Diagnostic value of F wave changes in patients with Charcot-Marie-Tooth1A and chronic inflammatory demyelinating polyneuropathy / 北京大学学报(医学版)

OBJECTIVE@#To analyze and compare the characteristics and causes of F wave changes in patients with Charcot-Marie-Tooth1A (CMT1A) and chronic inflammatory demyelinating polyneuropathy (CIDP).@*METHODS@#Thirty patients with CMT1A and 30 patients with CIDP were enrolled in Peking University Third Hospital from January 2012 to December 2018. Their clinical data, electrophysiological data(nerve conduction velocity, F wave and H reflex) and neurological function scores were recorded. Some patients underwent magnetic resonance imaging of brachial plexus and lumbar plexus, and the results were analyzed and compared.@*RESULTS@#The average motor conduction velocity (MCV) of median nerve was (21.10±10.60) m/s in CMT1A and (31.52±12.46) m/s in CIDP. There was a significant difference between the two groups (t=-6.75, P < 0.001). About 43.3% (13/30) of the patients with CMT1A did not elicit F wave in ulnar nerve, which was significantly higher than that of the patients with CIDP (4/30, 13.3%), χ2=6.65, P=0.010. Among the patients who could elicit F wave, the latency of F wave in CMT1A group was (52.40±17.56) ms and that in CIDP group was (42.20±12.73) ms. There was a significant difference between the two groups (t=2.96, P=0.006). The occurrence rate of F wave in CMT1A group was 34.6%±39%, and that in CIDP group was 70.7%±15.2%. There was a significant difference between the two groups (t=-5.13, P < 0.001). The MCV of median nerve in a patient with anti neurofascin 155 (NF155) was 23.22 m/s, the latency of F wave was 62.9-70.7 ms, and the occurrence rate was 85%-95%. The proportion of brachial plexus and lumbar plexus thickening in CMT1A was 83.3% (5/6) and 85.7% (6/7), respectively. The proportion of brachial plexus and lumbar plexus thickening in the CIDP patients was only 25.0% (1/4, 2/8). The nerve roots of brachial plexus and lumbar plexus were significantly thickened in a patient with anti NF155 antibody.@*CONCLUSION@#The prolonged latency of F wave in patients with CMT1A reflects the homogenous changes in both proximal and distal peripheral nerves, which can be used as a method to differentiate the CIDP patients characterized by focal demyelinating pathology. Moreover, attention should be paid to differentiate it from the peripheral neuropathy caused by anti NF155 CIDP. Although F wave is often used as an indicator of proximal nerve injury, motor neuron excitability, anterior horn cells, and motor nerve myelin sheath lesions can affect its latency and occurrence rate. F wave abnormalities need to be comprehensively analyzed in combination with the etiology, other electrophysiological results, and MRI imaging.

Benign Solitary Schwannoma of Right Ulnar Nerve – A Case Report.

Introduction: Benign peripheral nerve schwannomas are uncommon tumours. Extra cranial schwannomas have also been reported from uncommon and unusual sites including breast, pancreas, and gastrointestinal system. Peripheral nerve schwannomas may pose a problem in clinical diagnosis, however an appropriate diagnostic work-up including thorough history and clinical examination, Ultrasonography, magnetic resonance imaging, fi ne needle aspiration cytology, nerve conduction velocity and electromyography study may all help reaching the correct preoperative diagnosis. Th e important clinical diff erential diagnoses include traumatic neuroma, neurfi bromas, lipoma, cold abscess and muscle hernia. Th e defi nitive treatment of benign peripheral nerve schwannoma is complete enucleation of the tumour mass without damaging the intact nerve fascicles followed by confi rmatory histopathological examination. When there is a doubt on histopathology, a positive Immunohistochemical staining with S100 is helpful in confi rming a diagnosis of schwannoma. Case presentation: We had 40 years female who had a slow growing swelling over the inner aspect of her right elbow for the last one year; this was followed by pain, tingling and numbness over inner one and half fi ngers of her right hand for six months. Tinnels sign was positive over the swelling. Her subsequent clinical examination and investigations including a magnetic resonance imaging was suggestive of a benign growth in her right ulnar nerve in the elbow region. Complete enucleation of the swelling was done from the right ulnar nerve in the elbow region and subsequent histopathological examination confi rmed it to be a benign cellular schwannoma. Patient recovered successfully after the surgery and paresthesia in the distribution of her right ulnar nerve also improved six weeks after surgery. At her last follow-up six months after surgery, the patient was completely asymptomatic and highly satisfi ed with the results of surgery. Conclusion: A correct preoperative diagnosis of peripheral nerve schwannomas is possible, and it can be successfully managed with complete enucleation of tumour mass with satisfactory patient outcomes.

