolated from the EQ-5D™ questionnaire improved by 0.23 (95% CI: 0.16–0.30), translating to a minimum cost per QALY of £5,683. Conclusions Subacromial decompression leads to significant improvement in function and quality of life in a cost effective manner. This provides justification for its ongoing practice by appropriately trained shoulder surgeons in correctly selected patients. PMID:26263808

  12. Transforming growth factor-β3 promotes facial nerve injury repair in rabbits

    PubMed Central

    WANG, YANMEI; ZHAO, XINXIANG; HUOJIA, MUHTER; XU, HUI; ZHUANG, YOUMEI

    2016-01-01

    The present study investigated the effects of transforming growth factor (TGF)-β3 on the regeneration of facial nerves in rabbits. A total of 20 adult rabbits were randomly divided into three equal groups: Normal control (n=10), surgical control (n=10) and TGF-β3 treatment (n=10). The total number and diameter of the regenerated nerve fibers was significantly increased in the TGF-β3 treatment group, as compared with in the surgical control group (P<0.01). Furthermore, in the TGF-β3 treatment group, the epineurial repair of the facial nerves was intact and the nerve fibers, which were arranged in neat rows, were morphologically intact with visible myelin swelling. However, in the surgical control group, the epineurial repair was incomplete, as demonstrated by: Atrophic nerve fibers, partially disappeared axons and myelin of uneven thickness with fuzzy borders. Electron microscopy demonstrated that the regenerated fibers in the TGF-β3 treatment group were predominantly myelinated, with clear-layered myelin sheath structures and axoplasms rich in organelles. Although typical layered myelin sheath structures were observed in the surgical control group, the myelin sheaths of the myelinated nerve fibers were poorly developed and few organelles were detected in the axoplasms. Neuro-electrophysiological examination demonstrated that, as compared with the surgical control group, the latency period of the action potentials in the TGF-β3 treatment group were shorter, whereas the stimulus amplitudes of the action potentials were significantly increased (P<0.01). The results of the present study suggest that TGF-β3 may improve the regeneration of facial nerves following trauma or injury. PMID:26997982

  13. Identification of a Gene Essential for Sheathed Structure Formation in Sphaerotilus natans, a Filamentous Sheathed Bacterium

    PubMed Central

    Suzuki, Toshihiko; Kanagawa, Takahiro; Kamagata, Yoichi

    2002-01-01

    Sphaerotilus natans, a filamentous bacterium that causes bulking in activated sludge processes, can assume two distinct morphologies, depending on the substrate concentration for growth; in substrate-rich media it grows as single rod-shaped cells, whereas in substrate-limited media it grows as filaments. To identify genes responsible for sheath formation, we carried out transposon Tn5 mutagenesis. Of the approximately 20,000 mutants obtained, 7 did not form sheathed structures. Sequencing of the Tn5-flanking regions showed that five of the seven Tn5 insertions converged at the same open reading frame, designated sthA. The deduced amino acids encoded by sthA were found to be homologous to glycosyltransferase, which is known to be involved in linking sugars to lipid carriers during bacterial exopolysaccharide biosynthesis. Disruption of the gene of the wild-type strain by inserting a kanamycin resistance gene cassette also resulted in sheathless growth under either type of nutrient condition. These findings indicate that sthA is a crucial component responsible for sheath formation. PMID:11772646

  14. Organic core-sheath nanowire artificial synapses with femtojoule energy consumption.

    PubMed

    Xu, Wentao; Min, Sung-Yong; Hwang, Hyunsang; Lee, Tae-Woo

    2016-06-01

    Emulation of biological synapses is an important step toward construction of large-scale brain-inspired electronics. Despite remarkable progress in emulating synaptic functions, current synaptic devices still consume energy that is orders of magnitude greater than do biological synapses (~10 fJ per synaptic event). Reduction of energy consumption of artificial synapses remains a difficult challenge. We report organic nanowire (ONW) synaptic transistors (STs) that emulate the important working principles of a biological synapse. The ONWs emulate the morphology of nerve fibers. With a core-sheath-structured ONW active channel and a well-confined 300-nm channel length obtained using ONW lithography, ~1.23 fJ per synaptic event for individual ONW was attained, which rivals that of biological synapses. The ONW STs provide a significant step toward realizing low-energy-consuming artificial intelligent electronics and open new approaches to assembling soft neuromorphic systems with nanometer feature size. PMID:27386556

  15. Symptomatic phrenic nerve palsy after supraclavicular block in an obese man.

    PubMed

    Erickson, John M; Louis, Dean S; Naughton, Norah N

    2009-05-01

    Regional anesthesia has an expanding role in upper extremity surgery. Brachial plexus blocks offer several advantages including providing effective analgesia, reducing narcotic requirements, and facilitating ambulatory care surgery. Despite the popularity of nerve blocks, the surgeon must not forget the complications associated with regional anesthesia. This article describes a case of symptomatic phrenic nerve palsy after supraclavicular brachial plexus block in an obese man. A 46-year-old obese man underwent a left-sided supraclavicular block in preparation for decompression of Guyon's canal for ulnar mononeuropathy at the wrist. The patient experienced acute-onset dyspnea, chest discomfort, and anxiety, and physical examination demonstrated reduced breath sounds in the left hemithorax. Chest radiographs documented elevation of the left hemidiaphragm consistent with an iatrogenic phrenic nerve palsy. The patient was admitted for 23-hour observation and underwent an uncomplicated ulnar nerve decompression under Bier block anesthesia 1 week later. No long-term sequelae have been identified; however, there was a delay in surgical care, admission to the hospital, and transient pulmonary symptoms. We attribute this complication to significant abdominal obesity causing compromised pulmonary reserve and poor tolerance of transient hemidiaphragmatic paresis. In recent studies, waist circumference and abdominal height were inversely related to pulmonary function. We suspect that the incidence of symptomatic phrenic nerve palsy associated with brachial plexus blocks will increase as the prevalence of obesity increases in this country. PMID:19472948

  16. Effects of normal aging on myelin sheath ultrastructures in the somatic sensorimotor system of rats.

    PubMed

    Xie, Fang; Liang, Ping; Fu, Han; Zhang, Jiu-Cong; Chen, Jun

    2014-07-01

    Previous studies have presented qualitative and quantitative data regarding the morphological changes that occur peripherally in myelin sheaths and nerve fibers of rats during their lifespan. However, studies on ultrastructural features of myelinated fibers (MFs) in the central nervous system (CNS) remain limited. In the present study, morphological analyses of the somatic sensorimotor MFs in rats at time‑points between postnatal day 14 and postnatal month (PNM) 26 were conducted using electron microscopy. Significant alterations in the myelin sheath were observed in the sensorimotor system of aging and aged rats, which became aggravated with age. The ultrastructural pattern of myelin lamellae also exhibited age dependence. The transformation of the myelin intraperiod line from complete to incomplete fusion occurred after PNM 5, leading to an expansion of periodicity in myelin lamellae. These pathological changes in the myelin structure occurred very early and showed a significant correlation with age, indicating that myelin was the part of the CNS with the highest susceptibility to the influence of aging, and may be the main target of aging effects. In addition to the myelin breakdown, continued myelin production and remyelination were observed in the aging sensorimotor system, suggesting the presence of endogenous mechanisms of myelin repair.

  17. Bubble coalescence in rhyolitic melts during decompression from high pressure

    NASA Astrophysics Data System (ADS)

    Gardner, James E.

    2007-10-01

    When bubbly magma becomes permeable, its eruptive behavior is altered and gases are released that may be detected for monitoring. Permeability is produced by bubbles interacting and coalescing, but can be changed if the magmatic foam deforms. This study investigates how decompression rate and viscosity influence bubble coalescence through a series of hydrothermal experiments, in which bubble-bearing rhyolite is decompressed at temperatures ranging from 725° to 875 °C, producing viscosities of ˜ 10 5-10 7 Pa s. Most decompressions are at steady rates of 0.0064 to 0.025 MPa s - 1 , but a few are at rates that increase as pressure decreases; all are slow enough to maintain equilibrium as pressure drops. Bubble interaction and coalescence is recorded by variations in bubble sizes and bubble number density ( NB), and is found to be influenced strongly by melt viscosity, with more time needed for bubbles to coalesce as viscosity increases, yet the extent of coalescence appears limited by the distance between bubbles. The extent of coalescence is also influenced by decompression rate, with bubble interactions in lower viscosity melts being suppressed at decompression rates comparable to those expected for Plinian eruptions. In contrast, rates equivalent to lava dome extrusions are too slow to hinder bubble interactions from extensively altering the bubble population in lower viscosity melts. Deformation of coalescing permeable foam was observed when NB is on order of ˜ 10 5 cm - 3 , but not when it was on order of ˜ 10 7 cm - 3 , suggesting that magma degassing could be influenced by how many bubbles nucleate in the first place.

  18. Role of Inflammatory Reponse in Experimental Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Little, T.

    1999-01-01

    Decompression to altitude can result in gas bubble formation both in tissues and in the systemic veins. The venous gas emboli (VGE) are often monitored during decompression exposures to assess risk for decompression sickness (DCS). Astronauts are at risk for DCS during extravehicular activities (EVA), where decompression occurs from the Space Shuttle or Space Station atmospheric pressure of 14.7 pounds per square inch (PSI) to that of the space suit pressure of 4.3 PSI. DCS symptoms include diffuse pain, especially around joints, inflammation and edema. Pathophysiological effects include interstitial inflammatory responses and recurring injury to the vascular endothelium. Such responses can result in vasoconstriction and associated hemodynamic changes.The granulocyte cell activation and chemotaxin release results in the formation of vasoactive and microvascular permeability altering mediators, especially from the lungs which are the principal target organ for the venous bubbles, and from activated cells (neutrophils, platelets, macrophages). Such mediators include free arachidonic acid and the byproducts of its metabolism via the cyclooxygenase and lipoxygenase pathways (see figure). The cyclooxygenase pathway results in formation of prostacyclin and other prostaglandins and thromboxanes that cause vasoconstriction, bronchoconstriction and platelet aggregation. Leukotrienes produced by the alternate pathway cause pulmonary and bronchial smooth muscle contraction and edema. Substances directly affecting vascular tone such as nitric oxide may also play a role in the respose to DCS. We are studying the role and consequent effects of the release inflammatory bioactive mediators as a result of DCS and VGE. More recent efforts are focused on identifying the effects of the body's circadian rhythm on these physiological consequences to decompression stress. al

  19. Paradoxical Herniation After Unilateral Decompressive Craniectomy Predicts Better Patient Survival

    PubMed Central

    Chen, Weiqiang; Guo, Jingfang; Wu, Jin; Peng, Guoyi; Huang, Mindong; Cai, Chuwei; Yang, Yingming; Wang, Shousen

    2016-01-01

    Abstract Paradoxical herniation (PH) is a life-threatening emergency after decompressive craniectomy. In the current study, we examined patient survival in patients who developed PH after decompressive craniectomy versus those who did not. Risk factors for, and management of, PH were also analyzed. This retrospective analysis included 429 consecutive patients receiving decompressive craniectomy during a period from January 2007 to December 2012. Mortality rate and Glasgow Outcome Scale (GOS) were compared between those who developed PH (n = 13) versus those who did not (n = 416). A stepwise multivariate logistic regression analysis was carried out to examine the risk factors for PH. The overall mortality in the entire sample was 22.8%, with a median follow-up of 6 months. Oddly enough, all 13 patients who developed PH survived beyond 6 months. Glasgow Coma Scale did not differ between the 2 groups upon admission, but GOS was significantly higher in subjects who developed PH. Both the disease type and coma degree were comparable between the 13 PH patients and the remaining 416 patients. In all PH episodes, patients responded to emergency treatments that included intravenous hydration, cerebral spinal fluid drainage discontinuation, and Trendelenburg position. A regression analysis indicated the following independent risk factors for PH: external ventriculostomy, lumbar puncture, and continuous external lumbar drainage. The rate of PH is approximately 3% after decompressive craniectomy. The most intriguing findings of the current study were the 0% mortality in those who developed PH versus 23.6% mortality in those who did not develop PH and significant difference of GOS score at 6-month follow-up between the 2 groups, suggesting that PH after decompressive craniectomy should be managed aggressively. The risk factors for PH include external ventriculostomy, ventriculoperitoneal shunt, lumbar puncture, and continuous external lumbar drainage. PMID:26945365

  20. A single microvascular decompression surgery cures a patient with trigeminal neuralgia, hemifacial spasm, tinnitus, hypertension, and paroxysmal supraventricular tachycardia caused by the compression of a vertebral artery.

    PubMed

    Jia, Yin; Wenhua, Wang; Quanbin, Zhang

    2013-01-01

    This report presents a 72-year-old woman with posterior cranial fossa neurovascular compression syndrome that included paroxysmal supraventricular tachycardia. The patient underwent surgical exploration of the posterior cranial fossa, and a gross left vertebral artery was identified as the offending vessel. The neurovascular conflicts were associated with the cranial nerves V, VII, VIII, IX, and X. The patient experienced significant postoperative relief. Probably this is the first report of a single microvascular decompression, having cured such a high number of syndromes, including paroxysmal supraventricular tachycardia.

