RESUMO
BACKGROUND: Intrafascicular nerve torsion is a rare and poorly studied type of nerve compression. This disease can be assigned to compression-induced neuropathies, but it has a distinctive feature. It is a spontaneous intrafascicular compression following internal local spiral deformation and compression of the nerve outside routine tunnels due to its torsion around its own axis. Understanding the pathogenesis of such spiral compression is essential in diagnosis, prognosis and treatment of these patients. OBJECTIVE: To assess the effectiveness of various diagnostic techniques, the possibility and effectiveness of surgical treatment of patients with spiral intrafascicular nerve deformation. MATERIAL AND METHODS: The authors report 2 patients (45-year-old man and 38-year-old woman) who were examined for progressive radial neuropathy of unknown etiology. Ultrasound of the radial nerve and electroneuromyography were performed. These data made it possible to diagnose nerve lesion in both cases. These findings justified external and internal radial nerve decompression. RESULTS: Ultrasound was valuable to establish localization and cause of radial nerve lesion (local hourglass-shaped deformation). Electroneuromyography confirmed conduction disturbances along the altered segment of radial nerve in both patients. Intraoperatively, intrafascicular nerve torsion as a cause of functional disorders was confirmed in both cases. Both patients required external and internal nerve decompression with restoration of linear orientation of the nerve and its fixation within the epineurium. Positive effect was noted immediately after surgery. Control survey after 3 and 6 months revealed significant regression of symptoms (increase in muscle strength and motion amplitude) and high satisfaction with treatment outcomes. CONCLUSION: Clinical manifestations of intrafascicular radial nerve torsion imitate typical compression-induced neuropathy. However, this lesion is characterized by another unclear pathogenesis, localization far from natural tunnels, typical ultrasound and intraoperative patterns. Surgical treatment has certain features, and its effectiveness depends on surgical technique and ranges from 60% to 90%.
Assuntos
Síndromes de Compressão Nervosa , Neuropatia Radial , Feminino , Humanos , Masculino , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Paralisia , Nervo Radial/diagnóstico por imagem , Nervo Radial/cirurgia , UltrassonografiaRESUMO
The resistance of isolated, perfused by Langendorf the heart was compared in the experiments on Wistar rats with elevated by 7.3 times the concentration of the calcium in perfused solution. It was shown that one-hour stress of the "struggle" raised but six-hour one decreased the resistance of the heart to arrhythmogenic and contraction action of the surplus Ca2+.