Neural relapse in multibacillary leprosy 6 years after end of treatment / Recidiva neural em hanseníase multibacilar após 6 anos de tratamento

This article presents a case of relapse, with isolated neural manifestation, in a multibacillary patient previously treated with multidrug therapy for multibacillary leprosy (24 doses). The patient returned to the service six years after the end of treatment, with pain in hands and legs. He was investigated, and the serological monitoring showed an important increase in anti-phenolic glycolipid serum levels. A neural recurrence was suspected, since the patient had no new skin lesions. A new biopsy in the right ulnar nerve showed a bacilloscopy of 2 +, compatible with relapse. This is a literature review of the etiological, clinical, propedeutical and diagnostic aspects of this situation so poorly understood.

O presente artigo relata um caso de recidiva, com manifestação neural isolada, em paciente multibacilar previamente tratado com poliquimioterapia para multibacilar 24 doses. O paciente retorna ao serviço, seis anos depois do fim do tratamento, com dores em mãos e pernas. Na investigação, o acompanhamento da sorologia anti-glicolipídeo fenólico 1 demonstrou aumento importante dos níveis séricos, e foi aventada a hipótese de recidiva neural, já que o paciente não apresentava lesões cutâneas novas. Uma nova biópsia, em nervo ulnar direito, demonstrou baciloscopia de 2+, compatível com recidiva. Faz-se revisão da literatura sobre aspectos etiológicos, clínicos, propedêuticos e diagnósticos dessa situação tão pouco compreendida.

Contribución proximal del nervio ulnar para la formación del nervio digital palmar propio ulnar del dedo mínimo / Proximal contribution of the ulnar nerve in the formation of the ulnar proper palmar digital nerve of the little finger

La anatomía de la mano presenta padrones generales en la distribución de los nervios responsables de la inervación motora y sensitiva. Sin embargo, se encuentran variaciones que son de interés para la anatomía quirúrgica de la región. En una serie de 20 manos disecadas, en 19 (95 por ciento) observamos que el nervio digital palmar propio del lado ulnar del dedo mínimo correspondía a un ramo directo del nervio ulnar y en el caso restante (5 por ciento), de un cadáver de sexo femenino, se observó un ramo de origen antebraquial que participó en la formación del nervio digital palmar propio ulnar del dedo mínimo. Este ramo se originó desde el tronco del nervio ulnar, distal al origen del ramo dorsal de este nervio y proximal al hueso pisiforme. En su trayecto pasó a través del músculo abductor del dedo mínimo, emergiendo por la cara superficial de éste a una distancia de 11,3 mm del origen del músculo en el hueso pisiforme, uniéndose al nervio digital palmar propio del dedo mínimo, distal al hueso mencionado. A pesar que la literatura muestra diversas variaciones en la formación y distribución de los nervios en la mano, la disposición descrita es inusual y no ha sido mencionada en ella.

The hand anatomy presents general patterns in motor and sensitive nerves distribution. However, is possible to find some variations that are very important for the surgical anatomy of the region. We study 20 hands of 10 cadaver individuals, fixed in 10 percent formaldehyde solution. We found in 19 hands (95 percent) that the ulnar proper palmar digital nerve of the little finger was a direct branch of the ulnar nerve and only one case (5 percent) - of female cadaver ¡ we observed one branch originated from the forearm, which was a part in the formation of the nerve mentioned above. This branch originated from the trunk of the ulnar nerve, distal to the origin of the dorsal branch of this nerve, proximal to the pisiform bone. This nerve passed through of the abductor digiti minimi muscle and then it emerged by the superficial face of this muscle, 11,3 mm distal to its origin in the pisiform bone. Then, it joined to the ulnar proper palmar digital nerve of the little finger, distal to mentioned bone. Although the literature describes innumerous variations in the formation and distribution of the hand nerves, this disposition is rare and has not been mentioned.

