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Biomedical subjects

D G Kline

Publications and source records attributed to D G Kline.

At least 19 recordsLinked to original sources
PubMed1992

Indications for peripheral nerve and brachial plexus surgery.

Management of peripheral nerve injuries differs depending on the mechanism of injury. 1. If a nerve has been sharply and completely transected, it should be acutely repaired, especially if proximally located. 2. If a nerve has been bluntly divided and the stumps are found to be bruised, they should be tacked to adjacent planes. A secondary repair at 2 to 4 weeks is then recommended. 3. With closed injury in which the nerve is most likely still in continuity, the patient should be followed clinically and electrically for 2 to 5 months, depending on the nerve involved and the mechanism of injury. If there is no reversal of the proximal portion of the neurologic deficit by that time, surgical exploration should be done. Use of intraoperative NAP testing is important in this large category of injuries. 4. Injection and electrical injuries to a nerve are two special categories of lesions in continuity and require a highly specialized and individualized treatment dependent on the degree of deficit and severity of pain. 5. Pain unresponsive to medical treatment may also be an indication for surgery on a peripheral nerve, especially if the injured nerve needs to be repaired because of persistent neurologic loss. 6. Management of brachial plexus injuries is somewhat different. Function of each element of the plexus has to be analyzed separately. Several clinical, electrical, and radiologic findings may provide important information about how proximal the lesion is. 7. Missile wounds usually leave the nerve in continuity. Initial management is surgically conservative. Nonetheless, many of these lesions will subsequently require resection based on NAP recordings. 8. Management of obstetric brachial plexus palsy is controversial. We recommend initial conservative management, with observation much longer (9 to 12 months) than for other stretch injuries occurring in adults. With this approach, some but not many of such injuries will still need repair.

Brachial Plexus↗
PubMed1979

Peripheral nerve injection injury: an experimental study.

In an attempt to answer questions regarding nerve injection injuries, we injected 11 agents in current use and commonly administered by intramuscular injection into the sciatic nerves of adult Wistar rats. Equal volumes of normal saline were used as control. We harvested the sciatic nerves at various times after injection and examined them by both light and electron microscopy. We performed myelinated nerve fiber counts and constructed histograms. Any impairment of motor function was also noted. We gave injections to 79 animals a total of 158 times; 116 injections were directly into the nerve fascicle (intrafascicular) and 42 were into the epineural tissue (extrafascicular). The results revealed considerable variation in the degree of nerve fiber injury according to the agent injected. Minimal damage resulted from the injection of iron-dextran, meperidine, and cephalothin, and maximal nerve injury followed the injection of penicillin, diazepam, and chlorpromazine. The site of injection was crucial. Intrafascicular injection was invariably associated with severe nerve injury, but, with few exceptions, extrafascicular injection resulted in minimal damage. The quantity of drug injected was also important in determining the degree of injury. Large, heavily myelinated fibers were more susceptible to injection injury than smaller, thinly myelinated nerve fibers. The effect of the injected drug seemed to be related to injury of the nerve fiber unit--both the axon and the Schwann cell with its myelin sheath. Regeneration in damaged nerves was a constant finding; even the most severely injured nerves, with total axonal degeneration, underwent subsequent regeneration.

Animals↗
PubMed1979

Experimental interfascicular nerve grafting.

Twenty-nine adult rhesus monkeys underwent complete laceration of both tibial nerves at mid-thigh level and repair by different methods to study the relative efficacy of autogenous interfascicular nerve grafts. Sixteen animals in Group I had an interfascicular graft repair using short sural nerve autografts on one limb and fascicular repair without grafts on the other limb. Thirteen animals in Group II, after having a 1-cm segment of tibial nerve resected, had an interfascicular graft repair without tension in one limb and an epineurial repair under moderate tension in the other limb. Evoked nerve and muscle action potentials and muscle strenght in response to repetitive and tetanic stimulation were recorded as baseline values prelaceration and then on re-exploration at 4, 6, 9, or 12 months. All nerves were examined by light and electron microscopy. Electrophysiological data, particularly muscle strength response, showed non-graft repairs to be superior at 4 and 6 months of regeneration. However, by 9 and 12 months the graft repairs had caught up and were equal to the non-graft repairs. Histologically, it was observed that many axons missed the graft segments and were present in extrafascicular connective tissues. Nonetheless, enough axons regenerated to the distal nerve to explain the success of these relatively short grafts. From the results of these experiments, it is concluded that use of autogenous interfascicular grafts offers no advantage over end-to-end non-graft repair. When and end-to-end repair cannot be achieved, use of short interfascicular nerve grafts is feasible and will work.