  1. Characterization and outcomes of repeat orbital decompression for thyroid-associated orbitopathy.

    PubMed

    Zhang-Nunes, Sandy X; Dang, Sabin; Garneau, Helene Chokron; Hwang, Catherine; Isaacs, David; Chang, Shu-Hong; Goldberg, Robert

    2015-04-01

    Orbital decompression for thyroid-associated orbitopathy (TAO) is commonly performed for disfiguring proptosis, congestion, and optic neuropathy. Although one decompression typically achieves goals, a small percentage requires repeat decompression. We performed a 10-year retrospective chart review of all orbital decompressions for TAO at a single tertiary referral institution. Four-hundred and ninety-five orbits (330 patients) were decompressed for TAO, with 45 orbits (37 patients) requiring repeat decompression. We reviewed the repeat cases for indications, clinical activity scores, approach, walls decompressed, and outcomes. Nine percent of orbits required repeat decompression for proptosis (70%), optic neuropathy (25%) or congestion (45%). Sixty-four percent were for recurrence of disease, 36% were for suboptimal decompression. Three incisional approaches were used: lateral upper eyelid crease, inferior transconjunctival, and transcaruncular, with inferior transconjunctival being most common. Of the three walls removed, deep lateral, inferior, and medial, the deep lateral wall was most common (51%). A repeat lateral decompression was the most frequent pattern. Of 37 patients requiring repeat decompression, 40% had diplopia prior to repeat, and an additional 24% developed diplopia after the repeat. Whereas previous studies published by our group cited only 2.6% of deep lateral wall orbital decompressions leading to new-onset primary gaze diplopia, repeat orbital decompressions have a much higher rate of post-operative diplopia. The new onset primary gaze diplopia after repeat decompression group had a higher average preoperative CAS (3.3 vs. 2.4, p < 0.01), higher mean blood loss (56 vs. 19 mL, p = 0.04), more frequent medial wall decompressions (47% vs. 29%, p = 0.33), and greater proptosis reduction (2.4 vs. 1.7 mm, p = 0.24).

  2. CNS myelin sheath is stochastically built by homotypic fusion of myelin membranes within the bounds of an oligodendrocyte process.

    PubMed

    Szuchet, Sara; Nielsen, Lauren L; Domowicz, Miriam S; Austin, Jotham R; Arvanitis, Dimitrios L

    2015-04-01

    Myelin - the multilayer membrane that envelops axons - is a facilitator of rapid nerve conduction. Oligodendrocytes form CNS myelin; the prevailing hypothesis being that they do it by extending a process that circumnavigates the axon. It is pertinent to ask how myelin is built because oligodendrocyte plasma membrane and myelin are compositionally different. To this end, we examined oligodendrocyte cultures and embryonic avian optic nerves by electron microscopy, immuno-electron microscopy and three-dimensional electron tomography. The results support three novel concepts. Myelin membranes are synthesized as tubules and packaged into "myelinophore organelles" in the oligodendrocyte perikaryon. Myelin membranes are matured in and transported by myelinophore organelles within an oligodendrocyte process. The myelin sheath is generated by myelin membrane fusion inside an oligodendrocyte process. These findings abrogate the dogma of myelin resulting from a wrapping motion of an oligodendrocyte process and open up new avenues in the quest for understanding myelination in health and disease.

  3. Abiotic Deposition of Fe Complexes onto Leptothrix Sheaths

    PubMed Central

    Kunoh, Tatsuki; Hashimoto, Hideki; McFarlane, Ian R.; Hayashi, Naoaki; Suzuki, Tomoko; Taketa, Eisuke; Tamura, Katsunori; Takano, Mikio; El-Naggar, Mohamed Y.; Kunoh, Hitoshi; Takada, Jun

    2016-01-01

    Bacteria classified in species of the genus Leptothrix produce extracellular, microtubular, Fe-encrusted sheaths. The encrustation has been previously linked to bacterial Fe oxidases, which oxidize Fe(II) to Fe(III) and/or active groups of bacterial exopolymers within sheaths to attract and bind aqueous-phase inorganics. When L. cholodnii SP-6 cells were cultured in media amended with high Fe(II) concentrations, Fe(III) precipitates visibly formed immediately after addition of Fe(II) to the medium, suggesting prompt abiotic oxidation of Fe(II) to Fe(III). Intriguingly, these precipitates were deposited onto the sheath surface of bacterial cells as the population was actively growing. When Fe(III) was added to the medium, similar precipitates formed in the medium first and were abiotically deposited onto the sheath surfaces. The precipitates in the Fe(II) medium were composed of assemblies of globular, amorphous particles (ca. 50 nm diameter), while those in the Fe(III) medium were composed of large, aggregated particles (≥3 µm diameter) with a similar amorphous structure. These precipitates also adhered to cell-free sheaths. We thus concluded that direct abiotic deposition of Fe complexes onto the sheath surface occurs independently of cellular activity in liquid media containing Fe salts, although it remains unclear how this deposition is associated with the previously proposed mechanisms (oxidation enzyme- and/or active group of organic components-involved) of Fe encrustation of the Leptothrix sheaths. PMID:27271677

  4. The plasma drag and dust motion inside the magnetized sheath

    SciTech Connect

    Pandey, B. P.; Vladimirov, S. V.; Samarian, A.

    2011-05-15

    The motion of micron size dust inside the sheath in the presence of an oblique magnetic field is investigated by self-consistently calculating the charge and various forces acting on the dust. It is shown that the dust trajectory inside the sheath, which is like an Archimedean spiral swinging back and forth between the wall and the plasma-sheath boundary, depends only indirectly on the orientation of the magnetic field. When the Lorentz force is smaller than the collisional momentum exchange, the dust dynamics is insensitive to the obliqueness of the magnetic field. Only when the magnetic field is strong enough, the sheath structure and, thus, the dust dynamics are significantly affected by the field orientation. Balance between the plasma drag, sheath electrostatic field, and gravity plays an important role in determining how far the dust can travel inside the sheath. The dust equilibrium point shifts closer to the wall in the presence of gravity and plasma drag. However, in the absence of plasma drag, dust can sneak back into the plasma if acted only by gravity. The implication of our results to the usability of dust as a sheath probe is discussed.

  5. Nonextensive statistics and the sheath criterion in collisional plasmas

    SciTech Connect

    Hatami, M. M.

    2015-01-15

    The Bohm criterion in an electropositive plasma containing nonextensively distributed electrons and warm ions is investigated by using a steady state two-fluid model. Taking into account the ion-neutral collisions and finite temperature of ions, a modified Bohm criterion is derived which limits both maximum and minimum allowable velocity of ions at the sheath edge (u{sub 0i}). It is found that the degree of nonextensivity of electrons (q) and temperature of positive ions (T{sub i}) affect only the lower limit of the entrance velocity of ions into the sheath while the degree of ion collisionality (α) influences both lower and upper limits of the ion velocities at the sheath edge. In addition, depending on the value of q, it is shown that the minimum velocity of positive ions at the sheath edge can be greater or smaller than its Maxwellian counterpart. Moreover, it is shown that, depending on the values of α and T{sub i}, the positive ions with subsonic velocity may enter the sheath for either q > 1 or −1 < q < 1. Finally, as a practical application, the density distribution of charged particles in the sheath region is studied for different values of u{sub 0i}, and it is shown that monotonical reduction of the positive ion density distribution occurs only when the velocity of positive ions at the sheath edge lies between two above mentioned limits.

  6. Abiotic Deposition of Fe Complexes onto Leptothrix Sheaths.

    PubMed

    Kunoh, Tatsuki; Hashimoto, Hideki; McFarlane, Ian R; Hayashi, Naoaki; Suzuki, Tomoko; Taketa, Eisuke; Tamura, Katsunori; Takano, Mikio; El-Naggar, Mohamed Y; Kunoh, Hitoshi; Takada, Jun

    2016-01-01

    Bacteria classified in species of the genus Leptothrix produce extracellular, microtubular, Fe-encrusted sheaths. The encrustation has been previously linked to bacterial Fe oxidases, which oxidize Fe(II) to Fe(III) and/or active groups of bacterial exopolymers within sheaths to attract and bind aqueous-phase inorganics. When L. cholodnii SP-6 cells were cultured in media amended with high Fe(II) concentrations, Fe(III) precipitates visibly formed immediately after addition of Fe(II) to the medium, suggesting prompt abiotic oxidation of Fe(II) to Fe(III). Intriguingly, these precipitates were deposited onto the sheath surface of bacterial cells as the population was actively growing. When Fe(III) was added to the medium, similar precipitates formed in the medium first and were abiotically deposited onto the sheath surfaces. The precipitates in the Fe(II) medium were composed of assemblies of globular, amorphous particles (ca. 50 nm diameter), while those in the Fe(III) medium were composed of large, aggregated particles (≥3 µm diameter) with a similar amorphous structure. These precipitates also adhered to cell-free sheaths. We thus concluded that direct abiotic deposition of Fe complexes onto the sheath surface occurs independently of cellular activity in liquid media containing Fe salts, although it remains unclear how this deposition is associated with the previously proposed mechanisms (oxidation enzyme- and/or active group of organic components-involved) of Fe encrustation of the Leptothrix sheaths. PMID:27271677

  7. Ion Dynamics Model for Collisionless Radio Frequency Sheaths

    NASA Technical Reports Server (NTRS)

    Bose, Deepak; Govindan, T.R.; Meyyappan, M.

    2000-01-01

    Full scale reactor model based on fluid equations is widely used to analyze high density plasma reactors. It is well known that the submillimeter scale sheath in front of a biased electrode supporting the wafer is difficult to resolve in numerical simulations, and the common practice is to use results for electric field from some form of analytical sheath model as boundary conditions for full scale reactor simulation. There are several sheath models in the literature ranging from Child's law to a recent unified sheath model [P. A. Miller and M. E. Riley, J. Appl. Phys. 82, 3689 (1997)l. In the present work, the cold ion fluid equations in the radio frequency sheath are solved numerically to show that the spatiotemporal variation of ion flux inside the sheath, commonly ignored in analytical models, is important in determining the electric field and ion energy at the electrode. Consequently, a semianalytical model that includes the spatiotemporal variation of ion flux is developed for use as boundary condition in reactor simulations. This semianalytical model is shown to yield results for sheath properties in close agreement with numerical solutions.

  8. Probabilistic modelling for estimating gas kinetics and decompression sickness risk in pigs during H2 biochemical decompression.

    PubMed

    Fahlman, Andreas; Kayar, Susan R

    2003-07-01

    We modelled the kinetics of H2 flux during gas uptake and elimination in conscious pigs exposed to hyperbaric H2. The model used a physiological description of gas flux fitted to the observed decompression sickness (DCS) incidence in two groups of pigs: untreated controls, and animals that had received intestinal injections of H2-metabolizing microbes that biochemically eliminated some of the H2 stored in the pigs' tissues. To analyse H2 flux during gas uptake, animals were compressed in a dry chamber to 24 atm (ca 88% H2, 9% He, 2% O2, 1% N2) for 30-1440 min and decompressed at 0.9 atm min(-1) (n = 70). To analyse H2 flux during gas elimination, animals were compressed to 24 atm for 3 h and decompressed at 0.45-1.8 atm min(-1) (n = 58). Animals were closely monitored for 1 h post-decompression for signs of DCS. Probabilistic modelling was used to estimate that the exponential time constant during H2 uptake (tau(in)) and H2 elimination (tau(out)) were 79 +/- 25 min and 0.76 +/- 0.14 min, respectively. Thus, the gas kinetics affecting DCS risk appeared to be substantially faster for elimination than uptake, which is contrary to customary assumptions of gas uptake and elimination kinetic symmetry. We discuss the possible reasons for this asymmetry, and why absolute values of H2 kinetics cannot be obtained with this approach.

  9. Structural and Biochemical Analysis of the Sheath of Phormidium uncinatum

    PubMed Central

    Hoiczyk, Egbert

    1998-01-01

    The sheath of the filamentous, gliding cyanobacterium Phormidium uncinatum was studied by using light and electron microscopy. In thin sections and freeze fractures the sheath was found to be composed of helically arranged carbohydrate fibrils, 4 to 7 nm in diameter, which showed a substantial degree of crystallinity. As in all other examined motile cyanobacteria, the arrangement of the sheath fibrils correlates with the motion of the filaments during gliding motility; i.e., the fibrils formed a right-handed helix in clockwise-rotating species and a left-handed helix in counterclockwise-rotating species and were radially arranged in nonrotating cyanobacteria. Since sheaths could only be found in old immotile cultures, the arrangement seems to depend on the process of formation and attachment of sheath fibrils to the cell surface rather than on shear forces created by the locomotion of the filaments. As the sheath in P. uncinatum directly contacts the cell surface via the previously identified surface fibril forming glycoprotein oscillin (E. Hoiczyk and W. Baumeister, Mol. Microbiol. 26:699–708, 1997), it seems reasonable that similar surface glycoproteins act as platforms for the assembly and attachment of the sheaths in cyanobacteria. In P. uncinatum the sheath makes up approximately 21% of the total dry weight of old cultures and consists only of neutral sugars. Staining reactions and X-ray diffraction analysis suggested that the fibrillar component is a homoglucan that is very similar but not identical to cellulose which is cross-linked by the other detected monosaccharides. Both the chemical composition and the rigid highly ordered structure clearly distinguish the sheaths from the slime secreted by the filaments during gliding motility. PMID:9683490

  10. The Furcal Nerve Revisited

    PubMed Central

    Dabke, Harshad V.

    2014-01-01

    Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care. PMID:25317309

  11. Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis.

    PubMed

    Mehdi, Syed K; Alentado, Vincent J; Lee, Bryan S; Mroz, Thomas E; Benzel, Edward C; Steinmetz, Michael P

    2016-06-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior

  12. Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis.

    PubMed

    Mehdi, Syed K; Alentado, Vincent J; Lee, Bryan S; Mroz, Thomas E; Benzel, Edward C; Steinmetz, Michael P

    2016-06-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior

  13. Polylactic-co-glycolic acid microspheres containing three neurotrophic factors promote sciatic nerve repair after injury

    PubMed Central

    Zhao, Qun; Li, Zhi-yue; Zhang, Ze-peng; Mo, Zhou-yun; Chen, Shi-jie; Xiang, Si-yu; Zhang, Qing-shan; Xue, Min

    2015-01-01

    A variety of neurotrophic factors have been shown to repair the damaged peripheral nerve. However, in clinical practice, nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor are all peptides or proteins that may be rapidly deactivated at the focal injury site; their local effective concentration time following a single medication cannot meet the required time for spinal axons to regenerate and cross the glial scar. In this study, we produced polymer sustained-release microspheres based on the polylactic-co-glycolic acid copolymer; the microspheres at 300-μm diameter contained nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor. Six microspheres were longitudinally implanted into the sciatic nerve at the anastomosis site, serving as the experimental group; while the sciatic nerve in the control group was subjected to the end-to-end anastomosis using 10/0 suture thread. At 6 weeks after implantation, the lower limb activity, weight of triceps surae muscle, sciatic nerve conduction velocity and the maximum amplitude were obviously better in the experimental group than in the control group. Compared with the control group, more regenerating nerve fibers were observed and distributed in a dense and ordered manner with thicker myelin sheaths in the experimental group. More angiogenesis was also visible. Experimental findings indicate that polylactic-co-glycolic acid composite microspheres containing nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor can promote the restoration of sciatic nerve in rats after injury. PMID:26604912

  14. Polylactic-co-glycolic acid microspheres containing three neurotrophic factors promote sciatic nerve repair after injury.

