The No-Touch Saphenous Vein Harvesting Improves Graft Patency After Off-Pump Coronary Artery Bypass Surgery: A Propensity-Matched Analysis

ABSTRACT Introduction: This single-center study of propensity-matched data was performed to assess the effect of the no-touch saphenous vein (NTSV) harvesting technique on early- and long-term outcomes of patients after off-pump coronary artery bypass grafting (OPCABG) in China. Methods: A retrospective analysis of 767 patients who underwent OPCABG in the Beijing Anzhen Hospital (June 2017 to October 2021) was performed, and their data entered the conventional saphenous vein (CSV) harvesting technique group or the NTSV group. In-hospital and follow-up outcomes were evaluated by adjusting baseline characteristics using propensity score matching (1:1). Clinical outcomes and postoperative angiographic results were compared. Results: The saphenous vein graft patency rates at postoperative three months and one year for the NTSV group vs. CSV group were 99.6% vs. 96.2% (P<0.001) and 97.3% vs. 93.1% (P<0.001), respectively. The two matched groups received a significantly different cumulative incidence function of saphenous vein graft occlusion for the longer follow-up period in Kaplan-Meier curves (χ2=4.330, log-rank P=0.037). No difference in early- and long-term mortality or major adverse cardiac and cerebrovascular events (MACCE) were observed between the groups. The rate of MACCE was not statistically significant different between the groups, but there was a tendency favoring the no-touch technique (9.8% CSV vs. 4.8% NTSV; P=0.067). More patients in the NTSV group developed postoperative leg wound exudation (5.4% vs. 1.2%; P=0.032) and skin numbness (22.2% vs. 8.9%; P=0.001) than in the CSV group. Conclusion: The NTSV is an excellent conduit to be used in OPCABG. There remains a need to reduce leg wound complications.

Report of envenomation in humans by handling a dyeing poison frog Dendrobates tinctorius (SCHNEIDER, 1799) (Anura: Dendrobatidae) in the Amazon, Brazil

Abstract We report a case of envenomation by Dendrobates tinctorius in the northwest of the Amazon Forest. The patients were two men, who presented with numbness in the right arm and slight numbness in the lower lip, respectively. Dendrobates tinctorius secretions contain pumiliotoxin, one of several toxins found in the dendrobatidis skin, which interferes with muscle contraction and causes locomotor difficulties. Although Dendrobatidae is a family of anurans known for their venom, few studies describe the symptoms of envenomation in humans.

Late recurrence of Burkitt's lymphoma in the jaw: numb chin syndrome as the only symptom

The Numb Chin Syndrome (NCS) is defined as facial and oral numbness restricted to the mental nerve's distribution involving the lower lip, skin of the chin, or gingiva of the lower anterior teeth. Hypoesthesia can occur unilaterally or bilaterally. Although this syndrome is rare, its importance is related to the fact that it represents the clinical manifestations of malignant diseases. Breast cancer and non-Hodgkin lymphoma are the most common cause of NCS. The patient, a 58-year-old woman, treated for a Burkitt Lymphoma (BL) nine years ago, described a two-week history of change in sensitivity and pain in the chin region, without relief with the use of analgesics. She had no headache, speech disturbance, dysphagia, visual disturbance, or other neurological symptoms. No surgical intervention has been performed recently. The intraoral examination revealed a healthy oral mucosa and a small area adjacent to the right mental nerve region that was uncomfortable to palpation. No changes were found in the bone trabeculae at cone-beam computed tomography. The contrasted magnetic resonance features made it possible to identify a change in the mandibular body extending to the entire right side, coinciding with the patient's complaint, indicating a probable mandibular medullary invasion. The patient was submitted to a biopsy to rule out a possible recurrence of BL. The microscopic findings were consistent with the diagnosis of BL. The present report described a very unusual presentation of late recurrent BL nine years after the first treatment, which manifested as an NCS.

