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PubMed2005

Cerebellar haemorrhage and tension pneumocephalus after resection of a Pancoast tumour.

We present an unusual case of cerebellar haemorrhage followed by tension pneumocephalus several days after thoracotomy for resection of a Pancoast tumour. The postoperative course of the 32-year-old patient was complicated by a cerebellar haemorrhage and hydrocephalus caused by compression of the fourth ventricle. Immediate surgical evacuation of the haemorrhage and placement of an external ventricular drain was performed. Respirator ventilation maintaining a continuous positive airway pressure was required. Following weaning and extubation the patient rapidly deteriorated and became comatose. A cranial CT scan revealed a dilated ventricular system filled with air, and air in the subarachnoid space. Recovery of consciousness was observed after aspiration of intracranial air through the ventricular drainage. Recurrent deterioration of consciousness after repeated air aspiration indicated rapid refilling of the ventricles with air. The patient underwent emergency surgical re-exploration of the thoracic resection cavity: dural lacerations of the cervico-thoracic nerve roots C8 and Th1 were identified. Subarachnoid-pleural fistula, cerebellar haemorrhage and tension pneumocephalus after discontinuation of continuous positive airway pressure respiration are unusual complications of thoracic surgery. We discuss the putative pathomechanisms and present a brief review of the literature.

Adult↗
PubMed2004

Brachial plexus anatomy.

The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. It begins with the anterior rami of C5, C6, C7, C8, and the first thoracic nerve. It terminates with the formation of the musculocutaneous, median, ulnar, axillary, and radial nerves. The intermediate portions are displayed in sets of threes: three trunks are formed, followed by three divisions, then three cords. Each trunk gives rise to two divisions and each cord gives rise to two branches. The lateral cord divides into the musculocutaneous nerve and the lateral branch of the median nerve. The medial cord divides into the medial branch of the median nerve and the ulnar nerve. The posterior cord divides into the axillary and the radial nerves. The anatomy of the brachial plexus can be confusing, especially because of frequent variations in length and caliber of each of its components.

Brachial Plexus↗
PubMed1989

Isolated lateral pectoral nerve injury: trauma from a seat belt.

A 35-year-old man sustained an isolated injury to the lateral pectoral (anterior thoracic) nerve as the result of a seat belt injury. This resulted in atrophy of the clavicular head of the pectoralis major. Electromyography confirmed localized abnormal findings in this muscle and an isolated lesion of the lateral pectoral nerve, the first reported case of such a lesion.

Adult↗
PubMed2003

Concept for diagnosis and therapy of unilateral recurrent laryngeal nerve paralysis following thoracic surgery.

BACKGROUND: Injury to the recurrent laryngeal nerve is a potential complication in thoracic surgery, and may lead to postoperative dysfunction due to the resulting insufficient glottal closure. The aim of this study was, first, to develop an interdisciplinary concept of early diagnosis and adequate therapy of recurrent laryngeal nerve paralysis (RLNP), and second, to investigate efficiency of this approach. METHODS: 120 patients (77 male, 43 female) aged between 15 and 85 years (mean 57 years) were examined otolaryngologically before and after thoracic surgery. Individual therapeutic modalities were chosen according to established criteria. RESULTS: In 18 patients (15 %), RLNP was found (16 left, 2 right). Five had already been diagnosed preoperatively. Functional voice therapy, stimulation-current therapy or external vocal fold medialization was performed depending on the prognostic criteria. CONCLUSIONS: RLNP following thoracic surgery requires immediate diagnosis and therapeutic strategy to minimize postoperative complications and to overcome impairments in the voice, swallowing, and coughing. The interdisciplinary concept presented in this study is especially advisable in high-risk RLNP procedures.

Adolescent↗
PubMedDate not supplied

Cerebrospinal fluid filtration and immunoglobulins in multifocal motor neuropathy.

Cerebrospinal fluid (CSF) filtration has been shown to be of benefit in chronic inflammatory, demyelinating polyneuropathy, but has not been applied to multifocal motor neuropathy (MMN) so far. Twenty-seven months after a 48-year-old male patient had developed slowly progressive, distally prominent monoparesis of the left arm, MMN was diagnosed. Conduction blocks were found in the left brachial plexus after median, ulnar, and radial nerve stimulation. Serum anti-GM1 antibody titers were markedly increased. Biopsy of the motor long thoracic nerve showed reduction of small caliber myelinated axons and irregularly shaped myelin lamellae. Treatment with immunoglobulins 29, 31, 36, and 39 months after onset was followed by a distinct improvement each time. Thirty-four months after onset, one liter CSF was filtered off by means of a bidirectional syringe pump with only minor therapeutic effect. In conclusion, immunoglobulins had a stronger therapeutic effect than CSF filtration on the MMN patient described.