    PubMed

    Zhao, Qun; Li, Zhi-Yue; Zhang, Ze-Peng; Mo, Zhou-Yun; Chen, Shi-Jie; Xiang, Si-Yu; Zhang, Qing-Shan; Xue, Min

    2015-09-01

    A variety of neurotrophic factors have been shown to repair the damaged peripheral nerve. However, in clinical practice, nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor are all peptides or proteins that may be rapidly deactivated at the focal injury site; their local effective concentration time following a single medication cannot meet the required time for spinal axons to regenerate and cross the glial scar. In this study, we produced polymer sustained-release microspheres based on the polylactic-co-glycolic acid copolymer; the microspheres at 300-μm diameter contained nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor. Six microspheres were longitudinally implanted into the sciatic nerve at the anastomosis site, serving as the experimental group; while the sciatic nerve in the control group was subjected to the end-to-end anastomosis using 10/0 suture thread. At 6 weeks after implantation, the lower limb activity, weight of triceps surae muscle, sciatic nerve conduction velocity and the maximum amplitude were obviously better in the experimental group than in the control group. Compared with the control group, more regenerating nerve fibers were observed and distributed in a dense and ordered manner with thicker myelin sheaths in the experimental group. More angiogenesis was also visible. Experimental findings indicate that polylactic-co-glycolic acid composite microspheres containing nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor can promote the restoration of sciatic nerve in rats after injury.

  15. Absence of Debye sheaths due to secondary electron emission.

    PubMed

    Campanell, M D; Khrabrov, A V; Kaganovich, I D

    2012-06-22

    A bounded plasma where the hot electrons impacting the walls produce more than one secondary on average is studied via particle-in-cell simulation. It is found that no classical Debye sheath or space-charge-limited sheath exists. Ions are not drawn to the walls and electrons are not repelled. Hence the unconfined plasma electrons travel unobstructed to the walls, causing extreme particle and energy fluxes. Each wall has a positive charge, forming a small potential barrier or "inverse sheath" that pulls some secondaries back to the wall to maintain the zero current condition.

  16. Analytical model for the radio-frequency sheath

    NASA Astrophysics Data System (ADS)

    Czarnetzki, Uwe

    2013-12-01

    A simple analytical model for the planar radio-frequency (rf) sheath in capacitive discharges is developed that is based on the assumptions of a step profile for the electron front, charge exchange collisions with constant cross sections, negligible ionization within the sheath, and negligible ion dynamics. The continuity, momentum conservation, and Poisson equations are combined in a single integro-differential equation for the square of the ion drift velocity, the so called sheath equation. Starting from the kinetic Boltzmann equation, special attention is paid to the derivation and the validity of the approximate fluid equation for momentum balance. The integrals in the sheath equation appear in the screening function which considers the relative contribution of the temporal mean of the electron density to the space charge in the sheath. It is shown that the screening function is quite insensitive to variations of the effective sheath parameters. The two parameters defining the solution are the ratios of the maximum sheath extension to the ion mean free path and the Debye length, respectively. A simple general analytic expression for the screening function is introduced. By means of this expression approximate analytical solutions are obtained for the collisionless as well as the highly collisional case that compare well with the exact numerical solution. A simple transition formula allows application to all degrees of collisionality. In addition, the solutions are used to calculate all static and dynamic quantities of the sheath, e.g., the ion density, fields, and currents. Further, the rf Child-Langmuir laws for the collisionless as well as the collisional case are derived. An essential part of the model is the a priori knowledge of the wave form of the sheath voltage. This wave form is derived on the basis of a cubic charge-voltage relation for individual sheaths, considering both sheaths and the self-consistent self-bias in a discharge with arbitrary

  17. Electron-Hose Instability in an Annular Plasma Sheath

    SciTech Connect

    Whittum, David H.

    1999-07-08

    A relativistic electron beam propagating through an annular plasma sheath is subject to a transverse plasma-electron coupled electrostatic instability. From the linearized fluid equations, the beam-sheath interaction is resolved into three coupled equations. The corresponding wakefield is computed and the asymptotic linear evolution is noted. For illustration, numerical examples are given for a plasma accelerator employing such a sheath. While the coasting beam scalings are quite severe at low energy, single-bunch instability growth can in fact be reduced to nil, for a very high-gradient accelerator.

  18. Absence of Debye Sheaths Due to Secondary Electron Emission

    SciTech Connect

    M.D. Campanell, A. Khrabrov and I. D. Kaganovich

    2012-05-11

    A bounded plasma where the hot electrons impacting the walls produce more than one secondary on average is studied via particle-in-cell simulation. It is found that no classical Debye sheath or space-charge limited sheath exists. Ions are not drawn to the walls and electrons are not repelled. Hence the unconfined plasma electrons travel unobstructed to the walls, causing extreme particle and energy fluxes. Each wall has a positive charge, forming a small potential barrier or "inverse sheath" that pulls some secondaries back to the wall to maintain the zero current condition.

  19. Spontaneous rectus sheath hematoma in a patient treated with apixaban.

    PubMed

    Aktas, Halil; Inci, Sinan; Dogan, Pinar; Izgu, Ibrahim

    2016-02-01

    Apixaban, a non-vitamin K antagonist oral anticoagulants, is a Factor Xa inhibitor that is prescribed for the treatment of non valvular atrial fibrillation. Rectus sheath hematoma is a rare but significant complication of oral anticoagulant treatment. The important causes of rectus sheath hematoma include treatment with anticoagulants, hematologic diseases, trauma, intense physical activity, coughing, sneezing and pregnancy. In this report, we describe case of a 71-year-old woman undergoing apixaban treatment for non valvular atrial fibrillation who presented with spontaneous rectus sheath hematoma. PMID:26989650

  20. Measurement of sheath thickness at a floating potential

    SciTech Connect

    Han, Hyung-Sik; Lee, Hyo-Chang; Oh, Se-Jin; Chung, Chin-Wook

    2014-02-15

    In a cylindrical Langmuir probe measurement, ion current is collected from the surface of the sheath surrounded at probe tip, not at the surface of the probe tip. By using this, the sheath thickness can be obtained, if we know some unknown parameters, such as ion current, plasma density, and electron temperature. In this paper, we present a method to measure sheath thickness by using a wave cutoff method and a floating harmonic method. The measured result is in a good agreement with Allen-Boyd-Reynolds theory.

  1. Measurement of sheath thickness at a floating potential

    NASA Astrophysics Data System (ADS)

    Han, Hyung-Sik; Lee, Hyo-Chang; Oh, Se-Jin; Chung, Chin-Wook

    2014-02-01

    In a cylindrical Langmuir probe measurement, ion current is collected from the surface of the sheath surrounded at probe tip, not at the surface of the probe tip. By using this, the sheath thickness can be obtained, if we know some unknown parameters, such as ion current, plasma density, and electron temperature. In this paper, we present a method to measure sheath thickness by using a wave cutoff method and a floating harmonic method. The measured result is in a good agreement with Allen-Boyd-Reynolds theory.

  2. Effects of State and Decompression Rate on the Decompressive Response of Volatile- and Crystal-Bearing Analogue Magmas.

    NASA Astrophysics Data System (ADS)

    Spina, L.; Cimarelli, C.; Scheu, B.; Dingwell, D. B.

    2014-12-01

    Volcanic eruptive styles are influenced both by the physical properties of the ascending magma as well as the decompression rates involved. Systematic experimental investigations of both state and rate have been performed here on analogue basaltic systems. Controlled decompression experiments were performed in a shock tube system, using a silicon oil basis as the basalt proxy. The samples were saturated with 10 MPa of Ar for 72h, followed by controlled decompression. Four series of experiments were performed: 1) Pure liquids with viscosities ranging from 1 to 1000 Pa s were used to map the liquid response. 2) Micrometric spherical particles were added to the liquid to evaluate the effect of crystal fraction. 3) The role of crystal shape was examined by using particles with different aspect ratios. 4) Finally, the effects of saturation time and of pressure were examined via a series of experiments at 24 h, performed over a range of saturation pressure. The dynamics of foaming and flow of the bubbly fluid during decompression were constrained using image analysis, by measuring the height of the expanding column, as well as analyzing the bubble size distribution. At the onset a delayed nucleation event is observed. When the amount of nucleated bubbles approaches a critical thickness, a foam develops. Finally, the foam reaches equilibrium, and starts oscillating in response to the balance between foam disruption and growth. These observation may have important implications for oscillatory eruptive phenomena observed in active volcanoes (i.e. gas piston activity). Finally, the effect of crystals was investigated. In their presence, heterogeneous nucleation enhances the number of bubble nuclei, even at low crystal fractions. As a consequence, the foam develops earlier, and is able to ascend with major upward speed, in comparison to the pure oil. Experimental decompression of silicon oil has proven to be a unique tool to unravel the hidden dynamics of magma into the

  3. Nitrogen partial pressures in man after decompression from simulated scuba dives at rest and during exercise.

    PubMed

    Radermacher, P; Santak, B; Muth, C M; Wenzel, J; Hampe, P; Vogt, L; Hahn, M; Falke, K J

    1990-11-01

    In 5 subjects arterial and central venous nitrogen partial pressures (PN2) were measured after decompression from a chamber dive following a decompression schedule for scuba diving. The simulated dives consisted of exposure to air at 6 bar for 30 min corresponding to a depth of 50 m. Afterward the subjects were decompressed with decompression stops at 2.5, 2.2, 1.9, 1.6, and 1.3 bar with a total decompression time of 67 min. In 3 of the subjects the measurements were repeated after they had exercised (workload 75 W) during bottom time. Immediately after decompression and every 40 min until Minute 240 arterial and central venous blood samples were analyzed for PN2 using a manometric Van Slyke apparatus. Venous PN2 remained elevated until 160 min after decompression, indicating still incomplete nitrogen washout for at least 2 h after decompression had been accomplished. We did not find any difference in PN2 values after decompression from dives at rest and after exercise. Applying a computer program based on a wide range of theoretical tissue half-times nitrogen elimination proved to be consistent with Haldanian theories when using our decompression profile. Our data confirm that nitrogen elimination is prolonged after decompression from simulated dives at rest and after exercise.

  4. Schwannoma of the Median Nerve at Mid Forearm Level

    PubMed Central

    Dusad, Tarun; Meena, D.S.; Saini, Narendra; Sharma, Yogesh; Khurana, Deepak

    2016-01-01

    Introduction: Schwannomas are also known as neurilemmoma that usually originate from Schwann cells located in the peripheral nerve sheaths. It usually occurs in the age group of 20 to 70 years. These are the commonest tumors of the peripheral nerves, 5% of which occur in the adults and 19% of the tumors occur in upper extremities. Schwannomas are generally presented as an asymptomatic mass. Discomfort may be the only presenting complaint of the patient. Paresthesia may be elicited on tapping the swelling. Magnetic resonanceimaging, and ultrasound are helpful in the diagnosis. Surgical removal is usually curative. Case Presentation: A 28-year-old male came to our hospital for a lump located at the volar side of the right mid forearm for 10 years with discomfort and paresthesia in median nerve distribution of hand which appeared in last two years. Total excision was performed for the lesion. Histopathological examination of the mass revealed typical features of schwannoma. At two months follow-up, the patient was symptom free with mild paresthesia in his index and middle fingers. Conclusion: Benign tumours involving peripheral nerves of the upper extremity are uncommon. Schwannomas are theoretically removable because they repulse fascicular groups without penetrating them, thus allowing their enucleation while preserving nerve continuity, as reported in our patient.

  5. On diver thermal status and susceptibility to decompression sickness.

    PubMed

    Gerth, Wayne A

    2015-09-01

    In a recent Letter to the Editor, Clarke, et al, indicated that divers who deliberately chill themselves on a dive to reduce risk of decompression sickness (DCS) may be misinterpreting our 2007 Navy Experimental Diving Unit (NEDU) report. Indeed, we did not advocate that divers should risk hypothermia on bottom to reduce risk of DCS, nor do we dispute the authors' overall admonition to avoid diving cold unnecessarily. However, Clarke, et al, imply more generally that results of our study are not applicable to recreational or technical divers because the dives we tested were atypical of dives undertaken by such divers. We wish to clarify that our study does have implications for recreational and technical divers, implications that should not be ignored. The dives we tested were not intended to be typical of dives undertaken in any actual operational context. Instead, we chose to expose divers to temperatures at the extremes of their thermal tolerance in order to ensure that effects of diver thermal status on DCS susceptibility would be found if such effects existed. Our initial test dive profile provided appreciable time both on bottom and during decompression to allow any differential thermal effects during these two dive phases to manifest, while affording a baseline risk of DCS that could be altered by thermal effects without exposing subjects to inordinately high risks of DCS. Our results strongly indicate that the optimal diver thermal conditions for mitigation of DCS risk or minimization of decompression time entail remaining cool during gas uptake phases of a dive and warm during off-gassing phases. While the dose-response characteristics of our observed thermal effects are almost certainly non-linear in both exposure temperature and duration, it is only reasonable to presume that the effects vary monotonically with these factors. We have no reason to presume that such responses and effects under less extreme conditions would be in directions opposite to

  6. Investigating degassing dynamics into the shallow conduit through decompression experiments

    NASA Astrophysics Data System (ADS)

    Spina, Laura; Scheu, Bettina; Cimarelli, Corrado; Dingwell, Donald

    2014-05-01

    The history of bubbles' growth and interaction, as well as their spatial distribution in the shallow conduit, is deeply interconnected with the style of the eruptions. According to the fundamental role played by volatiles in the eruptive process, more effort is required in determining how the key factors of volcanic systems (i.e., magma properties, decompression rate) influence the dynamics of degassing. Therefore, our aim is to provide, through the analysis of decompression experiments on analogue materials, insights on such relations. We performed several decompression experiments with a shock-tube apparatus, and using silicon oil as laboratory-analogue for the magmatic melt. The sample was placed in a transparent autoclave, saturated with Argon for an established amount of time under a fixed pressure (up to a maximum of 10 MPa). Successively it was decompressed to atmospheric conditions, by releasing gas through a control valve. The dynamics of gas exsolution processes were recorded by using pressure sensors and a high speed camera. A range of viscosity values (1, 10, 100, 1000 Pa s) was investigated, for the same decompression path. Furthermore, some experiments were carried out with the addition of glass beads, as analogue to crystals, to the pure liquid. The height of the expanding column was monitored, in conjunction with images recorded during the experiments, and the growth rate of bubbles was measured at different times and depth. Finally, bubble size distribution has been evaluated at various stages for some experiments, in order to achieve a spatial map of the ongoing degassing phenomena. Results allowed us to define different regimes occurring during the decompression, whose features and characteristics are strongly affected by fluid viscosity. Indeed, several degassing phases were observed, from bubbly fluid to the eventual buildup of a more or less "foamy" phase, which ultimately experiences periodical oscillations around an average equilibrium level

  7. Crystal Nucleation and Growth in Mount Unzen Dacite Decompression Experiments

    NASA Astrophysics Data System (ADS)

    Almberg, L. D.; Larsen, J. F.; Eichelberger, J. C.

