Clinical manifestations of nodo-paranodopathy with anti-neurofascin 186 antibody positive(report of one case) / 临床神经病学杂志

Objective To investigate the clinical manifestations of nodo-paranodopathy(NPP)with anti-neurofascin 186(NF186)antibody positive.Methods The clinical data of a NPP patient with cranial nerve damage caused by anti-NF186 antibody positive was retrospectively analyzed.Results The patient was a 70-year-old male with sudden speech disorder and dysphagia one month ago.Glucocorticoid therapy was discontinued after improvement.The patient's speech,swallowing,chewing,bristling,turning and head-up movements were laborious and progressively aggravated 5 days ago.The EMG examination of the limbs was normal,and the serum and CSF anti-NF186 antibody were positive.The curative effect of glucocorticoid treatment was not obvious,and the symptoms were significantly improved after plasma exchange treatment.Conclusions Anti-NF186 antibody-positive NPP has late onset age,severe illness and accompanied with cranial nerves damage.Conventional hormone therapy is not effective,but plasma exchange therapy is effective.

Effect of sufentanil on apoptosis in spinal cord neurons of mice with peripheral nerve injury / 中华麻醉学杂志

Objective To evaluate the effect of sufentanil on apoptosis in spinal cord neurons of mice with peripheral nerve injury. Methods One hundred and fifty clean-grade healthy male BALB∕c mice, aged 6-8 weeks, weighing 18-22 g, were divided into 3 groups ( n=50 each) using a random number table method: sham operation group (group Sham), peripheral nerve injury group (group PNI) and sufentanil group ( group SF) . The model of unilateral sciatic nerve injury was established in PNI and SF groups. After establishing the model, sufentanil 5. 0 μg∕kg was intraperitoneally injected once a day for 3 consecutive days in group SF, while the equal volume of normal saline was given instead of sufentanil in Sham and PNI groups. Five mice in each group were sacrificed at days 1, 3, 7, 14 and 28 after surgery ( T0-4 ) , and L4-6 segments of the injure ipsilateral spinal cord were removed for examination of pathological changes ( with a light microscope) and for determination of neuronal apoptosis ( by TUNEL assay) . The ap-optosis index ( AI) was calculated. Five mice in each group were sacrificed at T0-4 , and L4-6 segments of the injured ipsilateral spinal cord were removed for detection of the expression of Bcl-2, Bax and cleaved caspase-3 by Western blot. The ratio of Bcl-2 expression to Bax expression ( Bcl-2∕Bax ratio) was calculat-ed. Results Compared with group Sham, the AI was significantly increased, the expression of Bcl-2 pro-tein was down-regulated, and the expression of cleaved caspase-3 and Bax was up-regulated in PNI and SF groups ( P<0. 05) . Compared with group PNI, the AI was significantly decreased, the expression of Bcl-2 protein was up-regulated, the expression of cleaved caspase-3 and Bax was down-regulated, the Bcl-2∕Bax ratio was increased (P<0. 05), and the pathological changes were significantly attenuated in group SF. Conclusion Sufentanil can inhibit apoptosis in spinal cord neurons of mice with peripheral nerve injury.

Microcirurgia das lesões traumáticas de nervo periférico do membro superior: [revisão] / Microsurgical treatment to repair injuries of the peripheral nerves in upper limb: [review]

Apesar da grande quantidade de publicações e surgimento de novos dados laboratoriais e clínicos relacionados aos conceitos da regeneração dos nervos periféricos, estas lesões são ainda um dos mais desafiadores e difíceis problemas cirúrgicos reconstrutivos. O emprego da microcirurgia tem melhorado os resultados do reparo de nervo, principalmente nas lesões agudas, contudo para reduzir as sequelas é importante a compreensão dos mecanismos, princípios técnicos e de reabilitação. Os autores realizaram revisão da literatura com enfoque para o reparo neural e a reabilitação pós-operatória.

Despite the large number of publications and development of laboratory and clinical concepts related to the regeneration of peripheral nerves, these injuries remain one of the most challenging and difficult surgical reconstructive problems. The microsurgery use has improved the outcome of nerve repair, especially in acute injuries, but to get reduce the consequences it is important to understand the mechanisms, technical principles and rehabilitation. The authors review the literature about neural repair, and rehabilitation after surgery.