Case-Control Studies↗
PubMed2004

Fiber arrangements of nerves belonging to ventral and dorsal divisions in the proximal region of the brachial plexus: a study using fluorescence of DiI and DiO in adult rats.

The motor and sensory fiber arrangements in the proximal region of the spinal nerves are important for understanding the relationship of the peripheral nerves to neuron distribution. On the other hand, the fiber arrangements are also important for the treatment of peripheral nerve grafting. We studied the fiber arrangements of two divisions (ventral and dorsal) in the proximal region of the brachial plexus and the fiber arrangements of the lateral cutaneous rami in Th7 and Th8 intercostal nerves in adult rats with a method using the fluorescent pigments DiI and DiO. Results showed that fiber arrangements belonging to the two divisions have a specific separate distribution in the distal region. However, this specific separate distribution form was absent in the proximal region of the spinal nerves in the plexus. Fiber arrangements of the lateral cutaneous ramus in the anterior branches of the thoracic nerves (intercostal nerves) were also observed in comparison with those in the brachial plexus by the same method. In the intercostal nerves, fibers of the lateral cutaneous ramus were distributed in the dorsal portion from distal to proximal. These results suggest that there are two types of fiber arrangement in the proximal regions of the spinal nerves: a ventrodorsal distributional type, comprising intercostal nerves and the dorsal branches of the spinal nerves; and a mixed type, comprising the anterior branches of the cervical and brachial (and perhaps lumbar) plexuses. On the other hand, fibers of the lateral cutaneous rami in the intercostal nerves were distributed on the dorsal part of the nerves. These results of fiber arrangement analysis for the intercostal nerves may offer an opportunity to improve the effect of treatments using peripheral nerve grafting and suturing in the brachial and lumbar plexus with intercostal nerves.

Animals↗
PubMed2004

Peripheral tumors of the intercostal nerves.

Fewer than 10% of primary neural tumors of the chest originate peripherally from intercostal nerves; most neural tumors of the chest arise in the mediastinum. Most patients with primary tumors of the intercostal nerve are asymptomatic. We report a case of neurilemmoma arising from an intercostal nerve in a woman seen for severe pain in the chest wall. Resecting the tumor relieved the pain. Recent medical literature describing peripheral tumors of thoracic nerves is reviewed.

Chest Pain↗
PubMed1980

[Use of histological criteria to evaluate the quality of vagotomy operations. Does ascending degeneration of the nerve exist? (author's transl)].

Following vagotomy it is a common finding to observe a neuroma at the upper extremity of the nerve. Furthermore, Tinel, quoting Ranson, believes that the sensory fibers of the sectioned pneumogastric may be affected by ascending degeneration. In fact, during thoracic vagotomy after an unsuccessful abdominal vagotomy, histological examination of the resected right thoracic nerve demonstrated disorganization with the appearance of partial ascending degeneration. It appeared possible, therefore, to assess the quality of a vagotomy, by studying the histological appearance of the resected vagus when a further operation using the thoracic approach is necessary. An experimental study was conducted in dogs and the results confirmed the presence, at the upper extremity, of both an amputation neuroma and neuronal changes, though these latter lesions were limited to a region 3 cm above the section level. It is reasonable to assume, therefore, that the lower segment of a vagus resected by the thoracic approach, after an unsuccessful abdominal vagotomy, should show degenerative lesions if the vagotomy had been effective, but these lesions are limited in extent.

Animals↗
PubMed1998

Thoracoscopic microsurgical excision of a thoracic schwannoma. Case report.

A 6-cm-diameter schwannoma located at T-2 was resected completely by using transthoracic microsurgical endoscopy. The partially cystic tumor widened the neural foramen and extended into the apex of the right thoracic cavity but did not extend intradurally. The tumor was accessed by means of three 15-mm incisions made in the intercostal spaces. The operative blood loss was only 200 ml, and there were no complications. The patient was discharged on the 2nd postoperative day and returned to full activity 1 week after surgery. Thoracoscopy provides an excellent alternative to thoracotomy for peripheral thoracic nerve sheath tumors that originate within the neural foramen or more distally along the intercostal nerves within the thorax. An anterior approach is required for intrathoracic tumors but is not suited for intradural tumors. An open posterior or posterolateral approach to the thoracic spine is required for intradural tumors to allow the dura to be closed adequately.