    2005-12-01

    Central to understanding eruption dynamics is the interplay of decompression and degassing, which triggers crystal nucleation and growth. Microlite and microphenocryst textures are an often-used tool to decipher the rates of magma ascent for specific eruptions. It is critical to determine the depth and time scale at which these processes take place to fully understand the system behavior. Conduit material retrieved from 1500 m depth from the USDP-4 at Mount Unzen, Japan provides a snap shot of a viscous magma en route to the surface and is a perfect counterpoint to compare with laboratory experiments under controlled P, T, and XH2O conditions. The core samples were identified as representing material from the 1991-1995 eruption based upon their elemental and isotopic composition and coincidence with a temperature maximum and alteration minimum (Nakada et al, ICDP Symposium, Potsdam, 2005). Three plagioclase crystal populations coexist in the spine emplaced at the conclusion of the eruption sequence in 1995, microlites (<20 μm), microphenocrysts (20-100 μm) and phenocrysts (>100 μm). Only phenocrysts and microlites are present in the samples extracted from 1500 m during drilling of the USDP-4 core. These textural differences are the focus of decompression experiments, with the purpose of replicating shallow level crystallization that may have occurred between 1500 m depth and the surface. It is possible that the microphenocrysts present in the dome lavas and absent in the conduit core could have formed at very shallow levels during magmatic ascent. Our experimental work delineates the role of decompression in controlling crystal size distributions in Unzen dacite, for comparison with the natural dome lavas and USDP-4 core samples. We conducted isothermal (870 ± 3°C) single and multi-step decompression experiments, equilibrated at 40 ± 3 MPa under water saturation and NNO conditions, and decompressed to 7.5 ± 0.5 MPa or 318 m depth. We ran such experiments for

  8. Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

    PubMed Central

    Lemos, Laurinda; Alegria, Carlos; Oliveira, Joana; Machado, Ana; Oliveira, Pedro; Almeida, Armando

    2011-01-01

    In idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols) from cases of idiopathic TN, or selected for MVD surgery (n = 22) due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS) and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug therapies, while after MDV surgery several patients showed important side effects. Data reinforce that, (1) TN patients should be carefully evaluated before choosing therapy for pain control, (2) different pharmacological approaches are available to initiate pain control at low costs, and (3) criteria for surgical interventions should be clearly defined due to important side effects, with the initial higher costs being strongly reduced with time. PMID:21941455

  9. [Pre-surgical simulation of microvascular decompression for hemifacial spasm using 3D-models].

    PubMed

    Mashiko, Toshihiro; Yang, Qiang; Kaneko, Naoki; Konno, Takehiko; Yamaguchi, Takashi; Watanabe, Eiju

    2015-01-01

    We have been performing pre-surgical simulations using custom-built patient-specific 3D-models. Here we report the advantageous use of 3D-models for simulating microvascular decompression(MVD)for hemifacial spasms. Seven cases of MVD surgery were performed. Two types of 3D-printers were used to fabricate the 3D-models:one using plaster as the modeling material(Z Printer®450, 3D systems, Rock Hill, SC, USA)and the other using acrylonitrile butadiene styrene(ABS)(UP! Plus 3D printer®, Beijing Tiertime Technology, Beijing). We tested three types of models. Type 1 was a plaster model of the brainstem, cerebellum, facial nerve, and the artery compressing the root exit zone of the facial nerve. Part of the cerebellum was digitally trimmed off to observe "the compressing point" from the same angle as that used during actual surgery. Type 2 was a modified Type 1 in which part of the skull was opened digitally to mimic a craniectomy. Type 3 was a combined model in which the cerebellum and the artery of the Type 2 model were replaced by a soft retractable cerebellum and an elastic artery. The cerebellum was made from polyurethane and cast from a plaster prototype. To fabricate elastic arteries, liquid silicone was painted onto the surface of an ABS artery and the inner ABS model was dissolved away using solvent. In all cases, the 3D-models were very useful. Although each type has advantages, the Type-3 model was judged extremely useful for training junior surgeons in microsurgical approaches.

  10. Microvascular decompression for glossopharyngeal neuralgia through a microasterional approach: A case series

    PubMed Central

    Revuelta-Gutiérrez, Rogelio; Morales-Martínez, Andres Humberto; Mejías-Soto, Carolina; Martínez-Anda, Jaime Jesús; Ortega-Porcayo, Luis Alberto

    2016-01-01

    Background: Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome. It is characterized by a sudden onset lancinating pain usually localized in the sensory distribution of the IX cranial nerve associated with excessive vagal outflow, which leads to bradycardia, hypotension, syncope, or cardiac arrest. This study aims to review our surgical experience performing microvascular decompression (MVD) in patients with GPN. Methods: Over the last 20 years, 14 consecutive cases were diagnosed with GPN. MVD using a microasterional approach was performed in all patients. Demographic data, clinical presentation, surgical findings, clinical outcome, complications, and long-term follow-up were reviewed. Results: The median age of onset was 58.7 years. The mean time from onset of symptoms to treatment was 8.8 years. Glossopharyngeal and vagus nerve compression was from the posterior inferior cerebellar artery in eleven cases (78.5%), vertebral artery in two cases (14.2%), and choroid plexus in one case (7.1%). Postoperative mean follow-up was 26 months (3–180 months). Pain analysis demonstrated long-term pain improvement of 114 ± 27.1 months and pain remission in 13 patients (92.9%) (P = 0.0001) two complications were documented, one patient had a cerebrospinal fluid leak, and another had bacterial meningitis. There was no surgical mortality. Conclusions: GPN is a rare entity, and secondary causes should be discarded. MVD through a retractorless microasterional approach is a safe and effective technique. Our series demonstrated an excellent clinical outcome with pain remission in 92.9%. PMID:27213105

  11. Cellulose/soy protein composite-based nerve guidance conduits with designed microstructure for peripheral nerve regeneration

    NASA Astrophysics Data System (ADS)

    Gan, Li; Zhao, Lei; Zhao, Yanteng; Li, Ke; Tong, Zan; Yi, Li; Wang, Xiong; Li, Yinping; Tian, Weiqun; He, Xiaohua; Zhao, Min; Li, Yan; Chen, Yun

    2016-10-01

    Objective. The objective of this work was to develop nerve guidance conduits from natural polymers, cellulose and soy protein isolate (SPI), by evaluating the effects of cellulose/SPI film-based conduit (CSFC) and cellulose/SPI sponge-based conduit (CSSC) on regeneration of nerve defects in rats. Approach. CSFC and CSSC with the same chemical components were fabricated from cellulose and SPI. Effects of CSSC and CSFC on regeneration of the defective nerve were comparatively investigated in rats with a 10 mm long gap in sciatic nerve. The outcomes of peripheral nerve repair were evaluated by a combination of electrophysiological assessment, Fluoro-Gold retrograde tracing, double NF200/S100 immunofluorescence analysis, toluidine blue staining, and electron microscopy. The probable molecular mechanism was investigated using quantitative real-time PCR (qPCR) analysis. Main results. Compared with CSFC, CSSC had 2.69 times higher porosity and 5.07 times higher water absorption, thus ensuring much higher permeability. The nerve defects were successfully bridged and repaired by CSSC and CSFC. Three months after surgery, the CSSC group had a higher compound muscle action potential amplitude ratio, a higher percentage of positive NF200 and S100 staining, and a higher axon diameter and myelin sheath thickness than the CSFC group, showing the repair efficiency of CSSC was higher than that of CSFC. qPCR analysis indicated the mRNA levels of nerve growth factor, IL-10, IL-6, and growth-associated protein 43 (GAP-43) were higher in the CSSC group. This also indicated that there was better nerve repair with CSSC due to the higher porosity and permeability of CSSC providing a more favourable microenvironment for nerve regeneration than CSFC. Significance. A promising nerve guidance conduit was developed from cellulose/SPI sponge that showed potential for application in the repair of nerve defect. This work also suggests that nerve guidance conduits with better repair efficiency

  12. A radio-frequency sheath model for complex waveforms

    SciTech Connect

    Turner, M. M.; Chabert, P.

    2014-04-21

    Plasma sheaths driven by radio-frequency voltages occur in contexts ranging from plasma processing to magnetically confined fusion experiments. An analytical understanding of such sheaths is therefore important, both intrinsically and as an element in more elaborate theoretical structures. Radio-frequency sheaths are commonly excited by highly anharmonic waveforms, but no analytical model exists for this general case. We present a mathematically simple sheath model that is in good agreement with earlier models for single frequency excitation, yet can be solved for arbitrary excitation waveforms. As examples, we discuss dual-frequency and pulse-like waveforms. The model employs the ansatz that the time-averaged electron density is a constant fraction of the ion density. In the cases we discuss, the error introduced by this approximation is small, and in general it can be quantified through an internal consistency condition of the model. This simple and accurate model is likely to have wide application.

  13. Measure Guideline: Guidance on Taped Insulating Sheathing Drainage Planes

    SciTech Connect

    Grin, A.; Lstiburek, J.

    2014-09-01

    The goal of this research is to provide durable and long-term water management solutions using exterior insulating sheathing as part of the water management system. It is possible to tape or seal the joints in insulating sheathing to create a drainage plane and even an air control layer. There exists the material durability component of the tape as well as the system durability component being the taped insulating sheathing as the drainage plane. This measure guideline provides best practice and product recommendations from the interviewed contractors and homebuilders who collectively have a vast amount of experience. Three significant issues were discussed with the group, which are required to make taped insulating sheathing a simple, long-term, and durable drainage plane: horizontal joints should be limited or eliminated wherever possible; where a horizontal joint exists use superior materials; and frequent installation inspection and regular trade training are required to maintain proper installation.

  14. Plasma sheath multipath analysis and its effect on GNSS navigation

    NASA Astrophysics Data System (ADS)

    Du, Yongxing; Xi, Xiaoli; Song, Zhongguo; Liu, Jiangfan

    2015-11-01

    When hypersonic vehicle reenters the Earth's atmosphere, the plasma sheath will be generated by its collision with ambient air that would affect global navigation satellite system (GNSS). In order to understand such effects, the transmission coefficient of the plasma sheath has been investigated using the numerical method before. But this is found to be insufficient, for besides the attenuation on the signal energy, the multipath effect between the plasma sheath and the vehicle surface is also a serious factor, which may result in errors in pseudorange measurement and carrier phase measurement of GNSS receiver and finally affect the positioning accuracy. The multipath of the plasma sheath is analyzed by finite-difference time-domain method combined with further signal processing, and a simulation platform is established to verify this effects on positioning performance. Simulation results indicate the degradation of positioning performance when these multipath signals were present, causing position error with several meters to tens of meters.

  15. 32. DETAIL OF GEARS LOOKING NORTH WITH SHEATHING REMOVED AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    32. DETAIL OF GEARS LOOKING NORTH WITH SHEATHING REMOVED AND SHAFT OF KING GEAR BEYOND - Caleb Crosby Threshing Barn, Noeton (moved to Norris Dam State Park, Lake City), Morristown, Hamblen County, TN

  16. Morphological analysis of the sheathed flagellum of Brucella melitensis

    PubMed Central

    2010-01-01

    Background It was recently shown that B. melitensis is flagellated. However, the flagellar structure remains poorly described. Findings We analyzed the structure of the polar sheathed flagellum of B. melitensis by TEM analysis and demonstrated that the Ryu staining is a good method to quickly visualize the flagellum by optical microscopy. The TEM analysis demonstrated that an extension of the outer membrane surrounds a filament ending by a club-like structure. The ΔftcR, ΔfliF, ΔflgE and ΔfliC flagellar mutants still produce an empty sheath. Conclusions Our results demonstrate that the flagellum of B. melitensis has the characteristics of the sheathed flagella. Our results also suggest that the flagellar sheath production is not directly linked to the flagellar structure assembly and is not regulated by the FtcR master regulator. PMID:21143933

  17. Porous protective solid phase micro-extractor sheath

    DOEpatents

    Andresen, Brian D.; Randich, Erik

    2005-03-29

    A porous protective sheath for active extraction media used in solid phase microextraction (SPME). The sheath permits exposure of the media to the environment without the necessity of extending a fragile coated fiber from a protective tube or needle. Subsequently, the sheath can pierce and seal with GC-MS septums, allowing direct injection of samples into inlet ports of analytical equipment. Use of the porous protective sheath, within which the active extraction media is contained, mitigates the problems of: 1) fiber breakage while the fiber is extended during sampling, 2) active media coating loss caused by physical contact of the bare fiber with the sampling environment; and 3) coating slough-off during fiber extension and retraction operations caused by rubbing action between the fiber and protective needle or tube.