Resting-state fMRI observation of persistent limb numbness induced with electrical stimulation / 中国医学影像技术

Objective: To investigate changes of brain function caused by persistent limb numbness induced with electrical stimulation by using fractional amplitude of low frequency fluctuation (fALFF) of resting-state fMRI (rs-fMRI), and to explore relative brain mechanisms. Methods: Totally 21 healthy adults were enrolled. rs-fMRI scans were performed with or without persistent limb numbness induced with electrical stimulation. The subjects were asked to rate the numbness intensity under the same electrical stimulation. fLAFF algorithm was used to analyze rs-fMRI data of brain with and without electrical stimulation. Brain regions with significant differences were acquired, and correlation analysis was performed for fALFF under stimulation and individual numbness intensity scores. Results: Brain regions with fALFF increase under electrical stimulation include medial frontal cortex, anterior cingulate cortex, bilateral middle temporal gyrus, bilateral inferior temporal gyrus and right temporal pole (all P<0.05, FDR corrected), those with fALFF decrease included precuneus/posterior cingulate gyrus and right cerebellum (all P<0.05, FDR corrected). Precuneus/posterior cingulate gyrus and left middle temporal gyrus were positively correlated with individual numbness scores (both P<0.05, FDR corrected0, right frontal pole and left inferior temporal gyrus were negatively associated with individual numbness scores (both P<0.05, FDR corrected). Conclusion: Persistent limb numbness involves brain regions related to sensorimotor, emotion, cognition and default mode network. Precuneus/posterior cingulate gyrus, temporal lobe and frontal lobe are significantly related to individual numbness.

Lepra neural pura de 18 años de evolución / 18 years of pure neuritic leprosy

La lepra puede presentar dificultades diagnósticas, especialmente en la forma neural primaria. Un hombre de 38 años, exsoldado y trabajador rural, presentó durante más de 10 años hiperestesia supraclavicular y supraescapular izquierdas y anestesia progresiva escapular y en guante de la mano y brazo izquierdos, con reabsorción ósea de las falanges distales del primero y segundo dedos de la misma mano, cambios que le dificultaban realizar sus labores; no tenía lesiones cutáneas de lepra. El nervio cubital izquierdo presentaba engrosamiento epitroclear, por lo que se sospechó lepra neural pura. Las baciloscopias de moco, pabellones auriculares y codos fueron negativas, al igual que los anticuerpos IgM contra el glicolípido fenólico 1; dos biopsias de piel de zonas anestésicas fueron normales también. La electromiografía evidenció disminución notoria de los potenciales sensitivos de los nervios cubital, radial y mediano izquierdos, lo cual favoreció el diagnóstico de lepra neural primaria. Se inició tratamiento para lepra multibacilar por tener afección de más de un tronco nervioso, dos meses después comenzó a presentar mejoría notoria de los síntomas y logró reanudar sus actividades comunes y laborales. La lepra neural primaria cursa con zonas de hipoestesia y anestesia cutánea y engrosamiento neural troncular, puede permanecer sin diagnóstico durante años. La electromiografía, que demuestra disminución de los potenciales sensitivos, es una ayuda diagnóstica considerable, mientras la biopsia de piel anestésica ayuda al diagnóstico solo en la tercera parte de los casos. La sospecha clínica razonable es suficiente para iniciar tratamiento antileproso, cuando no se dispone de otros medios diagnósticos.

Leprosy can be difficult to diagnose, in particular the pure neuritic leprosy type. A 38-year-old male, former soldier and rural worker, presented with a 10-year history of supraclavicular and suprascapular hyperesthesia of the left side and progressive scapular left arm anesthesia, including the hand, associated with bone resorption in distal phalanges of the first and second finger. No typical leprosy skin changes were present. An examination of the skin revealed epitrochlear thickening of the left side cubital nerve, therefore primary neural leprosy was suspected. Skin smears from the routine sites were normal, as were two skin biopsies and the serologic assay specific for M leprae to detect phenolic glycolipid-1. Electromyography revealed an important reduction in the sensory action potential of the ulnar, radial and medial nerves, which favored the primary neural leprosy diagnosis. After two months of multibacillar leprosy treatment, the symptoms started to disappear and the patient could recommence his old job. Pure neuritic leprosy presents with skin areas of hypesthesia and anesthaesia associated with nerve thickening. It is a disease that is commonly misdiagnosed for several years before the correct diagnosis is made and effective treatment is started. Electromyography can be a helpful tool in the diagnosis, typically showing reduced sensory action potential, while a biopsy of anesthetic skin is only helpful in one-third of cases. Reasonable clinical suspicion is sufficient to initiate antileprosy treatment when no other diagnostic methods are available.