Contribution of the Proximal Nerve Stump in End-to-side Nerve Repair: In a Rat Model

BACKGROUND: The aim of this study was to evaluate the contribution of the proximal nerve stump, in end-to-side nerve repair, to functional recovery, by modifying the classic end-to-side neurorrhaphy and suturing the proximal nerve stump to a donor nerve in a rat model of a severed median nerve. METHODS: Three experimental groups were studied: a modified end-to-side neurorrhaphy with suturing of the proximal nerve stump (double end-to-side neurorrhaphy, Group I), a classic end-to-side neurorrhaphy (Group II) and a control group without neurorrhaphy (Group III). Twenty weeks after surgery, grasping testing, muscle contractility testing, and histological studies were performed. RESULTS: The grasping strength, muscle contraction force and nerve fiber count were significantly higher in group I than in group II, and there was no evidence of nerve recovery in group III. CONCLUSIONS: The contribution from the proximal nerve stump in double end-to-side nerve repair might improve axonal sprouting from the donor nerve and help achieve a better functional recovery in an end-to-side coaptation model.

Uso da técnica ulnar-bíceps (oberlin) em paralisias altas do plexo braquial: estudo funcional de 20 casos / The use of ulnar-biceps technique's in high paralyses of plexo brachialfunctional study of 20 cases

O autor apresenta 20 casos de paralisia alta do plexo braquial, acometendo as raízes C5, C6 ± C7, tratadas pela neurotização dos fascículos do nervo musculocutâneo que inervam o músculo bíceps braquial por fascículos do nervo ulnar para recuperação da flexão do cotovelo (Técnica de Oberlin).A neurorrafia pode ser executada sem enxertos nervosos de interposição. Em todos os paciente aferiu-se resultado positivo, com início da recuperação funcional aos 5,5 ± 1,7 meses pós- operatórios e flexão do cotovelo contra resistência aos 14,7 ± 5,5 meses depois da cirurgia.A seqüela provocada pela secção dos fascículos doadores do nervo ulnar foram clinicamente desprezíveis quando comparadas ao beneficio proporcionado. O sucesso alcançado pelo procedimento cirúrgico se deu, principalmente, pelo curto espaço de tempo entre o acidente e a cirurgia. Os resultados descritos estão de acordo com os da literatura e reafirmam que a neurotização "Ulnar-Biceps" e o procedimento de escolha para o tratamento cirúrgico das paralisias altas do plexo braquial.

The author presents 20 cases of upper brachial plexus palsies, concerning C5, C6 ± C7 roots, treated by neurotization of the musculocutaneus nerve fascicles innervating the biceps brachial muscle with ulnar nerve fascicles to recover elbow flexion (Oberlin's Technique). The neurorraphy could be executed without interposition of nerve grafts. All the patients had positive result, with beginning of the functional recovery at 5.5 ± 1.7 of postoperative month sandel bow flexi on again stresistance at 14.7 ± 5.5 months after the surgery. The sequel provoked by the sectioned donor fascicles of the ulnar nerve is clinically worthless when compared with the benefit produced. The success reached by the surgical procedure can be mainly given by short gap of time between accident and surgery. The described results are in accordance with the literature and reaffirm that the Ulnar-Biceps neurotization is the first choice procedure for the surgical treatment of the upper brachial plexus palsies.

Anatomy study of MGA in Chinese and its effect on legal expertise / 法医学杂志

OBJECTIVE@#This study aimed to clarify the morphology of the Martin-Gruber anastomosis (MGA) in Chinese.@*METHODS@#One hundred and five Chinese upper limbs (36 males and 20 femalese) were dissected to find the connections between medial nerve and ulnar nerve. The MGA was classified as previously described by Lee.@*RESULTS@#MGA was found in 24 cases (22.9%), in 11 of the 36 male and 5 of the 20 female. There was no obvious difference in the frequency of MGA in both upper limbs. Most MGA ulnar position was located at the medial and distal segment of the forearm.@*CONCLUSION@#MGA anatomy could play important role in forensic diagnosis of ulnar nerve injury in Chinese population.