  18. Solitary fibrous tumor surrounding the carotid sheath.

    PubMed

    Gómez-Oliveira, Guillermo; Alvarez-Flores, Modesto; Arribas-García, Ignacio; Martínez-Gimeno, Carlos

    2010-03-01

    Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that are mostly found arising from the pleura. Although SFTs recently have been reported in other regions, they are rare in the head and neck and have often been misdiagnosed due to their rarity. SFTs are benign in most cases. Clinically, SFTs usually manifest as well-circumscribed, slow-growing, smooth and painless masses. Symptoms are often minimal, although they may include sore throat, difficulty in swallowing, change of voice or trismus. CT-Scan and MRI are the most sensitive imaging procedures used. The treatment of choice is complete surgical excision of the lesion. Because recurrences have been noted up to 30 years after surgery, long-term follow up is mandatory. In this article, we present a case of a Solitary Fibrous Tumor arising in the parapharyngeal space in a 20-year-old man, involving the carotid sheath, treated by surgical excision with no recurrence after 1 year. The clinical presentation, surgical management and pathological findings are described.

  19. Safety and efficacy of ureteral access sheaths.

    PubMed

    Stern, Joshua M; Yiee, Jenny; Park, Sangtae

    2007-02-01

    The ureteral access sheath (UAS) was introduced as a means of passing a flexible ureteroscope. Although the device was initially lauded for its ability to facilitate ureteroscopic access, passage was difficult and risked ureteral injury, and the UAS fell out of favor until the development of a new generation of devices that was easier to insert. The UAS should be advanced under fluoroscopy over a stiff guidewire, and the surgeon should ensure copious hydration of all inner and outer surfaces. Use of the UAS is purported to improve irrigant flow and visibility. The UAS can induce transient ureteral ischemia and promote an acute inflammatory response, but it also prevents potentially harmful elevations in intrarenal pressure. Unequivocal data are not yet available to suggest that UAS use during ureteroscopy protects or harms the upper urinary tract. The UAS also has the potential to improve stone-free rates by allowing passive egress or active retrieval of fragments. A large prospective study is needed to unequivocally determine if UAS use is superior in terms of stone-free rates. Cost studies reported to favor UAS use, although a formal cost-effectiveness analysis has not been performed. Further study is needed before routine use of the UAS can be recommended.

  20. The impact of frequency mixing on sheath properties: Ion energy distribution and Vdc/Vrf interaction

    NASA Astrophysics Data System (ADS)

    Shannon, Steven; Hoffman, Daniel; Yang, Jang-Gyoo; Paterson, Alex; Holland, John

    2005-05-01

    A dual frequency rf sheath is analyzed using a simple rf sheath model to study the interaction between the two driving rf currents and their effect on sheath parameters. A symmetric rf discharge with defined electron density and dc sheath potential is modeled using a sharp boundary sheath approximation. Three results of this study are reported: (1) reproduction of trends in ion energy distribution functions predicted and measured in previous studies, (2) a frequency-mixing-dependent relationship between the dc sheath potential and applied rf potential, and (3) an additional asymmetry in the ion energy distribution function generated by the intermodulation components resulting from the nonlinear sheath.

  1. Use of an introducer sheath for colonic stent placement.

    PubMed

    De Gregorio, Miguel A; Mainar, Antonio; Tejero, Eloy; Alfonso, Eduardo; Gimeno, María José; Herrera, Marcos

    2002-09-01

    We describe a technical modification of Wallstent implantation for the treatment of malignant rectosigmoid and descending colonic obstructions. The modification is the routine placement of an introducer sheath via the rectum before stent implantation in order to straighten the rectosigmoid region. This device facilitates catheter and guide wire manipulations and obtaining specimen biopsies for histopathological studies. The introducer sheath has been used without complications in 21 consecutive patients.

  2. Plasma sheath effects on ion collection by a pinhole

    NASA Technical Reports Server (NTRS)

    Herr, Joel L.; Snyder, David B.

    1993-01-01

    This work presents tables to assist in the evaluation of pinhole collection effects on spacecraft. These tables summarize results of a computer model which tracks particle trajectories through a simplified electric field in the plasma sheath. A technique is proposed to account for plasma sheath effects in the application of these results and scaling rules are proposed to apply the calculations to specific situations. This model is compared to ion current measurements obtained by another worker, and the agreement is very good.

  3. Sheath fold development around slip surfaces subject to general shear

    NASA Astrophysics Data System (ADS)

    Adamuszek, Marta; Senderak, Barbara; Dabrowski, Marcin

    2016-04-01

    Sheath folds are cone-shaped structures, which typically develop in high-strain shear zones in a variety of geological settings. When observed in the cross-sections perpendicular to the shear direction, sheath folds display characteristic elliptical closed contours. The aspect ratio of the outermost closed contour is commonly used for the classification and quantitative analysis. Alsop and Holdsworth (2006) showed that the outermost aspect ratio observed in the natural sheath folds varies between 1 and 7. Previous work on sheath folds development around slip surfaces focused on simple shear deformation (Reber et al., 2013). The aspect ratio developing under such conditions exhibits values larger than the ones observed in nature. Therefore, we investigate sheath fold development around slip surfaces under general shear conditions, in which a shortening component acts in the direction parallel to the shearing plane and perpendicular to the simple shear direction. In our models, the out-of-plane shortening is accommodated by 1) extension in the shear direction only or by 2) uniform extension perpendicular to the shortening direction (dilation). On one hand, the pure shear deformation leads to a decrease of the aspect ratio of the outermost closed contour of the developed sheath folds. On the other hand, it also modifies the slip surface size and orientation, which promotes development of sheath folds with larger aspect ratios. The numerical simulations show that the latter effect is minor and, for the two tested scenarios, we generate sheath folds with the aspect ratios of the outermost ellipse that favourably compare to the range observed in nature.

  4. Sheath ionization model of beam emissions from large spacecraft

    NASA Technical Reports Server (NTRS)

    Lai, S. T.; Cohen, H. A.; Bhavnani, K. H.; Tautz, M. E.

    1985-01-01

    An analytical model of the charging of a spacecraft emitting electron and ion beams has been applied to the case of large spacecraft. In this model, ionization occurs in the sheath due to the return current. Charge neutralization of spherical space charge flow is examined by solving analytical equations numerically. Parametric studies of potential large spacecraft are performed. As in the case of small spacecraft, the ions created in the sheath by the returning current play a large role in determining spacecraft potential.

  5. Microscopic and submicroscopic studies on the peripheral nerve and the skeletal muscle of the female. cadaver found in the Han Tomb No.1.

    PubMed

    Zheng, G Z; Feng, W H; Boa, Y H; Xue, J N; Ying, Y S

    1979-09-01

    The present paper deals with the microscopic and submicroscopic structures of the peripheral nerve of the lumbar plexus and the skeletal muscle of the m. psoas major of the ancient female cadaver buried about 2100 years ago, which was excavated from the Han Tomb No. 1 at Mawangdui (Mawangtui) near Changsha, Hunan Province. The connective tissues in the peripheral nerve and the skeletal muscle of the ancient cadaver were found well preserved. Under the electron microscope were observed the characteristic periodic bands of the collagenous fibrils as well as some axons and degenerated myelin sheath in the lumbar plexus. And in some of the better preserved nerve fibers, their axons and myelin sheaths are readily discernible. In the m. psoas major, cross striations are clearly visible in some muscle fibers. The remains of a blood vessel with only their connective tissues left were observed in the nerve of the lumbar plexus. Bacterial spores appeared in the two tissues.

  6. Inferior alveolar nerve repositioning.

    PubMed

    Louis, P J

    2001-09-01

    Nerve repositioning is a viable alternative for patients with an atrophic edentulous posterior mandible. Patients, however, should be informed of the potential risks of neurosensory disturbance. Documentation of the patient's baseline neurosensory function should be performed with a two-point discrimination test or directional brush stroke test preoperatively and postoperatively. Recovery of nerve function should be expected in 3 to 6 months. The potential for mandibular fracture when combining nerve repositioning with implant placement also should be discussed with the patient. This can be avoided by minimizing the amount of buccal cortical plate removal during localization of the nerve and maintaining the integrity of the inferior cortex of the mandible. Additionally, avoid overseating the implant, thus avoiding stress along the inferior border of the mandible. The procedure does allow for the placement of longer implants, which should improve implant longevity. Patients undergoing this procedure have expressed overall satisfaction with the results. Nerve repositioning also can be used to preserve the inferior alveolar nerve during resection of benign tumors or cysts of the mandible. This procedure allows the surgeon to maintain nerve function in situations in which the nerve would otherwise have to be resected. PMID:11665379

  7. Cryotherapy and nerve palsy.

    PubMed

    Drez, D; Faust, D C; Evans, J P

    1981-01-01

    Ice application is one of the most extensively used treatments for athletic injuries. Frostbite is a recognized danger. Five cases of nerve palsy resulting from ice application are reported here. These palsies were temporary. They usually resolve spontaneously without any significant sequelae. This complication can be avoided by not using ice for more than 30 minutes and by guarding superficial nerves in the area.

  8. Imaging the cranial nerves.

    PubMed

    Parry, Andrew T; Volk, Holger A

    2011-01-01

    An understanding of the normal course of the cranial nerves (CN) is essential when interpreting images of patients with cranial neuropathies. CN foramina are depicted best using computed X-ray tomography, but the nerves are depicted best using magnetic resonance imaging. The function and anatomy of the CN in the dog are reviewed and selected examples of lesions affecting the CN are illustrated.

  9. [Sciatic nerve intraneural perineurioma].

    PubMed

    Bonhomme, Benjamin; Poussange, Nicolas; Le Collen, Philippe; Fabre, Thierry; Vital, Anne; Lepreux, Sébastien

    2015-12-01

    Intraneural perineurioma is a benign tumor developed from the perineurium and responsible for localized nerve hypertrophy. This uncommon tumor is characterized by a proliferation of perineural cells with a "pseudo-onion bulb" pattern. We report a sciatic nerve intraneural perineurioma in a 39-year-old patient. PMID:26586011

  10. Predictive modeling of altitude decompression sickness in humans

    NASA Technical Reports Server (NTRS)

    Kenyon, D. J.; Hamilton, R. W., Jr.; Colley, I. A.; Schreiner, H. R.

    1972-01-01

    The coding of data on 2,565 individual human altitude chamber tests is reported as part of a selection procedure designed to eliminate individuals who are highly susceptible to decompression sickness, individual aircrew members were exposed to the pressure equivalent of 37,000 feet and observed for one hour. Many entries refer to subjects who have been tested two or three times. This data contains a substantial body of statistical information important to the understanding of the mechanisms of altitude decompression sickness and for the computation of improved high altitude operating procedures. Appropriate computer formats and encoding procedures were developed and all 2,565 entries have been converted to these formats and stored on magnetic tape. A gas loading file was produced.

  11. Doppler bubble detection and decompression sickness: a prospective clinical trial.

    PubMed

    Bayne, C G; Hunt, W S; Johanson, D C; Flynn, E T; Weathersby, P K

    1985-09-01

    Decompression sickness in human beings exposed to high ambient pressure is thought to follow from gas bubble formation and growth in the body during return to low pressure. Detection of Doppler-shifted ultrasonic reflections in major blood vessels has been promoted as a noninvasive and sensitive indicator of the imminence of decompression sickness. We have conducted a double-blind, prospective clinical trial of Doppler ultrasonic bubble detection in simulated diving using 83 men, of whom 8 were stricken and treated for the clinical disease. Diagnosis based only on the Doppler signals had no correlation with clinical diagnosis. Bubble scores were only slightly higher in the stricken group. The Doppler technique does not appear to be of diagnostic value in the absence of other clinical information.

  12. Prevention of decompression sickness during a simulated space docking mission.

    PubMed

    Cooke, J P; Bollinger, R R; Richardson, B

    1975-07-01

    This study has shown that repetitive exchanges between the American Apollo space vehicle atmosphere of 100% oxygen at 5 psia (258 torr) and the Russian Soyuz spacecraft atmosphere of 30% oxygen-70% nitrogen at 10 psia (523 torr), as simulated in altitude chambers, will not likely result in any form of decompression sickness. This conclusion is based upon the absence of any form of bends in seven crewmen who participated in 11 tests distributed over three 24-h periods. During each period, three transfers from the 5 to the 10 psia environments were performed by simulating passage through a docking module which served as an airlock where astronauts and cosmonauts first adapted to each other's cabin gases and pressures before transfer. Biochemical tests, subjective fatigue scores, and the complete absence of any form of pain were also indicative that decompression sickness should not be expected if this spacecraft transfer schedule is followed.

  13. Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction

    PubMed Central

    Ohya, Junichi; Chikuda, Hirotaka; Nakatomi, Hirofumi; Sakamoto, Ryuji; Saito, Nobuhito; Tanaka, Sakae

    2016-01-01

    Obstructive hydrocephalus has been described as a rare complication following foramen magnum decompression for Chiari malformation. However, there are few reports of obstructive hydrocephalus after spinal surgery for other pathologies of the craniovertebral junction (CVJ). The authors herein report a 52-year-old female with achondroplasia presenting with an 8-month history of myelopathy due to spinal cord compression at CVJ. She underwent resection of the C1 posterior arch and part of the edge of the occipital bone. A computed tomography (CT) scan obtained 1-week after the surgery revealed bilateral infratentorial fluid collection. The patient was first managed conservatively; however, on the 17th day, her consciousness level showed sudden deterioration. Emergency CT demonstrated marked hydrocephalus due to obstruction of the cerebral aqueduct. Acute obstructive hydrocephalus can occur late after decompression surgery at the CVJ, and thus should be included in the differential diagnosis of a deteriorating mental status. PMID:27366268

  14. Report on computation of repetitive hyperbaric-hypobaric decompression tables

    NASA Technical Reports Server (NTRS)

    Edel, P. O.