Action Potentials↗
PubMed1979

Histological studies of experimental interfascicular graft repairs.

Biopsies of sutured and grafted primate peripheral nerves were examined by light and electron microscopy after the final set of electrical measurements had been recorded. Inspection of all proximal stumps showed the expected regenerative activity which was not affected by the nature of the nerve repair. Transverse sections through the epineurial, interfascicular, and graft suture lines showed a similar pattern in all animals and at this site nerves sutured by epineurial technique could only be distinguished from those sutured by fascicular technique by loci of the non-absorbable suture. Fascicular repairs, whether done fascicle-to-fascicle or with interposition of grafts, had a more lengthy neuroma than did the epineurial repairs. Maintenance of fascicular architecture through the course of the grafts was variable. Fascicular structure was frequently absent in the central graft segments and in segments close to the second suture site. The method of repair used more proximally could not be distinguished by evaluation of distal stump segments. Measurements of myelinated fiber size made of distal stump axons revealed no statistical difference between the methods of repair.

Animals↗
PubMed1978

Anterior inferior cerebellar artery aneurysms. Case report.

A 54-year-old man experienced a right occipital headache accompanied by a roaring sound, nausea, vomiting, right facial weakness, and stiff neck. Vertebral angiography revealed an aneurysm of the right anterior inferior cerebellar artery (AICA) at the internal acoustic meatus which was later excised with favorable results. The literature is reviewed; operations have been reported in eight other cases. Inconstant waxing and waning cerebellopontine angle symptoms and signs can be found when a history of subarachnoid hemorrhage is lacking.

Arteries↗
PubMed1978

Exploration of selected brachial plexus lesions by the posterior subscapular approach.

The application of an old surgical technique, previously employed for treatment of thoracic outlet syndromes, to lesions of the brachial plexus is discussed. Positioning of the patient, the surgical procedure, and selected indications for a posterior subscapular approach with resection of the first rib are discussed. The indications for the use of this approach are: proximal plexus lesions involving roots and/or trunks believed to be repairable, complicated thoracic outlet syndromes, prior anterior exploration for vascular or nervous structure disease, and progressive plexus palsy associated with damage to the soft tissue of the anterior chest wall and supraclavicular regions secondary to irradiation. The authors' experience to date with 12 such cases is presented in chart form, while five cases are presented in some detail.

Adolescent↗
PubMed1977

Pancreatitis following spinal cord injury.

Six cases of pancreatitis following spinal cord injury are presented. No single, etiologically accepted mechanism already postulated to cause pancreatitis can account for all the cases reported. The authors hypothesize that spinal cord disruption may produce pacreatitis by sympathetic-parasympathetic nervous system imbalance resulting in over-stimulation of the sphincter of Oddi. This may lead to stasis of secretions with absorption of amylase into the systemic circulation, and structural pancreatic damage. Pancreatitis in those with cord injuries is easily overlooked because abdominal pain is usually absent and fever is usually attributed to more frequently occurring pulmonary or urinary tract infections. Recognition of this complication is important in order to decrease the morbidity and mortality that follows spinal cord damage.

Adult↗
PubMed1976

Pellet-gun brain wound complicated by Clostridium Perfringens meningitis.

A ten-year-old male was hospitalized for a pellet-gun wound to the brain. He developed Clostridial meningitis within eighteen hours in spite of radical debridement and prophylactic antibiotics. However, successful recovery was obtained with high levels of penicillin and chloromycetin antibiotic therapy.

Brain Injuries↗