Epidemiologia das lesões traumáticas tardias de nervoPeriférico do membro superior / Epidemiology of the traumatic injuries of the upper limbs peripheric nerves

As lesões de nervo periférico no membro superior sãocomuns e podem ocasionar graves déficits funcionais comrepercussões socioeconômicas. Os estudos epidemiológicos sãoimportantes para a compreensão dos mecanismos e padrões delesões de nervo. Objetivo: Descrever as lesões traumáticas tardiasde nervo periférico no membro superior. Método: Estudoretrospectivo de 538 pacientes apresentando traumatismos nomembro superior, atendidos no Hospital Sarah Brasília, noperíodo de janeiro de 2001 a dezembro de 2006. Do total depacientes, 144 apresentavam lesões de nervo periférico nomembro superior, prevalência de 27%. Desses, 70 pacientes, com89 lesões de nervos submeteram-se ao reparo neural e/ouepineurólise e um à transferência tendínea. Resultados: A maioriadas lesões aconteceu em pacientes do sexo masculino, comidade variando de 7 a 69 anos; atingiram o nervo radial em 18(25%), mediano em 16 (22%), nervo ulnar em 14 (19,4%), medianoe ulnar em 12 (16,7%), mediano, ulnar e radial em cinco (7%) edigital em sete (9,7%). A maioria dos casos foi provocada porobjetos cortantes, 49 (68%). Em 27 casos, foi decorrente deacidente de trabalho, seis por acidentes motociclísticos ouautomobilísticos e 16 devido a agressão física. Conclusão:Encontrou-se uma alta prevalência de traumatismos de nervo nomembro superior atendidos tardiamente. Na metade dos casoshaviam lesões associadas e necessitavam intervenção cirúrgicapara o reparo neural e programa de reabilitação.

Injuries of the upper limbs peripheric nerves arequite common and may lead to serious functional limitationswith socio-economical impact. The epidemiology studies areimportant for comprehensive the mechanisms and pattern ofupper limb nerve injuries. Objective: To describe traumatic lateinjuries of the peripheric nerve of upper limbs. Methods:Retrospective study of 538 patients, admitted at Sarah Hospitalfrom January 2001 to December 2006 (144 patients withupper limb nerve injury). Only 70, with 89 traumatic nerveinjuries, required study for nerve repair and only one requiretendon transfer. Results: Most of injuries occured in malepatients, with age from 7 to 69 years. We observed frequenciesof nerve injuries are radial 18 (25%),median 16 (22%),ulnar nerver14 (19.4%), median and ulnar 12 (16.7%), median, ulnar and radial5 (7%) and digital in seven (9.7%). The majority of the cases weredue to cutting object (49 cases/68%). In 27 other cases tolabor accidents, 6 by motorcicle or car accidentes and 16 byphysical struggle. Conclusion: We found a high rate of latetreatment of upper limb nerve injuries. Aproximadetly half ofthe cases other injuries were associated and need surgicalintervention for neural repair and rehabilitation program.

Long-term curative effects of one end-to-side and double end-to-side neurorrhaphy in treatment of peripheral nerve defects / 吉林大学学报(医学版)

0.05).Conclusion The long-term curative effects of one end-to-side and double end-to-side neurorrhaphy are the same.The proximal end of the transected nerve can be reconnected with the distal end by double end-to-side neurorrhaphy,but the connected fibers have only partial effects on the recovery of the nerve.

MR Imaging of Traumatic Brachial Plexus Injury

PURPOSE: The aim of our study was to evaluate the usefulness of MR imaging in cases of traumatic brachial plexus injury. MATERIALS AND METHODS: We evaluated 25 patients with traumatic brachial plexus injury as seen on MR images prior to surgical exploration and repair. MR images were retrospectively evaluated for nerve root avulsion and pseudomeningocele, and postganglionic lesions. Results were correlated with final diagnosis after surgical exploration . RESULTS: One hundred and four of 125 root levels (83%) were adequately imaged. Neve root avulsion was shown at 28 levels(54%). Avulsion with or without pseudomeningocele was seen at 37 levels(71%)(80% sensitivity, 91% specificity). The presence of ten of 12 postganglionic lesions (83%) was revealed by MR imaging. CONCLUSION: MR imaging is valuable for revealing preganglionic nerve root avulsion in patients with traumatic brachial plexus injury or postganglionic lesions.

MR Imaging of Traumatic Brachial Plexus Injury

PURPOSE: The aim of our study was to evaluate the usefulness of MR imaging in cases of traumatic brachial plexus injury. MATERIALS AND METHODS: We evaluated 25 patients with traumatic brachial plexus injury as seen on MR images prior to surgical exploration and repair. MR images were retrospectively evaluated for nerve root avulsion and pseudomeningocele, and postganglionic lesions. Results were correlated with final diagnosis after surgical exploration . RESULTS: One hundred and four of 125 root levels (83%) were adequately imaged. Neve root avulsion was shown at 28 levels(54%). Avulsion with or without pseudomeningocele was seen at 37 levels(71%)(80% sensitivity, 91% specificity). The presence of ten of 12 postganglionic lesions (83%) was revealed by MR imaging. CONCLUSION: MR imaging is valuable for revealing preganglionic nerve root avulsion in patients with traumatic brachial plexus injury or postganglionic lesions.