Activities of Daily Living↗
PubMed2000

A variation of the brachial plexus characterized by the absence of the musculocutaneous nerve: a case report.

A variation of the brachial plexus characterized by the absence of the musculocutaneous nerve on both sides was observed during the dissection of a 72 year-old female cadaver. The long thoracic nerve included only the fibers from C5 and C6 on the left side. The musculocutaneous nerve was absent and two branches from the lateral cord innervated the coracobrachialis muscle. The median nerve innervated the biceps brachii and brachialis muscles in the arm and also gave off the lateral antebrachial cutaneous nerve. Additionally, a communicating branch was found from the median nerve to the ulnar nerve in the forearm. The knowledge of the anatomical variations of the peripheral nerve system can help give explanation when encountering an incomprehensible clinical sign.

Aged↗
PubMed1987

[Extramedullary plasmacytoma forming a mass in the epidural space of the spinal cord: report of a case].

Plasmacytoma often forms an intramedullary mass in the vertebrae with absorption of trabecula and cortex of the bone. However, occasionally, it forms a mass in the extramedullary space of the vertebrae. The authors report such a rare case with plasmacytoma which formed a mass in the thoracic epidural space without evidence of involvement of the adjacent vertebra. On May 22, 1985, a 80-year-old man was admitted to our clinic with chief complaints of gait disturbance and hypesthesia below the umbilical level. Difficulty of walking developed approximately four months prior to admission with gradual aggravation and hypesthesia added thereafter. Neurological examinations at admission showed paraparesis with positive Babinski's and Chaddock's reflexes, hypesthesia and disturbances of vibration and position senses below the 9th thoracic nerve level. Myelography and CT scan using metrizamide indicated a presence of epidural mass at the 8th to 9th thoracic vertebrae. There was no abnormal bony change in the spine on plain X-ray and CT scan. On May 30, 1985, total removal of epidural tumor was performed by removing the laminae from the 7th to 10th vertebrae. Histological examinations including immunological stainings showed a plasmacytoma which produced monoclonal immunoglobulin of IgG-lambda type. Radiation therapy was not carried out. The serum protein fraction, immunoglobulin, immunoelectrophoresis, Bence-Jones protein and CSF immunoglobulin examined after operation, supported a histological diagnosis of plasmacytoma. Also, slight proliferation of plasma cells was noted in the bone marrow and peripheral blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Temperature-sensitive gating in a descending visual interneuron, DCMD.

Activity in neural circuits can be modified through experience-dependent mechanisms. The effects of high temperature on a locust visual interneuron (the descending contralateral movement detector, DCMD) have previously been shown to be mitigated by prior exposure to sub-lethal, elevated temperatures (heat shock, HS). Activity in the DCMD is reduced at high temperature in naïve animals (control), whereas HS animals show a maintained spike count at all temperatures. We examined whether this finding was due to direct effects of temperature on visual processing, or whether other indirect feedback mechanisms were responsible for the observed effect in the DCMD. Activity in the DCMD was elicited using a computer-generated looming image, and the response was recorded extracellularly. The temperature of visual processing circuits contributes directly to HS-induced plasticity in the DCMD, as maintaining the brain at 25 degrees C during a thoracic temperature ramp eliminated the high frequency activity associated with HS. Removing ascending input by severing the thoracic nerve cord reduced DCMD thermosensitivity, indicating that indirect feedback mechanisms are also involved in controlling the DCMD response to increased thoracic temperature. Understanding how thermosensitive feedback within the locust affects DCMD function provides insight into critical regulatory mechanisms underlying visually-guided behaviors.

Adaptation, Physiological↗
PubMed2003

Right diaphragm paralysis following cardiac radiofrequency catheter ablation for inappropriate sinus tachycardia.

We describe a case of permanent right diaphragm paralysis following a radiofrequency cardiac ablation procedure. The relationship between the procedure and the phrenic nerve lesion is discussed with respect to the possible pathogenetic mechanisms. Radiofrequency current used in cardiac electrophysiology may cause serious thoracic nerve injuries. Means to avoid this complication are pointed out.

Adult↗
PubMed1976

A new concept of the sympathetic pathways to the eye.