    1975-01-01

    The tables were constructed specifically for NASA's simulated weightlessness training program; they provide for 8 depth ranges covering depths from 7 to 47 FSW, with exposure times of 15 to 360 minutes. These tables were based up on an 8 compartment model using tissue half-time values of 5 to 360 minutes and Workmanline M-values for control of the decompression obligation resulting from hyperbaric exposures. Supersaturation ratios of 1.55:1 to 2:1 were used for control of ascents to altitude following such repetitive dives. Adequacy of the method and the resultant tables were determined in light of past experience with decompression involving hyperbaric-hypobaric interfaces in human exposures. Using these criteria, the method showed conformity with empirically determined values. In areas where a discrepancy existed, the tables would err in the direction of safety.

  15. Outer Electrospun Polycaprolactone Shell Induces Massive Foreign Body Reaction and Impairs Axonal Regeneration through 3D Multichannel Chitosan Nerve Guides

    PubMed Central

    Behrens, Peter; Wienecke, Soenke; Chakradeo, Tanmay; Glasmacher, Birgit

    2014-01-01

    We report on the performance of composite nerve grafts with an inner 3D multichannel porous chitosan core and an outer electrospun polycaprolactone shell. The inner chitosan core provided multiple guidance channels for regrowing axons. To analyze the in vivo properties of the bare chitosan cores, we separately implanted them into an epineural sheath. The effects of both graft types on structural and functional regeneration across a 10 mm rat sciatic nerve gap were compared to autologous nerve transplantation (ANT). The mechanical biomaterial properties and the immunological impact of the grafts were assessed with histological techniques before and after transplantation in vivo. Furthermore during a 13-week examination period functional tests and electrophysiological recordings were performed and supplemented by nerve morphometry. The sheathing of the chitosan core with a polycaprolactone shell induced massive foreign body reaction and impairment of nerve regeneration. Although the isolated novel chitosan core did allow regeneration of axons in a similar size distribution as the ANT, the ANT was superior in terms of functional regeneration. We conclude that an outer polycaprolactone shell should not be used for the purpose of bioartificial nerve grafting, while 3D multichannel porous chitosan cores could be candidate scaffolds for structured nerve grafts. PMID:24818158

  16. Miniature sheathed thermocouples for turbine blade temperature measurement

    NASA Technical Reports Server (NTRS)

    Holanda, R.; Glawe, G. E.; Krause, L. N.

    1974-01-01

    An investigation was made of sheathed thermocouples for turbine blade temperature measurements. Tests were performed on the Chromel-Alumel sheathed thermocouples with both two-wire and single-wire configurations. Sheath diameters ranged from 0.25 to 0.76 mm, and temperatures ranged from 1080 to 1250 K. Both steady-state and thermal cycling tests were performed for times up to 450 hr. Special-order and commercial-grade thermocouples were tested. The tests showed that special-order single-wire sheathed thermocouples can be obtained that are reliable and accurate with diameters as small as 0.25 mm. However, all samples of 0.25-mm-diameter sheathed commercial-grade two-wire and single-wire thermocouples that were tested showed unacceptable drift rates for long-duration engine testing programs. The drift rates were about 1 percent in 10 hr. A thermocouple drift test is recommended in addition to the normal acceptance tests in order to select reliable miniature sheathed thermocouples for turbine blade applications.

  17. Photoelectric sheath formation around small spherical objects in space

    SciTech Connect

    Misra, Shikha Sodha, M. S.; Mishra, S. K.

    2015-04-15

    The formation of a photoelectron sheath around positively charged small (∼cm) spherical objects roaming in near earth space due to the solar radiation (with continuous spectrum) and the solar wind plasma has been investigated. The sheath structure has been derived, taking into account anisotropic photoelectron flux with the Poisson equation, spherical geometry of the object, and half Fermi Dirac distribution of photoelectron velocities. Two cases, viz., when the object is illuminated by (i) isotropic or (ii) unidirectional (parallel beam) radiation, have been analyzed. The analysis predicts a spherically symmetric sheath in case of isotropic illumination, while a symmetry in sheath about a θ=π/4 is seen in case of parallel beam illumination; θ is the angle of incidence which is the angle made by the normal to a surface element with the direction of incidence of solar radiation. The radial and angular profiles of the electric potential and electron density in the photoelectron sheath have been evaluated and illustrated graphically; the dependence of the sheath structure on the solar wind plasma parameters, material properties of the spherical object, and its size have been discussed.

  18. Comment on 'Sheath model for dual-frequency capacitive discharges'

    NASA Astrophysics Data System (ADS)

    Chen, Wen-Cong; Pu, Yi-Kang

    2015-07-01

    Boyle et al (2004 J. Phys. D: Appl. Phys. 37 1451) introduced a sheath model for dual-frequency capacitive discharges. The electron sheath edge position s and the dc potential Φdc in the sheath are obtained with the assumption α/β  >> 1 (where α/β is the ratio of the low-frequency electric field to the high-frequency electric field). However, α/β  ≤  4 is usually found in processing applications. Under this condition, we show that the Boyle et al model gives multiple values for the dc potential Φdc(x) at any given position x in the sheath. For this reason, we introduce a model without the assumption α/β  >> 1. By comparing the results from the two models, it is found that, as the ratio α/β approaches 1, the sheath thickness sm and the sheath dc voltage Vdc obtained with the Boyle et al model are significantly underestimated.

  19. Why ions enter the sheath entrance at supersonic speed?

    NASA Astrophysics Data System (ADS)

    Tang, Xianzhu; Guo, Zehua

    2015-11-01

    In a boundary plasma of a fusion device, the sheath Knudsen number, which is defined as the ratio of the plasma mean-free-path and the plasma Debye length, is much greater than unity, so one anticipates a collisionless sheath, even though the overall boundary plasma in the scrape-off layer is collisional. This is supposed to be the regime for which the Bohm criteria for the ion entry flow at the sheath entrance, v >=cs with cs the sound speed, is usually satisfied at the equal sign. But numerical simulations using first-principles particle-in-cell codes tend to report a supersonic flow. Here we revisit the two-scale and transition layer analysis of the sheath-presheath transition, in tandem with the conventional Bohm criteria analysis, to understand why and how the supersonic sheath entry flow is established at the sheath entrance, which is a few Debye length away from the wall, and its impact on plasma particle and power load at the wall. Works upported by DOE OFES. Work supported by DOE OFES.

  20. The sheath effect on the floating harmonic method

    SciTech Connect

    Lee, Jaewon; Kim, Kyung-Hyun; Chung, Chin-Wook

    2015-12-15

    The floating harmonic method biases sinusoidal voltage to a probe sheath, and as its response, harmonic currents can be obtained. These currents can be used to determine the plasma parameters. However, different shapes of probes have different shapes of sheaths that can affect the diagnostic results. However, no research has been done on the sheath effect on the floating harmonic method. Therefore, we investigate the effect of the sheath during floating harmonic diagnostics by comparing cylindrical and planar probes. While the sinusoidal voltages were applied to a probe, because the sheath oscillated, the time variant ion current and their harmonic currents were added to the electron harmonic currents. In the floating harmonic method, the harmonic currents are composed of only the electron harmonic currents. Therefore, the ion harmonic currents affect the diagnostic results. In particular, the electron temperature obtained by the small probe tip was higher than that of the large probe tip. This effect was exacerbated when the ratio of the probe tip radius to the sheath length was smaller.

  1. Type VI secretion system sheaths as nanoparticles for antigen display

    PubMed Central

    Del Tordello, Elena; Danilchanka, Olga; McCluskey, Andrew J.; Mekalanos, John J.

    2016-01-01

    The bacterial type 6 secretion system (T6SS) is a dynamic apparatus that translocates proteins between cells by a mechanism analogous to phage tail contraction. T6SS sheaths are cytoplasmic tubular structures composed of stable VipA-VipB (named for ClpV-interacting protein A and B) heterodimers. Here, the structure of the VipA/B sheath was exploited to generate immunogenic multivalent particles for vaccine delivery. Sheaths composed of VipB and VipA fused to an antigen of interest were purified from Vibrio cholerae or Escherichia coli and used for immunization. Sheaths displaying heterologous antigens generated better immune responses against the antigen and different IgG subclasses compared with soluble antigen alone. Moreover, antigen-specific antibodies raised against sheaths presenting Neisseria meningitidis factor H binding protein (fHbp) antigen were functional in a serum bactericidal assay. Our results demonstrate that multivalent nanoparticles based on the T6SS sheath represent a versatile scaffold for vaccine applications. PMID:26929342

  2. Peripheral nerve stimulation: definition.

    PubMed

    Abejón, David; Pérez-Cajaraville, Juan

    2011-01-01

    Recently, there has been a tremendous evolution in the field of neurostimulation, both from the technological point of view and from development of the new and different indications. In some areas, such as peripheral nerve stimulation, there has been a boom in recent years due to the variations in the surgical technique and the improved results documented by in multiple published papers. All this makes imperative the need to classify and define the different types of stimulation that are used today. The confusion arises when attempting to describe peripheral nerve stimulation and subcutaneous stimulation. Peripheral nerve stimulation, in its pure definition, involves implanting a lead on a nerve, with the aim to produce paresthesia along the entire trajectory of the stimulated nerve.

  3. Microbubbles are detected prior to larger bubbles following decompression.

    PubMed

    Swan, J G; Wilbur, J C; Moodie, K L; Kane, S A; Knaus, D A; Phillips, S D; Beach, T L; Fellows, A M; Magari, P J; Buckey, J C

    2014-04-01

    Using dual-frequency ultrasound (DFU), microbubbles (<10 μm diameter) have been detected in tissue following decompression. It is not known if these microbubbles are the precursors for B-mode ultrasound-detectable venous gas emboli (bmdVGE). The purpose of this study was to determine if microbubbles could be detected intravascularly postdecompression and to investigate the temporal relationship between microbubbles and larger bmdVGE. Anesthetized swine (n = 15) were exposed to 4.0-4.5 ATA for 2 h, followed by decompression to 0.98 ATA. Microbubble presence and VGE grade were measured using DFU and B-mode ultrasound, respectively, before and for 1 h postdecompression, approximately every 4-5 min. Microbubbles appeared in the bloodstream postdecompression, both in the presence and absence of bmdVGE. In swine without bmdVGE, microbubbles remained elevated for the entire 60-min postdecompression period. In swine with bmdVGE, microbubble signals were detected initially but then returned to baseline. Microbubbles were not detected with the sham dive. Mean bmdVGE grade increased over the length of the postdecompression data collection period. Comparison of the two response curves revealed significant differences at 5 and 10 min postdecompression, indicating that microbubbles preceded bmdVGE. These findings indicate that decompression-induced microbubbles can 1) be detected intravascularly at multiple sites, 2) appear in the presence and absence of bmdVGE, and 3) occur before bmdVGE. This supports the hypothesis that microbubbles precede larger VGE bubbles. Microbubble presence may be an early marker of decompression stress. Since DFU is a low-power ultrasonic method, it may be useful for operational diving applications.

  4. 29 CFR Appendix A to Subpart S of... - Decompression Tables

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 8 2014-07-01 2014-07-01 false Decompression Tables A Appendix A to Subpart S of Part 1926..., Caissons, Cofferdams and Compressed Air Pt. 1926, Subpt. S, App. A Appendix A to Subpart S of Part 1926... pressure p.s.i.g. Working period hours 1/2 1 11/2 2 3 4 5 6 7 8 Over 8 9 to 12 3 3 3 3 3 3 3 3 3 3 3 14 6...

  5. On-the-Fly Decompression and Rendering of Multiresolution Terrain

    SciTech Connect

    Lindstrom, P; Cohen, J D

    2009-04-02

    We present a streaming geometry compression codec for multiresolution, uniformly-gridded, triangular terrain patches that supports very fast decompression. Our method is based on linear prediction and residual coding for lossless compression of the full-resolution data. As simplified patches on coarser levels in the hierarchy already incur some data loss, we optionally allow further quantization for more lossy compression. The quantization levels are adaptive on a per-patch basis, while still permitting seamless, adaptive tessellations of the terrain. Our geometry compression on such a hierarchy achieves compression ratios of 3:1 to 12:1. Our scheme is not only suitable for fast decompression on the CPU, but also for parallel decoding on the GPU with peak throughput over 2 billion triangles per second. Each terrain patch is independently decompressed on the fly from a variable-rate bitstream by a GPU geometry program with no branches or conditionals. Thus we can store the geometry compressed on the GPU, reducing storage and bandwidth requirements throughout the system. In our rendering approach, only compressed bitstreams and the decoded height values in the view-dependent 'cut' are explicitly stored on the GPU. Normal vectors are computed in a streaming fashion, and remaining geometry and texture coordinates, as well as mesh connectivity, are shared and re-used for all patches. We demonstrate and evaluate our algorithms on a small prototype system in which all compressed geometry fits in the GPU memory and decompression occurs on the fly every rendering frame without any cache maintenance.

  6. 29 CFR Appendix A to Subpart S of... - Decompression Tables

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 8 2010-07-01 2010-07-01 false Decompression Tables A Appendix A to Subpart S of Part 1926..., Caissons, Cofferdams and Compressed Air Pt. 1926, Subpt. S, App. A Appendix A to Subpart S of Part 1926... pressure p.s.i.g. Working period hours 1/2 1 11/2 2 3 4 5 6 7 8 Over 8 9 to 12 3 3 3 3 3 3 3 3 3 3 3 14 6...

  7. 29 CFR Appendix A to Subpart S of... - Decompression Tables

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 8 2011-07-01 2011-07-01 false Decompression Tables A Appendix A to Subpart S of Part 1926..., Caissons, Cofferdams and Compressed Air Pt. 1926, Subpt. S, App. A Appendix A to Subpart S of Part 1926... pressure p.s.i.g. Working period hours 1/2 1 11/2 2 3 4 5 6 7 8 Over 8 9 to 12 3 3 3 3 3 3 3 3 3 3 3 14 6...