Infraorbital Nerve Hypesthesia after Inferior Orbital Wall Fracture and Reconstruction Surgery

PURPOSE: To report the incidence of infraorbital nerve hypesthesia after inferior orbital wall fracture and reconstruction surgery and analyze the duration and factors to influence the occurence of the infraorbital nerve hypesthesia. METHODS: From March, 2001 to March, 2016, the medical records of 171 patients with isolated orbital floor fracture reconstructed with porous polyethylene or titanium mesh was analyzed retrospectively. Injury mechanism, fracture type, time interval to surgery, fracture size, type and thickness of implant were analyzed. Orbit computed tomography scan was performed at preoperative and postoperative 6 weeks. RESULTS: Mean age was 30.4 years (male:female = 130:41). The mean time interval to surgery was 9.5 days. Incidence of infraorbital hypesthesia was 9.9% preoperatively, 38% in a week of surgery, 13.5% in 6 weeks and 5.8% in 6 months. Infraorbital hypesthesia lasts 20.5 weeks and the length of infraorbital canal was the only risk factor of persistent infraorbital hypesthesia. CONCLUSIONS: Postoperative infraorbital nerve hypesthesia presents in a week in most patients. It last about 20.5 weeks, then mostly recovers in 6 months. This study will be useful to predict the clinical course of the patients with infraorbital nerve hypesthesia. Therefore, full explanation about the facial sense change is necessary for the patients with inferior orbital wall fracture.

The Measurement of the Sensory Recovery Period in Zygoma and Blow-Out Fractures with Neurometer Current Perception Threshold

BACKGROUND: Facial hypoesthesia is one of the most troublesome complaints in the management of facial bone fractures. However, there is a lack of literature on facial sensory recovery after facial trauma. The purpose of this study was to evaluate the facial sensory recovery period for facial bone fractures using Neurometer. METHODS: Sixty-three patients who underwent open reduction of zygomatic and blowout fractures between December 2013 and July 2015 were included in the study. The facial sensory status of the patients was repeatedly examined preoperatively and postoperatively by Neurometer current perception threshold (CPT) until the results were normalized. RESULTS: Among the 63 subjects, 30 patients had normal Neurometer results preoperatively and postoperatively. According to fracture types, 17 patients with blowout fracture had a median recovery period of 0.25 months. Twelve patients with zygomatic fracture had a median recovery period of 1.00 month. Four patients with both fracture types had a median recovery period of 0.625 months. The median recovery period of all 33 patients was 0.25 months. There was no statistically significant difference in the sensory recovery period between types and subgroups of zygomatic and blowout fractures. In addition, there was no statistically significant difference in the sensory recovery period according to Neurometer results and the patients' own subjective reports. CONCLUSIONS: Neurometer CPT is effective for evaluating and comparing preoperative and postoperative facial sensory status and evaluating the sensory recovery period in facial bone fracture patients.

Conjunctivo-limbal Autograft for Climatic Droplet Keratopathy with Ulcerative Keratitis: A Case Report.

Climatic droplet keratopathy (CDK) is one of the most frequent degenerative corneal diseases with high prevalence rates, especially in equatorial and polar regions. Th e profound hypoesthesia observed in some cases with advanced CDK may contribute to the occurrence of trophic-corneal ulceration, rapid bacterial over infection, diffi culty of healing and relentless evolution to perforation. Superfi cial keratectomy, lamellar or penetrating keratoplasty and excimer laser phototherapeutic keratectomy are various surgical options that have been tried in the management of CDK involving the visual axis, impairing the vision. We attempted conjunctivo-limbal autograft (CLAG) in a patient of advanced CDK with corneal ulceration and studied the outcome at the end of 6 weeks and found a better corneal epithelial regeneration post CLAG.

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications

BACKGROUND: The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. METHODS: The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. RESULTS: From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. CONCLUSIONS: The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

Efecto de la estimulación eléctrica neural transcutánea (TENS) a nivel lumbar segmentario / Effect of transcutaneous electrical neural stimulation (TENS) at lumbar segmental