Poor correlation of systemic immunological parameters with clinical features in macular leprosy.

On the basis of clinical features and bacteriological status, macular skin lesions of nine cases of leprosy were classified as falling within a spectrum between the tuberculoid at one end and the lepromatous at the other. While histologic correlation was seen in 60% of cases, humoral and cellular systemic immunologic features were found to be uncharacteristic. It is suggested that macular lesions form an early stage in the development of leprosy where the systemic immunological response is yet to set in fully.

Paralisia do nervo ulnar na lepra sem alteraçöes cutâneas: biópsia do ramo superficial do nervo ulnar na mäo / Ulnar nerve palsy in leprosy without skin changes: biopsy of the surface branch of the ulnar nerve in hand

A lepra constitui causa frequente de acometimento de nervos periféricos, em nosso meio. O sistema nervoso periférico é acometido por vezes sem que haja alteraçoes cutâneas: é a chamada forma neurítica pura. Nessa variante, o nervo mais afetado é o ulnar. Nos casos de acometimento isolado de nervos periféricos somente a feitura de biópsia de nervo conduzirá ao diagnóstico. Assim, resolvemos realizar biópsia do ramo sensitivo superficial do nervo ulnar na mao em 17 pacientes com paresia ou paralisia desse nervo e espessamento do mesmo na altura do cotovelo. Os pricnipais achados foram: reduçao do número de fibras mielínicas em 14 casos, infiltrado inflamatório em 13, fibrose em 12, desmielinizaçao e remielinizaçao em 9, presença de granuloma em 6 e visualizaçao do Mycobacterium leprae em 5. Concluímos que a biópsia do ramo sensitivo superficial do nervo ulnar na mao é um bom meio diagnóstico de lepra em pacientes com acometimento desse nervo.

Reaçäo hansênica tipo I na hanseníase borderline tuberculóide durante a poliquimioterapia: época de aparecimento e nervos acometidos / Type I reaction in borderline tuberculoid leprosy under multidrug therapy: time of onset and nerves affected

FUNDAMENTOS - A reaçäo tipo I é pouco estudada na literatura. OBJETIVOS - Descrever a época de aparecimento da reaçäo tipo 1 e os nervos acometidos, nos pacientes portadores de hanseníase borderline tuberculóide (BT), durante a poliquimioterapia(PQT). PACIENTES E MÉTODOS - Estudo longitudinal realizado no Ambulatório de Dermatologia da Faculdade de Medicina da UFMG. Setenta e um pacientes com hanseníase BT foram incluídos no estudo de agosto de 1989 a agosto de 1993. RESULTADOS - 89,3 por cento dos pacientes hansenianos BT com reaçäo tipo 1 apresentaram esse surto atá a sexta dose de tratamento. O nervo ulnar foi o mais acometido nas reaçöes tipo 1 (37,0 por cento). CONCLUSÃO - A reaçäo tipo 1 nos pacientes hansenianos BT ocorre mais frequentemente até a sexta dose de PQT. O nervo ulnar foi o mais acometido

Exame palpatório de nervos periféricos (espessados na hansenáse) e suas vias anatômicas / Palpations of peripheral nerves (thickened in leprosy) and their anatomical pathways

Este trabalho demonstra, por meio de dissecçäo, o trajeto superficial dos nervos comprometidos na hanseníase. Nessa doença, as lesöes ocorrem com mais frequência em determinados nervos que, nesses casos, se tornam mais espessos do que o normal. Esses nervos específicos säo superficiais em alguma parte de seus trajetos anatômicos e, aí, mais facilmente palpáveis

Calcification of ulnar nerve in leprosy--a case report.

A case of Tuberculoid leprosy who had taken irregular treatment for five years and had thickened ulnar nerve which on radiological examination showed calcification, is reported.

Calcification of ulnar nerve in a patient with tuberculoid leprosy--a case report.

A case of Tuberculoid Leprosy who showed Evidence of Calcification of Right Ulnar Nerve at Elbow on Radiological Examination is reported.

Tuberculoid granuloma in a clinically normal looking skin.

A case of tuberculoid leprosy showing well defined tuberculoid granuloma in the skin without any morphological changes is reported.