  8. Early decompressive hemicraniectomy in fulminant herpes simplex encephalitis.

    PubMed

    Maraite, N; Mataigne, F; Pieri, V; Dang, T; Diederich, N J

    2010-01-01

    Herpes encephalitis can be a life-threatening condition, despite early instauration of acyclovir treatment. In particular patients may succumb to rapidly progressive cerebral oedema. We report a 66-year patient with a Glasgow Coma Score (GCS) of 6 and incipient uncus herniation of the right temporal lobe on the third day. Decompressive hemicraniectomy was immediately performed. The long-term outcome was satisfactory with unassisted gait and a Barthel Index score of 70 after 9 months.

  9. Early decompressive hemicraniectomy in fulminant herpes simplex encephalitis.

    PubMed

    Maraite, N; Mataigne, F; Pieri, V; Dang, T; Diederich, N J

    2009-01-01

    Herpes encephalitis can be a life-threatening condition, despite early instauration of acyclovir treatment. In particular patients may succumb to rapidly progressive cerebral oedema. We report a 66-year patient with a Glasgow Coma Score (GCS) of 6 and incipient uncus herniation of the right temporal lobe on the third day. Decompressive hemicraniectomy was immediately performed. The long-term outcome was satisfactory with unassisted gait and a Barthel Index score of 70 after 9 months.

  10. AFM combines functional and morphological analysis of peripheral myelinated and demyelinated nerve fibers.

    PubMed

    Heredia, Alejandro; Bui, Chin Chu; Suter, Ueli; Young, Peter; Schäffer, Tilman E

    2007-10-01

    Demyelination of the myelinated peripheral or central axon is a common pathophysiological step in the clinical manifestation of several human diseases of the peripheral and the central nervous system such as the majority of Charcot-Marie-Tooth syndromes and multiple sclerosis, respectively. The structural degradation of the axon insulating myelin sheath has profound consequences for ionic conduction and nerve function in general, but also affects the micromechanical properties of the nerve fiber. We have for the first time investigated mechanical properties of rehydrated, isolated peripheral nerve fibers from mouse using atomic force microscopy (AFM). We have generated quantitative maps of elastic modulus along myelinated and demyelinated axons, together with quantitative maps of axon topography. This study shows that AFM can combine functional and morphological analysis of neurological tissue at the level of single nerve fibers.

  11. [High resolution 3T magnetic resonance neurography of the peroneal nerve].

    PubMed

    Pineda, D; Barroso, F; Cháves, H; Cejas, C

    2014-01-01

    Peroneal neuropathy is the most common mononeuropathy of the lower limbs. The causes of peroneal neuropathy include trauma, tumors of the nerve and nerve sheath, entrapment, and others like perineurioma, fibromatosis, lymphoma, and intraneural and externeural ganglia. The diagnosis is based on clinical manifestations and electrophysiological studies. Nowadays, however, magnetic resonance (MR) neurography is a complementary diagnostic technique that can help determine the location and cause of peroneal neuropathy. In this article, we describe the MR anatomy of the peroneal nerve, its relations, and the muscles it innervates. We also discuss the clinical and electrophysiological manifestations of peroneal neuropathy, describe the technical parameters used at our institution, and illustrate the MR appearance of various diseases that involve the peroneal nerve.

  12. Myelinated mouse nerves studied by X-ray phase contrast zoom tomography.

    PubMed

    Bartels, M; Krenkel, M; Cloetens, P; Möbius, W; Salditt, T

    2015-12-01

    We have used X-ray phase contrast tomography to resolve the structure of uncut, entire myelinated optic, saphenous and sciatic mouse nerves. Intrinsic electron density contrast suffices to identify axonal structures. Specific myelin labeling by an osmium tetroxide stain enables distinction between axon and surrounding myelin sheath. Utilization of spherical wave illumination enables zooming capabilities which enable imaging of entire sciatic internodes as well as identification of sub-structures such as nodes of Ranvier and Schmidt-Lanterman incisures. PMID:26546551

  13. Myelinated mouse nerves studied by X-ray phase contrast zoom tomography.

    PubMed

    Bartels, M; Krenkel, M; Cloetens, P; Möbius, W; Salditt, T

    2015-12-01

    We have used X-ray phase contrast tomography to resolve the structure of uncut, entire myelinated optic, saphenous and sciatic mouse nerves. Intrinsic electron density contrast suffices to identify axonal structures. Specific myelin labeling by an osmium tetroxide stain enables distinction between axon and surrounding myelin sheath. Utilization of spherical wave illumination enables zooming capabilities which enable imaging of entire sciatic internodes as well as identification of sub-structures such as nodes of Ranvier and Schmidt-Lanterman incisures.

  14. Intramedullary decompression with condylectomy for intractable plantar keratoma.

    PubMed

    Roven, M D

    1985-07-01

    A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described. PMID:4028490

  15. Decompressive surgery in the treatment of traumatic brain injury.

    PubMed

    Piek, Jürgen

    2002-04-01

    According to European Brain Injury Consortium (EBIC) and American Brain Injury Consortium (ABIC) guidelines for severe head injuries, decompressive craniectomy is one therapeutic option for brain edema that does not respond to conventional therapeutic measures. As a result of the failure of all recently developed drugs to improve outcome in this patient group, decompressive craniectomy has experienced a revival during the last decade. Although class I studies of this subject are still lacking, there is strong evidence from prospective, uncontrolled trials that such an operation improves outcome in general and also has beneficial effects on various physiologic parameters that are known to be independent predictors for poor outcome. Whether this operation should be performed in a protocol-driven or in a prophylactic manner remains unclear. Decompressive craniectomy may, however, be the only method available in developing countries with limited ICU and monitoring resources. Prospectively controlled and randomized studies to definitively evaluate the effect of this old neurosurgical method on outcome in patients with traumatic brain injury (TBI) are forthcoming.

  16. Influence of repeated daily diving on decompression stress.

    PubMed

    Zanchi, J; Ljubkovic, M; Denoble, P J; Dujic, Z; Ranapurwala, S; Pollock, N W

    2014-06-01

    Acclimatization (an adaptive change in response to repeated environmental exposure) to diving could reduce decompression stress. A decrease in post-dive circulating venous gas emboli (VGE or bubbles) would represent positive acclimatization. The purpose of this study was to determine whether four days of daily diving alter post-dive bubble grades. 16 male divers performed identical no-decompression air dives on 4 consecutive days to 18 meters of sea water for 47 min bottom times. VGE monitoring was performed with transthoracic echocardiography every 20 min for 120 min post-dive. Completion of identical daily dives resulted in progressively decreasing odds (or logit risk) of having relatively higher grade bubbles on consecutive days. The odds on Day 4 were half that of Day 1 (OR 0.50, 95% CI: 0.34, 0.73). The odds ratio for a >III bubble grade on Day 4 was 0.37 (95% CI: 0.20, 0.70) when compared to Day 1. The current study indicates that repetitive daily diving may reduce bubble formation, representing a positive (protective) acclimatization to diving. Further work is required to evaluate the impact of additional days of diving and multiple dive days and to determine if the effect is sufficient to alter the absolute risk of decompression sickness.

  17. Musculoskeletal-induced Nucleation in Altitude Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. There are limited data available to evaluate cost-benefit relationships. Understanding the relationship is important to improve our understanding of the underlying mechanisms of nucleation in exercise prebreathe protocols and to quantify risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS.

  18. Adjacent level spondylodiscitis after anterior cervical decompression and fusion.

    PubMed

    Basu, Saumyajit; Sreeramalingam, Rathinavelu

    2012-05-01

    Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF) is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7) followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin) were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup. PMID:22719127

  19. Ancient schwannoma arising from mental nerve. A case report and review.

    PubMed

    Subhashraj, Krishnaraj; Balanand, Subramanian; Pajaniammalle, Subhashraj

    2009-01-01

    Schwannoma is an intraoral rare, benign neoplasm derived from the nerve sheath of peripheral nerves. "Ancient schwannoma" shows histopathological features, such as degenerative changes and atypical nuclei, and may easily be confused with malignant neoplasms. Ancient schwannoma of the head and neck region is relatively uncommon and very few cases had been reported in the oral cavity. We present a case of ancient schwannoma arising from the mental nerve in a 19 year old male which was of eight months duration. Examination revealed a 30 x 25 mm firm, strawberry-like mass in the periapical region of the left lower first premolar, extending anteriorly to the canine and posteriorly to the first molar, obliterating the buccal vestibule, with an intact overlying mucosa. Ultrasonography showed that the tumor was closely associated with the mental nerve on the left side, suggestive of a peripheral neural sheath tumor. Complete excision of the lesion was done under local anesthesia, preserving the mental nerve. The histological picture was strongly suggestive of ancient schwannoma (Antoni A type). There was no evidence of recurrence 18 months after excision. The clinicopathological aspects of this special case are discussed, and the literature regarding this entity is reviewed. PMID:19114949

  20. Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study.

    PubMed

    Prakash; Bhardwaj, Ajay Kumar; Singh, Deepak Kumar; Rajini, T; Jayanthi, V; Singh, Gajendra

    2010-01-01

    Superficial peroneal nerve and its branches are frequently at risk for iatrogenic damage. Although different studies on anatomical variations of superficial peroneal nerve are available in the medical literature, such reports are rare from India. Hence the present study was undertaken on Indian population. A total of 60 specimens of inferior extremities from 30 properly embalmed and formalin fixed cadavers were dissected and examined for the location and course of the superficial peroneal nerve including number, level, course and distributions of branches. The superficial peroneal nerve in 28.3% specimens was located in the anterior compartment of the leg. In 8.3% specimens the superficial peroneal nerve branched before piercing between the peroneus longus and extensor digitorum longus muscle whereas in 11.7% specimens it branched after piercing the aforementioned muscles and before piercing the deep fascia. In 41 out of 60 specimens the sensory division of superficial peroneal nerve branched into the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve distal to its emergence from the deep fascia and proximal to its relation to the extensor retinaculum. In 20 out of 60 specimens the accessory deep peroneal nerve, an additional branch from the sensory division of superficial peroneal nerve, through its course in the anterior compartment of the leg passed deep to the extensor retinaculum and supplied the ankle and the dorsum of foot. Hopefully the present study will help in minimizing iatrogenic damage to the superficial peroneal nerve and its branches while performing arthroscopy, local anesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle.

  1. Equine laryngeal hemiplegia. Part II. An electron microscopic study of peripheral nerves.

    PubMed

    Cahill, J I; Goulden, B E

    1986-10-01

    The recurrent laryngeal nerves were examined by electron microscopy in five control, four subclinical and four clinical laryngeal hemiplegic horses. In addition, the peroneal nerve was examined in two horses in the latter group. The distally distributed loss of large myelinated fibres in the left recurrent laryngeal nerve seen by light microscopy was confirmed. In addition, active axonal pathology was found to be more evident than indicated by light microscopic investigations. The onion bulb formations observed indicated the repetitive nature of the damaging influence to nerve fibres. Although the pathological changes were most obvious in the distal left recurrent laryngeal nerve, alterations similar in type and distribution were present in other areas of the left and right nerves, and in the distal hindlimb nerves. The observation of fibres with inappropriately thick myelin sheaths relative to their axonal calibre, was confirmed statistically by determining the regressions of axis cylinder perimeter against the number of myelin lamellae. In conclusion, the peripheral nerve pathology of equine laryngeal hemiplegia was demonstrated to be a distally distributed loss of myelinated fibres, with considerable active axonal damage, in conjunction with axonal atrophy. These features suggest that this disease may be classified as a distal axonopathy.

  2. Ion Velocimetry In Magnetized DC Sheaths

    NASA Astrophysics Data System (ADS)

    Young, Christopher; Lucca Fabris, Andrea; Cappelli, Mark

    2013-09-01

    Particle dynamics near the magnetic cusps in cusped field plasma thrusters are still not well understood; characterizing the ion velocity distribution functions in these regions can help thruster designs maximize electron trapping and minimize erosion of the channel wall. To that end, a robust argon ion velocity sensor is developed using a three-level laser-induced fluorescence (LIF) technique. The 3d4F7 / 2 --> 4p4D5/ 2 0 ArII transition at 668.61 nm is pumped with a 25 mW tunable external cavity diode laser, and fluorescence down to the 4s4P3 / 2 state at 442.72 nm is collected with phase-sensitive detection. The Doppler shift in the acquired signal peak, compared to a stationary reference, gives the ion velocity component parallel to the exciting laser. We demonstrate this LIF scheme by obtaining the argon ion velocity profile through a magnetized DC sheath. The LIF measurement is used to validate a new optogalvanic velocimetry technique in which two lasers (chopped at different frequencies) intersect one another at 90° in the measurement volume. Using a lock-in amplifier, changes observed in the DC discharge current at the sum and difference of the two chopping frequencies may be related back to the mean ion velocity at that point. The authors acknowledge support from the Air Force Office of Scientific Research (AFOSR). CY acknowledges support from the DOE NNSA Stewardship Science Graduate Fellowship under contract DE-FC52-08NA28752.

  3. Automatic identification and morphometry of optic nerve fibers in electron microscopy images.

    PubMed

    Zhao, Ximei; Pan, Zhenkuan; Wu, Jinyan; Zhou, Guomin; Zeng, Yanjun

    2010-04-01

    The neuroanatomical morphology of the optic nerve is an important description for understanding different aspects like topological distribution of nerves. Manual identification and morphometry has been usually considered as tedious, time consuming, and susceptible to error. A method that automates the identification and analysis of axons from electron micrographic images is presented. First, using region growing approach binarizes the image by combining the feature information together with spatial information, and obtains a coarse classification between myelin and non-myelin pixels. Next, identifies the axon candidates by region labeling and remove false axons on the basis of the identification ruler. Then the connected myelin sheaths are separated from each other using the maximum gradient magnitude of the outer annulus. Finally, analyses the morphological data of fibers. The developed method has been tested on a number of optic nerve images and results were presented. Regional distributions of axon caliber were unimodal. The thickness of the myelin sheath was highly correlated with the fiber diameter; hence, myelin sheath width was also distributed in a unimodal manner.