En lo referente a agentes físicos utilizados en kinesiología, la electroestimulación transcutánea (TENS) es muy utilizada para tratar, entre otros, problemas musculares, edemas y procesos dolorosos. El siguiente estudio tiene como propósito determinar los efectos hipoestésicos de la aplicación de TENS a nivel medular segmentario sobre las extremidades inferiores. Para el desarrollo del estudio se seleccionaron por conveniencia 14 estudiantes de la Facultad de Medicina de la Universidad de Chile (18-24 años), que fueron divididos en dos grupos aleatoriamente, uno control y otro experimental. Para ambos grupos se determinó el umbral de presión inicial mediante un algómetro de presión en el músculo cuádriceps de la extremidad inferior izquierda, luego el grupo experimental fue estimulado con TENS en el nivel lumbar correspondiente (L3-L4), mientras en el grupo control se simuló una situación similar sin paso de corriente. Finalmente, se midió nuevamente el umbral de presión en ambos grupos mediante el método inicial. Los resultados mostraron que existe una diferencia significativa (p=0,001) entre el umbral de presión previo y posterior a la aplicación de TENS en el grupo experimental, a diferencia del grupo control, que no mostró diferencias significativas (p=0,140), por lo que se demuestra el efecto hipoestésico que genera en las extremidades la aplicación de electroestimulación en el nivel lumbar correspondiente. Lo anterior resultaría de gran utilidad en la aplicación de TENS en pacientes con trastornos músculoesqueléticos, evitando el contacto con la zona lesionada, que puede presentar dolor, hiperalgesia o alodinia...

Concerning the physical agents utilized in physical therapy, transcutaneous electric nerve stimulation (TENS) is commonly used to treat muscular problems, edemas and painful processes, among others. The following study is aimed at determining the hypoesthesia effects’s of TENS application at a segmental medullary level, on the lower limbs. To develop the study, fourteen students (aged 18 and 24 years old) from the Medicine Faculty were chosen by convenience. They were divided at random into two groups: one for control and the other experimental. For both groups initial pressure threshold was determined through a pressure algometer on the lower left extremity’s quadriceps muscle. Then the experimental group was stimulated with TENS on the corresponding lumbar level (L3, L4). In the meantime, in the control group a similar situation was simulated, without current flow. Finally, the pressure threshold was measured again in both groups through the initial method. The results showed that there is a significant difference (p=0,001) between the pressure threshold occurring before, and after the TENS application in the experimental group. On the contrary, the group control didn’t show any significant difference (p=0,140). Therefore, this shows the hypoesthesia effect’s generated in the limbs by the electrostimulation on the corresponding lumbar level. This would be very useful in the TENS application on patients suffering from muscle-skeletal disorder, thus avoiding the contact with injured zone, which can present pain, hyperalgesia, or allodynia...

Sensation disorders of lateral skin of the incision after total knee arthroplasty / 中华骨科杂志

ObjectiveTo investigate the sequelae and relative factors of sensation disorders of lateral skin of the incision after total knee arthroplasty (TKA) and to explore its effect on knee function.MethodsThirty-six patients (53 knees) who underwent TKA were continuously selected in this study.The length of the incision and the area of sensation disorders of skin around the incision were measured 1 week postoperatively.The area of sensation disorders of skin around the incision was measured again 1.5 years postoperatively,and the range of motion of the knee and the knee society score (KSS) were recorded.ResultsAll of the patients presented with objective hypesthesia of lateral skin of the incision.Twenty-six (72％) patients existed subjective numbness,whose areas of hypesthesia were larger than those of patients without subjective numbness.The average area of hypopselaphesia and average area of hypalgesia were(36.43±14.71) cm2 and (69.62±23.48) cm2,respectively.Both of them had positive correlation with the length of the incision (r=0.303,P=0.04; r=0.318,P=0.03).One and a half years postoperatively,besides 5 patients recovered completely,all other patients existed no hypopselaphesia,and the average area of hypalgesia was(8.55±4.56)cm2,which was statistically different with that 1 week postoperatively(t=2.553,P=0.012).The KSS score was lower in patients with subjective numbness than that in patients without subjective numbness (t=2.066,P=0.044).ConclusionThe hypesthesia of lateral skin of the incision is common after TKA,which can recover partially or completely over time.All patients should be advised of this complication as part of their informed consent before TKA.

Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester

INTRODUCTION: As dental implant surgery is becoming increasingly popular, it has become one of the causes for the hypesthesia of the inferior alveolar nerve, along with other surgical procedures, such as a third molar extraction. In addition, it tends to cause legal problems between the operator and patient. Therefore, there must be a proper method that is reliable, objective and economical to assess the nerve impairment. For this reason, an attempt was made to use an Electric Pulp Tester to assess inferior alveolar nerve block anesthesia. MATERIALS AND METHODS: Thirty patients were tested. Electric pulp testing of the lower jaw skin was performed at the three different times, before anesthesia, at the onset of sensory changes and after 15 minutes waiting from the onset, and on the 10 points of the chin, which produced 10 sections on the skin area. RESULTS: Twenty seven patients (90%) could feel the electric stimulus on the chin at all 10 points before local anesthesia and the scores represent the statistical differences between the right and left points except R4 and L4. After anesthesia, the difference between the right and left points (L3-R3, L4-R4, L5-R5) increased significantly with time but two points (L2, R2) showed no significant difference. The scores on the left chin (L3, L4, L5) increased, whereas the other points (R1-R5, L1, L2) showed no significant differences. CONCLUSION: This study highlights the potential clinical use of an electric pulp tester for an assessment of inferior alveolar nerve impairment.

Application of contact heat evoked potentials in multiple sclerosis / 中华神经科杂志

Objective To establish a method to evoke cerebral potentials by stimulating nociceptive fibers with contact heat evoked potential stimulator,evaluate the state of nociceptive system in patients with multiple sclerosis and assess the value of the potentials in multiple sclerosis(MS).Methods Thirty-six definite MS patients and 40 sex-,height-and aged-matched healthy persons underwent stimulation of contact heat delivered via a circular thermode to excite selectively nociceptors with a rapid rising time at 70℃/s to elicit pain and contact heat evoked potentiaI(CHEP).Thermal stimuli were sent at two intensity levels (47 ℃ and 51℃)to 3 body sites:volar surface of the forearm,the skin of leg 5 cm proximal to the medial malleolus and lumbar part.The CHEP were recorded from Cz.The relationship between the stimulus intensity and pain rating was observed,and the main components of the evoked potential were recorded.Then,somatosensory evoked potential(SEP)was examined in 36 patients with MS.Results CHEP were elicited reliably and stably in all control subjects.In contrast,in 4 patients there were no recordable CHEP on stimulation of the upper limb,and in some cases of lower limb(n=5).Conduction velocity of Aδ fihers was(18.1±7.3)m/s.The 21 MS cases had hypesthesia in upper limb and 29 cases in lower limb.The visual analog scale(VAS)for pain perception was higher in control subjects(upper limb:8.0±0.7;lower limb:7.9±0.7)than MS with hypesthesia(upper limb:6.1±0.9;lower limb:5.6±1.3,Z=-3.249 and -5.272,both P＜0.01).The group of patients (MS) with hypesthesia(upper limb 17 cases,lower limb 24 cases)had markedly reduced N-P amplitudes(upper limb:(30.5±12.8)μV;lower limb:(28.2±16.2)μV,t=-4.612 and -3.144,both P＜0.01)and prolonged N-wave latencies(upper limb:(387.3±34.2)ms;lower limb:(489.9±70.2)ms,t=4.790 and 4.798,both P＜0.01)compared with the control group in CHEP mediated by Aδ fibers.CHEP abnormality was observed more often in the lower(26/36,72.2%)than the upper limb(16/36,44.4%,P=0.031)and SEP(19/36,52.8%,χ~2=4.261,P=0.039).CHEP were abnormal in 3 of 15 skin areas with clinically normal nociception in upper limb,and in some cases of lower limb(2 of 7).Conclusions CHEP provides a clinically practical,non-invasive and objective measure,and can be a useful additional tool for the assessment of nocieptive system.Combined assessment of other Eps can help to document dissemination of demyelinating CNS lesions and detect subclinical lesions thus contribute to the diagnosis of multiple sclerosis.

Corneal Neovascularization and Corneal Hypesthesia as Contact Lens Complications

PURPOSE: To investigate the relationship between corneal neovascularization (CNV), corneal hypesthesia and dry eye syndrome. METHODS: From July 2003 to November 2004, patients who had history of weraing soft contact lenses were selected and administered the Schirmer test; those with conjunctival inflammation and corneal complications were tested using an esthesiometer, and were given a dry eye questionnaire. RESULTS: A longer period of soft contact lens wear was related to CNV and corneal hypesthesia (p<0.01), and theses two complications showed a significan relationship with symptoms of dry eye syndrome (p<0.01). CONCLUSIONS: Corneal neovascularization and corneal hypesthesia should be considered in cases of long term wear of soft contact lenses. The eyes with CNV and corneal hypesthesia had more severe symptoms of dry eye syndrome.