The sympathetic pupillociliary pathways controlling the dilatation of the pupil in man have been recorded by many authorities as passing via the first and/or second thoracic (dorsal) rami to the lower part of the stellate (first thoracic) ganglion. It has been stated by these and other authorities that the removal of the lower part of the stellate ganglion and/or resection of the first and/or second thoracic rami would produce a Horner's syndrome. This currently accepted concept of the sympathetic pathways to the eye we believe to be incorrect. Our entire clinical experience has consistently contradicted the findings and reports of other investigators. It is suggested that the ability afforded by a new surgical approach to reach, dissect, and exactly control the line of resection without undue trauma to the stellate ganglion has made possible for the first time a definitive statement concerning the entry of the pupillociliary pathways into the sympathetic chain. It is, therefore, postulated that the preganglionic neurons controlling the pupil enter the upper portion of the stellate ganglion by a separate paravertebral route leaving the ventral roots of the eighth cervical, first and/or second thoracic nerves. Our entire clinical experience refutes the concept that these pathways pass via the first ramus communicans to the first thoracic ganglion. This thesis is based on and supported by the results of new surgical approach originally designed to permit a more direct exposure and to overcome many of the deficiencies of current surgical approaches. The anterior transthoracic, transpleural wound employed allows a more direct approach and a more accurate and complete dissection of this segment of the sympathetic supply to the head, neck, upper extremity, heart, and coronary vessels without incurring the undesirable sequela of a Horner's syndrome in 93% of patients.

Ciliary Body↗
PubMed2004

[Electrodiagnostic assessment of neuromuscular junction disorders].

Electrodiagnosis of neuromuscular junction disorders relies on repetitive nerve stimulation tests (RS) and single-fiber EMG (SFEMG). RS tests are usually performed on proximal and distal nerves (axillary, accessory, radial, facial, ulnar, median, peroneal). Ischemic test substantially improves ulnar RS sensitivity. More recently RS of masseter and hypoglossal nerves have been proposed to increase RS sensitivity in patients with bulbar symptoms in myasthenia gravis (MG). RS of phrenic and long thoracic nerves could be used in MG patients with respiratory symptoms. Sensitivities of these tests are widely different but they are complementary. SFEMG is far more sensitive but technical difficulties have limited its use. In generalized MG, RS should be performed first. Clinically involved muscles should be examined first, then other muscles. If RS tests are negative, SFEMG of facial muscles can be used. In ocular MG, SFEMG, if available, is the best option. In Lambert-Eaton myasthenic syndrome, a single shock on ulnar nerve before and after a brief maximum voluntary contraction should be used to demonstrate increment and 3 Hz RS a decrement. If negative, median and radial nerves should be studied. Additionally electrodiagnosis features of congenital myasthenic syndromes and botulism are reviewed.

Electrodiagnosis↗
PubMed2005

[Study on the quantity and distribution of motor fiber of rat's C7 nerve root].

OBJECTIVE: To investigate the quantity and distribution of motor fiber of rat's C7 nerve root. METHODS: Motor fiber quantity and section area in the main nerves of the upper extremity and the fascicles of C7 in 30 SD rats were analyzed. RESULTS: Fascicles and certain amount (207) of motor fibers from the anterior division of C7 were distributed to musculocutaneous nerve and median nerve, the orientation of these fibers were not clear. The ones (323) from posterior division were to the axillary, radial, and dorsal thoracic nerves, thus the orientation of these fascicles was relatively definite. CONCLUSION: The distribution of the motor fibers and fascicles in the divisions of C7 in rat is similar to human beings, so rat is a relatively good model for the study of selective C7 nerve root transfer.

Animals↗
PubMed1988

Experience with the free vascularized ulnar nerve graft in repair of supraclavicular lesions of the brachial plexus.

The treatment consisted of a free vascularized ulnar nerve graft in 63 patients with lesions of the supraclavicular brachial plexus. Since 1978, the outcome in 42 patients with a minimum follow-up period of 30 months was certainly better than with an avascular segment of ulnar nerve. Clear proof of hopeless prognosis for recovery along the course of the ulnar nerve is essential before using this graft. The early operations used the ulnar artery and accompanying veins as the pedicle for the graft; later a technique using collateral vessels in the arm has been favored. Although functional elbow flexion has been regained in the majority of patients, recovery of function into the hand has been disappointing. Although it cannot be proved that results are better than when conventional sural nerve grafts are performed, the authors believe that this is the case. The vascularized ulnar nerve graft (VNG) is indicated in more severe injuries of the brachial plexus, where preganglionic injury to the eighth cervical and first thoracic nerves is proven, where the gap between nerve stumps is long, and when the presence of two or three proximal stumps allows the opportunity for extensive repair.

Adult↗