  4. Estimating Serious Decompression Sickness after Loss of Spacecraft Atmosphere

    NASA Technical Reports Server (NTRS)

    Gernhardt, Michael; Abercromby, Andrew F. J.

    2016-01-01

    INTRODUCTION: Pressure suits are worn inside spacecraft to protect crewmembers in the event of contamination or depressurization of the spacecraft cabin. Protection against serious (Type II) decompression sickness (DCS) in the event of an unplanned rapid cabin depressurization depends on providing adequate suit pressure to crewmembers because there is no opportunity for oxygen prebreathe. METHODS: A model was developed using literature reports from 41 altitude chamber tests totaling 3,256 decompressions (1,445 including exercise at altitude) with 282 cases of serious DCS. All data involved prebreathe durations < 30 min followed by = 120 min exposures at 13.8 to 34.5 kPa (2 to 5 psia) in young men. A time-dependent index of decompression stress was calculated for the historical decompressions using an existing Tissue Bubble Dynamics Model. This index, in combination with physical activity level at altitude (resting vs. active), provided significant prediction of serious DCS in the dataset when used in a logistic regression model, which was then used to estimate serious DCS risk for a range of hypothetical suit pressures and decompression scenarios. RESULTS: The probability of one or more cases of serious DCS in a four person crew was estimated as 0.73 assuming initial saturation at 1 atmosphere, no prebreathe, ascent to 24.1 kPa (3.5 psia) in 30 sec, and 120 min of activity at 3.5 psia. The estimated probability reduced to 0.36 and 0.16 for equivalent exposures at 31.0 and 40.0 kPa (4.5 and 5.8 psia), respectively. Extrapolation to exposures longer than 120 min suggest further increases in serous DCS risk. DISCUSSION: The need to operate critical spacecraft functions coupled with delayed access to hyperbaric treatment further increases the risk to crewmember safety if serious DCS symptoms are experienced following cabin depressurization. A suit pressure of 5.8 psia provides significantly greater protection to crewmembers than lower pressure alternatives. Lower

  5. Cranial Nerve Schwannomas: Diagnostic Imaging Approach.

    PubMed

    Skolnik, Aaron D; Loevner, Laurie A; Sampathu, Deepak M; Newman, Jason G; Lee, John Y; Bagley, Linda J; Learned, Kim O

    2016-01-01

    Schwannomas are benign nerve sheath tumors that may arise along the complex course of the cranial nerves (CNs), anywhere in the head and neck. Sound knowledge of the CN anatomy and imaging features of schwannomas is paramount for making the correct diagnosis. In this article, we review approaches to diagnosing CN schwannomas by describing their imaging characteristics and the associated clinical presentations. Relevant anatomic considerations are highlighted by using illustrative examples and key differential diagnoses categorized according to regions, which include the anterior skull base, orbit, cavernous sinus, basal cisterns, and neck. The clinical presentations associated with CN schwannomas vary and range from no symptoms to symptoms caused by mass effect or CN deficits. Individuals with the inherited disorder neurofibromatosis type 2 are predisposed to multiple schwannomas. When a lesion follows the course of a CN, the radiologist's roles are to confirm the imaging features of schwannoma and exclude appropriate differential considerations. The characteristic imaging features of CN schwannomas reflect their slow growth as benign neoplasms and include circumscribed margins, displacement of local structures, and smooth expansion of osseous foramina. These neoplasms exhibit various degrees of solid enhancement, often with internal cystic spaces on magnetic resonance (MR) and computed tomographic (CT) images and heterogeneous high signal intensity specifically on T2-weighted MR images. Clinical and/or imaging evidence of end-organ compromise of the involved CN may exist and aid in the identification of the nerve of origin. With a detailed understanding of the course of the CNs, the diagnostic features of CN schwannomas, and the correlation between these data and the associated clinical presentations of these tumors, the radiologist can have a key role in the diagnosis of CN schwannomas and the treatment planning for affected patients. (©)RSNA, 2016. PMID

  6. Purinergic nerves and receptors.

    PubMed

    Burnstock, G

    1980-01-01

    The presence of a non-cholinergic, non-adrenergic component in the vertebrate autonomic nervous system is now well established. Evidence that ATP is the transmitter released from some of these nerves (called "purinergic') includes: (a) synthesis and storage of ATP in nerves: (b) release of ATP from the nerves when they are stimulated; (c) exogenously applied ATP mimicking the action of nerve-released transmitter; (d) the presence of ectoenzymes which inactivate ATP; (e) drugs which produce similar blocking or potentiating effects on the response to exogenously applied ATP and nerve stimulation. A basis for distinguishing two types of purinergic receptors has been proposed according to four criteria: relative potencies of agonists, competitive antagonists, changes in levels of cAMP and induction of prostaglandin synthesis. Thus P1 purinoceptors are most sensitive to adenosine, are competitively blocked by methylxanthines and their occupation leads to changes in cAMP accumulation; while P2 purinoceptors are most sensitive to ATP, are blocked (although not competitively) by quinidine, 2-substituted imidazolines, 2,2'-pyridylisatogen and apamin, and their occupation leads to production of prostaglandin. P2 purinoceptors mediate responses of smooth muscle to ATP released from purinergic nerves, while P1 purinoceptors mediate the presynaptic actions of adenosine on adrenergic, cholinergic and purinergic nerve terminals. PMID:6108568

  7. Anatomic and Compression Topography of the Lesser Occipital Nerve

    PubMed Central

    Pietramaggiori, Giorgio; Scherer, Saja

    2016-01-01

    Background: The surgical treatment of occipital headaches focuses on the greater, lesser, and third occipital nerves. The lesser occipital nerve (LON) is usually transected with relatively limited available information regarding the compression topography thereof and how such knowledge may impact surgical treatment. Methods: Eight fresh frozen cadavers were dissected focusing on the LON in relation to 3 clinically relevant compression zones. The x axis was a line drawn through the occipital protuberance (OP) and the y axis, the posterior midline (PM). In addition, a prospectively collected cohort of 36 patients who underwent decompression of the LON is presented with their clinical results, including migraine headache index scores. Results: The LON was found in compression zone 1, with a mean of 7.8 cm caudal to the OP and 6.3 cm lateral to the PM. The LON was found at the midpoint of compression zone 2, with an average of 5.5 cm caudal to the OP and 6.2 cm lateral to the PM. At compression zone 3, the medial-most LON branch was located approximately 1 cm caudal to the OP and 5.35 cm lateral to the PM, whereas the lateral-most branch was identified 1 cm caudal to the OP and 6.5 cm lateral to the PM. Of the 36 decompression patients analyzed, only 5 (14%) required neurectomy as the remainder achieved statistically significant improvements in migraine headache index scores postoperatively. Conclusion: The knowledge of LON anatomy can aid in nerve dissection and preservation, thereby leading to successful outcomes without requiring neurectomy. PMID:27257569

  8. Protective mechanisms of the common fibular nerve in and around the fibular tunnel: a new concept.

    PubMed

    El Gharbawy, Ramadan M; Skandalakis, Lee J; Skandalakis, John E

    2009-09-01

    The most frequent site at which the common fibular nerve is affected by compression, trauma, traction, masses, and surgery is within and around the fibular tunnel. The aim of this study was to determine whether there were protective mechanisms at this site that guard against compression of the nerve. Twenty-six lower limbs of 13 preserved adult cadavers (11 males and two females) were used. Proximal to the entrance of the tunnel, three anatomical configurations seemed to afford the required protection for the nerve: reinforcement of the deep fascia; tethering of the common fibular nerve to both the tendon of the biceps femoris and the reinforced fascia; and the particular arrangement of the deep fascia, fibular head, and soleus and gastrocnemius muscles. At the entrance of the tunnel, contraction of the first segment of fibularis longus muscle could afford the required protection. In the tunnel, contraction of the second and third segments of fibularis longus muscle could guard against compression of the nerve. The tough fascia on the surface of fibularis longus muscle and the fascial band within it, which have long been accused of compression of the nerve, may actually be elements of the protective mechanisms. We conclude that there are innate, anatomical protective mechanisms which should be taken into consideration when decompressing the common fibular nerve. To preserve these mechanisms whenever possible, the technique should be planned and varied according to the underlying etiology.

  9. Intraparotid facial nerve neurofibroma.

    PubMed

    Sullivan, M J; Babyak, J W; Kartush, J M

    1987-02-01

    Neurogenic neoplasms of the intraparotid facial nerve are uncommon and are usually diagnosed intraoperatively by tissue biopsy. Fifty-six cases of primary neurogenic neoplasms involving the facial nerve have been reported. The majority of these have been schwannomas. A case of a solitary neurofibroma involving the main trunk of the facial nerve is presented. Schwannomas and neurofibromas have distinct histological features which must be considered prior to the management of these tumors. The management of neurogenic tumors associated with normal facial function is a particularly difficult problem. A new approach for the diagnosis and management of neurogenic neoplasms is described utilizing electroneurography. PMID:3807626

  10. Radial Nerve Tendon Transfers.

    PubMed

    Cheah, Andre Eu-Jin; Etcheson, Jennifer; Yao, Jeffrey

    2016-08-01

    Radial nerve palsy typically occurs as a result of trauma or iatrogenic injury and leads to the loss of wrist extension, finger extension, thumb extension, and a reduction in grip strength. In the absence of nerve recovery, reconstruction of motor function involves tendon transfer surgery. The most common donor tendons include the pronator teres, wrist flexors, and finger flexors. The type of tendon transfer is classified based on the donor for the extensor digitorum communis. Good outcomes have been reported for most methods of radial nerve tendon transfers as is typical for positional tendon transfers not requiring significant power. PMID:27387076

  11. Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study

    PubMed Central

    Kang, Ho Jung; Oh, Won Taek; Koh, Il Hyun; Kim, Sungmin

    2016-01-01

    Purpose Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. Materials and Methods Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. Results Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. Conclusion An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years. PMID:26847300

  12. High Ulnar Nerve Injuries: Nerve Transfers to Restore Function.

    PubMed

    Patterson, Jennifer Megan M

    2016-05-01

    Peripheral nerve injuries are challenging problems. Nerve transfers are one of many options available to surgeons caring for these patients, although they do not replace tendon transfers, nerve graft, or primary repair in all patients. Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which are critical to function of the hand. PMID:27094893

  13. Diabetes and nerve damage

    MedlinePlus

    Diabetic neuropathy; Diabetes - neuropathy; Diabetes - peripheral neuropathy ... In people with diabetes, the body's nerves can be damaged by decreased blood flow and a high blood sugar level. This condition is ...

  14. Vagus Nerve Stimulation

    PubMed Central

    Howland, Robert H.

    2014-01-01

    The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuroendocrine-immune axis to maintain homeostasis through its afferent and efferent pathways. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, including manual or electrical stimulation. Left cervical VNS is an approved therapy for refractory epilepsy and for treatment resistant depression. Right cervical VNS is effective for treating heart failure in preclinical studies and a phase II clinical trial. The effectiveness of various forms of non-invasive transcutaneous VNS for epilepsy, depression, primary headaches, and other conditions has not been investigated beyond small pilot studies. The relationship between depression, inflammation, metabolic syndrome, and heart disease might be mediated by the vagus nerve. VNS deserves further study for its potentially favorable effects on cardiovascular, cerebrovascular, metabolic, and other physiological biomarkers associated with depression morbidity and mortality. PMID:24834378

  15. Sacral nerve stimulation.

    PubMed

    Matzel, K E; Stadelmaier, U; Besendörfer, M

    2004-01-01

    The current concept of recruiting residual function of an inadequate pelvic organ by electrostimulation involves stimulation of the sacral spinal nerves at the level of the sacral canal. The rationale for applying SNS to fecal incontinence was based on clinical observations of its effect on bowel habits and anorectal continence function in urologic patients (increased anorectal angulation and anal canal closure pressure) and on anatomic considerations: dissection demonstrated a dual peripheral nerve supply of the striated pelvic floor muscles that govern these functions. Because the sacral spinal nerve site is the most distal common location of this dual nerve supply, stimulating here can elicit both functions. Since the first application of SNS in fecal incontinence in 1994, this technique has been improved, the patient selection process modified, and the spectrum of indications expanded. At present SNS has been applied in more than 1300 patients with fecal incontinence limited.

  16. Degenerative Nerve Diseases

    MedlinePlus

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical ...

  17. Damaged axillary nerve (image)

    MedlinePlus

    Conditions associated with axillary nerve dysfunction include fracture of the humerus (upper arm bone), pressure from casts or splints, and improper use of crutches. Other causes include systemic disorders that cause neuritis (inflammation of ...

  18. Iatrogenic accessory nerve injury.

    PubMed Central

    London, J.; London, N. J.; Kay, S. P.

    1996-01-01

    Accessory nerve injury produces considerable disability. The nerve is most frequently damaged as a complication of radical neck dissection, cervical lymph node biopsy and other surgical procedures. The problem is frequently compounded by a failure to recognise the error immediately after surgery when surgical repair has the greatest chance of success. We present cases which outline the risk of accessory nerve injury, the spectrum of clinical presentations and the problems produced by a failure to recognise the deficit. Regional anatomy, consequences of nerve damage and management options are discussed. Diagnostic biopsy of neck nodes should not be undertaken as a primary investigation and, when indicated, surgery in this region should be performed by suitably trained staff under well-defined conditions. Awareness of iatrogenic injury and its consequences would avoid delays in diagnosis and treatment. Images Figure 2 PMID:8678450

  19. Femoral nerve dysfunction

    MedlinePlus

    Neuropathy - femoral nerve; Femoral neuropathy ... Craig EJ, Clinchot DM. Femoral neuropathy. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation . 3rd ...

  20. Diabetic Nerve Problems

    MedlinePlus

    ... the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get it. ... change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. Controlling ...